Modified Essay Question Dr. Omar Shiddo Consultant Family & Community Medicine

Aims and Objective( General) To assess the candidate’s ability to conduct a good consultation and problem solving skills. To assess the candidate ability to identify the nature of a prevented problem and to propose a range of solutions To identify and evaluate the candidate attitude to the situation described.

Aims and Objective (Specific) The Assessment of adequate consultation skills. The comprehensive of history-taking. Explaining to the patient the nature of his problem's). Selection of relevant health promotion and prevention. Relevant clinical examination. Relevant laboratory investigation. Appropriate management strategy. Rational prescribing. Effective referral if needed. Evidence of being a competent and safe doctor.

Common theme in M.E.Q All aspect of clinical and preventive family medicine. Problem and difficult patients. Psychological problems in individuals and families. Consultation process. Practice organization. Relationships with colleagues and others. Controversial and new topics. The doctor’s own feeling. Ethics and attitudes

How should you set about answering M.E.Q ? Read the scenario carefully. Every word has some significance. Think in broad terms about the whole of the case, not just about the superficial symptoms or diagnosis described. Think of the context in which the situation arises, and the resources you can command to deal with it. Think of what you need to do to convey your ideas and implement them. Keep it brief - notes or statement. Time – divide equally Practice family medicine – justify your action and how? Who will help you and how? Structure your answer to cover all aspects.

Marking schedule What are the contents of marking schedule of Modified Essay Question?

Clinical competence Assess of physical state, relevant clinical examination, appropriate investigation, and evaluation of therapy. Psychological, social, and environmental factors. Family situation and support. Compliance.

Practice management and organization Communication, team work. Follow up. Value of regular visits. Shared care.

Patient autonomy and expectations What does the patient want or expect? What does the doctor think is possible? What is realistic in the circumstances?

Attitudinal factors How does the candidate consider resources outside the practice? Implication of social class and doctor- patient relationship.

R.A.P.R.I.O.P R- reassurance A- advice P- prescribe R- referral I- investigation O- observe P- plan

Sttot and Davis Management of presenting problems. Management of continuing problems. Modification of help-seeking behaviors. Opportunistic health promotion.

EXERCISES :1 Ali is 8 years old, a school boy. Ali’s mother brings him along saying “ he’s got a sore throat again doctor”. Before you can say anything, she is demanding antibiotics to fix it quickly and asking about taking his tonsils out and she complained that the other doctors in the health center was negligent because he told her Ali does not need antibiotic. You notice on the card that Ali has had two episodes of sore throat this winter, the second of which was diagnosed as tonsillitis and treated with penicillin. This time in fact, the main symptoms ( and signs) are a runny nose and cough. He is febrile. His throat is injected with only slight tonsillar enlargement and no pus. These are a few non-tender cervical lymph nodes. Chest, ears and sinuses are clear. Q. How are you going to establish and maintain effective relationship with Ali and his mother?

Q. How would you approach Sabha’s problem? II Sabha is 38 years old lady, divorced 2 weeks ago, running small business, looking after 5 children by herself, complaining of 2 weeks history of headache. Q. How would you approach Sabha’s problem?

III Mrs. K 18 years secretary, presented for the first time complaining of painful lumpy breasts. She had been married for 1 week and was on no contraception because her husband did not want her to use the pill. She said she had found marriage depressing. She admitted to a fear of pregnancy. Her sister had had an ante-partum hemorrhage at 30 weeks pregnancy. Examination revealed normal breasts and no other physical abnormalities. Q. What was the patient’s actual reason for coming to see the doctor?

IV Mr. Saleh is a 44- year-old electrician present with a 10 days history of back pain., which get worse today. Physical examination is normal, apart from local tenderness in the sacral part of his back. Q. How are going to conduct this consultation?