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Key Scoring Point in History Taking and Examination for Postgraduate Orthopaedic Exams
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Key Scoring Point in History Taking and Examination for Postgraduate Orthopaedic Exams
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Segment:0 .
Thank you for joining this Wednesday teaching from the FRCS mentor group. Um, this evening, our representative is one of our senior mentors, David. Hughes. He's a surgeon from Warwick, and he's also the convener of the Warwick FRCS course, which is an excellent clinical course, maybe he could tell us about this course later on if he likes what we have.
Also with us, Amjad Amjad is one of the new mentors here, and we are very grateful to have him as an active mentor in the group myself. Firas, I'm going to help modulate the session. I please pay attention. The session title is very important and commonly overlooked, which is a key scoring points for history taking. It's something we take for granted.
However, it's very important, and David's going to tell us all about it. The key scoring points for taking history for their fastest exam. And please ask questions on the chart option or raise your hand symbol next to your name if you like to talk or ask any questions. And there will be a short, brief Viva session once we finish. Only two or three candidates will be picked, so please, if you're interested in taking part, express your interest as early as possible.
So I will leave you with David from now on. OK good evening, everyone. Thank you very much. I know it's Wednesday evening, but this is important. So one thing that often gets overlooked when we're studying for the fellowship exams is history taken because we do it all the time. Unfortunately, sometimes when you're doing something all the time, we do drop into bad habits and it's quite easy to miss something.
So when I run the Warwick air, yes, of course, with Mr. Hashmi, and we've got one course coming up next week. This is from a previous course where we did talk about it and we discussed there's a lot of the candidates found it very useful. So I'm letting you guys know about it, particularly as the exams coming up in just over 6 under six weeks now, so you can start thinking about your history taking. So it does actually count quite a few marks and they're easy scoring marks.
So if you can do well in that intermediate case will set you up for the clinical quite well, and you need to pass the clinical to pass overall. There are very few people who pass just on Survivor. Most of the people ask because they've passed the clinical well and that you can make up so many marks there. OK, so this is so we're just going to start off with a little bit of the clinical exam.
So obviously, we know it's, you know, it's one hour long. So the key thing is to intermediate cases, which lasts about 30 minutes to two cases, 15 minutes each have sections actionscript history, exam discussion. You need to go through all three of those. You need to get a discussion. You you don't get to discussion. You only score for discussion and then it means any scoring for history in exam.
Generally, they very rarely bump your mark up. OK so it is key that you are very succinct in your history taking you yet the salient points across. You can score well and that could push you onto the go, getting a good clinical exam and getting lots of discussion because that's where the meat of the points are going to happen. But still, in terms of the history, you're going to examiners in each history, but that's for scoring.
So for scoring opportunities? OK so if you could get a good eight, you're starting. Well, aren't we? All right? And we all know about the short cases, upper them and lower them. So for six cases, five minutes each, but I'm going to focus mainly on History. Now than the intermediate.
So when you look at the examiner's manual and they give us this as well, it's quite a lot to take in. Isn't it really bedside manner, the quality of response? Lots of different points. And so we kind of glaze over it. I have to say I did as well initially and thinking, what's all this off? But in my process of looking around for tips about the history taking for the exam, I discovered a few key things from previous exams.
So these are the key headlines you they want to see when you're doing a history. Obviously, quality of history obtained. So if you're a person of a hit problem, they want to make sure you're finding things about the hip problem, not about their cat from 1922. So it's about it's very important to stay focused on what you've been asked to. And that's usually not a little summary at the beginning where they say, please ask this question, this person about their knee, their hip, the shoulder.
They also want to see how you get on with the patient ability to communicate with patient. So you've got to be friendly, you've got to be polite and courteous. I've done a bit of teaching for people doing the masks, and it's all about introducing your name, saying what you're doing. Smiling, washing your hands.
These things do count and it helps with the patient. It makes you look professional. Um, presentation of the principal clinical findings. OK differential diagnosis, investigation pathways. These are things that they want you to talk about in the history. And when you come to discussion, they're talking about the suggested interventions in management, including the role of surgery and relevant basic sciences.
Now what we sometimes forget when we're taking history and this is very important from our point of view, is. Social implications of the condition. So, yes, it causes them pain, it stops them being able to do their job, it stops them being able to do the normal level of activities. These are things that they want you to ask and state. The an important considerations for in consent. So will this person be able to follow the rehab?
Do they understand the implications of having the operation? Do they appreciate that? Yes, a knee replacement would be great, but it might take them six months before they're feeling better. They also want to know morbidity and complications, so key things from a surgical point of view, are they an aspirin? Are they on warfarin?
Are they insulin? So these are sort of little things you need to make sure that are aware of. Also, health promotion considerations, if you can get that ball, I.e., conservative measures, have they lost weight? Are they doing physio things like that? And again, this is a difficult thing being able to gain confidence of a patient in such a short space of time.
Again, if you have a nice ease and you have and you have a good pathway of how you're going to ask questions, it does help and get the patient on your side. Most of the time, these patients want to help, they do so. As long as you're polite and courteous to them, they will. They will. They'll be nice to us and they will be helpful and they'll be positive.
Sometimes they'll be too courteous. I had one poor person. I stupidly asked him questions about his model train set, and I could see the back of my AIIS. The exam was AIIS rolling, saying, Oh no, not another one. He's ask that question. But it is important you can be polite and say that's very good, that's very interesting. Can I just get back on to asking about your battle or your hip or your knee?
So it is do try and getting their confidence, but bring them back to the subject matter. OK so just the key things when I'm taking the history, I need to make sure. So when you're doing this, so you have these things in your background, so introduce yourself. Presentation what? Why they why are they here today?
No, not because of the exam. What first brought them to see a doctor about this problem? Ask medical history. So previous surgery rather than the issue. So have they got heart problems, lung problems, drug history? So I say the key things anticoagulants, steroids if it's rheumatoid disease modifying drugs and diabetes. Social history, so hand dominance, if you are doing an upper limb case is very important.
Occupation, if they're still working and it is even if they're retired, there's a lot of our patients will be to ask what they used to do because that may have some effect on them smoking as well, particularly if you've got a foot exam because there's so many foot surgeons. As soon as you say a smoker, they go, right, OK, I don't need to do anything very important this patient expectations.
They want the surgery, but what they want from out of the consultation review. Now, a little trick that you can do after you've taken the history is to summarize your findings to the patient. That way you look good. The examiner and then you can ask the question it's anything I've missed. You never know.
At that point, the patient might tell you something very important and pertinent. Then present your findings to the examiner rather than the other way around, because once you presented the exam, you can't go back because the exam looks like. What about this? What about that? If you summarize the patient first, then they will help you fill in any gaps that you've missed.
This is a very useful tip, and I know lots of examiners have mentioned past examples have mentioned this before to me and saying this is a good way of being able to make sure that you don't miss anything. And actually, when you say that, that's when it gives the patient the opportunity to help you as well. So we will as difficult to do an examination online in this little forum, but I will go over a few things, so I'm not going to go over a clinical exam in detail, but I want but if you've got the exam coming up, you've got a month now.
So at this stage, I'm hoping that you're honing your skills you're getting. And if you're in clinic, have your consultants say, I need to exam the shoulder one exam this step. I want you to look at me examining this patient and tell me where I'm going wrong or where I'm going. I conclude, this is very important. You've got to look slick when you're doing this. It's very clear.
If you can get the examination in under three minutes, get all the important things across because that will give you lots of time to get to the discussion. And that discussion is a mini viable station, basically. And you can if you score well in that, you'll give you good points overall. OK I think we've all seen this book by Nick Harris, Nick Harris and Faisal Ali.
It is a fantastic book. If you haven't got it, get it. I to talk in broad principles with regards to the clinical exam. It's about having a system so that you it's quite easy to get slap and concerned and nervous and anxious. But if you have a system, it makes life easier for you, allows you to go back to basics and pay off.
In that situation, the examiners will say you in the right direction because they want to help lot all the time. But if you're being bombastic, dogmatic and you're going yourself down the cul-de-sac, they might just watch you. But you have a nice system that will help. So it's a good case of look, not just at the patient. Look at their shoes.
Look for when you're walking out, so you've got to use everything around you. And feel for the patient, avoid pain, so the key thing is, any time you examine them, make sure you can see the patient's face so they're not causing the pain. If it is a shoulder exam. So you want to do it from the back of a mirror, that's how we do it normally.
So I can see their face and make sure I'm not causing pain already gets you in the patient's good books and examines good looks because you're showing due consideration for the patient. And once you've got the patient on your side, exam is a lot easier. A move with only lower limb dope and spine. Don't forget to walk. I see a special test.
I mean, if you've got Pfizer. Look, it is fantastic to have all those special tests and what I can tell you, I've been on the train going to the exams. I've seen exam is coming in and they've got the book in front of them on the train, reading, reading it, trying to make sure they can get it through. They can remember how to examine the shoulder or a knee to give their A hand surgeon or a foot surgeon.
They've never done it for 10 years or so. Think so it's not like I'm repeating myself, but I cannot stress this enough discussion is very key. You have to get to that discussion. It is very easy to feel to get caught in the history taking or rush through the exam before you realize they've only got 1 minute left to the discussion. Try and get your history done in under three minutes, if you can.
Four minutes is fine. I know they say leave up to five minutes, but you want to give yourself time and again an examination. You can do most systems under three, four minutes. That gives you five six minutes for the discussion. OK, and you for lots of points there. And again, I can't stress this enough. These they're quite harsh in terms of it all for the discussion because you haven't done a discussion.
It's for the history. It's for, for the clinical. OK, so you need to get a discussion that way you can get the scores that you've earned from the good history and the good clinical exam. OK talking about it is for history taking, obviously for the intermediate cases or intermediate cases. Sorry, Yes. So you will you may be asked in this short cases to say, what questions you might want to ask.
A classic one would be so if you are shown a short and obvious thing like someone who's got stupid friends in the short case, they might say what one question is, do you want to ask this patient? And if you see both hands, the thing to ask then is say, do you have any involvement of your feet? Does that look that already tells the exam that there's other disease, other disease processes involved?
So things like that, so it's where, but it will be something that's the word B barn door or such. And again, they're not going to hand a rheumatoid arthritis in a short case. They may also again ask is any questions you like to ask? The key thing then, is to ask about function. What can you do if your hand? What do you want to be able to do with your hands? That's very important there.
Again, key as well. If you have a rheumatoid patient in an intermediate case, it's a fantastic history in a way because actually there's so much you can just focus on a little bit of the history of the rheumatoid tab. And the key thing they want to know in that, for example, is disease modifying drugs and what they're doing with the hands and function. Very important as well.
What the patient wants, what the patient expectation are. So you might see patients with so much pathology you don't know what to do. The patient's going, I'm fine. I'm actually not in pain. I'm just here because I've got good signs. And actually, that's the exams are happy with that. They're fine with that because they know in the exam there's so much to talk about a rheumatoid hand, and it's quite easy.
As a candidate, you see a room for that like, oh, what do I do? What do I talk about? But as I say, if you can do a focus thing about function, because what can you as an orthopedic surgeon do improve, help reduce pain and help with function? That's what we're doing with most of our interventions. So if the patients fail their function, I would paint. We're not really going to help them all we.
Absolutely, I think this is very important. David, as you said, if you are short, if any of the candidates are short on time for any reason during the intermediate case, for example, you know, if you've been faced with a complex case or when you don't have time in the short cases if you're stuck. Just ask the patients about the pain and the function and what do they want and/or how the condition is affecting them, and that will guide you through what you do because again, with the intermediate case.
You will have obviously two intermediate cases for the exam, as you guys know, and you will receive a referral letter. The exam will give you a referral letter from a GP with two lines very, very brief. Not like a normal GP letter, something like 55 years old lady complaining of shoulder pain. Please advise.
Yeah, like that it was. It won't really have any useful much just focusing on which part of the body to look at. And then, as I say, just take a focused history, be Precice with the pain. And for example, where is the pain and things like this? Be Precice with that. And I know patients can distract you a little bit. They can tell you, well, my leg hurts.
You know, you need to get to the bottom of it. Where? ask about the pain, ask about the function, social background, medical background. With the patient expectations, you've got to cover all these and very, very important not to skip through any of these. And then, as David said, summarize at the end, because the summary at the end you might find out, you know, it's just a chance for you to go over things again.
When I, when I say something really important, summarizes the patient first. And that way they have the opportunity to answer to say you what you've missed. I'll write to the consultant, to the examiners. Then you've missed that boat. So very big take home. If you can summarize to take back, they can today is when you've done your history, a quick summary to the patient.
There's another way as well demonstrating how a quick and easy way of actually getting the patient on your side as well. You talk to them as a person, you're not. You're ignoring the exam and they love the patient will love you for that. Tort cases, says, guys, please, if you can, if you want to write it down, ask three questions. Where is the pain?
How is your condition affecting you? And what treatment have you had so far? And I think these three questions will get you out of majority of trouble in the short cases. Short cases are very difficult. And again, those as well just to add to that as well. When you're in that situation where you have a very vague thing like exam this person's leg, use your eyes, look around, there will always be a clue.
You'll find there's a walking aid. You'll find that actually they've got characters or they've got a big shoe, a shoe raised. There's always going to be something that obvious that they will, that they want you to use your AIIS. I want to look. So there will be a clue there. When it's something vague, there's usually a clue. Ask the patient the question, or there's a clue around near the patient which point in the right direction.
So if you, they will give you big thumbs up. If you say, oh, look at the shoe, there's a big heel, right? Hey, you're the first person who's done that big tick. So just use your AIIS and look around and be aware of your surroundings. Yeah when you practicing with your colleagues for history, please allow only four minutes, not five minutes. That will be the end of this webinar.
So thank you very much, David, for giving us this wisdom and teaching us about a farke's focused history taking. And Thanks to Amjad also for stepping in and helping us. We will end the session just before we go. I just want to say you've got time, so I know you all focus on practicing survivors, but please, please, please spend the time as well thinking about what are going to do in the history situation and start thinking about your clinical exam.
Go you do. We do clinics on a regular basis. When you're in clinic next, you got an interesting case. Say to your consultant, I'm going to examine this patient and you look at me, examine the patient and give me a critique. And then I'll have a summarize to you. Can you give me a critique as well? They want the most of the consultants will be happy to do that, but it's important that you practice do not be in that situation where the first time you're being examined or be tested is the exam situation.
So if you haven't done a clinical course, you can do one in your own clinic with your consultant. So please, please, please practice, practice, practice. You've got time you can get. You can look slick against the exam, so keep it. So and yeah, if one thing you get away from today is, you know, you have to do practice, please, they'll be giving you so much more points in the exam. OK all right.
And David runs this fantastic clinical course. Not many around, and there is one next week. If anyone is free or next Thursday Friday, you will free to you are welcome to register. There are still some places, so thank you very much. And if anyone who has attended today is interested in a CPD certificate, please get in touch with me and I will show you one.
Well, thank you very much. We will end the session now and there will be a Viva session.
Segment:0 .
Thank you for joining this Wednesday teaching from the FRCS mentor group. Um, this evening, our representative is one of our senior mentors, David. Hughes. He's a surgeon from Warwick, and he's also the convener of the Warwick FRCS course, which is an excellent clinical course, maybe he could tell us about this course later on if he likes what we have.
Also with us, Amjad Amjad is one of the new mentors here, and we are very grateful to have him as an active mentor in the group myself. Firas, I'm going to help modulate the session. I please pay attention. The session title is very important and commonly overlooked, which is a key scoring points for history taking. It's something we take for granted.
However, it's very important, and David's going to tell us all about it. The key scoring points for taking history for their fastest exam. And please ask questions on the chart option or raise your hand symbol next to your name if you like to talk or ask any questions. And there will be a short, brief Viva session once we finish. Only two or three candidates will be picked, so please, if you're interested in taking part, express your interest as early as possible.
So I will leave you with David from now on. OK good evening, everyone. Thank you very much. I know it's Wednesday evening, but this is important. So one thing that often gets overlooked when we're studying for the fellowship exams is history taken because we do it all the time. Unfortunately, sometimes when you're doing something all the time, we do drop into bad habits and it's quite easy to miss something.
So when I run the Warwick air, yes, of course, with Mr. Hashmi, and we've got one course coming up next week. This is from a previous course where we did talk about it and we discussed there's a lot of the candidates found it very useful. So I'm letting you guys know about it, particularly as the exams coming up in just over 6 under six weeks now, so you can start thinking about your history taking. So it does actually count quite a few marks and they're easy scoring marks.
So if you can do well in that intermediate case will set you up for the clinical quite well, and you need to pass the clinical to pass overall. There are very few people who pass just on Survivor. Most of the people ask because they've passed the clinical well and that you can make up so many marks there. OK, so this is so we're just going to start off with a little bit of the clinical exam.
So obviously, we know it's, you know, it's one hour long. So the key thing is to intermediate cases, which lasts about 30 minutes to two cases, 15 minutes each have sections actionscript history, exam discussion. You need to go through all three of those. You need to get a discussion. You you don't get to discussion. You only score for discussion and then it means any scoring for history in exam.
Generally, they very rarely bump your mark up. OK so it is key that you are very succinct in your history taking you yet the salient points across. You can score well and that could push you onto the go, getting a good clinical exam and getting lots of discussion because that's where the meat of the points are going to happen. But still, in terms of the history, you're going to examiners in each history, but that's for scoring.
So for scoring opportunities? OK so if you could get a good eight, you're starting. Well, aren't we? All right? And we all know about the short cases, upper them and lower them. So for six cases, five minutes each, but I'm going to focus mainly on History. Now than the intermediate.
So when you look at the examiner's manual and they give us this as well, it's quite a lot to take in. Isn't it really bedside manner, the quality of response? Lots of different points. And so we kind of glaze over it. I have to say I did as well initially and thinking, what's all this off? But in my process of looking around for tips about the history taking for the exam, I discovered a few key things from previous exams.
So these are the key headlines you they want to see when you're doing a history. Obviously, quality of history obtained. So if you're a person of a hit problem, they want to make sure you're finding things about the hip problem, not about their cat from 1922. So it's about it's very important to stay focused on what you've been asked to. And that's usually not a little summary at the beginning where they say, please ask this question, this person about their knee, their hip, the shoulder.
They also want to see how you get on with the patient ability to communicate with patient. So you've got to be friendly, you've got to be polite and courteous. I've done a bit of teaching for people doing the masks, and it's all about introducing your name, saying what you're doing. Smiling, washing your hands.
These things do count and it helps with the patient. It makes you look professional. Um, presentation of the principal clinical findings. OK differential diagnosis, investigation pathways. These are things that they want you to talk about in the history. And when you come to discussion, they're talking about the suggested interventions in management, including the role of surgery and relevant basic sciences.
Now what we sometimes forget when we're taking history and this is very important from our point of view, is. Social implications of the condition. So, yes, it causes them pain, it stops them being able to do their job, it stops them being able to do the normal level of activities. These are things that they want you to ask and state. The an important considerations for in consent. So will this person be able to follow the rehab?
Do they understand the implications of having the operation? Do they appreciate that? Yes, a knee replacement would be great, but it might take them six months before they're feeling better. They also want to know morbidity and complications, so key things from a surgical point of view, are they an aspirin? Are they on warfarin?
Are they insulin? So these are sort of little things you need to make sure that are aware of. Also, health promotion considerations, if you can get that ball, I.e., conservative measures, have they lost weight? Are they doing physio things like that? And again, this is a difficult thing being able to gain confidence of a patient in such a short space of time.
Again, if you have a nice ease and you have and you have a good pathway of how you're going to ask questions, it does help and get the patient on your side. Most of the time, these patients want to help, they do so. As long as you're polite and courteous to them, they will. They will. They'll be nice to us and they will be helpful and they'll be positive.
Sometimes they'll be too courteous. I had one poor person. I stupidly asked him questions about his model train set, and I could see the back of my AIIS. The exam was AIIS rolling, saying, Oh no, not another one. He's ask that question. But it is important you can be polite and say that's very good, that's very interesting. Can I just get back on to asking about your battle or your hip or your knee?
So it is do try and getting their confidence, but bring them back to the subject matter. OK so just the key things when I'm taking the history, I need to make sure. So when you're doing this, so you have these things in your background, so introduce yourself. Presentation what? Why they why are they here today?
No, not because of the exam. What first brought them to see a doctor about this problem? Ask medical history. So previous surgery rather than the issue. So have they got heart problems, lung problems, drug history? So I say the key things anticoagulants, steroids if it's rheumatoid disease modifying drugs and diabetes. Social history, so hand dominance, if you are doing an upper limb case is very important.
Occupation, if they're still working and it is even if they're retired, there's a lot of our patients will be to ask what they used to do because that may have some effect on them smoking as well, particularly if you've got a foot exam because there's so many foot surgeons. As soon as you say a smoker, they go, right, OK, I don't need to do anything very important this patient expectations.
They want the surgery, but what they want from out of the consultation review. Now, a little trick that you can do after you've taken the history is to summarize your findings to the patient. That way you look good. The examiner and then you can ask the question it's anything I've missed. You never know.
At that point, the patient might tell you something very important and pertinent. Then present your findings to the examiner rather than the other way around, because once you presented the exam, you can't go back because the exam looks like. What about this? What about that? If you summarize the patient first, then they will help you fill in any gaps that you've missed.
This is a very useful tip, and I know lots of examiners have mentioned past examples have mentioned this before to me and saying this is a good way of being able to make sure that you don't miss anything. And actually, when you say that, that's when it gives the patient the opportunity to help you as well. So we will as difficult to do an examination online in this little forum, but I will go over a few things, so I'm not going to go over a clinical exam in detail, but I want but if you've got the exam coming up, you've got a month now.
So at this stage, I'm hoping that you're honing your skills you're getting. And if you're in clinic, have your consultants say, I need to exam the shoulder one exam this step. I want you to look at me examining this patient and tell me where I'm going wrong or where I'm going. I conclude, this is very important. You've got to look slick when you're doing this. It's very clear.
If you can get the examination in under three minutes, get all the important things across because that will give you lots of time to get to the discussion. And that discussion is a mini viable station, basically. And you can if you score well in that, you'll give you good points overall. OK I think we've all seen this book by Nick Harris, Nick Harris and Faisal Ali.
It is a fantastic book. If you haven't got it, get it. I to talk in broad principles with regards to the clinical exam. It's about having a system so that you it's quite easy to get slap and concerned and nervous and anxious. But if you have a system, it makes life easier for you, allows you to go back to basics and pay off.
In that situation, the examiners will say you in the right direction because they want to help lot all the time. But if you're being bombastic, dogmatic and you're going yourself down the cul-de-sac, they might just watch you. But you have a nice system that will help. So it's a good case of look, not just at the patient. Look at their shoes.
Look for when you're walking out, so you've got to use everything around you. And feel for the patient, avoid pain, so the key thing is, any time you examine them, make sure you can see the patient's face so they're not causing the pain. If it is a shoulder exam. So you want to do it from the back of a mirror, that's how we do it normally.
So I can see their face and make sure I'm not causing pain already gets you in the patient's good books and examines good looks because you're showing due consideration for the patient. And once you've got the patient on your side, exam is a lot easier. A move with only lower limb dope and spine. Don't forget to walk. I see a special test.
I mean, if you've got Pfizer. Look, it is fantastic to have all those special tests and what I can tell you, I've been on the train going to the exams. I've seen exam is coming in and they've got the book in front of them on the train, reading, reading it, trying to make sure they can get it through. They can remember how to examine the shoulder or a knee to give their A hand surgeon or a foot surgeon.
They've never done it for 10 years or so. Think so it's not like I'm repeating myself, but I cannot stress this enough discussion is very key. You have to get to that discussion. It is very easy to feel to get caught in the history taking or rush through the exam before you realize they've only got 1 minute left to the discussion. Try and get your history done in under three minutes, if you can.
Four minutes is fine. I know they say leave up to five minutes, but you want to give yourself time and again an examination. You can do most systems under three, four minutes. That gives you five six minutes for the discussion. OK, and you for lots of points there. And again, I can't stress this enough. These they're quite harsh in terms of it all for the discussion because you haven't done a discussion.
It's for the history. It's for, for the clinical. OK, so you need to get a discussion that way you can get the scores that you've earned from the good history and the good clinical exam. OK talking about it is for history taking, obviously for the intermediate cases or intermediate cases. Sorry, Yes. So you will you may be asked in this short cases to say, what questions you might want to ask.
A classic one would be so if you are shown a short and obvious thing like someone who's got stupid friends in the short case, they might say what one question is, do you want to ask this patient? And if you see both hands, the thing to ask then is say, do you have any involvement of your feet? Does that look that already tells the exam that there's other disease, other disease processes involved?
So things like that, so it's where, but it will be something that's the word B barn door or such. And again, they're not going to hand a rheumatoid arthritis in a short case. They may also again ask is any questions you like to ask? The key thing then, is to ask about function. What can you do if your hand? What do you want to be able to do with your hands? That's very important there.
Again, key as well. If you have a rheumatoid patient in an intermediate case, it's a fantastic history in a way because actually there's so much you can just focus on a little bit of the history of the rheumatoid tab. And the key thing they want to know in that, for example, is disease modifying drugs and what they're doing with the hands and function. Very important as well.
What the patient wants, what the patient expectation are. So you might see patients with so much pathology you don't know what to do. The patient's going, I'm fine. I'm actually not in pain. I'm just here because I've got good signs. And actually, that's the exams are happy with that. They're fine with that because they know in the exam there's so much to talk about a rheumatoid hand, and it's quite easy.
As a candidate, you see a room for that like, oh, what do I do? What do I talk about? But as I say, if you can do a focus thing about function, because what can you as an orthopedic surgeon do improve, help reduce pain and help with function? That's what we're doing with most of our interventions. So if the patients fail their function, I would paint. We're not really going to help them all we.
Absolutely, I think this is very important. David, as you said, if you are short, if any of the candidates are short on time for any reason during the intermediate case, for example, you know, if you've been faced with a complex case or when you don't have time in the short cases if you're stuck. Just ask the patients about the pain and the function and what do they want and/or how the condition is affecting them, and that will guide you through what you do because again, with the intermediate case.
You will have obviously two intermediate cases for the exam, as you guys know, and you will receive a referral letter. The exam will give you a referral letter from a GP with two lines very, very brief. Not like a normal GP letter, something like 55 years old lady complaining of shoulder pain. Please advise.
Yeah, like that it was. It won't really have any useful much just focusing on which part of the body to look at. And then, as I say, just take a focused history, be Precice with the pain. And for example, where is the pain and things like this? Be Precice with that. And I know patients can distract you a little bit. They can tell you, well, my leg hurts.
You know, you need to get to the bottom of it. Where? ask about the pain, ask about the function, social background, medical background. With the patient expectations, you've got to cover all these and very, very important not to skip through any of these. And then, as David said, summarize at the end, because the summary at the end you might find out, you know, it's just a chance for you to go over things again.
When I, when I say something really important, summarizes the patient first. And that way they have the opportunity to answer to say you what you've missed. I'll write to the consultant, to the examiners. Then you've missed that boat. So very big take home. If you can summarize to take back, they can today is when you've done your history, a quick summary to the patient.
There's another way as well demonstrating how a quick and easy way of actually getting the patient on your side as well. You talk to them as a person, you're not. You're ignoring the exam and they love the patient will love you for that. Tort cases, says, guys, please, if you can, if you want to write it down, ask three questions. Where is the pain?
How is your condition affecting you? And what treatment have you had so far? And I think these three questions will get you out of majority of trouble in the short cases. Short cases are very difficult. And again, those as well just to add to that as well. When you're in that situation where you have a very vague thing like exam this person's leg, use your eyes, look around, there will always be a clue.
You'll find there's a walking aid. You'll find that actually they've got characters or they've got a big shoe, a shoe raised. There's always going to be something that obvious that they will, that they want you to use your AIIS. I want to look. So there will be a clue there. When it's something vague, there's usually a clue. Ask the patient the question, or there's a clue around near the patient which point in the right direction.
So if you, they will give you big thumbs up. If you say, oh, look at the shoe, there's a big heel, right? Hey, you're the first person who's done that big tick. So just use your AIIS and look around and be aware of your surroundings. Yeah when you practicing with your colleagues for history, please allow only four minutes, not five minutes. That will be the end of this webinar.
So thank you very much, David, for giving us this wisdom and teaching us about a farke's focused history taking. And Thanks to Amjad also for stepping in and helping us. We will end the session just before we go. I just want to say you've got time, so I know you all focus on practicing survivors, but please, please, please spend the time as well thinking about what are going to do in the history situation and start thinking about your clinical exam.
Go you do. We do clinics on a regular basis. When you're in clinic next, you got an interesting case. Say to your consultant, I'm going to examine this patient and you look at me, examine the patient and give me a critique. And then I'll have a summarize to you. Can you give me a critique as well? They want the most of the consultants will be happy to do that, but it's important that you practice do not be in that situation where the first time you're being examined or be tested is the exam situation.
So if you haven't done a clinical course, you can do one in your own clinic with your consultant. So please, please, please practice, practice, practice. You've got time you can get. You can look slick against the exam, so keep it. So and yeah, if one thing you get away from today is, you know, you have to do practice, please, they'll be giving you so much more points in the exam. OK all right.
And David runs this fantastic clinical course. Not many around, and there is one next week. If anyone is free or next Thursday Friday, you will free to you are welcome to register. There are still some places, so thank you very much. And if anyone who has attended today is interested in a CPD certificate, please get in touch with me and I will show you one.
Well, thank you very much. We will end the session now and there will be a Viva session.
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