CLINICAL EXAMINATION GUIDELINES

1.          INTRODUCTION

The Medical and Dental Council, Ghana (MDCG) Clinical Examination is an integrated multidisciplinary structured clinical assessment in both medicine and dentistry. In Medicine it assesses clinical skills in Internal Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics and Community Health. In Dentistry it assesses clinical skills In Restorative Dentistry, Oral Medicine/Oral Pathology, Oral Surgery, Orthodontics/Paedodontics, Periodontics and Community Dentistry. It also assesses ability to communicate with patients, their families and other health workers and professional medical ethics.

The MDC registration examination process is designed to assess the relevant knowledge and clinical skills of medical and dental graduates from accredited training institutions worldwide.  The process provides a comprehensive test of medical/dental knowledge and clinical competence aimed at ensuring safe practice by the medical doctors and dentists upon passing these examinations.

There shall be two stages of the registration examination for both the medicine and dentistry examinations. The first stage will be a theory, made up of multiple-choice questions (MCQ), and the second stage, a clinical examination using the Objective Structured Clinical Examination (OSCE) format.

Both the theory and clinical components of the examination are multidisciplinary and integrated covering applied basic sciences, paraclinical sciences and the relevant clinical sciences in medicine or dentistry.

A candidate will have to obtain a pass mark (a score of 50%) at STAGE 1 (Theory Examination) to be eligible to take STAGE 2 (Clinical Examination).

Please see section 5 below.

2.          THEORY EXAMINATION FORMAT

The theory examination will focus on candidates having the requisite knowledge and understanding of applied basic, paraclinical and clinical sciences across all disciplines in medicine and dentistry, respectively. It will additionally test candidates’ understanding of disease processes, clinical examination skills, diagnosis, investigation, therapeutics and overall management. It will also assess the candidates’ ability to exercise judgment and reasoning in distinguishing between the correct answer and plausible alternatives.

The theory aspects of the examination shall consist of 200 Single Best Answer (SBA) MCQs administered in two (2) sessions on the same day for both medicine and dentistry candidates. Each session will have 100 MCQs administered over a two (2) hour period, with a 30 minute break in between the sessions.

3.          CLINICAL EXAMINATION FORMAT

The general objective of the MDC’s clinical examination is to assess the clinical competence of the candidate for the safe and effective clinical practice of medicine or dentistry in Ghana.  The Objective Structured Clinical Examination (OSCE) and Objective Structured Practical Examination (OSPE) formats will be used for the clinical examination throughout.

The clinical examination will assess the candidate’s capacity in such areas as history taking, physical examination, diagnoses formulation, ordering and interpretation of investigations, clinical management, prescribing, ability to carry out simple clinical procedures and communication with patients, their families and other healthcare workers.

Generally, the clinical examination for both medicine and dentistry will consist of twelve (12) stations for investigations and interpretations and a total of nineteen (19) manned stations comprising 17 manned active stations and 2 rest (inactive) stations of Objective Structured Clinical Examination (OSCE). Each manned station will have two (2) examiners giving a total of 34 examiners for the manned stations. The unmanned stations will be administered a day prior to the commencement of the manned OSCE.

1. For Medical candidates, there will be nineteen (19) stations, seventeen (17) manned active stations (at which the candidate must perform tasks or activities), and two (2) rest (inactive) stations (at which no activity will be performed). The active stations shall comprise three (4) stations each for Internal Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics and one (1) station for Community Health.
2. For Dental candidates, there shall be four (4) stations for restorative dentistry, two (2) stations each for oral medicine, oral pathology, oral surgery, orthodontics, community dentistry and three (3) stations for paedodontics/periodontics. There shall be two (2) rest stations.
3. For both the medical and dental OSCE/OSPE, each station will last 10 minutes. Generally, seven (7) minutes of this time will be for performance of an activity or task and three (3) minutes for interaction with the examiners. However, this time allocation within the maximum 10-minute per station may differ slightly from time to time depending on the scenario set for the station.
4. Stations may use actual patients, standardised patients, or role-playing patients, manikins, instruments, images, prescriptions, data interpretation etc. Candidates are advised to regard the role-playing patients as real patients and treat them accordingly.
5. Scoring will be uniform for all disciplines. It will include separate scoring for performance of activities/demonstration of skills and candidate’s interpretation of the clinical findings.

There will be standardised checklists for the performance of each of the following tasks per OSCE/OSPE station and per discipline. 

• History taking
• Physical examination
• Investigations
• Diagnosis/differential diagnoses
• Management/therapeutics
• Viva / Counselling / patient education / data interpretation
• Clinical procedures
• Viva for Community Health

4.          STANDARD OF PERFORMANCE REQUIRED

The clinical examination requires candidates to demonstrate, to the satisfaction of the examiners, clinical ability at the level of a graduating final year medical student who is about to commence Housemanship training.

Candidates are required to:

• be familiar with the common and important health promotion strategies, health/medical disorders, prevention strategies and related issues in the Ghanaian/tropical setting and have some awareness of other less common health issues in Ghana and around the world.
• take a competent history, perform a competent physical examination, arrive at relevant appropriate diagnoses with differentials, order and/or interpret relevant investigations, describe/explain management plans and prescribe appropriate medications safely.
• be familiar with the indications for, the mechanisms of action, and the adverse effects of, the major therapeutic agents.
• explain and justify an approach to stated interventions for solving patient problem(s)

Examples of material that could be featured at the OSCE/OSPE stations may include, but will not be limited to:

• taking detailed relevant history directly from a patient (or simulated patient) with varied complaints [history taking station]
• taking a history from a third party such as the parent or caregiver of a patient (history taking station)
• physical examination of a patient (simulated patient or manikin) with varied conditions [examination station]
• interpretation of a clinical investigation results and data [diagnostic formulation station]
• educating a patient or parent of a child or other relative of a patient on the use of a medical gadget, explaining the diagnosis or breaking bad news [management/counselling/ education station]
• counselling a patient with obesity [management/counselling/education station]
• presenting a management plan for a patient presentation (management/counselling/ education station).

The scenarios used in the assessed stations comprise:

• a clinical stem of essential information to the candidate about the scenario, which may include investigations, imaging or charts
• a series of tasks to perform, commonly three to four

Each scenario has a single “predominant assessment area” (namely history, physical examination, diagnosis formulation, or management/ counselling/ education station).  Assessment tasks will be focused on this area but may include other areas. During the ‘reading time’ the candidate evaluates the given information and plans their approach to the assessment phase. They should plan their time, taking into account the number and type of tasks, and take careful note of the time allotted to be guided accordingly. During the ‘assessment time’ the candidate conducts the interaction as required and performs the designated clinical tasks. The clinical tasks include but are not limited to; history taking, physical and mental state examination, investigation planning and interpretation, diagnostic formulation, management planning, prescribing, counselling and performance of procedures. A clinical scenario may test a candidate’s ability in responding to these tasks in various health care settings, including:

• community or general hospital services
• regional, district or rural locations
• any phase of health care: preventative, acute/critical care and continuing care for chronic disorders
• any patient age group: newborn to elderly
• direct patient care, care and family interactions or multidisciplinary team interactions.

5.          REQUIREMENTS FOR THE STAGE 1 AND STAGE 2 EXAMINATIONS

Candidates shall apply and be registered for the full examination (Stages 1 and 2) as one examination with two stages. If a candidate fails the STAGE 1 (theory component MCQ), and therefore does not qualify to take the OSCE, he/she would have to pay to take the whole examination again to re-sit the examination. 

5.1    Stage 1

• Candidates should have qualified with a Bachelor of Medicine, Bachelor of Surgery (MB.ChB.) degree or equivalent (e.g. MB. BS., MD etc.) from an institution recognised by the Medical and Dental Council (MDC) of Ghana and the World Medical Association (WMA) and be in possession of a valid certificate and transcript to apply for the medicine examination.
• Candidates must have qualified with Bachelor of Dental Surgery degree (BDS) or its equivalent (e.g. MB. BS., MD etc.) from an institution recognised by the Medical and Dental Council (MDC) of Ghana and the World Medical Association (WMA) and be in possession of a valid certificate and transcript to apply for the dentistry registration examination.
• A candidate must obtain a minimum score of 50% in the Stage 1 examination to be eligible to progress to Stage 2 (OSCE).
• A candidate who passes Stage 1 may hold onto the pass for up to one year within which he or she can take the Stage 2 examination. After the one year maximum grace period the candidate will have to restart the entire process to take both STAGE 1 and STAGE 2 examination.
• A candidate who scores less than 50% in Stage 1 may retake the examination at the next available opportunity, and at his or her convenience.
• The maximum number of attempts to take the Stages 1 and 2 examinations is five (5). Please note that a candidate who has exhausted the five (5) attempts is NOT eligible to take subsequent Council’s registration examinations.

5.2    Stage 2

• A candidate must obtain a score of 50% or more in Stage 1 to be eligible to take the Stage 2 examination.
• A candidate must obtain a score of 50% or more to pass the Stage 2 examination.
• An average overall score of 50% of the combined Stage 1 & Stage 2 will constitute a pass in the entire licensure examination, provided the candidate obtains a score of 50% or more in the Stage 2 examination. Passing the STAGE 2 is mandatory requirement to pass the entire examination.
• A candidate who is eligible to take the Stage 2 examination but does not pass with a score of 50% and above may retake only the Step 2 examination at the next available opportunity at his or her convenience within the next two (2) After the two (2) year maximum grace period the candidate will have to retake Stage 1 and restart the process.
• The maximum number of attempts to take the Stages 1 and 2 examinations is five (5).
• Please note that a candidate who has exhausted the five (5) attempts is NOT eligible to take subsequent Council’s registration examinations.

6.          EXAMINATION PERIOD

The available dates for the clinical examinations would be regularly communicated / updated on the Council’s website. There are specified examination dates and defined registration closing dates. All final dates for the examinations may be subject to change. In case of any such changes to published examination dates, the MDC will notify candidates well in advance to provide candidates the opportunity to apply for alternative dates.

• Clinical examinations will be held at designated centers that will be communicated to candidates for each examination.
• Clinical examinations will be held 2-3 times a year.

Candidates may only register for one clinical examination at a time.  Candidates who have applied and have been scheduled for a clinical examination may not re-apply for another clinical examination until they have received their results from the last scheduled examination.

PLEASE NOTE AND NOTICE is hereby served that this is a professional examination and as such candidates are expected to conduct themselves with the highest level of professional integrity and conduct and any candidate found to have breached or been in breach of the examination rules and regulations as are from time to time issued by Council would be sanctioned including cancellation of results, suspension from subsequent examinations for a period to be determined by the circumstances of each case, and an outright ban or prohibition from ever taking Council’s registration examinations.