2021 07 06 Clinical Exam Spec.V0.5
2021 07 06 Clinical Exam Spec.V0.5
2021 07 06 Clinical Exam Spec.V0.5
4. Feedback .................................................................................................................. 12
5. Process of a clinical examination ........................................................................... 13
1.2. Privacy
The AMC observes the provisions of the Privacy Act which sets out the requirements for the
collection and use of personal information collected.
Each of the Application Forms required by the AMC includes a statement relating to the AMC’s
privacy procedures. Each must be signed by the applicant to give formal consent for the AMC
to collect and hold personal information.
Please note: if this consent is not provided, the AMC will not be able to process the
application.
The AMC’s full Privacy Policy may be found on the AMC web site at
http://www.amc.org.au/about/privacy-policy.
be familiar with the common and important health promotion strategies, health disorders,
prevention strategies and related issues in the Australian community and have some
awareness of other less common health issues in the Australian community
be familiar with the indications for, the mechanisms and actions of, and the adverse effects
of, the major therapeutic agents
(Note, special scheduling processes apply until July 2021 due to the trialing and initial
implementation of the on-line examination. These processes may be found on the
website.)
Once an examination is open for scheduling, candidates will be able to log into their
candidate portal and directly apply for their preferred examination date.
Payment of the examination fee is ONLY accepted by credit card. There will be a 15-
minute period to complete payment for the examination, once this has lapsed, the
placement will be released to the next candidate. Please note that Cheque payment is not
accepted for scheduling of Clinical examinations
Once payment has been successfully processed, a placement letter and receipt
confirming candidate examination details will be available immediately to download from
the candidate portal
Once the examination placements have been filled, the AMC will compile a cancellation
list. To be put on this list, candidates must email [email protected] (please note
telephone requests will not be accepted). In the event that a candidate is unable to proceed
with their examination, candidates on the cancellation list will be contacted to fill the
available position. Please note the cancellation list does not guarantee an examination
placement and is only valid for the month that is open for scheduling
For further information regarding examination closing dates, please see:
http://www.amc.org.au/assessment/clinical-exam/clinical-events
Candidates must arrive at the NTC or log in as requested if attending the online examination.
Candidates must report to the administrative staff in attendance no later than the time advised
Due to the multi-station structure of the examination, candidates arriving or logging in late will
not be permitted to commence the examination.
The examination fees for the clinical examination are shown on the AMC website
(http://www.amc.org.au/).
Most stations are of 10 minutes duration (comprising two minutes reading time, and eight
minutes assessment time.
Stations may use actual patients, simulated patients, or videotaped patient presentations.
Other relevant materials, such as charts, digital images and photographs may also be used in
the examination.
history taking
examination
diagnostic formulation
management/counselling/education.
Examples of material that could be included in the stations are:
taking the history of a patient with symptoms of shortness of breath [history taking station]
taking a history from a third party such as the parent or carer of a patient (history taking
station)
physical examination of a patient with symptoms of suspected vascular disease
[examination station]
interpretation of a laboratory report result [diagnostic formulation station]
diagnosis of a common skin lesion [diagnostic formulation station]
educating an asthmatic patient on the use of an inhaler
[management/counselling/education station]
counselling a patient with obesity [management/counselling/education station]
presenting a management plan for a patient presentation
(management/counselling/education station).
Examiners from all disciplines contribute to the assessment process.
The format of examination stations has been developed for online delivery. The
assessment blueprint and criteria remain the same as the in-person NTC examination with
the exception of hands-on components of physical examination.
Physical examination skills will be tested at as high a level as possible in the online
environment.
The candidate will be required to exhibit clinical reasoning, interpretation and detailed
description of physical examination techniques and process.
The candidate may be delivering this information to either the examiner, medical student,
patient, family member, carer or health professional.
a clinical stem of essential information to the candidate about the scenario, which may
include investigations, imaging or charts
a series of tasks, commonly three to four
a suggested timing for the main task(s)
Each scenario has a single “predominant assessment area” (namely history, physical
examination, diagnostic formulation, or management/counselling/education). Assessment
tasks will be focussed on this area, but may include other areas.
During the reading time the candidate evaluates the given information and plans their
approach to the assessment phase. They should plan their time, taking into account the
number and type of tasks, and take careful note of any given time guidelines.
During the assessment time the candidate conducts the interaction as required and performs
the designated clinical tasks.
The clinical tasks include but are not limited to; history taking, physical and mental state
examination, investigation planning and interpretation, diagnostic formulation, management
planning, prescribing, counselling and performance of procedures.
A clinical scenario may test a candidate's ability in responding to these tasks in various health
care settings, including:
3.2. Domains
Typically, there will be between three and five assessed domains in each station. The
candidate performance on each separate domain is rated on a seven-point scale. There is no
pass/fail point for these ratings.
Domains may include (but are not limited to) such items as approach to the patient, history
taking, choice and technique of physical examination, accuracy of physical examination,
differential diagnosis, choice or interpretation of investigations, management, and patient
education/counselling.
The expectations of the candidate are described specifically for each domain as relevant to
the individual station.
A pass will be awarded where a candidate obtains a pass score in 10 or more of the
14 assessed stations.
A fail will be awarded where a candidate obtains a pass score in nine or less of the 14
assessed stations. There is no limit on the number of attempts a candidate may have
at the clinical exam.
4. Feedback
A number of aspects of a candidate’s performance can be used to provide feedback to the
candidate.
It is important to note however, that the scores for the aspects of the marking that are reported
as part of the feedback provided to candidates do not directly or numerically determine an
overall result of a pass or a fail for the station. The pass/fail result is determined by the
examiner making a separate global rating about a candidate’s performance across all aspects
of the station, not just those for which feedback has been provided.
Although the aspects of a station that are reported as part of the feedback provided to
candidates may contribute to an examiner's global rating, it is not possible to determine
whether a global rating that would result in a station being passed or failed was obtained for a
station simply by looking at the scores associated with the aspects of the station provided in
the candidate feedback.
Each candidate will receive a computer-generated breakdown of their performance against
selected aspects of the station marks to assist with revision for future attempts.
Candidates who may require special assistance during the examination should inform the
AMC as early as possible prior to their examination. This may include medication requirements
or food intake due to a medical condition.
Candidates will be moved to their starting station where an invigilator will inform the candidate
when the examination will commence. A notification will indicate the start of the two-minute
reading time of the candidate’s first station.
A second notification will indicate the start of the examination and candidates will then
commence the station. In most stations there are eight minutes to complete the tasks.
In some stations the candidate will be asked to perform only part of a physical examination
while other information will be provided on request by the examiner.
5.7.1. Online
Physical examination stations online will be of 5 or 10 minutes total duration. The time will be
clearly stated. There will be two minutes reading time for an eight minute station, and one
minute reading time for a four minute station. Candidates should follow the station tasks
exactly as they are described.
Candidates will be provided with writing material in the examination room for taking any notes
during the assessment. Any notes made by the candidate during the assessment time are
not permitted to be taken out of the examination room.
AMC staff may request to inspect any items retained by the candidate including items in
pockets or the like prior to, during, or after the examination if necessary.
If candidates require any medications during the examination, they should bring this to the
attention of the AMC prior to the examination day and a marshal before the examination
starts. Medication must be approved.
No books, textbooks, notes, items of jewellery, tie pins or other materials are allowed into the
examination room, including recording devices, watches (smart, digital and analogue) or
handbags. Candidates are not permitted to write any prompting material on their skin before
or during the examination.
In order for candidates and the AMC to communicate with each other in the event of a technical
issue, candidates will be permitted to have their mobile phone switched to silent in the same
room. Candidates will be required to show the invigilator that their phone is switched to silent.
Only one phone is to be in the examination room.
The invigilator or coordinator may request to view any items or the examination room itself
prior to, during, or after the examination if necessary.
If candidates may require any medications during the examination, they should bring this to
the attention of the AMC prior to the examination day and the invigilator before the examination
starts.
All candidates must comply with the instructions of all clinical examination staff during
examinations. Failure to do so will constitute a breach of examination procedures and may
result in the candidate being excluded from the examination or refused the opportunity to sit
future examinations.
For exams at the NTC, family and friends accompanying candidates to an examination are
NOT permitted to enter the examination venue.
For exams online – Candidates must advise people in the household or other venue that they
are sitting an examination and cannot be interrupted.
Professional boundaries are crossed when any interaction of an unwanted or sexual nature
occurs between a doctor and the patient or an immediate family member of the patient. The
Medical Board of Australia has codes of practice on this matter.
A doctor who crosses professional boundaries while undertaking the AMC clinical examination
may be guilty of professional misconduct and may be investigated and subjected to
disciplinary action by regulatory authorities.
Candidates in clinical examinations are expected to observe fully the confidentiality of patients
and simulated patients who participate in the examination and should not discuss the personal
details of the consultations outside the examination at any time, with any person.
• The AMC CEO will consider all the material, including any response from the candidate,
and will determine a final decision regarding the candidate examination result.
• The AMC CEO may also decide that the candidate may not be permitted to continue
with any AMC assessment, may be refused the opportunity to sit future examinations,
• Where a concern is identified during the course of a Clinical examination and reported
to the authorised authority conducting the examination, the same person may direct that
the candidate be immediately excluded from the examination, and the matter be referred
to the Clinical Results Panel for further investigation in accordance with these
specifications.
All AMC candidates should be aware that, under Australian law, copyright of all examination
materials rests with the Australian Medical Council. No part of any examination may be
reproduced, stored or transmitted by any means.
carefully read any preliminary data supplied, and take especial note of tasks given
at NTC examinations, listen carefully to the examiner’s instructions and ask for clarification
– or for the question to be repeated – if uncertain about any instruction or question from
the examiners
not overlook the fact that there may be simulated or real patients in the clinical
examination. Examiners will take note of the manner in which a candidate addresses and
deals with the patient. Medical practitioners have a duty of care to patients, and patients
in the examination have a right to receive the same care.
at NTC exercise care with both technique and accuracy when physical examination of a
real or simulated patient is required. Candidates should ensure that they do not cause
unnecessary discomfort to the patient
avoid discussing patients with other candidates who may attend the clinical examination
in the future, because patients are rotated and, in some cases, alternative conditions are
examined in patients with multiple clinical signs. Any candidate who attempts to formulate
a diagnosis or management on the basis of information provided by other candidates,
without having seen the patient themselves, is likely to compromise their assessment.
candidate number
full name
previous address
new address
candidate signature
date of birth.
Under the provisions of the Commonwealth Privacy Act the AMC is unable to accept changes
of address or other candidate details submitted by email, unless provided on the Change of
address form.
Included below is the list of graduate outcome statements. These statements, divided into four
domains, reflect the skills, knowledge and attitudes that Australian medical students are
required to demonstrate upon graduation. Graduate outcome statements can also be found in
the AMC’s Standards for assessment and accreditation of primary medical programs.
Domain 1
Science and Scholarship: the medical graduate as scientist and scholar
On entry to professional practice, Australian and New Zealand graduates are able to:
Domain 2
Clinical Practice: the medical graduate as practitioner
On entry to professional practice, Australian and New Zealand graduates are able to:
Domain 3
Health and Society: the medical graduate as a health advocate
On entry to professional practice, Australian and New Zealand graduates are able to:
Accept responsibility to protect and advance the health and wellbeing of individuals,
communities and populations.
Explain factors that contribute to the health, illness, disease and success of treatment of
populations, including issues relating to health inequities and inequalities, diversity of
cultural, spiritual and community values, and socio-economic and physical environment
factors.
Communicate effectively in wider roles including health advocacy, teaching, assessing and
appraising.
Understand and describe the factors that contribute to the health and wellbeing of
Aboriginal and Torres Strait Islander peoples and/or Māori, including history, spirituality
and relationship to land, diversity of cultures and communities, epidemiology, social and
political determinants of health and health experiences. Demonstrate effective and
culturally competent communication and care for Aboriginal and Torres Strait Islander
peoples and/or Māori.
Explain and evaluate common population health screening and prevention approaches,
including the use of technology for surveillance and monitoring of the health status of
populations. Explain environmental and lifestyle health risks and advocate for healthy
lifestyle choices.
Domain 4
Professionalism and Leadership: the medical graduate as a professional and leader
On entry to professional practice, Australian and New Zealand graduates are able to:
Provide care to all patients according to “Good Medical Practice: A Code of Conduct for
Doctors in Australia” and “Good Medical Practice: A Guide for Doctors” in
New Zealand.
Demonstrate professional values including commitment to high quality clinical standards,
compassion, empathy and respect for all patients. Demonstrate the qualities of integrity,
honesty, leadership and partnership to patients, the profession and society.
Describe the principles and practice of professionalism and leadership in health care.
Explain the main principles of ethical practice and apply these to learning scenarios in
clinical practice. Communicate effectively about ethical issues with patients, family and
other health care professionals.
Demonstrate awareness of factors that affect doctors’ health and wellbeing, including
fatigue, stress management and infection control, to mitigate health risks of
professional practice. Recognise their own health needs, when to consult and follow
advice of a health professional and identify risks posed to patients by their own health.
Identify the boundaries that define professional and therapeutic relationships and
demonstrate respect for these in clinical practice.
Demonstrate awareness of and explain the options available when personal values or
beliefs may influence patient care, including the obligation to refer to another
practitioner.
Describe and respect the roles and expertise of other health care professionals, and
demonstrate ability to learn and work effectively as a member of an inter-professional team
or other professional group.
Self-evaluate their own professional practice; demonstrate lifelong learning behaviours
and fundamental skills in educating colleagues. Recognise the limits of their own expertise
and involve other professionals as needed to contribute to patient care.
Describe and apply the fundamental legal responsibilities of health professionals
especially those relating to ability to complete relevant certificates and documents,
informed consent, duty of care to patients and colleagues, privacy, confidentiality,
mandatory reporting and notification. Demonstrate awareness of financial and other
conflicts of interest.
take a relevant focused history to enable you to further evaluate this problem; you should
take no more than five minutes for this task
obtain the relevant examination findings from the examiner; the examiner will only give
you the results of the examination findings you specifically request
explain to the patient the probable diagnosis and the possible differential diagnoses giving
your reasons.
take a relevant focused history from you to further evaluate this problem
obtain the relevant examination findings from the examiner
explain to you the probable diagnosis and the possible differential diagnoses
How to play the role:
If at any stage the candidate provides you with information which you do not understand, for
example, because of technical language or because of ambiguities, ask for clarification until
you are provided with a clear, consistent explanation in plain language. Say: 'I don't
understand what you mean, would you explain?' or 'I'm not clear about what you just said.'
Other than clarification questions, do not ask further questions; it is up to the candidate to
provide fluent advice.
Towards the conclusion of the station, if the candidate says to you: 'Do you have any
questions?' say: 'What else should I know, Doctor?'
Opening statement:
In response to further open questions such as 'Have you noticed anything else?', say:
'I don't think I've noticed anything more, although I'm still a little breathless.'
I couldn't sleep last night because of breathlessness and had to sleep sitting up.
I'm not as short of breath today as I was yesterday.
I've never had shortness of breath like this before.
I've been able to walk on the flat easily, but have had trouble walking up stairs in the last
24 hours.
I haven't noticed any chest pain.
There have been no palpitations.
I've been coughing up phlegm since developing the shortness of breath.
It was white and clear but it had a few spots of blood in it today (only provide this detail if
the candidate asks about the phlegm colour).
I have not fainted or lost consciousness.
I don't have any wheezing.
I've never had asthma.
I have not had any fever.
I have not had any recent colds or the flu.
I haven't had any leg or ankle swelling.
There's been no calf pain or tenderness.
Three weeks ago I was on holidays in the States and arrived home six days ago (Do not
give any of this information unless travel has been specifically asked about).
I took sleeping tablets to help me sleep during the flight. I managed to sleep most of the
way home.
I'm not on the oral contraceptive pill or any other medications. I get my sexual partner to
use a condom.
I have never had DVT or blood clots.
No one in my family had DVTs or blood clots.
I smoked about ten cigarettes a day from my late teens until about two years ago.
I'm only a social drinker and have an occasional glass of white wine at weekends.
To other questions, respond with either 'no', 'I don’t know' or 'I'm not sure'.
If a diagnosis that the average patient would not know much about (i.e. pulmonary
embolism), say: 'What is that?' and 'Is it serious?'
If only one diagnosis is mentioned, ask: 'Could it be anything else?'
If told that you will have to go to hospital, say: 'Is that really necessary?' and: 'What will
they do?'
take an appropriate focused history to evaluate and diagnose the likely cause of the
sudden onset of shortness of breath in this woman. The possible diagnosis could be
asthma, pulmonary embolism, pneumothorax, or chest infection (including bird flu) each
of these possibilities should be addressed in the history
select the essential components of the physical examination of this patient
explain to the patient the most likely diagnosis and the appropriate differential diagnoses.
The predominant assessment area is DIAGNOSTIC FORMULATION
EXAMINER TO START BY SAYING:
The candidate must ask for each specific component of the examination, and findings should
NOT be provided where they are not specifically requested.
Vital signs: pulse 104/min and regular, BP 110/65mmHg, temp 36.8°C, respiratory rate
24–26/minute, oxygen saturation 90% on room air.
Height 155 cm, weight 68kg.
BMI 28 (overweight range)
The patient is short of breath, but not otherwise in distress.
The trachea is not deviated.
There is no evidence of cyanosis.
Heart: Apex beat 5LICS, no parasternal heave, two normal heart sounds, pulmonary
second sound is not increased, no bruits.
JVP: not increased.
Lungs: normal findings on inspection, palpation, percussion and auscultation, no rubs.
Abdominal examination: normal.
Extremities: no oedema, no calf tenderness, all peripheral pulses are present. If actual
measurements are requested indicate these are the same in both calves and thighs.
pulmonary embolism
pneumothorax
infection: bacterial or viral
asthma
myocardial infarction
acute left ventricular failure
The candidate must convey to the patient, without unnecessarily alarming her, that this is a
serious illness which could be life threatening, requiring immediate management in hospital
for investigation and treatment.