PCIA - Replacing the former patient interaction component of the Final Exam Medical Viva
18 March 2024
In 2025, the patient interaction component of the final exam medical viva will be re-introduced as the patient clinical interaction assessment (PCIA).
Prior to 2020, the final exam included two medical vivas. These were held the day after the written exam, at a small number of centralised hospital locations and involved bringing in volunteer patients from the community. For many reasons, we needed to move away from this format. However, the doctor-patient interaction prior to anaesthesia is critical for shared decision-making and appropriate preparation and planning for surgery. We need to ensure our new fellows are competent to manage this work.
In 2021 ANZCA established a working group to address the gap left by the loss of the patient clinical interaction in the previous medical viva. The group produced a proposal, consulted with key committee stakeholders, refined the proposal to address feedback, and presented a final proposal with recommendations to ANZCA Council in 2023. The recommendations have been endorsed by ANZCA to implement the new PCIA in 2025.
The Australian Medical Council has also recognised the importance of this assessment by placing a condition on ANZCA to develop, implement, and document a competence-based patient-interaction assessment to support progression from advanced to provisional fellow training stages.
The assessment will take place in the trainee or SIMG’s work environment by trained PCIA assessors from their hospital, who will observe the trainee conducting a formal preoperative assessment of a co-morbid patient awaiting surgery. The assessor scores the trainee using a structured marking template. After the patient leaves, the assessor asks questions about reasoning, decision-making, and planning and provides constructive feedback.
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The key features of the PCIA
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Venue
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Pre-assessment clinics, on patients who are attending for anaesthesia pre-assessment. Under some circumstances, the PCIA could involve an inpatient awaiting pre-assessment for potential surgery.
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Timing
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Any time during Advanced Training (AT) prior to sitting the final exam. For SIMGs who present for the SIMG exam, the PCIA will need to be completed after at least one approved clinical practice assessment (CPA) report and prior to sitting the SIMG exam.
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Selection of cases
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SOT or PCIA assessor identify suitable patients booked to attend clinic on a set day. The patient must have co-morbidities that could impact on their management before and during surgery.
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Required numbers of PCIAs
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Two PCIAs to the required standard for progression to Provisional Fellowship year (PFY) at the core unit review.
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Standard required
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Competent to communicate with, assess, and appropriately plan care for a patient with significant co-morbidities presenting for formal anaesthesia pre-assessment prior to surgery.
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Number of repeats allowed if standard not achieved
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The PCIA can be repeated until the standard to progress is achieved in two PCIAs. Trainees are encouraged to undertake practice PCIAs prior to the formal PCIA.
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PCIA assessors
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Details of this role are still being considered by the WG in collaboration with key stakeholders.
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Patient safety
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The PCIA assessor may intervene in the consultation if they are concerned about patient management. This will likely indicate the trainee has not yet reached the standard to practice unsupervised.
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PCIA assessor support
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The PCIA assessor role will require assessment skills, as well as perioperative medicine. Support will be provided through online training and a standardised template that guides both the assessor and the trainee or SIMG through the assessment and the subsequent feedback.
Further support will be developed in collaboration with the PCIA assessors.
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PCIA governance
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The system of assessments, including the PCIA, will be managed by an ANZCA sub-committee, be subject to monitoring, evaluation and quality improvement, and training site accreditation.
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Start date
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The intention is to introduce the PCIA for trainees and SIMGs taking up their AT or CPA from the beginning of 2025. |
What happens next?
In 2024 the PCIA Working Group will trial the process in a range of departments, develop training materials for PCIA assessors, recruit assessors, and communicate details to trainees and fellows.
We are aware of concerns about time requirements, impact on service role/s as well as having appropriate venues and assessors across all training sites. The working group is engaging with stakeholders to achieve the balance of having a robust assessment that will be a valuable to trainees and SIMGs yet workable in our clinical environments.
Updates on the project will be communicated via stakeholder committees and through college publications such as e-newsletters and the ANZCA Bulletin.
This is an important assessment and will require input from all those involved to get the process right and ensure the PCIA is of value for trainee learning as perioperative physicians and for progression decisions to the Provisional Fellowship year.
If you’re interested in piloting a PCIA assessment with one of your trainees and providing feedback, please email us your details. This will help us to refine the processes.