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GUIDELINES FOR CANDIDATES AND EXAMINERS

OCCUPATIONAL MEDICINE SPECIALTY EXAMINATION

FELLOW OF THE COLLEGE OF PUBLIC HEALTH MEDICINE (DIVISION OF OCCUPATIONAL MEDICINE)

FCPHM(SA) Occ Med Introduction This document should always be read in consultation with the latest updated Regulations for Admission to the examination for the FCPHM(SA) Occ Med (June 2004). These are available from the Colleges office in Johannesburg and are also reproduced on the College’s web site. The reasons for writing and circulating this document are as follows: 1) To provide the latest interpretation of our assessment system. 2) To enhance the validity of our assessment methods. 3) To improve the reliability of our assessment methods. 4) To promote transparency concerning the assessment process. The Grading System currently in use The system presented below is a default system. It is used especially for the research reports and the oral examinations. However, examiners may also use it for the short answers paper and the essay paper in preference to the rubrics that are shown later on. The candidate passes or fails on the basis of the overall average mark achieved. A pass standard is the standard that is expected of a specialist and we call this standard 50%. A distinction is 75% or above. The candidate scoring the highest aggregate will be considered for the award of the SASOM medal only if he/she achieves an aggregate mark of 70% or above and 65% or above in each exam component Examiners will award a qualitative assessment for the answer or section (e.g. “excellent, clear distinction”, or “does not meet the expected standard” and will then allocate a percentage mark in multiples of 5 (at the request of the ECC of the Colleges). The possible marks awarded are (marks typed in bold will be allocated more readily, if appropriate, whereas those in italics will be allocated only rarely): Excellent, outstanding, clear distinction: 75; 80; 85; 90; 95; 100 Very good 65; 70 Adequate, comfortable pass 60 Barely adequate 50; 55 Sub-standard 40; 45 Abysmal 0; 5; 10; 15; 20; 25; 30; 35 For the MCQ paper, and for the MMed dissertation mark awarded by Universities, however, the percentage marks earned will be incorporated into the calculation of the final mark as is and without modification. In addition, the marking of the two written papers is somewhat different, making use of rubrics.

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WEIGHTING OF DIFFERENT PARTS OF THE EXAMINATION The following section will replace weighting allocated in the section 16.5 of the FCPHM (Occ Med) regulations dated June 2004. The different parts of the examination are weighted in the final average mark as follows:

• MMed dissertation (or long report/defence) 20/100* • Short report (e.g. case study) 12/100 • Multiple choice paper 12/100 • Short answers paper 12/100 • Essay paper 12/100 • Oral exam (questions and presentation) 12/100 • Occupational medicine skills examination 20/100 * or the mark weighted accordingly for the long report and its oral defence where this option is permitted Note that the candidate must obtain an average passing mark (50% or greater) for the “unseen” sections namely the three written papers and the occupational medicine skills examination marked together and weighted for this purpose as follows: Multiple choice paper 12/56 Short answers paper 12/56 Essay paper 12/56 Occupational medicine skills exam 20/56 THE STRUCTURE OF THE EXAMINATION I: THE FORMATIVE ASSESSMENT Candidates are required to produce at least SIX formative assessment reports, one for every 6 months of completed training, satisfactorily completed, for the examinations. The assessments should cover the whole period of training. These formative assessments should be in the required format, or one that is very similar (Appendix number 1). The examinations office staff will send the formative assessments to the convenor as soon as entries close. The convener must, after consultation with a second examiner, either “accept” or “reject” them, and thereafter inform Mrs Ann Vorster in Johannesburg of the decision within 3 weeks of the extended closing date for entry for the examination. If the formative assessment is unacceptable then the candidate will be denied entry to the examination, which is why there is a need to communicate the outcome as soon as possible. It would be highly unusual to reject the formative assessments outright unless it is clear that the candidate has had little relevant formal training. In such cases the decision to reject must be ratified by the president of the College after due consultation. The formative assessments are also taken to the examiners’ meeting after the examination where they may be used to offer advice to candidates who fail and who require some guidance from the examiners as to how they might best structure their learning experiences before attempting to write again.

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II: THE SHORT REPORT The short report (maximum 4000 words) must be in acceptable format. Instructions to candidates are presented as Appendix 2. In practice a report would be acceptable if it addresses an important issue and makes a compelling and well-supported case. The short report could take the form of an occupational medicine clinical case study, clinical case record review, a programme implementation or evaluation report. It should be between 20-40 pages long (1 ½ spacing, size 12 font and excluding title page, summary, acknowledgements and bibliography). The short report should indicate the name of the supervisor and the specific role of the student in relation to the contents of the report. The examinations office will send copies of the short report to each of the four “core” examiners soon after the closing date for entry. Should there be more than 3 candidates, the additional examiners will be requested to mark the short reports. III: THE MMED DISSERTATION (LONG REPORT) All candidates are required to submit the MMed thesis to their academic institution for marking prior to sitting for the examination. This should be a long report (maximum 7000 words, excluding tables, figures, references and appendices) containing the results of an analytical, quantitative, epidemiological study carried out by the candidate (see Appendix 2 for a more detailed guideline). For the exceptional candidates who are required to submit a College long report rather than an MMed dissertation mark the long report must be quantitative as above. In such cases the examinations office will send copies of the long report to each of the four “core” examiners soon after the closing date for entry. These examiners are asked to grade the long reports and complete a score sheet for each and return these score sheets to the convenor (Appendix 3). Where a candidate submits an MMed mark for a dissertation in lieu of satisfying this requirement, this latter procedure does not apply. Instructions to candidates are presented as Appendix 2. In such cases, the mark must be submitted by the candidate with the application to enter the examination. IV: THE WRITTEN PAPERS Three, written, closed book examination papers, each potentially covering the entire syllabus which will be a combination of basic public health sciences and occupational health sciences (occupational medicine, occupational hygiene and occupational health service management), but collectively demonstrating an appropriate balance between the different sections. Overall pass mark for written examinations taken as a whole: 50% with a sub-minimum of 45% on any individual paper.

• “Multiple choice”/“annotate the diagram”/ “sketch a diagram” style of questions • Short answer questions • Essay questions

a) The MCQ paper This paper has 60 questions. Questions will be of the format illustrated in Appendix 4. This will include an appropriate proportion of clinically oriented questions. The duration of this

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paper will be three hours. b) Short answer paper This paper has 12 questions of which candidates are required to select and answer no more than 10. These are fairly specific questions each requiring an answer of about one page and taking about 15-20 minutes to answer. The marking is done according to an answer rubric along the lines presented in Appendix 5 or by using the “default” method. The duration of this paper will be three hours. c) Essay questions paper This paper has four questions and candidates must answer any three questions to demonstrate integrative skills. The duration of this paper will be three hours. There are a number of purposes behind this paper:

• to assess understanding of content

• to assess written skills, i.e. structure and readability;

• to assess ability to integrate content material across disciplines and/or sectors;

• to evaluate skills at presenting a logical exposition or if appropriate a convincing argument.

An answer sheet that is generic for all essays is presented in Appendix 6. Alternatively, the “default” system of grading, described earlier on, may be used. It is suggested that, for each answer, you spend 15 minutes planning your answer (rough work should be clearly marked as such) and 45 minutes writing your answer.

V: THE ORAL EXAMINATIONS An oral examination in two parts. In the first part (30 minutes), the candidate will be asked to answer questions on any occupational medicine topic by a panel of 4 examiners. This will test breadth of knowledge. Each examiner will be required to provide the question and a broad outline of the answer to the convenor one week prior to the oral exam. In the second part (40 minutes) the candidate will asked to make a 20 minute powerpoint presentation of their approach to or solution of a complex occupational health practice scenario, followed by 20 minutes of questions, This will serve as an integrative assessment. The topic will be sent to the candidate together with the invitation to attend the oral, i.e. after the written examinations have been marked. This will give the candidate approximately one month to prepare. The candidate must bring their presentation on a virus-free flash drive to the examination. The candidate will be assessed according to the schedule outlined in Appendix 8. The two parts may be conducted in any order.

VI: THE CLINICAL SKILLS EXAMINATION The clinical examination is a central component of the oral examinations. Candidates will be required to take an appropriate history and conduct a physical examination of a short case. Candidates will be given approximately 45 minutes to do this. The candidate will be

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given 15 minutes to present the case. The candidate will be questioned by two examiners for 15 minutes. They will be assessed according to the schedule outlined in Appendix 7. The second component of this exam will be an OSCE (Objective structured clinical examination) of 10 stations requiring interpretation of case studies, special investigations (e.g. spirogram, audiogram, chest radiographs, allergy tests etc.) and photographs or other visual material. These will be items that cannot be tested in the written or general oral examinations. The duration of the OSCE exam will be 60 minutes. The answers will be marked in a similar manner according to the rubric for short answers contained in Appendix 5.

WHAT HAPPENS IF A CANDIDATE FAILS THE EXAMINATION? Where a candidate fails to achieve an overall mark of 50% for the examination, or fails to achieve a mark of > 50% for the unseen components (as an aggregate mark for these) the examiners may recommend that the candidate be exempted from repeating one or more of the following sections in future attempts, provided that they have been passed at the current attempt and that the candidate wishes this; and that the candidate attempts the examination at the next available opportunity:

The short report/case study The 3 written papers taken as a whole The oral exam and clinical components taken as a whole (The long report - if marked through the College)

In such cases the marks for the exempted sections must be carried forward to the next attempt, and a distinction may not be awarded at that attempt. If the candidate is still unsuccessful (i.e. aggregate mark is still < 50%) then all components of the examination must be re-taken at the following attempt. FEEDBACK TO THE CANDIDATE The conduct and outcome of the examination are confidential in the sense that details may only be discussed with the candidate concerned. Candidates who require feedback should request this after the examiners’ meeting, which follows immediately after the oral examinations. This includes feedback on research reports marked by the College, in which case the comments supplied by the examiners are given to the candidates, but with the examiner’s name obscured.

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APPENDIX 1: THE FORMATIVE ASSESSMENT FORM

FORMATIVE ASSESSMENT OF CANDIDATES WHO WISH TO WRITE THE FCPHM(SA) OCC MED EXAMINATION OF THE COLLEGE OF PUBLIC HEALTH MEDICINE (SA)

(Division Occupational Medicine) This formative assessment should be carried out 6 monthly by the candidate and Head of Department (HOD) or occupational medicine academic training convenor. The formative assessment provides an opportunity for the candidate and HOD to regularly review the learning that has taken place, and that is planned for the next 6 months. The dates for completion of these forms are Jan 31 and July 31 each year.

CANDIDATE’S NAMES:

NAME OF INSTITUTION:

NAME OF HOD:

PERIOD COVERED: FROM: TO:

TABLE I: PLANNED LEARNING OBJECTIVES FOR THE PERIOD UNDER REVIEW Learning objectives that were planned for the period being reviewed should be listed in the table below. This section must be completed at the start of the assessment period, and in subsequent periods will simply be copied from the plan drawn up at the previous period of assessment. Example: ACTIVITY PLANNED MAJOR LEARNING OUTCOMES ENVISAGED

1. Two stats modules 20% of the outcomes listed under biostatistics in the College regulations Appendix A

2. Rotation at NIOH (3/12) Writing a study protocol

Reading and grading chest X-rays for silicosis

3. Attachment at hospital (2/12) Learning about the duties of the MS

Learning about the HIS and its strengths/weaknesses and how to improve it

Conducting meetings

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TABLE II: THE CANDIDATE’S SELF-ASSESSMENT OF THE LEARNING EXPERIENCE Example: 1. Two stats modules were attended, final mark was 83%. I feel I mastered all the topics covered but will need to

consolidate my learning about logistic regression modeling through practical experience by collecting and analyzing suitable data. I could achieve this by constructing a hypothetical data set for a hypothetical study and then asking Dr X to review the way in which I analyzed the data. I also need more experience using Stata, and such an exercise will be helpful with this as well. I will incorporate this suggestion into my next learning plan.

2. The occupational health rotation at the occupational health centre (3/12) was useful. I developed a protocol for a hepatitis B staff immunization survey that is now being implemented. In addition I completed Prof White’s ROLDS course by distance learning and now feel reasonably confident that I will be able to read and interpret chest X-rays of mine workers for silicosis.

3. The attachment at the hospital (2/12) was only partially successful. I was never permitted to actually convene and chair any meetings, so although I have observed the process I feel I need to actually do it to be more confident. I will ask the HOD if I might convene chair and minute some departmental meetings over the next 3 months and ask the staff of the department to feed back and critique my performance.

Regarding the HIS I wrote up a description of the system and made recommendations to the MS. We held a 1 day workshop with 40 participants at the end of the attachment in which participants identified those parts of the report that were worth taking forward. They also identified a work plan for the implementation of these proposals. I feel, however, that the workshop participants did not really accept some of the findings and recommendations that I thought were more important, while dwelling on “smaller” issues that I felt were less important. One of the problems was that my supervisor was not available to chair the workshop and so it was chaired by one of the MSs who is not involved with the HIS. Also, although my report was ready 2 weeks before the workshop I would have preferred to have discussed it with my supervisor before circulating it to the workshop attendees, but my supervisor was overseas at the time.

Table III should be completed by the HOD or occupational medicine academic training mentor/supervisor after having met with the candidate to discuss the contents of Table II. TABLE III: THE HOD OR ACADEMIC MENTOR/SUPERVISOR’S ASSESSMENT OF THE LEARNING EXPERIENCE Example: 1. I would support that the candidate designs and carries out this statistical analysis exercise and will ask the

biostatistician to give her help with assessment.

2. Good learning appears to have taken place. Since the candidate is especially interested in occupational lung disease, I will try to arrange for a further attachment next year during which he should work on a project that will be suitable for the dissertation.

3. The candidate can chair the monthly education committee meeting for the next 4 months. We will all meet between each meeting to give feedback and advice.

E-mail could have been used to keep in contact with the supervisor: he however did not have e-mail access while traveling. In future all staff who are traveling on business should arrange e-mail contact prior to departure if this is deemed necessary.

The candidate would probably benefit from attending the negotiation skills module that is offered at the Business School in three months’ time.

TABLE IV: THE CANDIDATE’S LEARNING PLAN FOR THE NEXT 6 MONTHS

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Example: MATTERS TO CARRY FORWARD:

1. To design a hypothetical project, generate a dummy data set and analyze it using Stata.

2. To prepare a protocol for a dissertation that involves reading and interpreting chest X-rays for silicosis screening.

3. To attend the Negotiating Skills module at the Business school.

NEW ACTIVITIES PROPOSED

ACTIVITY LEARNING OUTCOME

4. 6/12 rotation with the LA To learn about the way in which the LA carries out its environmental health duties

To learn about the legislative framework in which these duties are carried out

To learn how to control prevent and measure air pollution

To assist with infectious diseases outbreaks that might occur

5. Module on outbreak investigation 100% of relevant learning objectives mastered

6. Module on environmental health 40% of content of environmental health in the College regulations

TABLE V: ADDITIONAL COMMENTS a) FROM THE REGISTRAR:

a) FROM THE CLINICAL/SERVICE SUPERVISOR:

SIGNED: ____________________________ DATE _________________ (REGISTRAR) ____________________________ DATE _________________ (HOD)

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APPENDIX 2: GUIDELINE FOR RESEARCH REPORTS Short reports In practice a report would be acceptable if it addresses an important issue and makes a compelling and well-supported case. The short report could take the form of an occupational medicine clinical case study, clinical case record review, a programme implementation or evaluation report. A rapid epidemiological assessment method would be acceptable provided that the context is appropriate and limitations are fully discussed. The length of the report is expected to be approximately 20-40 pages, but must not exceed 60 pages excluding the title page, indices, bibliography and appendices. Suggested suitable short reports would include:

• A detailed clinical case report and commentary of a patient with an interesting/unusual clinical presentation (this should follow a standard clinical case report as is reported in the literature)

• A record review of all noise-induced hearing compensation claims in a factory

• An occupational health service review/audit

• An economic analysis of a medical surveillance programme with policy recommendations

• A detailed risk assessment of a workplace (with recommendations for interventions)

• A KAP study of HIV/AIDS in the workplace Long reports For “long” reports that are submitted to the College for assessment, a formal epidemiological study which explores an occupational health question is required in all cases. The standard of work must be sufficient to convince the examiner that a publication based on the work could be accepted (after editing) by an indexed peer-reviewed journal. The length of the report is expected to be approximately 50-100 pages, but must not exceed 120 pages excluding the title page, indices, bibliography and appendices. Depending on the nature of the research, it may be possible to present shorter reports than indicated and to do well. Suggested suitable long reports would include an analysis of routine or descriptive data, a cross-sectional, cohort or case-control study, a controlled intervention study or a systematic review. The structure should include:

• Background

• Objectives questions, or hypotheses of the investigation

• A critical literature review

• The population to which the results apply and, sampling methods

• Methods of gathering and managing data and quality control steps (to maximize reliability and validity of measurements)

• Statistical methods used

• Ethical issues

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• Results

• Discussion including main findings, limitations, concordance with the literature, conclusions and recommendations.

NB!!! In all cases the research report must include a copy of the ethics committee approval form for the study. Failure to include this form or an exemption certificate if appropriate, will lead to a compulsory failing mark for the report.

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APPENDIX 3: MARKING SCORE SHEET FOR RESEARCH REPORTS

THE COLLEGE OF PUBLIC HEALTH MEDICINE (Division Occupational Medicine)

The marks allocated per section are a rough guideline only and need not be followed exactly

NAME OF CANDIDATE:

TOTAL MARK OUT OF 100 =

TITLE OF REPORT:

OVERALL PRESENTATION:

(10)

INTRODUCTION AND LITERATURE REVIEW AND OBJECTIVES:

(20)

METHODS:

(25)

RESULTS

(25)

DISCUSSION,

CONCLUSIONS AND, RECOMMENDATIONS:

(20)

FURTHER COMMENTS:

MARKER’S NAME*: *The marker’s name will not be divulged to any third party

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APPENDIX 4: THE FORMAT FOR MCQ QUESTIONS THERE WILL BE NO NEGATIVE MARKING

Q1 With regard to the demographic composition of the South African population, which ONE of the following statements is the most correcta. 90% of the total population is over the age of 15

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b. All adult women outnumber all adult men by a ratio of 3:2 c. Foreign born adults make up 40% of the formal workforce d. 15% of the total population live in rural areas e. Of the nine provinces, Gauteng has the highest population density

The answer to Q 1 is e.

Q2 In a cohort study, 16 out of 20 workers who are exposed to a respiratory sensitiser develop asthma symptoms whereas only 4 out of 16 who are not exposed develop asthma symptoms. Which ONE of the following statements is incorrecta. At least one expected value is less than 5 in the 2x2 contingency table

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b. The positive predictive value is 0.80 c. The negative predictive value is 0.75 d. The odds ratio is 12.00 e. The relative risk is 3.20

The answer to Q 2 is a. Q a. b. c. d. e.

The answer to Q is

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APPENDIX 5: A RUBRIC FOR ANSWERS TO SHORT QUESTIONS Short questions are each marked out of 10 in units of 0.5 and the combined mark for the ten questions is the mark for the paper as a whole. This is just a suggested rubric for marking the short question answers. Examiners are welcome to improve/adapt it as they see fit. The answer is clear and correct in every detail: order, factual detail, correctness, logical argument. This candidate has completely mastered the concepts

10

The answer is clear and correct in most aspects. This candidate has mastered the concepts reasonably well

8

There is some lack of order, factual detail, correctness, or of logical argument in the answer

6-7

The answer has not covered what could be expected but has shown some relevant knowledge or insight

5

The candidate has missed the point entirely but has shown knowledge of some relevant detail

3-4

The candidate has not any idea of what was required, or left the question blank

0

APPENDIX 6: A MARK SCHEDULE FOR ESSAY ANSWERS Essays are each marked out of 100 each and the average of the 3 marks is awarded to the paper as a whole. Please use multiples of 5 for each of the component marks awarded. Mark out of Mark awarded

Is the essay well structured and logical with an orderly set of headings and sub-headings appropriate to the question, and easy to read?

20

Is the content factually complete, i.e. accurate and covers enough of the main items that one would expect?

50

Has the candidate shown the ability to integrate the material across at least two domains of occupational health, and more if appropriate to the question?

30

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APPENDIX 7.

MARKING GUIDE FOR EXAMINERS FOR CLINICAL CASES

MARK DESCRIPTION

Less than

40%

Please specify

mark within

this range

The candidate:

• Fails to elicit most

OR

of the important aspects of the history and/or physical examination, as would be expected of a competent specialist physician

• Reaches his/her conclusions by fraudulent or dishonest means, in the examiners’ opinion

OR

• Displays serious disrespect towards the patient

40 – 45%

Please specify

mark within

this range

The candidate:

• Fails to elicit some

OR

important aspects of the history and/or physical examination, as would be expected of a competent specialist physician

• “Manufactures” or finds features on history or physical examination which are, in fact, not present. Examiners must satisfy themselves by their own independent evaluation that this is the case

OR

• Is unable to make a pathophysiologically plausible clinical assessment, with an appropriate differential diagnosis, and a rational plan of further investigation.

52 - 69%

The candidate:

• Successfully elicits most

AND

of the relevant aspects of the history and physical examination, as would be expected of a competent physician. Examiners should be satisfied that no important aspects of the history or physical examination have been missed

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Please specify

mark within

this range

• Makes a pathophysiologically plausible clinical assessment, with an appropriate differential diagnosis, and a rational plan of further investigation

70 - 74%

Please specify

mark within

this range

The candidate:

• Successfully elicits all

AND

the relevant aspects of the history and physical examination, as would be expected of a competent physician

• Makes a pathophysiologically plausible clinical assessment, with an appropriate differential diagnosis, and a rational plan of further investigation

AND

• Demonstrates clinical maturity, insight and a breadth of experience and knowledge

75-100%

Please specify

mark within

this range

The candidate:

• Successfully elicits all

AND

the relevant aspects of the history and physical examination, as would be expected of a competent physician

• Makes a pathophysiologically plausible clinical assessment, with an appropriate differential diagnosis, and a rational plan of further investigation

AND

• Demonstrates clinical maturity, insight and an outstanding grasp of clinical medicine, including both a broad and deep experience and theoretical knowledge

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APPENDIX 8: A MARK SCHEDULE FOR THE ORAL PRESENTATION Oral presentations are marked out of 100 using the following schedule. Please use multiples of 5 for each of the component marks awarded. Mark out of Mark awarded

Is the presentation well structured and logical with an orderly and appropriate framework, and communicated effectively?

20

Is the content factually complete and integrated across at least two domains of occupational health, and more if appropriate to the question?

30

Has the candidate demonstrated the ability to defend the contents of the presentation and answer questions appropriately?

50

January 2010