MEDICAL EDUCATION

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AVOIDING COMMON ERRORS IN KEY FEATURE PROBLEMS

SK Kwa FRACGP, FAFPM
Sheikh Mohd Amin FRACGP, FAFPM
AC Ng FRACGP, FAFPM

Editor’s note: Dr Kwa Siew Kim, Dr Sheikh Mohd Amin and Dr Ng Aik Chew are from the Board of Examiners of the Academy of Family Physicians of Malaysia, Dr Sheikh Mohd Amin is the Chief Examiner.

Address for correspondence: Assoc Prof Kwa Siew Kim, International Medical University, Jalan Rasah, 70300 Seremban, Malaysia. Tel: 06-7677798, Fax: 06-7677709, Email: siewkim_kwa@imu.edu.my

Kwa SK, Sheikh Mohd Amin, Ng AC. Avoiding common errors in Key Feature Problems. Malaysian Family Physician. 2007;2(1):18-21

Introduction
Questions on Key Features Problems (KFP) are an important component of the theory paper for Part 1 of the membership examination of the Academy of Family Physicians of Malaysia (MAFP) and the Fellowship for the Royal Australian College of General Practitioners (FRACGP).¹

These KFP questions are designed to assess yourreasoning and decision-making skills at every stage of a consultation process. They reflect common or life-threatening problems typically encountered by family physicians. The questions focus on your ability to take critical steps to resolve a medical problem. They may begin with the historical data of a case. Using the KFP format, you can be assessed on your ability to make critical decisions, e.g. arrive at a diagnosis, based on the historical data provided. Determining your ability to choose the areas to focus on when conducting a physical examination and your ability to appraise relevant positive or negative signs are also critical decision-making aspects of medical practice that the KFP assesses. The KFP questions further test your ability to choose essential and cost-effective investigations and to provide appropriate short and long term management of the patient’s problems.

The KFP is one ofthe most difficult and discerning of all the theory papers because it tests the highest level of learning i.e. the application and clinical reasoning. Many candidates find KFP the most challenging because unlike the applied knowledge test (AKT), no books on KFP cases are available for reference. The 2007 Examination Handbook provides six questions from previous years.¹

This paper will attempt to provide information on the format and marking scheme of KFP. Expected answers for some KFP cases will be discussed and common errors made by candidates highlighted with suggestions on how to avoid them.

Format of KFP
KFP cases generally cover the breadth of theproblems seen in Family Medicine. Questions from previous years include acute conditions (pneumonias, urinary tract infections, jaundice) and chronic conditions (hypertension, diabetes, heart failure, dyslipidaemias, obesity, thyroid problems), emergencies (coma, anaphylaxis), musculoskeletal problems (sports and work injuries, degenerative disorders), depression, anxiety, sexually transmitted infections, teenage problems, women’s health like breastfeeding and contraception, childhood problems, geriatric care and preventive care including screening at the different ages.

A maximum of 25 KFP cases may be given for a 3-hour examination. For the 2006 Conjoint MAFP/FRACGP examination, 16 KFP cases were offered to be attempted in 2 hours. Each case is followed by a number of questions (usually 2-4) addressing the key features of the case. Each question is answered either by writing in note form the answer(s) in the space(s) provided or by selecting choices from a numbered list of options (usually between 10 and 30). The maximum number of options or written answers that are to be provided by candidates without penalty is also stated.

KFP Case 1 given in the discussion below illustrates the format used in KFP. This case comes with 2 questions. The first question requires a write-in answer with no clues given for expected answers. The second question provides a list of 18 possible answers for candidates to choose from.

Marking Scheme

It is important that you read carefully the case scenarios and thequestions. Failure to follow instructions may result in unnecessary loss of marks. Examiners who are correcting the answer scripts have to abide by the caveats pre-set in the scoring key for each question. Using Case 1 as an example, Question 1 requires the candidate to list a maximum of FIVE (5) differential diagnoses. Any listing above five will cause the caveat to be exercised and zero mark is awarded for that particular question.

Question 2 requires candidates to circle up to FOUR (4) options. You may lose all marks for that particular question if you miss putting in a “mandatory” option even though you have other correct answers. Listing an answer that is considered “dangerous” can also cause you to lose all marks for that particular question. An example would be to offer a beta blocker to a hypertensive patient who has asthma.