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AMC clinical examination tips and tricks

(July 2014)
You should know by now that the AMC clinical examination is a vey unusual and vey
stess!ul examination" #oweve$ it is actually at the level o! a !inal yea medical student
and %uite &doable' with the a((o(iate (e(aation and undestandin) o! the natue o! it"
Most *M+s !ind that it is not so much a test o! medical knowled)e (that was coveed in
the MC, exam-)$ but much moe a (atient cented$ communication skill testin)
examination" .hat means the (e(aation !o this examination is not so much about moe
knowled)e ac%uisition but about you behaviou and you (o!essional attitude"
.his exam is like a )ame / you need to (lay by the ules- 0thes say it is like a dance and
you have to know the ste(s well o it is like takin) (at in a movie and you have to know
you ole well---
You will deal mainly with ole1(ayes and usually the examine does not ask any
%uestions but 2ust obseves you (e!omance" .he ole1(layes ae o! vayin) %uality$
o!ten youn) medical students (layin) eldely (atients which can be %uite con!usin) when
you walk into the oom" .hee ae some eal (atients$ e")" with heumatoid !eatues$
cadiac mumus$ (ei(heal neuo(athy$ 2oint (oblems$ live sym(toms etc" but they ae
a aity"
*n )eneal the ole1(layes$ (atients and examines ae vey su((otive and want to hel(
you (even thou)h you mi)ht not believe this)- 3o (lease listen to them cae!ully$ they
o!ten ty to )ive you valuable hints-
0n many occasions thee is a second examine (esent (not in the new 4.C in Melboune
anymoe-) who is actually thee to assess the (ocess o! the examination itsel! and otates
thou)h the stations" .hat examine does not 2ud)e you (e!omance$ so (lease do not
woy about he5is (esence"
PREPARATION:
.he &AMC #andbook o! Clinical Assessment' is the best investment you can eve make"
*t )ives you vey com(ehensive ex(lanation o! the examination (ocess$ has incedibly
im(otant hints !o the di!!eent clinical aeas coveed in the exam and )ives !antastic
exam(les with detailed ex(lanations o! all as(ects o! a scenaio"
6ach cha(te is (e!aced by most valuable ex(lanatoy notes which * encoua)e you to
ead thoou)hly because they ex(lain the Austalian a((oach- A )eat exam(le is the
intoduction to &.he 7sychiatic Consultation' which coves in a vey bie! and (ecise
way what you ae ex(ected to conside when examinin) a mental health (atient"
Cases !om the book and !om the &ecalls' a((ea e)ulaly in the examination and
su(isin)ly many candidates !ail these stations--- &8ecalls' can be vey misleadin) and
athe than to ote1lean the stations * ecommend to be awae o! to(ics but to wok
thou)h them in a thoou)h way ealisin) that a scenaio can easily chan)e$ e")" 89, (ain
in a !emale (atient mi)ht be a((endicitis in one exam but could be ecto(ic$ an twisted
ovaian cyst$ enal colic o domestic violence in anothe exam" You eally have to have a
)ood undestandin) o! the undelyin) issues---
My ex(lanation o! this (henomenon is that the examine !inds out vey %uickly i! a
candidate has 2ust ote leant a case$ e)u)itatin) !acts but not demonstatin) a thoou)h
undestandin) o! the case"
* believe that the (ublication o! the book has )iven *M+s an o((otunity to undestand the
natue and e%uiements o! this examination much bette than eve be!oe and it is eally
im(otant to know about the ex(ectations and to undestand the im(otance o! !o
exam(le citical eos"
7a)e 1
0the necessay books and esouces in (ioity listin):
1. John Muta)h;s &+eneal 7actice'
2. .ally < 0;Conno &Clinical 6xamination'
3. &7aediatic #andbook'$ 8oyal Childen;s #os(ital and also on the net :
www.rch.org.au/clinicalguide/index.cfm?fuseaction=home.titles
4. .he 8oyal =omen;s Clincial +uidelines http://www.thewomens.org.au/AtoZIndex
. &.hea(eutic +uidelines Antibiotic' but thee ae many othes which ae
wothwhile eadin)"
!. >a(lan;s Clinical 7sychiaty

8e)adin) othe books covein) su)ey$ medicine$ 0?+$ (sychiaty and othe !ields
(lease e!e to the AMC web site"
*n you (e(aation concentate on the 0?+ and (aeds cases !ist because you have to
(ass at least one o! each othewise you !ail the whole exam" .hat means you should evise
the a((oximately 1@0 (aeds ecalls and 1A0 0?+ ecalls which should )ive you a )ood
chance to aleady (ass B stations--- / sim(le mathematical odds---
.he thid (ioity )oes to (sychiaty because thee ae usually two (sychiaty scenaios in
the exam and most *M+s don;t !eel com!otable with mental health issues" .he
intoduction to the (sychiatic consultation in the AMC handbook ((a)es 4CB144B) is an
excellent statin) (oint and hi)hli)hts the aeas we ex(ect doctos in Austalia to know
about-
.hee ae (obably about A0 (sych ecalls" *! you )o thou)h them$ you now should have
a )ood chance to have (assed aleady A stations--- sim(le mathematical odds---
You should ty to cove at least 4 yeas o! ecalls$ i! not even @---
Anothe &mathematical' hint (ovided by a (evious AMC candidate is that the se%uence
o! the stations has always been the same u( to now (con!imed by many exam
candidates)$ althou)h be awae that this system could chan)e one day:
1" Medicine$ +eneal 7actice o 6me)ency Medicine
2" 7aediatics
C" 8est station
4" 3u)ey
@" 0?+
B" +eneal 7actice 5 Medicine o 6me)ency Medicine
D" 7sychiaty o +eneal 7actice 5 Medicine 5 6me)ency Medicine
A" 8est station
E" Medicine 5 +eneal 7actice 5 6me)ency Medicine
10" 7aediatics
11" 0?+
12" 3u)ey
1C" 8est station
14" +eneal 7actice 5 6me)ency Medicine
1@" Medicine
1B" 7aediatics
1D" 3u)ey
1A" 8est station
1E" 7sychiaty o +eneal 7actice
20" 0?+
7a)e 2
7sychiaty is usually station D and 1E$ althou)h sometimes +eneal 7actice Medicine
a((eas in one o! these stations" Medicine$ +eneal 7actice and 6me)ency Medicine
s(ead ove @ stations (1$B$E$14 and 1@)" 3tations @$11 and 20 ae 0?+$ station 2$10 and
1B (aeds and station 4$12 and 1D su)ey" *n summey you should know what !ield is
tested in which station" .his can be im(otant in a &dual to(ic' station" Fo exam(le i! a
woman (esents with a )ynae (oblem but also has a (sychiatic com(onent it would have
to be a (sychiatic main (oblem i! it was the (sych station but an 0?+ main (oblem i! it
was an 0?+ station-
.he e1test has usually the !ollowin) stuctue:
1" Medicine
2" 7aediatics
C" 8est station
4" 3u)ey
@" 0?+
B" Medicine 5 +eneal 7actice
D" 7sychiaty
A" 8est station
E" +eneal 7actice 5 Medicine
10" 3u)ey
Objective tr!ct!red Clinical Examination" #OCE$ and M!ltidisciplinar%
Clinical Assessment Tasks" #MCAT$: .he assessment domains include:
A((oach to (atient
7atient counsellin) 5 education
#istoy
.echni%ue o! examination$ o)aniGation and se%uence
Accuacy o! examination
Commentay to examine
Choice o! investi)ations
*nte(etation o! investi)astions
Hia)nosis 5di!!eential dia)nosis
*nitial mana)ement (lan
6x(lanation o! clinical (ocedue
7e!omance o! (ocedue
Familiaity with test e%ui(ment
Answes to examine;s %uestions
A )ood st!d% &ro!p is most bene!icial and you should actively ole1(lay and be vey
citical with each othe- Fom my ex(eience the best study )ou( has C (eo(le (one
candidate$ one Iexamine;$ one obseve) because eveyone will want the chance to
(e!om and you will lean by (e!omin)- 6veybody should )et a chance to ole1(lay
and )ivin) honest citi%ue is vey use!ul !o the obseve as well as !o the ole (laye-
*deally you should o)aniGe eal &tial exams' with you study )ou($ !o exam(le A o 1B
cases in a ow$ even cases out o! the book-
*nclude han)in) the stem on the wall o a doo and (etend that you come into the
examination oom" *t hel(s you to undestand the (essue o! the exam and to lean how to
(ut a bad (e!omance behind you"
7a)e C
9ike the C &7;s' in eal estate ((osition$ (osition$ (osition)$ hee it is practice' practice'
practice(((
*t is eally wothwhile doin& it- Just eadin) and thinkin) about these execises does not
hel($ do it like .homas .he .ank ( a lovely childen;s stoy) and you;ll !ind
)o! can do it(((
T*E TEM:
8ead the instuctions cae!ully-
.#6 @ ,s (%uestions) (always ask yousel! at the doo while eadin) the case in!o):
1" =ho am *J (+7 o 2unio M0)
2" =hee am * ()eneal (actice o hos(ital / ual o metoJ)
C" =hat ae the (oblemsJ (dia)nosis$ di!!eential dia)noses$ main and hidden issues$
e")" (olyuia (esentin) as J(ostate (oblem$ but bein) .2HM o head ban)in)
child whee the mothe has si)ni!icant social (oblems which need to be addessed
as well)
4" *s it an eme)encyJ (immediate (hysical examination$ H8AKC and mana)ement
!istJ$ make sue (atient is 3AF6---)
@" =hat ae my tasksJ (stick to the tasks---$ mana)e you time a((o(iately-)"You
only have A minutes$ so be well o)aniGed-
6vey wod has a meanin)- *! the stem mentions that the (atient is an &abattoi' woke$
this can be an extemely im(otant !act that he mi)ht su!!e !om a Goonosis$ a disease
tansmitted by wokin) with animals- *! the stem says that a (atient is on &tamoxi!en'$ she
(obably had beast ca"
*! you ae not sue about any as(ect e)adin) the stem$ you will have an o((otunity to
ask the examine !o clai!ication a!te you have enteed the oom"
.he scenaios ae usually sin)le to(ic stations$ the main dia)nosis will be a((aent !aily
ealy$ sometimes even a!te !inishin) eadin) the stem outside the oom" *! it seems to be a
case o! cholecystitis ty to demonstate an o)aniGed$ stuctued and !ocused a((oach$
honin) in onto the &main (oblem'" #oweve$ kee( an o(en mind and talk about
di!!eential dia)noses as well$ because you mi)ht 2ust think it is &cholecystits' but in
eality it mi)ht be (anceatitis o somethin) else" .his becomes es(ecially im(otant i! the
ole (laye o the examine makes comments like: &H" last time * had cholecystitis$ it !elt
%uite di!!eent' (this is only an exam(le-)" 7ick u( you eas and stat to eview i! the ole
(laye mi)ht ty to )ive you a hint that this case is somethin) di!!eent"
0ccasionally one station can contain two se(aate issues$ e")" a (aeds case mi)ht be
com(licated by a (aent with a (sych o social (oblem and you mi)ht be ex(ected to
cove both to(ics" *! you deal %uite well with the (aediatic com(onent but i)noe the
!athes &dinkin) (oblem' (!o exam(le)$ you could be at hi)h isk to !ail the station"
*n summay$ in most stations you should have a )ood idea about the task and a well
stuctued (lan o! a((oach in you head at the end o! the eadin) time and be!oe you
walk into the oom"
.hee is anothe co(y o! the instuctions in the oom and o!ten it is use!ul to look at them
a)ain to make sue that you ae !ollowin) the (escibed tasks"
.hee is also a (en and (a(e$ so (lease make notes eithe !o you own (lan o! (o)ess$
e")" 1"$2"$C" etc o H8AKC o dawin)s !o the (atient to ex(lain thin)s"
7a)e 4
INTRO+,CTION:
Ke mind!ul o! dess code$ (obably a bit !omal but loose enou)h to !eel
com!otable-
7lease intoduce yousel! to the (atient 5 ole (laye$ 3M*96 and be nice----
Addess the (atient as Ms" o M"$ not 2ust &Jane' o &John' o ask the (atient
&#ow do you want me to addess youJ'
3it at the consultin) oom desk$ elax$ kee( you back stai)ht$ lean !owad a little
bit and kee( you ams elaxed in you la( o on the desk
>ee( eye contact with the (atient !o at least E0L o! the inteview$ don;t look
down onto the in!omation sheet o the desk !o lon)- 9ook at the (atient;s
!oehead o between the eyes )ivin) the im(ession that you look into the (atient;s
eyes all the time"
Ke mind!ul o! you body (osition$ sit u(i)ht with an o(en stance towads the
(atient$ but not too close and elax 1 that way you a((ea moe con!ident- 8elax
you !acial muscles and smile (cae!ul / not in &beakin) bad news stations-)"
3(eak clealy$ not too !ast$ not monotonous$ not too loud--- Mse a modeately
(itched$ so!t voice-
.y not to inteu(t the (atient althou)h you mi)ht have to inteu(t i! the (atient
)oes on and on"
*t is most im(otant to analyse at the be)innin) i! the case could be an eme)ency and
then you should always stat with &H8AKC' (o a %uestion to the examine &*s my (atient
stableJ') and most likely )ive oxy)en---
*! thee is a hint that the (atient has (ain$ you should always conside to (ovide some
(ain elie!"
6xhibit con!idence$ (actice )ood communication skills$ includin) you body lan)ua)e$
how you (osition yousel! etc" 8es(ect the (atient;s (ivacy and Is(ace; N don;t )et too
close- *n most stations you;ll sit in !ont o! a desk$ lean towads the (atient"
.y to &take contol' o! the consultation and ima)ine that it is 2ust you and the (atient like
in a eal situation$ be convincin) and con!ident---
*ITOR): *nvite the (atient to &tell thei stoy &" *! they use tems that you don;t
undestand ask them !o an ex(lanation" Make a de!inite attem(t to use o(en ended
%uestions (.ell me moe aboutO"P *s thee anythin) else you would like to talk 5 you ae
wondein) aboutJ)"
C04C64.8A.6 on im(otant and relevant issues$ don;t ask unelated %uestions---
9isten cae!ully to the (atient;s5ole (laye;s wods o %uestions" .hey have stict
instuctions to make cetain comments o ask cetain %uestions diectly elatin) to the
(oblem and thee is always an im(otant meanin) behind it- * call it &kee( you antennas
tuned in' so you can ealise what the ole (laye o the examine wants to )et thou)h to
you" Hon;t cut them o!!- 6ncoua)e the ole (laye to ask %uestions wheneve (ossible"
.hey ae thee to hel( you and mi)ht (ut you on the i)ht tack o )ive you clues in which
diection to )o" You mi)ht like to e(eat what the (atient has said !o clai!ication and
make sue what knowled)e o undestandin) (o misundestandin)) the (atient has about
the (oblem- You mi)ht like to ask &Any %uestions you want to ask meJ' o &Ho you
undestandJ' o &Anythin) else you want to tell meJ'"
3ometimes ole (layes do not voluntee a lot o! in!omation and you have to ask
s(eci!ically$ so (lease stick to you systematic a((oach o! histoy takin)$ but o!ten ole1
(layes (ovide vital in!omation i! you as the i)ht %uestion like &What do you think is
causing the rash?' (My nei)hbou;s son had a sla((ed cheek last week-)
7a)e @
+ood communication skills ae extemely im(otant (s(eakin) and listenin)---)$ (lease
(actice you 6n)lish and make a contact with you !amily o !iends to 049Y s(eak
6n)lish in the B months leadin) u( to the examination---
H04;. use medical 2a)on$ but sim(le lan)ua)e--- Althou)h sometimes you can and want
to use a medical tem like &subaachnoid haemoha)e' (to demonstate you knowled)e
to the examine) but you have to ex(lain in sim(le tems that this is the s(ace between the
skull and the bain o ask the (atient i! s5he undestands what you talk about / in the
examination the (atient most likely will answe &Yes$ * have head that tem be!oe'$ so
thee is no time wasted"
*n (obably A0L o! (esentations you should be able to establish the (obable o even
de!inite dia)nosis a!te a (o(e inte(etation o! the histoy- Make sue you have a
systematic a((oach and (lan you a((oach to (hysical examination$ investi)ations and
mana)ement:
a) .he most likely and C a)e 5 )ende elated di!!eential dia)nosesJ
b) =hat would be im(otant to concentate on in (hysical examination and
investi)ations to con!im o exclude dia)nosisesJ
c) =ee thee othe im(otant !actos o isks in the (atient;s histoy su((otin)
one o! the dia)nosises ove anotheJ
d) #ow do you ex(lain the dia)nosis and di!!eentials includin) (o)nosis and
(ossible com(lications to the (atientJ
e) =hat is the most a((o(iate mana)ement !o the main and othe di!!eential
dia)nosises$ includin) li!estyle$ counselin) and (eventionJ
E-AMINATION:
=hen it comes to the examination$ o!ten you do not (e!om a (hysical examination but
you have to ask the examine !o the !indin)s" 7lease a((oach this in a vey well
stuctued way$ !istly tell the (atient that you will ask the examine !o the !indin)s and
then be (leasant to the examine and it does not hut to say &.hank you' at the end"
Ke systematic (.alley 0;Conno style-) statin) with the )eneal a((eaance and vital
si)ns"
8e)adin) the vital si)ns$ the examine will nomally (ovide (ulse$ blood (essue$
es(iatoy ate$ oxy)en satuation and tem(eatue" #oweve$ i! you sus(ect a (ossible
di!!eence in e")" blood (essue in i)ht and le!t am$ o i! you ex(ect an othostatic o i!
thee is a chance o! co1actation o! the aota you will have to s(eci!ically e%uest the
s(eci!ic coes(ondin) !indin)s like K7 in i)ht and le!t am$ K7 lyin) and standin) and
adial as well as !emoal (ulses"
.hen !ollow the usual examination (ath !om head to toes$ althou)h o!ten it is more
appropriate to .oc!s on t/e area concerned$ !o exam(le the abdomen$ i! it is an
abdominal (ain station and it is wothwhile to ask the examine &*s it ali)ht to )o stai)ht
to the abdominal examination' (most likely the answe will be &Yes' / a)ain no time
wastin)-)"
3ometimes it (ays o!! to bie!ly ask !o esults o! the cadiovascula o es(iatoy system
examination and you;ll !ind that the examine %uickly ski(s ove it and says &all nomal'
o &(lease concentate on O"(e")" the abdomen)'"
7a)e B
You need to ealise that the examine will only )ive you !indin)s i! you s(eci!ically ask"
Fo exam(le it is (etty useless to ask &=hat ae the !indin)s on ins(ection o! the
abdomen' o &Ae thee si)ns o! live !ailueJ'/ the examine most likely will es(ond
&=hat ae you lookin) !oJ' .his wastes a lot o! time" 7lease ask stai)ht away &0n
ins(ection * look !o distension o! the abdomen' / the answe will be &it is (o it is not)
distended'"
*deally you should tell the examine at the same time why you (e!om an examination$
what you ex(ect to !ind and what the undelyin) (oblem could be$ e")" &* am lookin) !o
tendeness in the 8*F ove the McKuney;s (oint to con!im o exclude a likely
a((endicitis'"
*n a eal (hysical examination$ e) &the shoulde'$ !ist use a hand cleane$ tell the (atient
what you (lan to do and ask !o consent" 6")" &* want to examine you shoulde$ is that
o"k"J'-
*t is well eceived i! you )ive &r!nnin& commentaries" and ex(lanations to the (atient
(and indiectly to the examine-) o &mumble' to yousel! (and the examine) what you
ae doin)"
7lease be )entle to the (atient5ole (laye (they )o thou)h this u( to C2 times duin) the
day----
AMC (ovides all the necessay tools$ althou)h most candidates like to bin) thei own
stethosco(e but all the othe (aa(henalia (e")" ed to((ed (in$ 3nellen chat$ e!lex
hamme$ cotton wool$ !ilament$ measuin) ta(e$ (illow !o hand examination etc") ae
thee" #oweve$ you mi)ht have to ask !o them and then the examine will (oduce them
!o you" *n some stations thin)s ae on the desk and you 2ust have to )ab them and it is
su(isin) how o!ten a candidate will not use the (ovided thin)s like cotton wool !o
sensoy testin) etc"
IN0ETI1ATION:
8e)adin) investi)ations it is vey use!ul not to ask !o &FK6$ 638$ C87$ M?6$ 9F.;s
etc"' but athe to be s(eci!ic and indicate to the examine the elevance why you ode
the test$ what you sus(ect and what the test esult would mean to eithe dia)nosis o
mana)ement5teatment" 3how (es(ective athe than odein) ielevant and unnecessay
tests- Fo exam(le don;t 2ust ode an FK6 in a (atient with sus(ected chest in!ection" *t is
much bette to !ocus on the =CC to exclude leucocytosis" 0de sim(le investi)ations
!ist$ es(ecially o!!ice tests i! a((licable- Moe com(lex investi)ations like C. and M8*
came late" .he most valuable o!!ice tests ae the uine di(1stick$ uine (e)nancy test and
!in)e (ick !o )lucose-
+IA1NOI:
0!ten the dia)nosis is clea vey ealy$ so tell the (atient what you sus(ect it is in lay
lan)ua)e and tems the (atient undestands" Ask the (atient i! s5he knows the dia)nosis
and what s5he knows about- >ee( di!!eential dia)nosises in mind and demonstate
analytical thinkin) and citical decision makin)-
*! the (atient seems hesitant to acce(t you dia)nosis o advice be (e(aed to chan)e
you mind i! the evidence doesn;t su((ot you dia)nosis"
.his is vey much a (atient centeed examination and it is always a((eciated i! you daw
a (ictue$ a dia)am o a decision tee (thee ae (en and (a(e on the desk--) to make
you ex(lanations cleae !o the (atient (and the examine-) and you can always add:
&O" and * will )ive you a hand out to take home"'
7a)e D
MANA1EMENT should include:
*nvesti)ations (outine investi)ations be!oe invasive and avoid ove investi)atin))
Medication and othe teatment (su)ey$ (hysio etc")
8eassuance
Conside wokin) with othe health (o!essionals in a multi disci(linay .6AM---
J 8e!eal
J Admission to the hos(ital
9on) tem mana)ement and .ollo2 !p$ incl" community esouces$ e")" &Keyond
Klue'
Management includes the 5 Rs.
R-Rx- treatment6x(lain teatment o(tions$ includin) non (hamacolo)ical
o(tions
R-Review- Follow u( in a !ixed time$ o!ten the next day o may be !ew weeks o
days
R-Referral-8e!e to a s(ecialist i! needed but ex(lain what to ex(ect
R-Red flags-6x(lain ed !la)s *"e" dan)eous thin)s e")" #y(o)lycemia <
#y(e)lycemia in Hiabetes < what to do
R-reading material-#andove eadin) mateial so that (atient can emembe what
you said to him
H04;. e!e a (atient to you senio$ a consultant o out(atients without ex(lainin) to the
(atient exactly what will ha((en" *t is a mistake to ty to )et out o! a situation by sayin)
&0h$ *;ll e!e you to the otho(aedic su)eon"'" You have to be %uite s(eci!ic why and
what will ha((en thee" #oweve$ e!ein) to a cadiolo)ist !o cath lab$ to membes o!
the multidisci(linay team$ e")" (hysio$ s(eech (atholo)ist$ e)ista etc" is %uite
a((o(iate but the eason and what has to be ex(ected should be ex(lained to you
(atient5ole (laye-
* (e!e to say that &* will include the cadiolo)ist' athe than &* will e!e you to the
cadiolo)ist'"
Hon;t be too !im in you advice to the (atient$ athe (esent o(tions- *t is the (atient;s
choice what s5he is com!otable with" Hon;t be sucked in to say &0h$ yes$ you de!initely
should have a hysteectomy' (!o exam(le in menoha)ia) / it is only one o(tion o! a
an)e o! mana)ement (ossibilities- Make sue the (atient undestands the o(tions-
3ometimes a (atient5ole (laye does not acce(t you advice$ e")" Jehovah;s witness and
blood tans!usion o e!usal to have childen immunised" All you ae ex(ected to do in
such a situation is to acce(t thei (oint o! view but to ex(lain the issues and conse%uences
to the (atient o in ae cicumstances you mi)ht have to e!e to a )uadianshi( boad"
Always conside !ollow1u( a((ointments$ es(ecially e &side1issues' like smokin) and
dinkin) i! they ae not the main to(ic" *t is a (atient cented examination and li!estyle
advice is vey im(otant$ howeve you mi)ht not have enou)h time to )o into )eat detail"
To2ards t/e end o. t/e station al2a%s ask +o %o! /ave an% 3!estions"4 T/at /elps
t/e role pla%er to &ive /ints i. %o! /ave missed somet/in&(
7a)e A
.*M6-
A minutes is a vey shot (eiod- #avin) a clealy visible watch can be you li!e save in
the exam-
3ometimes thee will be a bell in)in) duin) the exam and the examine mi)ht inteu(t
you a!te e")" 4 minutes to say &7lease move on to you next task' o &*t is time to move
on to you next task'
C43 (duin) the exam):
QCA9M / emainin) calm in unex(ected o di!!icult cicumstances is the key to suvive
that station o even the est o! the exam" You may neve know that you will still (ass that
station even i! you don;t know much o you !eel so bad-
Q4*C6 / always be nice to the (atient" 6veythin) counts" You attitude$ manne$ voice
and lan)ua)e" Hon;t end the consultation in a way that (atient !eels moe con!used$
theatened$ o(tionless o not bein) taken cae o!"
&A((oach to (atient': obtain the tust and con!idence o! the (atient whilst bein) honest
about the !utue" 7oint out the level o! success which can be ex(ected with moden
mana)ement" +uaded eassuance- *nstuctions should be clea and (ecise-
Q3AF6 / neve !o)et that you;e eithe a +7 o 2unio M0" Hon;t hesitate to ask !o hel(
o second o(inion !om a senio docto" At least to mention you would ask o check with
O"" (such and such a consultant) i! you ae not sue" *n some stations it is im(otant i!
not even citical to e!e a (atient to a s(ecialist (e")" (sychiatist etc")" *! they can;t see
the (atient soon$ then )et thei advice ove the (hone" *! time allows$ always (ovide a
sa!ety net$ e) !ollow1u($ when to seek hel( $ etc"

Most candidates !ail a !ew stations$ so be prepared ( 0!ten thee is one scenaio which
you mi)ht not know much about at all and you soon think that you have !ailed that
station" *t is extemely im(otant not to think about it any lon)e$ once you have walked
out o! the oom$ clea you mind$ !o)et about it$ (ut it behind you and concentate on the
next station and believe in yousel!---
8e)adin) the esult o! the exam it is im(otant to ealiGe that a e1test is not a bad esult$
actually the e1test is easie in its stuctue because at this sta)e thee have neve been any
new cases in a e1test examination which means i! you )o thou)h @ o B yeas o! ecalls
you should be vey sa!e to (ass the e1test-
6ven i! somebody !ails the examination$ it is not a disaste" A wise man said:
&FA*9M86 *3 049Y A =08H$ 40. A 364.64C6-'
3ometimes you mi)ht have &neves' o even a &bain block' / it is most im(otant to
elax and )o back to basics$ e")" )o back to the (evious task o even the be)innin) and
talk to the (atient$ e")" &0"k" you told me you histoyOO' and wait what ha((ens" .he
ole (laye mi)ht hel( you with a hint because they ae vey willin) to hel( you out-
0 use (en and (a(e to summaise what you have done and whee you ae to !ind you
thead a)ain" A summay whee you ae u( to mi)ht (om(t !uthe %uestions !om the
ole (laye-
7a)e E
+ON5T 6ITEN TO NE1ATI0E TORIE AN+ R,MOR((((((((( 7
TA) POITI0E((((((((((((((((
#oo stoies ae usually based on the ne)ative ex(eience o! collea)ues who !ailed a
station and natually thei view is coloued by that- 6ven sim(le umous like
&Melboune' is moe di!!icult than &3ydney'" Kelieve me it is not tue$ the standad is the
same in each examination cente- #oweve$ i! you ae convinced by such a umo$ 2ust
don;t a((ly !o the exam in that city$ sim(ly !o (sycholo)ical easons"
T/e da% o. t/e examination:
*! you )o intestate (lease allow su!!icient time to !amiliaiGe yousel! with the location o!
the examination cente" Make sue i! have a elaxin) evenin) be!oe the exam day$ that
mi)ht include a massa)e$ a omantic dinne$ a walk on the beach$ a concet o whateve
&tickles you !ancy'" H04;. 3.MHY--- =hat you haven;t leaned by now you won;t
catch u( with toni)ht-
0n the day itsel! ty to elax$ elax$ elax-
7am(e yousel!$ (ut you !avouite make1u( on$ dess u( a bit$ wea lose clothin) / most
o! us stat to )et vey nevous and to sweat a bit and no doubt you;ll !eel uncom!otable i!
you have ti)ht !ittin) clothes on with a sweat stain unde you ams"

Just a eminde that you also should look !owad to &li!e a!te the examination' and that
means !indin) a 2ob" 8emembe you need to have all you (a(ewok eady !o
e)istation with a medical boad in the state whee you a((ly o now the national medical
boad" .he most commen hold1u(s ae lack o! cuent lan)ua)e ceti!icate (it has to be
within the last 2 yeas) and the ceti!icate o! )ood standin) !om medical authoity in the
county whee you (acticed medicine be!oe" *t ha((ens e)ulaly that *M+s can;t stat
because o! some as(ects o! the (a(e wok bein) missin)-
1ENERA6 *INT 8OR E-AMINATION PREPARATION:
Plannin& .or t/e examination:
.he waitin) time between MC, and clinical examination can be %uite lon) and extemely
!ustatin)" *t seems un!ai" #oweve$ thee is no way to chan)e this (like the weathe) and
you have to acce(t it and deal with it in a ational manne" AMC tells us that thei main
consideation is you ankin) o (e!omance in the MC, examination" .he avea)e wait
is (obably 1A months althou)h )ettin) shote since o(enin) o! the (u(ose built
4ational Medical .est Cente in Melboune"
=hen you a((ly !o an examination date you should then wok towads bein) in to( !om
!o that date$ like an athlete (e(ain) !o the 0lym(ic )ames"
You want to (eak at the i)ht moment and emembe$ you ae in contol-
You have to be eally motivated to sit the exam othewise you mi)ht as well not )o !o it-
Personal responses to t/e examination stress:
=e ae all di!!eent and will ex(eience di!!eent emotional and (hysiolo)ical es(onses to
the exam stess which also in!luences ou social and !amily envionment"
Many candidates exhibit sym(toms o! anxiety o sometimes even de(ession which need
to be addessed (ossibly with a e!eal to a counsello"
A healthy balance o! mind and body is im(otant and can be su((oted by elaxation
techni%ues$ massa)e$ (hysical !itness execises etc"
7a)e 10
P6EAE ease the wods &3i)ns o!O"' and &Hon;t woy-' !om you memoy bank
because as outlined unde examination the %uestion !o &3i)ns o! O""' will not be
answeed by the examine who will wait until Y0M ask s(eci!ically !o those si)ns$ e")" in
cadiac !ailue you want to know i! the JR7 is aised o sacal oedema etc"
.he comment &Hon;t woy-' does not )o down well with the (atient because even it is a
tivial (oblem$ the (atient *3 =088*6H- And the (atient will think that you 2ust don;t
undestand which is not a )ood stat to develo( a docto / (atient elationshi("
7A+6 11