SRI LANKA
MEDICAL COUNCIL
THE EXAMINATION FOR
REGISTRATION TO PRACTISE
MEDICINE IN SRI LANKA
[ERPM]
THE REVISED
NEW FORMAT
FROM JANUARY 2006
INCLUDES THE EXAMINATION RULES
COMPILED BY THE EDUCATION
COMMITTEE OF THE COUNCIL
FOREWORD
The Examination for Registration to Practice Medicine (ERPM) in Sri Lanka is conducted by the Sri Lanka Medical Council (SLMC) for citizens of Sri Lanka who obtained their medical qualification abroad.
It is the examination prescribed in terms of Act No.16 of 1965 and Section 29 (1) (b) (ii) (cc) of the Medical Ordinance. It was referred to as the Act 16 Examination earlier. The candidates should possess the MBBS or an equivalent degree recognized by the SLMC, to be eligible to sit this examination. It is only after passing this examination, that they can apply for Provisional or Full Registration with the SLMC. Although the principles of medical practice remain the same, clinical teaching and the relative emphasis on various aspects of training differ from country to country, depending on the pattern of disease prevalence and the facilities and resources available for treating them.
The ERPM is conducted to ascertain whether medical graduates qualified abroad have adequate knowledge, skills and aptitude to take up hands-on clinical training and patient care as an intern medical officer under local conditions. The Education Committee of the SLMC has carried out a major review of the ERPM. Recommendations were made to have a new format for the examination so that it would serve to test the following:
a) Core knowledge of common communicable and non-communicable diseases and their prevention.
b) Ability to make a provisional diagnosis and plan initial management.
c) Ability to adapt to the facilities and resources available in the hospital.
d) Basic knowledge of the healthcare structure and the medicolegal system in Sri Lanka and the responsibilities of medical practitioners.
The new format is more objective, comprehensive and structured. It aims to ensure that the examination is appropriate and conforms to the objectives. It is also logistically easier to conduct and is candidate-friendly. It is our hope that the new format will stimulate others to re-examine their present format of assessment of clinical training. This document provides the candidates with an overview of the new format.
The new format came into effect from January 2005.
Education Committee
SLMC
31, Norris Canal Road,
Colombo 10.
February 2006
The Examination for Registration to Practise Medicine in Sri Lanka
Objective:
To assess,
a) the core knowledge in clinical subjects with particular reference to problems prevalent in Sri Lanka.
b) the skills and competence required, for training and to shoulder responsibilities, as a pre-registration house officer (intern medical officer).
Eligibility:
a) should be a citizen of Sri Lanka.
b) should possess a MB BS degree or equivalent qualification obtained abroad, recognized by the SLMC.
Components:
There are two parts – Part A and Part B.
Part A is the written component containing multiple choice questions – (MCQ) papers.
Part B is an interactive assessment in clinical/practical problems.
ERPM Part A – Written papers
There will be three papers.
Paper 1:
Objective: – Testing the core knowledge in clinical subjects
Question type – True/False MCQs
Composition –
Medicine and Psychiatry 15
Obstetrics and Gynaecology 15
Paediatrics 15
Surgery 15
Total No of questions 60
Duration: 2 hours and 30 minutes
Marking –
Each question will have five responses. The correct response will score +1 and the wrong -1. The negative marks will not be carried over to the next question. The range of marks would be 0 to 5 for each question.
Paper 1 will carry 300 marks.
Paper 2:
Objective: To assess the ability of the candidate –
a. To interpret data in a given clinical scenario and to draw conclusions.
b. To take decisions regarding initial managements on clinical scenarios on practical problems in the context of facilities and resources available
in hospitals in Sri Lanka.
Question type: Best response type MCQs – (Best of five)
Composition:
Medicine and Psychiatry 24 (18+6)
Surgery 12
Obstetrics and Gynaecology 12
Paediatrics 12
Total No. of questions 60
Marking:
Each question will have five responses. The correct response will score +5. There will be no negative marks. Paper 2 will carry 300 marks.
Duration: 2 hours.
Paper 3:
Objective: Testing the core knowledge in selected para-clinical subjects:
Question type: True/False MCQs
Composition:
Forensic medicine 10
Community medicine 10
Clinical pathology 10
Total No. of questions 30
Marking:
Each question will have five responses. The correct response will score +1 and the wrong one -1. The negative marks will not be carried over to
the next question. The range of marks would be 0 to 5 for each question.
Paper 3 will carry 150 marks.
Duration: 1 hour and 15 minutes.
A Pass in written papers (Part A):
Total marks available:
Paper 1 300
Paper 2 300
Paper 3 150
Grand Total 750
Pass mark 50%
A candidate should obtain a total of 375 from the three papers to pass Part A.
The Clinical subjects (in Papers 1 and 2) can be passed separately by obtaining 300 marks out of 600 available, without passing Paper 3. Paper
3 can also be passed by obtaining 75 marks out 150 without passing the Papers 1 and 2.
A candidate has to pass all 3 papers in Part A to proceed to Part B.
ERPM – Part B
Objective: Assessment of:
a. skills in consultation and clinical examination.
b. ability to cope with common medical emergencies and forensic problems.
c. knowledge in nature and the scope of community health services in Sri Lanka.
Eligibility:
All who have passed Part A of ERPM within the preceding two years of the date of the clinical exam for which they opt to sit.
e.g. Those who have passed the Part A of ERPM in July 2006 should sit for Part B before July 2008.
If 2 years have elapsed after passing Part A, before sitting Part B for the first time, then the candidate has to re-sit Part A in full. A candidate has to pass the ERPM (both Part A and Part B) within five years of sitting for the Part A examination for the first time. He or she will not be allowed to sit the examination thereafter.
Components:
Part B
This will have two components:
a. Clinical section
b. Orals
1. Clinical Section of ERPM Part B
Objective:
To assess the ability and competence in:
a. history taking,
b. clinical examination,
c. drawing conclusions, planning management, and explaining to the patient about the illness and the proposed plan of action.
This section has six stations. There will be 2 sets of three stations each, as shown in the figure below. Each station will be assessed by two examiners independently. Candidates will start at one station and then move round the stations at 20 minute intervals until they complete the set.
There will be a three minutes interval between each station. At the end of a set there will be a short interval and then the candidate will move on to the next set.
Set 1
Set 2
Clinical Stations 1, 3 and 5
Objective:
These stations will assess the candidate’s ability to gather data from the patient, assimilate the information, discuss the differential diagnoses, and examine and/or look for physical signs in the system(s) and/or area(s) as directed by the examiners. Candidates should also be able to:
a. map out the preliminary management plan, and
b. explain this to the patient.
Clinical Station 2
Objective:
This will assess the candidate’s ability to examine a particular system, interpret physical signs, and discuss the possible diagnosis(es). There will be two patients, an adult and a child. Any two of the following systems – Cardiovascular, Respiratory, Abdomen and part of the Nervous system will be given at this station. For example, if the examination of the adult patient is in one system, the paediatric case would be in one of the other three.
The candidate will be examined by a physician and a paediatrician at this station.
Clinical Station 4
Objective:
This aims to assess the candidate’s ability to examine surgical short case(s)/ “spots” and examine/discuss a gynaecologcal problem. The candidate will be examined by a surgeon and a gynaecologist at this station.
Clinical Station 6
Objective:
To assess the ability of the candidate to take an obstetric history, examine a pregnant lady and discuss the proposed plan of management with the examiners and with the lady.
Marking in the Clinical Stations 1 to 6:
Each examiner will mark independently, out of a possible 100 marks.
Pass: A candidate should obtain a minimum average mark of 50% to pass the clinical section. Any candidate who gets 30 or less from any 4 examiners will fail the entire clinical section. He/she has to re-sit the entire clinical section. The clinical section will either be preceded or followed by the orals in Emergency Medicine, Forensic Medicine and Community Medicine.
Orals:
Station 7
Emergency Medicine
Objectives:
To assess the knowledge of the candidate in managing common Clinical Emergencies in Medicine, Surgery, Paediatrics and Obstetrics and Gynaecology.
There will be a panel of 2 examiners from any two of the above specialties.
Each examiner will question for 7½ minutes. Each will mark independently out of 50 and a candidate should obtain a total of 50 (50%) to pass this section.
Station 8
Forensic Medicine
Objectives:
To assess the ability of the candidate to deal with common Forensic problems
There will be two Forensic Specialist examiners. Each will mark independently out of 50 and a candidate should obtain a total of 50 (50%) to pass in this section.
Station 9
Community Medicine
Objectives:
1) To assess the knowledge of the candidate about the common public health problems and services, available in Sri Lanka.
2) To assess the ability of the candidate to plan out management with regard to common public health problems.
There will be two examiners who will mark independently out of 50. The candidate should obtain a total of 50 (50%) to pass this section.
Passing Part B of ERPM
A candidate can pass the Part B in full by scoring 36 marks (with not less than 2 marks from 4 examiners) in the Clinical Section, 50 in Emergency Medicine, 50 in the Forensic Medicine, and 50 in Community Medicine.
He/she can also pass section by section.
Examples:
Clinical Station 1
“A fifty year old male complains of fever and cough of four weeks”
The candidate will be expected to take a relevant history for about nine minutes in the presence of the examiners eliciting the salient features in the history. Then he/she will discuss with the examiners the possible differential diagnoses, relevant physical signs to be looked for, and perform examination of the patient as directed by the examiner. He should be able to mention appropriate investigations and then explain to the patient the proposed management. Depending on the clinical scenario, the time allowed to take the history may vary.
Clinical Station 2
Case 1
“A twenty year old female with weakness of both lower limbs”
The candidate may be asked to examine the nervous system of the lower limbs and discuss the physical signs elicited.
Case 2
“A ten year old boy with mitral stenosis and regurgitation”
The candidate may be asked to examine the heart of this child and will be questioned on the findings.
Clinical Station 3
“A child of five years with failure to thrive”
The candidate will be expected to take the history from the mother and child, discuss the differential diagnoses, and then explain to the mother the proposed plan of manangement.
Clinical Station 4
Surgical:
“A patient with scrotal swelling and another with a lump in the neck”
The candidate may be asked to examine these swellings and discuss the findings.
Gynaecological
“A forty five year old lady with menorrhagia”
The candidate will be expected to take a history from the patient and then discuss with the examiner how he or she would arrive at a diagnosis.
Clinical Station 5
“A 60 year old patient with progressive dysphagia for three months”
The candidate will be expected to take a full history and then discuss with the examiners the salient features, differential diagnoses and proposed investigations.
He/she will also be expected to obtain an informed consent for any invasive investigation / surgery.
Clinical Station 6
“A forty year old grand multipara”
The candidate will be expected to take an obstetric history and do a relevant examination and discuss the findings with the examiners and then explain to the patient the proposed line of management.
Emergency Medicine – Station 7
“A middle aged man admitted in an unconscious state, known to be a diabetic taking Insulin”
The candidate may be asked to describe the immediate measures to be taken.
and
“A man knocked down by a vehicle on the road, is admitted in a collapsed state”
The candidate may be asked to describe the immediate management.
or
“A baby is asphyxiated at birth”
The candidate will be asked to demonstrate resuscitation with a mannequin provided.
and
“A mother who has delivered a baby in the labour room has a retained placenta”
The candidate would be asked for the management of the patient as a House Officer.
Forensic Medicine – Station 8
“A photograph of a middle aged man with injuries”
The candidate may be shown a photograph of self-inflicted wounds and expected to recognize them and may be questioned on that further. The candidate may also be shown a skull with a fracture and expected to identify the sex and discuss the possible causes for the injury seen in the skull.