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Format of the Comprehensive Objective Examination in Dermatology

Comprehensive objective examinations make it possible to obtain a more complete evaluation of the candidate’s strengths and weaknesses. The important feature of comprehensive objective examinations is that candidates do not need to pass the written component in order to take the oral component. Success or failure is based on consideration of all components of the examination. Comprehensive objective examinations are considered as a “whole” and cannot be fragmented. If candidates are unsuccessful at this examination, they must repeat all components of the examination within their period of candidate eligibility.

  1. Written Component

    1. Objective of Written Component

      The objective of the written component is to examine candidates on factual knowledge relevant for physician competency in the specialty of dermatology. This includes an appreciation of the recent literature pertaining to the practice of dermatology, and an understanding of rare diseases occasionally encountered in practice, as well as of basic science informing the practice of dermatology. The written component will evaluate knowledge pertaining to therapeutics in dermatology, including the appropriate selection and use of medications and dermatologic surgical procedures. The content of the examination is based upon a blueprint that reflects the Objectives of Training in Dermatology to ensure that the examination is well balanced.

    2. Format of Written Component

      The written component consists of two, three-hour papers, comprising approximately 200 short answer questions (SAQs) with approximately 500 answers. Each paper contains 80 to 100 SAQs.

      Both papers will include, but not be limited to, questions in the following six major subject areas:
      1. Basic sciences, including critical appraisal of the literature
      2. Clinical dermatology
      3. Cutaneous manifestations of systemic disease
      4. Dermatologic therapy, dermatologic surgery, cosmetic dermatology
      5. Dermatopathology and immunopathology
      6. CanMEDS Roles other than Medical Expert


      Marks are awarded only for correct answers; no marks are deducted for incorrect answers. If a specific number of answers is requested (e.g. list FOUR), do not list more than the number requested as they will not be marked (e.g. if four answers are requested, only the first four will be marked). Write or print as legibly as possible. Be as brief and direct as possible, making use of the space provided after each question.

  2. OSCE (or oral) Component

    1. Objective of OSCE (or oral) Component

      The objective of the oral component is to examine candidates on their ability to integrate knowledge for the competent clinical care of patients with dermatologic conditions. Integration of knowledge includes factual organization and clinical reasoning. The examination is designed to assess all the CanMEDS competencies required to function as a general dermatologic consultant in ambulatory and hospital settings. The content of the examination is based on a blueprint that reflects the Objectives of Training in Dermatology to ensure that the examination is well balanced.

    2. Format of OSCE (or oral) Component

      The OSCE component consists of a series of different stations.

      There will be between 10 and 12 stations of approximately 10 to 15 minutes each.

      The different stations may cover clinical dermatology, dermatopathology, basic sciences, diagnostic tests, medications, surgery and/or CanMEDS Roles as outlined in the Objectives of Training in Dermatology.

      The following are some of the possible structures of stations:
      • There may be a written clinical vignette (with or without images) followed by questions from the examiner including, but not limited to, discussions on diagnostic interventions, therapy and/or natural course of disease.
      • There may be unmanned stations composed of a series of images with an answer sheet provided for candidates to indicate their responses. These images could include dermatopathologic images (regular H&E stains, immunofluorescence, immunohistochemistry, etc.) or clinical images.
      • There may be some role-playing scenarios with the examiner, for example, to demonstrate how one would counsel a patient regarding the side effects of medications.
      • Stations may include laboratory investigations, pathology reports or other relevant information to be interpreted by the candidate and applied to support or eliminate items in the differential diagnosis.
      • Standardized patients may be present as part of the OSCE examination.

    3. Examination Process and Timing

      The examination process is intended to evaluate the candidate’s ability to analyze accumulated information and integrate this information in near real-life patient management.

      A Royal College observer may be present during the examination. The observer will not interact with the candidate or the examiners, will not contribute in any way to the candidate’s evaluation, and is there only to observe the conduct of the examination.

      Examiners are responsible for monitoring the candidate’s time and ensuring that all the material and questions are covered. Examiners may interrupt the candidate during the scenario to seek information or to move the scenario forward. Examiners may probe the candidate to explore the candidate’s full understanding of answers provided. Examiners may take notes during the examination to document performance. They may appear neutral in their reactions to answers and have been instructed not to give any feedback to candidates on their performance.

      Examiners will not be aware of the candidate’s performance on any other part of the examination.

    4. Evaluation

      A Global Rating Scale will be used to score the candidate’s performance. It assesses the candidate’s ability to systematically work through a case, demonstrate a focused, rational and efficient approach to the problems encountered. The evaluation will focus on the clinical approach and clinical reasoning relevant to the case. Reponses to probing may result in slight variations in content covered from candidate to candidate, for a given station. These variations are incorporated into the Global Rating Scale evaluation.

    5. Equipment

      The candidate should not bring any medical device (such as a dermoscope) to the oral examination.

      No special equipment is required. Electronic devices, including cellular telephones, are not allowed.

  3. Clarification of Terms Used in the Examination

    Within any of the examination components, when a clinical scenario is presented, the questions posed relate solely to that clinical scenario. With respect to specific terms, the following clarifies their meaning:

    MOST likely: refers to the response most likely for that specific clinical scenario

    initial: refers to the first step you would take in that specific clinical scenario

    next: refers to the next step you would take in that specific clinical scenario

    assessment: refers to the clinical assessment for that specific scenario, and would include history, physical examination, bedside point-of-care testing (but would not include results of laboratory investigations)

    investigations: refers to all investigations for that specific clinical scenario, and may include laboratory tests, diagnostic imaging, ECG, etc.

    treatment: refers to all therapies for that specific clinical scenario, and may include pharmacologic treatments, non-pharmacologic treatments, nutritional therapies, education, counselling, and follow-up.

    management: refers to the steps you would take in the clinical assessment, and may include investigation and/or treatment for that specific clinical scenario.


  4. Sample Questions and Reference Material / Resources

    Questions are largely derived from standard textbooks.

    Standard Textbooks (including, but not limited to):

    General Dermatology

    Fitzpatrick's Dermatology in General Medicine, by Goldsmith, Katz, Gilchrist, et al.

    Dermatology, by Bolognia, Jorizzo and Schaffer

    Surgical Dermatology

    Surgery of the Skin: Procedural Dermatology, by Robinson

    Primer in Dermatologic Surgery: A Study Companion, by Mariwalla and Leffell

    Pathology

    Weedon's Skin Pathology, by David Weedon

    McKee's Pathology of the Skin, by Calonje, Brenn, Lazar and McKee

    Contact Dermatitis Fisher's Contact Dermatitis, by Rietschel and Fowler
    Pediatric Dermatology

    Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence, by Paller and Mancini

    Genodermatoses: A Clinical Guide to Genetic Skin Disorders, by JL Spitz

    Therapeutics

    Comprehensive Dermatologic Drug Therapy, by Wolverton

    Treatment of Skin Disease, by Lebwohl, Heymann, Berth-Jones and Coulson

    Source articles are chosen based on quality and their relevance to clinical practice. Some questions may be derived from relevant articles in general dermatology journals, such as continuing medical education (CME) articles, such as those commonly found in the Journal of the American Academy of Dermatology (JAAD), the Journal of the American Medical Association-Dermatology (JAMA-Dermatology) and the British Journal of Dermatology (BJD), and from articles relevant to dermatology in top-tier general medicine journals such as the New England Journal of Medicine (NEJM).




    Oral Examination Question Example:

    Case Scenario:
    A 32–year-old woman is referred to you for assessment of a skin eruption that began 2 weeks after she started epidermal growth factor receptor (EGFR)-inhibitor therapy with cetuximab (Erbitux®) for a head and neck carcinoma. [THERE IS ONE PHOTO. Show the photo.]

    <Photo would appear here>

    Question 1:
    What is your differential diagnosis? Indicate your preferred diagnosis.

    Question 2:
    What is the typical distribution of an acneiform eruption that is induced by EGFR-inhibitor therapy?

    Question 3:
    What other possible cutaneous adverse effects would you look for or expect to see in this patient?

    Question 4:
    What treatment strategies or advice can you offer this patient?


 

[SAMPLE SAQ EXAM ]

Revised September 2017