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MRCGP Written/Orals Examination Answer Structures & Grids.

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Presentation on theme: "MRCGP Written/Orals Examination Answer Structures & Grids."— Presentation transcript:

1 MRCGP Written/Orals Examination Answer Structures & Grids

2 Consultation Models Pendleton Neighbour Byrne & Long Stott & Davis

3 Pendleton “7 Tasks” 1 1) Define reason for attendance (patients ideas/concerns/expectations) 2) Consider other problems 3) Choose appropriate action for each problem 4) Achieve shared understanding 5) Involve patient/accept responsibility 6) Use time/resources appropriately 7) Establish/maintain relationship with patient 1. Pendleton D, Schofield T, Tate D & Havelock P (1984) The Consultation: An Approach to Learning and Teaching (Oxford, OUP)

4 Neighbour: “5 Checkpoints” 2 Connecting Summarising Handing Over Safety Netting Housekeeping 2. Neighbour R (1986) The Inner Consultation

5 Byrne & Long 3 1) Doctor – Patient Relationship 2) Discover reason for attendance 3) Verbal/Physical Examination 4) Doctor/Patient consider condition 5) Doctor/Patient consider Treatment/Investigation 6) Terminate consultation 3. Byrne PS & Long BEL (1976) Doctors Talking to Patients (London HMSO)

6 Stott & Davis 4 Management of presenting problems Modification of help-seeking behaviour Management of continuing problems Opportunistic health promotion 4. Stott NCH & Davis RH (1979) The Exceptional Potential in each Primary Care Consultation JRCGP; 29: 201-205

7 Problem-Oriented Medical Records SOAP Subjective Objective Assessment Plan Pseudo-Latin Hx (History) Sx (Symptoms) Ix(Investigation) Mx (Management) Rx (Prescribe)

8 5 Areas of General Practice 1) Clinical Practice – Health & Disease 2) Clinical Practice – Human Development 3) Clinical Practice – Human Behaviour 4) Medicine & Society 5) The Practice

9 Health & Disease  Normal Range  Patterns of Illness  Natural History  Prevention  Early Diagnosis  Diagnostic skills/techniques  Management/Treatment

10 Human Development Genetics Foetal Development Childhood Development Physical Intellectual Emotional Normal Range

11 Human Behaviour Behaviour presenting to Doctor Behaviour in Relationships Behaviour in Family Behaviour in Doctor-Patient Relationship

12 Medicine & Society Sociological aspects Uses of Epidemiology Organisation of Healthcare in UK comparison with abroad recent changes Relationship between Healthcare services and other institutions of society

13 The Practice Practice Management The PHC Team Finance Premises & Equipment Medical Records Medico legal issues Research Lifelong Learning

14 Question Maker Problem Definition Management Prevention Communication Organisation Professional Values Personal Development

15 Situation Problems Advantages Disadvantages Applied to: Doctor Patient Practice PHC Team Relatives Community Healthcare General Public

16 Clinical Problems “HEIRS” History Examination Investigation Referral See again? “RAPRIO(P)” Reassure Advice Prescribe Refer Investigate Observe (Preventative)

17 Illness Always answer in terms of: Physical Psychological Social Family/Community

18 Patient’s request Agree Disagree Negotiate

19 Ethical problems Utilitarianism examines moral dilemmas seeks to make decisions based on outcomes applies to large populations e.g. “the greatest good for the greatest number” Deontological applies to individuals based on the duties of the doctor and the rights of the patient (and, of course, vice versa)

20 Ethical solutions ABCDE Autonomy (Patient) Beneficence “above all, do no harm” “do good where possible” Confidentiality Do not lie (Truthfulness) Everybody else (Society)

21 Doctor’s feelings Awareness Power Anger Guilt Stress Conflicts

22 Breaking Bad News “A KISS” Anxiety: try to elicit anxieties Knowledge: try to elicit knowledge Information: give information simply re treatment, prognosis, follow up Sympathy: give human contact (touch) Support: give practical help

23 Dealing with Anger “AFVER” Avoid Confrontation Facilitate Discussion Ventilate Feelings Explore Reasons Refer/Investigate

24 Marking Schedules Model answer Areas of Competence Word Mapping

25 Areas of Competence Problem Definition Management Prevention Practice Organisation Communication Professional Values Personal/Professional Development

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