INFORMATION FOR CANDIDATES TAKING THE 2009 ECEIM GENERAL AND CERTIFYING EXAMINATIONS

This document contains information to help you prepare for the ECEIM general and certifying examinations of the European College of Equine Internal Medicine including

• Examination location and dates
• The overall structure of the exam
• The exam timetable
• The scoring methods and criteria for acceptable completion of the separate parts and the examination as a whole
• Comments and examples of question formats
• Comments on exam preparation

For additional information please contact Scott Pirie (Tel 44-131-650-7230/6253, Fax 44-131-650-8824, email scottp@staffmail.ed.ac.uk)

EXAMINATION LOCATION AND DATES

Location; Campus of the Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.

Dates; Sat. 24^th – Mon. 26^th January 2009, inclusive.

Details of this location, travel, and suggested accommodation will be forwarded to candidates after their application to sit the examination has been accepted.

STRUCTURE OF THE EXAMINATIONS

GENERAL EXAMINATION

This will comprise multiple choice questions (MCQ) and extended match questions (EMQ) [see below for description of these question formats]. 50 MCQ/EMQ will be aimed at testing the candidates’ knowledge and understanding of concepts relating to the medical and biological sciences that underpin clinical practice of internal medicine (for example pharmacology, microbiology, physiology, pathology, epidemiology, diagnostic imaging). A further 50 MCQ/EMQ will be aimed at testing the candidates’ clinical knowledge and their ability to synthesise this to address clinical problems. The blueprint below documents how many MCQ/EMQ will be assigned to specific body systems and spheres of knowledge within the examination.

The examination will be conducted in 2 sections each lasting 3.5 hours: thus the candidates will have 4.2 minutes per question. Candidates will be allowed to take a non-medical English language dictionary into the examination. Candidates will be encouraged to provide feedback on specific questions in particular to identify any difficulties in comprehension they have encountered and these comments will be considered in the examination assessment process.

CERTIFYING EXAMINATION

This will consist of 3 sections:

1. 50 MCQ/EMQ aimed at testing the candidates’ ability to address clinical problems. Particular emphasis will be given to the candidates’ ability to demonstrate clinical judgement when presented with a case scenario. 50 MCQ/EMQ will be answered in 3.5 hours thus the candidates will have 4.2 minutes per question. Candidates will be allowed to take a non-medical English language dictionary into the examination. Candidates will be encouraged to provide feedback on specific questions in particular to identify any difficulties in comprehension they have encountered and these comments will be considered in the examination assessment process.
2. Essay Section: Candidates will be required to answer 2 of 3 essay questions over a period of 3.5 hours. Candidates will be allowed to take a non-medical English language dictionary into the examination. We hope to be able to offer computers with basic word processing software to candidates who wish to use them to type the essays; we will confirm whether this is possible in due course.

See website for examples of previous essay questions.

3. Objective case management section: Candidates will be given clinical information on 3 cases and given a minimum of 1 hour to review this information. For each case, candidates will be given a list of questions that they will be asked when they present the cases to a panel of at least 2 examiners, such as ‘summarise the clinical examination findings for this case’ or ‘summarise the laboratory abnormalities for this case, and indicate how you would interpret each of these abnormalities’. During the presentation, the candidate will be asked further structured questions regarding interpretation of the clinical and laboratory data, disease pathogenesis, further diagnostic techniques, case management and prognosis. This section of the examination will be completed in 60 minutes. A comprehensive table of laboratory reference ranges will be provided to all candidates. Candidates will be given the option to have this section recorded on videotape and a copy of this video will be retained by the Examination Committee for review in the event that the candidate lodges an appeal against the Examination Committee’s decision. Measures will be put in place to ensure that candidates cannot communicate with each other before and after the OCM, therefore, please anticipate that you will be required to wait in a secure area before and after the exam for the entire duration of time that the Committee are examining other candidates (likely to be up to 9 hours). Please feel free to bring books, computers or other items with you to fill the time. Refreshments will be provided.

See website for examples of previous OCM questions

Language

The exam will be conducted in English. Candidates who are not native English speakers have the option of having an observer attend the examination who is fluent in their own language. Please request this facility when you apply for the examination.

PROPOSED SCHEDULE OF THE EXAMINATION

NOTE THESE DETAILS WILL BE CONFIRMED AFTER YOU RECEIVE NOTIFICATION OF WHETHER YOUR APPLICATION HAS BEEN SUCCESSFUL

DATE	SECTION	LOCATION	TIME
24 January 2009	General Part 1	UAB*	0930-1300
24 January 2009	General Part 2	UAB	1400-1730
25 January 2009	Certifying MCQ	UAB	0930-1300
25 January 2009	Certifying Essay	UAB	1400-1730
26 January 2009	Objective case management	UAB	Candidates will be given individual appointments – you will be required to spend all day in a secure area.

* Campus of the Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.

NOTE: Due to the nature of this examination, each section will be administered at one time and place ONLY. There will be no alternative arrangements for any reason.

HOW THE EXAMINATION IS SCORED:

In any given year, it is possible for all the candidates to pass the examination. Thus, the pass grades are determined based on the minimal level of competence determined by Diplomates rating the examination, not on the basis of a specific proportion of the candidate population passing or failing.

Candidates must pass both the general and certifying examination in order to be considered eligible to become Diplomates of the College (see ECEIM constitution).

General Examination: the marks of both parts will be added to produce one final mark. The MCQ are set and evaluated by Diplomates of ECEIM and by colleagues who are Diplomates in related disciplines or from out-with Europe. A process of rating and evaluation of validity by Diplomates of ECEIM will determine the pass grade.

Certifying Examination: candidates must achieve a pass mark in each of the 3 sections. As described in the constitution of ECEIM, candidates that fail only one section of the Certifying Exam can re-take that section individually. If more than one section is failed, the entire Certifying Examination must be retaken. All parts must be completed within 8 years of the initial application. The number of reapplications to sit parts or all of the examination is 3.

Multiple Choice Questions: these are set and evaluated by Diplomates of ECEIM and by colleagues who are Diplomates in related disciplines or from out-with Europe. A process of rating and evaluation of validity by Diplomates of ECEIM determines the pass point.

Essay: each essay is independently graded by at least 2 members of the examination board, who have participated in the construction of an optimal essay response. The two independent grades are averaged: Essays are re-graded if large discrepancies between the independent grades occur. Additional Diplomates also rate each essay question and key.

Objective Case Management: The candidate will be expected to answer a predefined series of objective questions relating to disease aetiopathogenesis, and diagnostic and therapeutic plans, based on the case material they are given. All candidates will be asked the same series of questions, in the same predetermined order, but the number of questions answered will be dependent upon the speed with which the questions are answered. Questions will be marked objectively according to a predetermined marking scheme.

Appeals: for details of the Appeals process, see the ECEIM constitution.

BLUEPRINT FOR MCQ/EMQ SECTIONS

SYSTEM / SPHERE OF KNOWLEDGE	GENERAL 1 UNDERPINNING SCIENCES	GENERAL 2 CLINICAL SCIENCES	CERTIFYING CLINICAL PROBLEMS
Behaviour	2
Cardiovascular	2	3	3
Clinical Pathology*	3
Critical Care & emergency medicine		3	3
Dermatology	2	3	3
Diagnostic Imaging*	2
Epidemiology and medical statistics*	4
Endocrinology, metabolic & hepatic	3	4	4
Exercise Physiology & sports medicine	2		3
Fluid, electrolyte and acid-base balance		3	3
Gastrointestinal	3	7	7
Genetics & molecular biology*	4
Haemolymphatic		4	3
Immunology*	3
Infectious disease & microbiology*	5	3	1
Neurology, neuromuscular, & musculoskeletal	1	4	3
Nutrition*	3
Ophthalmology		3	3
Parasitology*	3		1
Perinatology*		3	3
Pharmacology & toxicology*	4
Respiratory	3	7	7
Urinary	1	3	3
Total	50	50	50

* Elements of these disciplines will be incorporated into the clinical questions and problems relating to the various body systems.

COMMENTS AND EXAMPLES OF QUESTION FORMATS

MCQ questions

The MCQ questions are designed to test knowledge, synthesis of information and clinical judgement. Clearly the realities of practice dictate that the selection of diagnostic tests and treatments is often constrained by financial considerations however, for the purposes of this examination, candidates are encouraged to select their answer on the basis of best medical practice and to assume that there are no specific financial constraints unless they are mentioned within individual questions. Questions on exotic diseases or important diseases which occur only in certain parts of Europe will be included however, in selecting questions, the examination board will ensure that there is no geographic bias and thus, diseases which do not occur within some areas of Europe will not be given undue prominence within the examination. Candidates who are experiencing difficulties related to language during the examination are encouraged to seek assistance from the invigilators. Candidates will also be given the opportunity to comment on the questions, particularly if they feel that the language is difficult, or the options for answers are ambiguous.

All MCQ will be of single best answer format with 3 – 5 distractors (incorrect or less good options). This means that you must select the one option that you consider the best answer to the questions. The distractors are likely to be options that are not necessarily completely wrong but the correct answer will be one that the majority of evidence or opinion in the current literature supports. For example, if you are asked “If antimicrobial therapy is to be used, which of the following drugs is considered the most appropriate for treating Strep. equi equi infection? With the options of: penicillin, trimethoprim sulphonamide, ticarcillin or oxytetracycline? Notice that Strep. equi equi can be sensitive to all of these drugs but penicillin is the correct answer. Of the options given, it is recommended by most (probably all) current texts, although there are clinical circumstances in which one would conceivably choose to use one of the other options (for example if your case was known to be allergic to penicillin, or there were practical difficulties over arranging intramuscular injection etc etc). Equally, when presented with that question, you may feel that you want to make an argument that you would not use antimicrobials in a case of Strangles, however this specific MCQ does not address that issue therefore that argument, while perfectly valid in general terms, is not relevant to this specific MCQ question.

Examples of MCQ typical of those that will be included in each of the 3 MCQ papers (i.e. General 1: Medical and Biological Sciences, General 2: Clinical Sciences and Certifying: Clinical Problems) are given below.

Extended Match Questions

Some of the questions may be of “Extended Match Format”. In this format there will be a list of up to 10 options (A – J) together with a list of questions. The candidate must select the correct answer from the list of options. Please note that each of the options may be used more than once and not all of the options will be used: an example is given below.

Essay Section

Essays will cover topics relating to the pathophysiology of disease, disease treatment and prevention, diagnostic tests, drug therapy and other contemporary internal medicine topics. Essay questions may be constructed in a series of short answers, lists, tables or diagrams. If a list or table is requested, you must provide a list or table etc. Candidates will be allowed to select 2 of 3 questions to answer.

Objective Case Management Section

This section of the examination is designed to test the clinical competency of the candidate. Specific recommendations for preparation cannot be made beyond the clinical experience gained from participation in a residency programme. You will be given time to review the case material before the exam begins: the examiners will then expect you to answer a series of pre-determined objective questions.

EXAMPLES OF QUESTION FORMATS

Examples of Multiple Choice Questions (MCQ) suitable for General Section 1:

QUESTION

Regarding the pathophysiology of neuromuscular disease, which one of the following statements is correct?

ANSWERS & DISTRACTORS

1. Botulinum and tetanus neurotoxins block the action of acetylcholinesterase at the synapse.
2. Botulinum and tetanus neurotoxins increase the action of acetylcholinesterase at the synapse.
3. Botulinum neurotoxin augments the action of acetylcholinesterase at the synapse, while tetanus neurotoxin blocks the activity of acetylcholinesterase at the synapse.
4. Botulinum and tetanus neurotoxins inhibit exocytosis of neurotransmitters from presynaptic nerve terminals.
5. Botulinum and tetanus neurotoxins stimulate exocytosis of neurotransmitters from presynaptic nerve terminals
6. Botulinum neurotoxin blocks exocytosis of neurotransmitters from presynaptic nerve terminals, while tetanus neurotoxin stimulates exocytosis of neurotransmitters from presynaptic nerve terminals

CORRECT ANSWER D

QUESTION

Regarding gastric physiology, which of the following statements is correct?

ANSWERS & DISTRACTORS

1. There is no physiological reflux of duodenal content into the stomach in healthy horses.
2. The physiological reflux of duodenal content to the stomach can have a strong influence on the pH of the gastric content in healthy horses.
3. The physiological reflux of duodenal content to the stomach has a minor influence on the pH of the gastric content in healthy horses.
4. The physiological reflux of duodenal content to the stomach has no influence on the pH of the gastric content in healthy horses.

CORRECT ANSWER B

QUESTION

When infused intravenously in healthy horses at a dose that does not influence systemic arterial pressure and heart rate, phenylethylamine causes:

ANSWERS & DISTRACTORS

1. an increase in digital arterial blood flow and in plasma 5-hydroxytryptamine concentration.
2. a decrease in digital arterial blood flow and in plasma 5-hydroxytryptamine concentration.
3. an increase in digital arterial blood flow and a decrease in plasma 5-hydroxytryptamine concentration.
4. a decrease in digital arterial blood flow and an increase in plasma 5-hydroxytryptamine concentration.

CORRECT ANSWER D

Example of MCQ suitable for General Paper 2

QUESTION

Which of the following sets of laboratory data would you expect to find in a horse that has a mass causing obstruction of the common bile duct?

ANSWERS & DISTRACTORS

	Packed Cell Volume (l/l)	Serum Haemoglobin (g/dl)	Serum total bilirubin (µmol/l)	Serum direct bilirubin (µmol/l)	Urine Bilirubin	Urine urobilinogen
A	0.27	9	100	80	+	-
B	0.32	10.6	40	4	-	-
C	0.12	5.2	160	80	+	+
D	0.32	10.6	100	4	-	+
E	0.27	9	160	80	+	-
F	0.12	4	40	4	+	-

CORRECT ANSWER A

Example of an Extended Match Question (EMQ) suitable for use in General Paper 2.

For each of the following potential risk factors, select the risk factor that increases the risk of the disease occurring

1. Gender: female
2. Age > 15 years
3. Age 5 years
4. Arabian Breed
5. Standardbred Breed
6. May to August
7. August to November
8. High concentrate/low roughage diet
9. Anthelmintic therapy within the last 2 weeks
10. Increasing plane of exercise

1. Caecal Impaction (Correct Answer C)
2. Non-specific (medical) colic (Correct Answer D)
3. Larval cyathostomiasis (Correct Answer I)
4. Complex congenital cardiac defects (Correct Answer D)
5. Aortic Insufficiency (Correct Answer B)
6. Pituitary pars intermedia dysfunction (Correct Answer B)

Example of an MCQ suitable for Certifying Exam (clinical problem-solving)

QUESTION

You attend a 4-year-old Thoroughbred broodmare, shortly after her return from a stud farm in Normandy (France). The owner reports anorexia and depression and a rectal temperature of 40.2°C. Initially, he suspected transport-stress and over the next two to three days, the fever remained high and the mare also started to cough.

Your clinical examination reveals nasal discharge, rhinitis, conjunctivitis, peri- and supra-orbital oedema, and limb oedema. There is leukopaenia and lymphopaenia.

You plan to submit samples for laboratory testing. Which one of the following viruses do you consider the most important to test for?

ANSWERS & DISTRACTORS

1. Equine Influenza
2. Equine Herpesvirus
3. Equine Viral Arteritis
4. Equine Rhinovirus
5. Equine Adenovirus

CORRECT ANSWER C

Examples of Essay in Certifying Exam:

See website for examples of previous essay questions

Example of an Objective Case Management (OCM) question in Certifying Examination

See website for examples of previous OCM questions
GENERAL COMMENTS ON EXAM PREPARATION.

The entire examination will emphasize information taken from the current veterinary literature. Selected information will also be taken from the current human and general biomedical literature. With respect to the veterinary literature, current veterinary textbooks and papers published in refereed journals should be the primary study area. Candidates are advised to prepare for the examination by a systematic review of recent textbooks and periodicals. Your mentors can help you select appropriate study material. WE CANNOT DEFINE CONCLUSIVELY THE BODY OF KNOWLEDGE NECESSARY TO PASS THIS EXAMINATION – the following list is ONLY A GUIDELINE.

Textbooks

Equine Internal Medicine (Reid, Bailey, Sellon)

Equine Medicine and Surgery (Merritt, Moore, Mayhew et al)

Current Therapy in Equine Medicine I – 5 (Robinson)

Large Animal Internal Medicine (Smith)

Equine Sports Medicine and Surgery (Hinchcliff et al)

Clinical Biochemistry of Domestic Animals (Kaneko)

A current textbook in physiology (e.g. Guyton and Hall or Ganong)

Clinical Physiology of Acid-base and electrolyte disorders

A current textbook in immunology (e.g. Roitt or Tizard)

Large Animal Neurology (Mayhew)

Veterinary neuroanatomy and clinical neurology (DeLahunta)

The Pharmacological basis of Therapeutics (Goodman and Gilman)

Veterinary Drug Handbook (Plumb)

Respiratory Physiology (West)

Veterinary Laboratory Medicine (Duncan, Prasse, Mahaffey)

Veterinary Clinical Epidemiology (Smith), or Veterinary Epidemiology (Thrusfield)

Equine Diagnostic Ultrasound (Reef)

Manual of Equine Gastroenterology (Mair, Divers Ducharme)

Equine Respiratory Medicine and Surgery (McGorum, Dixon, Robinson, Schumacher)

Equine Emergencies (Orsini and Divers)

Equine Infectious Diseases (Sellon and Long)

Equine Neonatal Medicine (Paradis)

Equine Neurology (Reed and Furr)

Diagnostic Techniques in Equine Medicine (Taylor, Brazil and Hillyer)

Journals

Journal of Veterinary Internal Medicine

Equine Veterinary Journal

Journal of the American Veterinary Medical Association

American Journal of Veterinary Research

Compendium of Continuing Education for the practising veterinarians

Veterinary Clinics of North America

Equine Veterinary Education

New England Journal of Medicine (major review articles)

Veterinary Record

Veterinary Journal

ACVIM and AAEP Proceedings (recent years)