Purpose of this presentation To give you an overview of the RACP Divisional Clinical Examination To explain how the the scoring grid and bands are used. We will talk about: The purpose / format of the clinical examination How pass and fail results are determined The scoring grid and bands

Statement of Purpose of the Clinical Exam The purpose of the RACP Divisional Clinical Examination is to assess the clinical skills, clinical acumen and interpersonal skills to inform whether trainees have reached the standard for completion of Basic Physician Training. (TW) Both long case and short case are important. We want candidates to be good at both.

Examination Format The Divisional Clinical Exam consists of: Two (2) Long Cases Focus on history, clinical examination, synthesis and prioritisation of clinical problems, impact on patient/family, appropriate management plan. Four (4) Short Cases Focus on physical examination technique and accuracy, interpretation and synthesis of findings, interaction with patient/family and investigation and management. Real patient situations. Two (2) examiners per case. Each case is rated on a six-point scale (see Purpose and Rubric video on the RACP website). The two examiners mark individually and then come to a consensus score after a discussion.

How are pass and fail results determined? Does the candidate meet the expected standard? Overall performance across the whole exam Combination of candidate’s long case scores and short case scores

Divisional Clinical Examination Score Grid Guidelines The Divisional Clinical Examination must be considered as one examination that includes both Long and Short cases. The sufficient differences between competencies assessed in the long and short cases mean that a minimum standard must be achieved in at least one long and one short case. The overlap between competencies assessed means that a weaker performance in one case may be compensated by a stronger performance in another.

Considering Long Cases   Long Case #1 Score 1 2 3 4 5 6 Long Case #2 Score Below Standard Above Standard

Considering Long Cases Long Case #1 score Long Case #2 score 1 2 3 4 5 6 Candidates who score less than 3 on both long cases have not demonstrated that they meet the required standard. Therefore, the grid classifies all candidates whose scores for both long cases fall within the 9 squares that include squares 1–3 across and 1–3 down (i.e. scores  of less than or equal to 3 on each long case) as not having passed the examination. Candidates who score 1 and 4 on each long case respectively also are not classified as meeting the required standard. It has been  determined that a passing score of 4 on one long case does not compensate sufficiently for a score of 1 on the other long case.  

Combining performance on short cases and long cases… Balance of performance on all cases. When looking at short cases, we need to consider: The number of short cases passed (over 4) Sum of performance (or ‘Aggregate’) on all four short cases. Stronger short case (SC) performance should compensate for weaker long case (LC) performance and vice versa

Divisional Clinical Examination Banded Model

Overview Long cases on axes Diagonal progression of ‘bands’ differing requirements of short case performance Poorer long case performance requires better short case performance The bands are consistent except for long case scores of 3 and 3 as both long cases have not met the standard (so Band 0, not Band 1) The bands are symmetrical. For example long case scores of (5 and 2) are identical to (2 and 5)

Examples To illustrate how this model works, we have provided a few examples using a 2-step process. Step 1: Determine the Band based on Long Cases Step 2: Apply the Band Rules based on Short Cases

Long Case Scores Short Case Scores Example 1 Long Case Scores Short Case Scores 5,5 4,4,4,4 Step 1: Determine Band Band: 4 Step 2: Apply Band Rules SC Passed: 4 SC Aggregate: 16 Outcome PASS

Long Case Scores Short Case Scores Example 2 Long Case Scores Short Case Scores 4,4 4,4,4,4 Step 1: Determine Band Band: 3 Step 2: Apply Band Rules SC Passed: 4 SC Aggregate: 16 Outcome PASS

Long Case Scores Short Case Scores Example 3 Long Case Scores Short Case Scores 4,4 2,4,2,4 Step 1: Determine Band Band: 3 Step 2: Apply Band Rules SC Passed: 2 SC Aggregate: 12 Outcome FAIL

Long Case Scores Short Case Scores Example 4 Long Case Scores Short Case Scores 6,3 3,3,2,4 Step 1: Determine Band Band: 4 Step 2: Apply Band Rules SC Passed: 1 SC Aggregate: 12 Outcome FAIL

Long Case Scores Short Case Scores Example 5 Long Case Scores Short Case Scores 2,4 4,6,5,4 Step 1: Determine Band Band: 1 Step 2: Apply Band Rules SC Passed: 4 SC Aggregate: 19 Outcome PASS

Long Case Scores Short Case Scores Example 6 Long Case Scores Short Case Scores 3,4 4,2,4,6 Step 1: Determine Band Band: 2 Step 2: Apply Band Rules SC Passed: 3 SC Aggregate: 16 Outcome PASS

More information For more information about the Divisional Clinical Exam and the 2019 rubric see the accompanying video https://www.racp.edu.au/trainees/assessments/exams/divisional-clinical-examination/resources The 2019 rubric for the Divisional Clinical Examinations in Adult Medicine and Paediatrics & Child Health can be downloaded at: https://www.racp.edu.au/trainees/assessments/exams/divisional-clinical-examination/resources