Office of Postgraduate Education

DEPARTMENTAL ORAL EXAMINATION SCORE SHEET

(Examination Score Sheet to be completed conjointly and signed by both examiners -- one final score)

Please Print Clearly…

Name of Resident / PGY / Date / PASS / FAIL
Day/Month/Year / Please Circle
Name of Examiners / 1 / Hospital
2

PART ONE: INTERVIEW

INTERVIEW CONTENT

ITEM / UNSATISFACTORY / B / SATISFACTORY
HPI:
Illness Onset / Fails to identify circumstances of onset of illness/episode. / Establishes premorbid state, stressors, time of onset of illness.
Symptoms / Symptoms are not clearly identified and clarified / Symptoms of current episode/illness are clearly identified, and are not blurred with past episode
Course of Episode / Evolution of current illness is unclear. / Establishes clear sequence of events of current episode/principle illness, including interventions.
Comorbidity Screening / Preoccupied with a single diagnosis. Does not screen for comorbidity. / Reviews “A” criteria for likely comorbid illness.
SAFETY / Fails to assess or minimizes risk of self harm, aggression, or self care. OR Exaggerates seriousness of threat. / Asks about suicidality, aggressivity competency to care for self. IF indicated by patient’s mental status during interview.
Risk Assessment / Fails to review risk factors, OR reviews in depth when not warranted. / Systematically reviews risk factors for suicide, self-harm, self-care, IF INDICATTED. Does not do so if not required.
MEDS / Does not ask about medications. / Asks about current medications: dose, duration, effectiveness, side effects.
PSYCH HX
Px Episodes / Fails to review / Reviews previous episodes, hospitalizations, evolution of illness, aggression and self-harm
Treatments / Fails to review / Reviews therapists (relations to them…), medications: (dose, duration, efficacy, side effects, compliance)
Substance Use
Forensics HX / Fails to review / Reviews substance use/abuse and legal involvements.
FAMILY
PSYCH HX / Fails to review / Reviews family psychiatric history, using lay terminology, and including substance abuse.
MEDICAL HX / Fails to review / Reviews Medical History, including allergies, serious drug reactions in past, responses to illness.
GROWTH, PERSONAL HISTORY / Fails to review / Reviews early childhood and adolescent relations and development, abuse, academic achievement, work and marital relations. Notes culturally relevant interpretations of social stressors, available social supports, and levels of functioning and disability, eg. religion and kin networks, impact of migration, poverty, and discrimination.
Relationships / Fails to review / Reviews current relationships, supports, work context, finances.
Cultural identity / Fails to review / Reviews ethnic affiliation or cultural
reference groups including language abilities, use and preference. For immigrants and ethnic minorities, note involvement with culture of origin and host culture.
Cultural explanations of the individual’s illness / Fails to review / Identifies explanatory models - meaning
and perceived cause and severity of the
patient’s illness- and predominant idioms of
distress.
MSE (IF indicated) / Performs formal mental status when not indicated
MSE too standardized, ignoring cultural elements Re: appearance, speech, non-verbal communication, cultural norms. / Conducts formal mental status examination IF indicated. DOES NOT DO SO if not indicated. Aware of cross-cultural considerations in MSE, for example speech, non-verbal communication, cultural norms.
RAPPORT
Establishes
Relationship / Does not introduce self or exam. Uncertain. Does not assume control OR Begins asking direct, closed questions. Shows lack of respect for cultural differences. / Introduces self, explains interview concisely. Begins in open, exploratory manner. Treats patient like a responsible adult. Engages patient in a culturally appropriate manner.
Maintains professional, therapeutic relationship / Mechanistic, distant, unresponsive, disrespectful, patronizing. Fails to acknowledge patient distress, OR colludes or over-identifies with patient. Lacks awareness of cultural elements of the relationship between patient and clinician. / Respectful. Genuinely interested. Eye contact, body posture suggests active listening. Acknowledges distress with nonjudgmental, empathic responses. Able to recognize and work with differences in culture and social status between patient and clinician and the problems that these differences may cause in engagement.
INTERVIEW TECHNIQUE:
Information Gathering / Excessive closed or vague questions. Multiple simultaneous questions. Excessive jargon. Does not get detail. Uncomfortable with psychotic or sensitive material. / Mixes open and closed questions. Few leading or stacked questions. Asks clear, specific questions in plain English.
Attention/Listening / Talks over patient, OR passive, unsure, leaving awkward silences. Does not make use of nonverbal material. / Practices receptive listening: allows silences and seems comfortable doing so. Notes and responds to nonverbal cues.
Clarifies, follows up, confronts / Fails to clarify details of events, time sequences. Reluctant to challenge patient. Unsupportive when confronting patient. / Systematically clarifies details, unusual replies, inconsistencies. Pursues detail. Confronts inconsistencies supportively.
Assuredness / Uncomfortable with feeling or psychotic content. Becomes flustered, freezes, or stifles such content. / At ease with affective, anxious, or psychotic content of interview. Normalizes or helps patient understand symptoms.
Feedback, Interaction / Provides no feedback to patient, OR talks, educates, hypothesizes excessively without regard for patient’s explanatory model of illness. / Reframes, paraphrases. Summarizes understanding of story periodically. Reviews cultural explanations of the patient’s illness. Gives a brief closing summary statement to patient.
ORGANIZATION
Conducts orderly
Assessment / Inflexible, ignores patient needs. Ends early OR conducts a disorganized, disjointed interview. / Conducts structured but flexible interview, completing sections of interview in an orderly manner. Allocates time efficiently.
Conducts comprehensive interview / Focuses solely on principle problem, does not review for comorbidity. Ignores the person in pursuit of symptoms. / Scans “A” criteria and reviews common comorbid diagnoses related to principal diagnosis. Gets clear sense of the person.
Control / Allows patient to lead interview, drift, unable to focus. / Is able to politely redirect patient back to area under review, help patient focus.

PART TWO: PRESENTATION AND DISCUSSION

CASE PRESENTATION

UNSATISFACTORY / B / SATISFACTORY
Case is disorganized or a simple repetition of symptoms without a unifying storyline or sense of the person. Time sequences mix current with past episodes. / Case is presented in an orderly, systematic manner. Presentation successfully “tells the patients story”. Paints a clear picture of the course of illness.
Symptoms are not clustered to aid with diagnosis, OR Symptoms are presented in excessive detail. / Presentation includes relevant positive and negative symptoms needed to support the diagnosis.
Case is rambling and over inclusive, OR presentation is unduly brief and uninformative. / Case presentation is concise (less than 10 minutes), but includes relevant detail and texture.
MSE too standardized , ignoring cultural elements Re: appearance, speech, non-verbal communication. / Aware of cross-cultural considerations in MSE, for example speech, non-verbal communication, cultural norms e.g. thought content where culturally based beliefs can be misinterpreted as delusions.

DIAGNOSIS

UNSATISFACTORY / B / SATISFACTORY
Proposes a diagnosis or principal problem unsupported by the interview. / Provides a realistic working diagnosis supported by evidence from the interview.
Unable to present or defend a differential diagnosis, OR Provides an over inclusive differential, stressing the esoteric. / Provides a brief and realistic differential diagnosis and is able to explain process of further clarifying the diagnoses.
Is inflexible in discussing diagnoses. Is unable to entertain alternatives. / Able to discuss difficulties in supporting and refuting diagnoses in a thoughtful, balanced manner.
Is unaware of issues related to comorbidity. / Is able to discuss comorbidity and interplay between diagnoses.

FORMULATION & DISCUSSION

UNSATISFACTORY / B / SATISFACTORY
Is unable to provide a summative understanding of the patient. Focuses narrowly on a single aspect or phase of their illness. / Identifies predisposing, precipitating, perpetuating factors for patients problems, described in a manner which recreates a whole person and their life, incorporating cultural identity and client’s explanatory model.
View of patient neglects key components of their life, is unduly limited in its grasp. Uninterested in patient as a person. / Able to identify biopsychosocial and cultural/spiritual components of patients illness, and describe the interplay between these elements at this time.
Is unable to identify dynamic or cognitive factors influencing patient’s presentation. / Able to identify core conflicts of patient, cognitive distortions, dependency or interpersonal needs of patient.
Rigid, inflexible, confrontational in discussion. Unable to entertain other possibilities. OR unable to take a position for discussion. Immediately accepts examiner’s viewpoint. / Demonstrates capacity for open-minded, thoughtful discussion of issues identified.

PART TWO: PRESENTATION AND DISCUSSION

MANAGEMENT

UNSATISFACTORY / B / SATISFACTORY
Treatment plan has no clear goals or expected outcomes. Plan is unrealistic for the patient, or is not attainable in existing mental health system. / Provides realistic treatment plan covering short term, medium term and long term goals of treatment.
Has very limited understanding of indications for and limitations of pharmacotherapy. Recommends inappropriate pharmacotherapy, without understanding of risks, benefits. Lacks evidence for efficacy of treatment proposed. / Able to recommend and defend SPECIFIC pharmacotherapies, if indicated. Aware of evidence for efficacy of therapy proposed. Appropriate management of ethnic differences when using pharmacotherapy and somatic therapy.
Unaware of indications for and limitations of specific types of psychotherapy. Recommends inappropriate therapy. / Able to recommend and defend prescriptions of SPECIFIC psychotherapies, if relevant. Understands cultural issues in psychotherapeutic interventions and can adaptively modify goals as needed.
Has poor understanding of long term prospects for patient. Provides unrealistic outcomes, little under-standing of real life, day to day management issues. / Able to provide realistic prognosis. Able to describe barriers to compliance, effective intervention with THIS patient.
Lacks awareness of cultural elements of the relationship between patient and clinician. / Able to recognize and work with differences in culture and social status between patient and clinician and the problems that these differences may cause in treatment
Does not acknowledge need for interpreter
or cultural consultant when appropriate. / Able to suggest appropriate use of translator or cultural interpreter in ongoing assessment and treatment.
Does not attend to issues of racism, access barriers and other social factors leading to mental health sequalae and health disparities in disadvantaged.
Groups / Recognizes issues of racism and access barriers, where present, as important factors in treatment.

QUESTIONS

UNSATISFACTORY / B / SATISFACTORY
Has inadequate understanding of mental health legislation and its day to day application. / Is knowledgeable about legal issues related to patient and public safety.
Demonstrates poor understanding of roles of psychotherapy/pharmacotherapy in treating mental illness. / Understands and is able to apply principles of pharmacotherapy and psychotherapy.
Appears disrespectful to patients or diagnostic subtypes of patients. Appears to be “making up” information to support conclusions. Has an overly casual attitude towards boundaries. / Demonstrates professional attitudes (responsibility, collegiality, respect, integrity, honesty, cultural competence, etc).
Demonstrates limited problem-solving skills. Does not appear to recognize gaps in knowledge or skills or have strategies for correcting these. / Able to problem solve. Recognizes limits of own knowledge and means of correcting this.
Is rigid, opinionated or argumentative in discussing cases, OR, seems uncertain and unable to take a position and argue persuasively for it. / Demonstrates open-mindedness, flexibility and thoughtfulness in discussing ethical issues and case problems.

OVERALL IMPRESSION

Examiner should provide a global impression of the candidate, noting areas of significant deficit or strength. Please provide comments explaining the basis for your impression.
OVERALL IMPRESSION Continued…
By signing this form, you confirm that you have discussed this review in detail with your examiners. Signing this form does not necessarily indicate that you agree with this evaluation.
Resident Signature / Date
1. Examiner Signature / Date
2. Examiner Signature / Date

Thank you…!

Please return the completed form to your hospital Postgraduate Site Coordinator

Please Fax To: 416-979-6928 ATTN: Sue Eccles

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