MCCQE Part II

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MCCQE Part II

• Preparing for the MCCQE Part II
• Things you should know .
• But were afraid to ask!
• OR
• Couldnt bother preparing for!

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MCCQE Part II

• Overview of exam structure
• Ross Walker
• Exam preparation and stress management
• Mala Joneja
• Practical tips and personal experience
• Aaron Aggarwal

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MCCQE Part II

• Why?
• Deterioration in Queens Resident performance
  over the past 4 years (2004 2008)
• From top cohort of pass rates to last (16th)!
• Decrease in the pass rate from 97 to 87!
• Ranking of 5th place in 2004 but last place in
  2004
• Consistent performance until 2004
• Equally poor performance across all Programs!
• You may not think this exam is important BUT its
  too expansive to have to do it more than once!

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MCCQE Part II

• Three (3) hour OSCE
• The questions will be in the domains of Medicine,
  Surgery, Obstetrics Gynecology, Paediatrics
  Psychiatry.
• Preventative Medicine and Community Health will
  be incorporated into some of the stations.
• MCC Objectives are exhaustive and should be
  reviewed at www.mcc.ca/Objective

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MCCQE Part II

• The OSCE is made up of a series of 10 minute
  stations with short breaks between stations
• The exam is made up of 10 minute couplet stations
  and 10 minute history or physical stations
• Couplet stations consist of a 5 minute clinical
  encounter followed by a 5 minute post-encounter
  probe (PEP)
• The PEP is a written station
• DDx, interpret test results, write orders or
  prescriptons, etc.

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MCCQE Part II

• 10 minute stations are usually history taking or
  physical examination stations.
• There is usually a oral question asked by the
  examiner at the 9 minute mark.
• There are examples of all of these stations on
  the MCC website.

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Couplet History Taking

• This is a 5 minute station with 5 minute PEP
• What the candidate reads
• Candidates Instructions
• Luc Léger, 59 years old, presents to your office
  complaining of jaundice.In the next 5 minutes,
  obtain a focused and relevant history.At the
  next station, you will be asked to answer
  questions about this patient.

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Couplet History Taking

• What the examiner completes
• Examiners ChecklistFill in the bubble for each
  item completed satisfactorily
• 1.Elicits onset/duration
• 2.Elicits progression
• 3.Elicits associated symptoms
• dark urine
• pain
• color of stool
• fever

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Couplet History Taking

• 4.Elicits risk factors 
• previous exposure to hepatitis
• recent blood transfusion
• intravenous drug use
• foreign travel
• 5.Elicits an alcohol use history
• 6.Conducts a review of systems
• skin
• gastrointestinal
• weight loss
• change in appetite
•  

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Couplet History Taking

• Examiner asked to judge performance as
  Satisfactory (borderline/good/excellent) or
  Unsatisfactory (borderline/poor/inferior)
• This is a global rating
• If unsatisfactory there are several reasons
• Inadequate medical knowledge
• Could not focus
• Poor communication/interpersonal skills
• Potential harm to patient
• Dangerous act

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Post-encounter Probe (PEP)

• What the candidate receives (5 minutes to write
  this answer)
• Post-Encounter Probe
• Q1. The abdominal examination of Luc Léger
  revealed no organ enlargement, no masses and no
  tenderness. What radiologic investigation would
  you first order to help discriminate the cause of
  the jaundice?1.__________________________________
  ____________________
• Q2. If the investigations revealed that this
  patient likely had a post-hepatic obstruction,
  what are the two principal diagnostic
  considerations?
• 1.________________________________________________
  ____ 
• 2.________________________________________________
  ____
• Q3. What radiologic procedure would you consider
  to elucidate the level and nature of the
  obstruction? 1.__________________________________
  ____________________
• Q4. If this patient were found to have a cancer
  localized to the ampulla of vater, what single
  treatment would you recommend?
• 1._______________________________________________
  _______

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Post-encounter Probe (PEP)

• What the post-encounter probe marker receives
• Answer Key
• Q1.
• The abdominal examination of Luc Léger revealed
  no organ enlargement, no masses and no
  tenderness.  What radiologic investigation would
  you first order to help discriminate the cause of
  the jaundice?
• Score
• A1. Abdominal (liver) ultrasound 4
• Endoscopic retrograde cholangiopancreatography
  (ERCP) 2
• Maximum 4   
• Q2.
• If the investigations revealed that this patient
  likely had a post-hepatic obstruction, what are
  the two principal diagnostic considerations?
• Score
• A2. Pancreatic (periampullary) cancer 2
• Choledocholithiasis 2
• Gallstones 1
• Maximum4   
• Q3.
• What radiologic procedure would you consider to
  elucidate the level and nature of the
  obstruction?
• Score
• A3. Endoscopic retrograde cholangiopancreatography
  (ERCP)4

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Couplet Physical Examination

• What the candidate reads
• Candidates InstructionsJoseph Trans, 12 years
  old, has been brought to your office with a
  history of right hip pain which occasionally
  radiates to the knee.
• In the next 5 minutes, conduct a focused and
  relevant physical examination.
• As you proceed, explain to the examiner what you
  are doing and describe any findings.At the next
  station, you will be asked to answer questions
  about this patient.

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Couplet Physical Examination

• Examiners ChecklistFill in the bubble for each
  item completed satisfactorily
• 1 Observes patient walking
• 2 Examines stance - looks at leg lengths and
  measures
• - checks for Trendelenburg sign standing
  on each leg alternately
• 3 Examines hips - palpation
• - flexion
• - extension patient on side or front
• - internal rotation
• - external rotation
• - abduction
•  4.Examines knees - palpation
• - flexion 

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Couplet Physical Examination

• Did the candidate respond satisfactorily to the
  needs/problem(s) presented by this patient?
• If unsatisfactory, please specify why(For items
  4-6, please explain below)
• Satisfactory - Borderline
• - Good
• - Excellent
• Unsatisfactory - Borderline
• - Poor
• - Inferior
• Inadequate medical knowledge and/or provided
  misinformation
• Could not focus in on this patient's problem
• Demonstrated poor communication and/or
  interpersonal skills
• Actions taken may harm this patient
• Actions taken may be imminently dangerous to this
  patient
• Other
• Do you have concerns regarding this candidate's
  ethical and/or professional behavior? Yes
  (please specify)                             No

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Couplet Physical Examination PEP

• What the candidate receives
• Post-Encounter Probe
• Q1. Examine the antero-posterior / frog x-ray of
  both hips of this patient. List the
  abnormalities, if any. If normal, state so.
• _(Multiple Answers allowed)______________________
  _____
• Q2. What is the most likely diagnosis?
• __(one answer only!)______________________________
  _
• Q3. What is the appropriate management of this
  patient?
• __(Multiple answers allowed)_____________________
  _____

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Couplet Physical Examination PEP

• What the Post-Encounter Probe marker receives
• Answer KeyCandidates are provided with the
  antero-posterior / frog x-ray of both hips for
  this patient.
• Q1. Examine the antero-posterio / frog x-ray of
  both hips of this patient. List the
  abnormalities, if any.  If normal, state so.
• A1. Posterior inferior slip of epiphysis of
  metaphysis 4
• Slipped epiphysis 3
• Mention made in any way of opposite side
  (bilateral approx. 50 in this condition) 1
• Abnormality of the hip 1
• Maximum 4   
• Q2.What is the most likely diagnosis?
• A2. Slipped epiphysis OR slipped capital femoral
  epiphysis 4
• Arthritis 1
• Septic hip 0
• Trochanteric bursitis 0
• Tendinitis 0
• Legg-Calvé-Perthes 0
• Maximum 4   
• Q3. What is the appropriate management of this
  patient?
• A3. Medication OR urgent referral to orthopedic
  surgeon within 1 week 3
• Crutches until sees orthopedic surgeon 1

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Ten (10) minute history station

• What the candidate reads
• Candidates Instructions
• Julia Russo, 65 years old, has come alone to your
  office with the following complaint  "I just
  can't cope.  Everything seems to be going wrong."
  She brought with her a note from her son which
  she gave to your receptionist (see below).
• In the next 10 minutes, complete a focused
  history and mental status examination.
• Dear Doctor,My mother is no longer able to
  manage herself and her affairs. She makes
  frequent financial mistakes such as not paying
  her bills, getting overdrawn at the bank, and
  hoarding money in her home. The bank manager is
  very concerned and so are we. She is not herself.
  She seems sad and irritable. She does not
  remember much of what we, or others tell her. We
  are afraid that she is not safe at home and
  should not be living on her own.Thank you for
  your help.Oliver RussoOffice 222-9999

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Ten (10) minute history station

• What the examiner completes
• Examiners Checklist - Fill in the bubble for
  each item completed satisfactorily  
• 1. Elicits  - onset/duration
• - memory
• 2. Elicits - mood
• - anxiety
• 3. Asks about changes in daily activities
• 4. Asks about
• - drug use
• - alcohol use
• 5. Elicits dangerousness/risk factors
• - suicide potential
• - getting lost
• - financial management
• 6. Elicits constitutional signs and symptoms
• - energy
• - sleep
• - appetite
• - weight gain/loss

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Ten (10) minute history station

• Did the candidate respond satisfactorily to the
  needs/problem(s) presented by this patient?  If
  unsatisfactory, please specify whySatisfactory
  - Borderline
• - Good
• - Excellent
• Unsatisfactory - Borderline
• - Poor
• - Inferior
• Inadequate medical knowledge and/or provided
  misinformation
• Could not focus in on this patient's problem
• Demonstrated poor communication and/or
  interpersonal skills
• Actions taken may harm this patient
• Actions taken may be imminently dangerous to this
  patient
• Other
• Do you have concerns regarding this candidate's
  ethical and/or professional behavior?
• Yes (please specify)    No

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Rating Scales

• Each station will have an associated interaction
  rating scale
• Ethical Conduct (inappropriate effective)
• Compliance optimization (negativehighly
  effective
• Facilitates Informed Decision making
  (deceptive-clear, organized and effective)
• Responds to Questions (ignores-empathetic)
• Organized Physical Exam (not attempted-purposeful)
  
• Attentive to patient comfort (NOT-consistent)
• Patient Relationship (None-at ease with patient)

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Common Mistakes

• Not reading the question!
• Asking too many unfocused questions (shotgun)
• Not explaining what you are doing during physical
  examination stations
• Rectal, vaginal and inguinal exams not allowed
  BUT you will not be given credit unless you
  indicate that you would do them when appropriate.
• Talking too fast and too much maintain
  professional courtesy
• Trying to guess what the station is about and not
  listening to the patient

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MCCQE Part II

• Questions?