Mr Moore’s Year 3 Case Based Discussion Examination Tips

How to do well in the BSMS third year surgical case based discussion exams

Mr Moore is a regular BSMS examiner.  Here follows his personal hints and tips to help with examination success.

BSMS medical students take two surgical exams during their third year.  These are the case based discussion (CBD) and the OSCE exams.

The CBD exam occurs immediately after the surgical ward attachments.  During their time on the surgical wards, third year medical students should pick one case that they found interesting and that they would like to study in greater depth.  This case will then be used for the CBD examination so medical students have a lot of say in the content of their CBD exam and therefore their success is largely in their own hands because they already know the surgical scenario that will be discussed even before they set foot into the examination room.  This is quite unlike the OSCEs.

I would advise that you choose an interesting case but not one that is too complicated or rare.  Remember that you are a third year and you still have two years of medical school to go.  Your grasp of medicine is not yet matured and your examiners will be experienced surgeons.  You control which case you choose so why choose a case that is really rare and complicated that may lead to tricky questions?  It is much more important in the third year to gain a firm grasp of basic general surgery principles.

You should also choose a case where you have personally taken a history from the patient and you have personally examined them and you have followed them throughout their in-patient stay.  This is important because the examiners will expect you to have a grasp of your patient’s hospital journey.  It is not just the actual surgical disease that is important but also how has the patient coped with this during their hospital stay and what were their concerns and feelings?  You will only know about this if you have seen the patient daily during their hospital stay and seen at first hand the discussions of the patient with the doctors on the daily ward round.

When you have chosen your case then run it by one of the firm doctors.  If the doctor says that they do not think that you have chosen a good case then I would listen to this and choose another one.

When you have finalised your choice write down your history and examination.  Then study the hospital notes and write down anything extra that the doctors or other health professionals have recorded.  Write your CBD notes as if they are going to be an official clerking kept in the patient’s hospital notes.  Date, time and sign every piece of paper.  Write legibly.

You should record the results of any investigations and make sure you know why each investigation was done.  If you don’t know then ask a firm doctor.

You should record any medical management that took place such as an operation.  Do you understand why the medical management was done and what it entailed?  If you don’t know then ask a firm doctor.

Then re-organise your presentation into a logical stream of information which would allow you to present your case with ease if talking to a consultant on the telephone.

Then you should think about your case.  Do you fully undertand what happened.  If you don’t understand any aspect of the case then please make sure that you ask a firm doctor because it is too late when you are in the examination room.  Read about the surgical condition of your patient because you are likely to be asked about it in the exam.  Make sure that you have a good differential diagnosis for the case and think of ten things that the patient might have had instead with their presenting symptoms.  It is very important that you make sure that you have considered the most common general surgery diseases that you should have come across during your surgical attachment.  The CBD exam does not just focus on your patient’s specific disease but it also looks at the generality of surgery.  You will gain a good grounding of the generality of surgery if you make sure that you are diligent in attending your surgery firm’s ward rounds and other activities and getting involved and asking questions.

Then you should make sure that you have recorded the discharge planning of your patient and the impact that their surgical disease will have on their life outside of the hospital.

When you have done all of this you should ask one of the ward doctors if you can run your case by them.  Do this well before the exam and take note of any criticisms or recommendations and after you have made changes then practice presenting to a doctor again.  Ask the doctors to guess what questions they think you might be asked about the case and then make sure that you have sound answers.  You can now see why you might not want to choose a very very complex case!

On the day of the exam you should turn up in good time so that the examiners are not kept waiting.

Take your notes with you and you are allowed to bring in to the exam any notes that you have made so you only have yourself to blame if you do not have details of all of the investigation results and the medical management details.  Any confidential patient information should be kept confidential and disposed of in non-readable form.

Present to the examiners as if you were on a consultant ward round (see ward round tips link below) and this is why it is so important to put yourself forward and gain experience of presenting patients to doctors during your surgical attachment.

Finish your presentation with a one sentence summary.

After the presentation your examiners will ask you some questions related to your case.  Remember that your case will be used to see if you have achieved a basic understanding of common surgical principles during your third year surgical attachment.  If you have spent your surgical attachment weeks in the library only reading about your individual patient’s specific disease rather than regularly attending the surgical wards and seeing the management of numerous surgical patients then you are not going to do very well in this exam.  You should have a basic knowledge of the most common general surgery conditions and the best way to gain this knowledge is by attending post take surgical ward rounds and firm consultant ward rounds attentively.  Please also note that it is very easy for examiners to identify those students who have spent their surgical attachment weeks unwisely elsewhere away from the hospital surgical wards where they should have been.