Stage A Chemical Pathology Examination

The Stage A Examination is primarily intended to be a test of competency and aptitude for further training in the specialty. The Stage A Examination questions will be simple uncomplicated scenarios and you will not be expected to have a detailed knowledge of the analytical methodologies, or the diagnosis or management of complicated or rare cases.

You should expect to be asked to perform practical procedures such as point of care testing, including urinalysis, perform simple calculations and comment on clinical cases which involve the interpretation of biochemical data. In the calculation questions, if a particular formula or equation is needed, then this will be given in the question paper. It is important that you record how you performed any calculation in your answer paper, since the method by which you arrived at your answer, as well as the numerical value you give, will all attract marks.

You are allowed to bring your own electronic calculator.

The number of answers required for each question, or part of a question, will be clearly stated in the question paper. The assessors will mark the answers in the order in which you give them, up to the number of answers specified in the question, or part of the question. Any answers in excess of the number specified will be disregarded by the assessors.

There will be 19 stations and you will have 9 minutes at each station.

Examination Content

The following is a list of subjects which will form the core of the Stage A Examination:

 1. A basic knowledge of analytical methods which are applied in routine clinical laboratory practice and calculations based on these methods.

2. A basic knowledge of the performance characteristics of assays and calculations of such characteristics. Specifically: bias, imprecision, range and analytical interferences.

3. Understanding the basis for intra- and inter- individual variability of biological/physiological methods, the derivation and use of reference ranges and calculations based on these topics.

4. A basic knowledge of the principles of quality control, including the interpretation of external quality assurance reports.

5. Understanding the principles of specimen collection, documentation and storage.

6. Knowledge of elementary statistical tests, to include descriptive methods such as mean, median, mode, standard deviation, range and confidence intervals, and calculations based on these tests.

7. Knowledge of the statistical interpretation of test results, to include sensitivity, specificity, predictive values and receiver operator characteristic curves, and calculations based on these tests.

8. Ability to conduct, record and interpret simple point of care biochemical tests.

9. Ability to interpret the results of routine biochemical tests and advise at the appropriate level of understanding further investigations which might be required.

10. Knowledge of the diagnosis and treatment of common biochemical and metabolic disorders.

11. Management of acute biochemical and metabolic emergencies.

12. Health and safety aspects in the laboratory.

13. The importance of patient confidentiality.

Standard Setting the Stage A Examination

For the Stage A Examination, the standard will be set before the examination is taken, using the Angoff method.

The assessors/examiners who will derive the standard are knowledgeable in the content area. All the regional and deputy members of the Stage A Chemical Pathology Examination Panel are practitioners in the relevant field – familiar with the Stage A curriculum and are involved in the educational process of ST1 chemical pathology and ST3 chemical pathology (metabolic medicine) trainees.

What is Angoff?

The Angoff is an iterative standard setting method that focuses on individual questions and the probability that the just minimally competent candidate will answer each question correctly.

The main advantages of the Angoff method are that:

  • reproducibility is good

  • the pass mark is known in advance as it is set before the examination takes place

  • it is credible and defensible – candidates are evaluated according to minimum standards and not the standards of the examination group.

The main disadvantages are that:

  • it is resource intensive

  • it is time consuming – as all percentages outside the average range are discussed.

The Stage A Examination paper will consist of a mixture of previously validated and new questions confirmed by the Stage A Chemical Pathology Examination Panel. The overall provisional Angoff pass mark for the paper will be the total of the chosen questions.

A standard setting meeting will be held to discuss and determine the final overall pass mark for the Stage A Examination. For each station, the individual pass mark, derived from the Angoff standard setting method will be considered and the station pass mark adjusted accordingly following specialist and expert advice.

There are two criteria required to pass the Stage A Examination. Trainees must achieve or exceed both:

  • The pre-specified Angoff pass mark in at least 12 of the 19 stations. This is roughly equivalent to passing 60% of the stations, and so, if one or more stations have to be eliminated from the final scoring due to technical problems, the ‘number of stations passed’ criterion will be adjusted downwards to reflect a requirement to pass 60% of the remaining stations.
  • The global Angoff pass mark for the entire complement of stations in the examination. Since the global pass mark will depend on the stations selected for each examination, this will differ slightly from one examination to another, but in general the global pass mark has always been within a few percentage points of 60%.

The minimum number of stations required and the global pass mark for the each opportunity of the Stage A Examination will be determined by the Stage A Chemical Pathology Examination Panel.

References

1. Norcini, JJ. Setting standards on educational tests. Med Educ 2003;37(5):464–469.