Fellowship SAQ Templates
1. ASSESSMENT QUESTION
Put AIMS at start:
1) Severity
2) Differential Diagnosis
3) Complications
“My aims are to…”
1) Rapidly assess SEVERITY of illness
Ie do they need resuscitation?
2) Establish a DIAGNOSIS
Ie What is DIFFERENTIAL DIAGNOSIS?
Put: Most LIFE THREATENING/REVERSIBLE FIRST
Then: MOST COMMON
Can do by :
Systems: CVS/Resp/Neuro etc
Specialty: Medical, Surgical, Psychiatric, Obstetric
TRY & PRIORITISE LISTS
Then state severity of MOST LIKELY DIAGNOSIS
To guide Mx/disposition
3) Identify complications
Could do:
1) Rapidly assess severity of illness
2) Establish a diagnosis (for this specific condition)
THEN:
1) HISTORY
2) EXAMINATION
For SIGNS/SOURCE/EFFECTS of illness
For SEVERITY: eg arousal/alertness, vital signs, cap refill
“I would perform a complete physical examination…
…Fully undress patient…
including/looking for…”
“I would examine…” General/ENT/CHEST/ABDO/DERM/HAEM
Try & make it specific to case
3) INVESTIGATION
Can include “A period of observation in the ED”
2. DISCUSS QUESTIONS
READ EACH WORD IN QUESTION
Focus on question/case
“What I would do”
What are my PRIORITIES?
Eg To exclude a certain Dx
AIMS
May write aims FOR THE SPECIFIC Q.
Eg Investigation
Then put in context in 1-2 sentences
Then describe each point in format
PROS
CONS
KEY WORDS/PHRASES
 PRE TEST PROBABILITY
 SENSITIVITY/SPECIFITY
 RISK STRATIFICATION
CONS:
Eg for an Ix: False reassurance eg of non-bacterial illness with normal WCC/CRP
Remember specific figures for tests eg WCC in paeds sepsis (15,000)
3. EXAMINATION:
Need to mention what you are examining for:
I will examine for signs of:
Envenomation
Toxicity
Shock… tricky
Can say: eg
Vital signs
For signs of:
Shock
Cardiovascular collapse
Indicating severe envenomation/toxicity
A/B/C’s
Expand for specific questions
Eg in awake multi-trauma patient, with fractured pelvis
A: Likely to be patent/protected in this patient
Anticipate & manage:
Need for endotracheal intubation
If GCS drops to <8
B: Apply oxygen at 15L/min via Hudson mask
C: Large bore IV access x 2
Anticipate and manage large volume blood loss
Normal saline boluses 20ml/kg
O-negative or cross matched blood as required/available
Pelvic stabilisation – binder/external fixation/internal fixation
Consider embolisation/theatre if above unsuccessful
Eg Snakebite:
Vital signs… as above
Coagulopathy
Bleeding puncture sites
IV sites
Occult bleeding
Gastrointestinal
IntracranialNeurological
Ptosis
Limb weakness
Rhabdomyolysis
Muscle tenderness
Bite site
Single or multiple
First aid/ Pressure immobilisation
4. INVESTIGATION Questions (Part of “Assessment Q’s)
Bedside
Radiological
Laboratory
Others
Can (& should) write in any order appropriate to topic
ie Put MOST RELEVANT FIRST
Can list as:
Tests to:
Establish diagnosis
Look for complications
Determine treatment
Can list as:
1st line
2nd line
In some cases NO INVESTIGATIONS may be warranted
Eg Appendicitis
“This is a clinical diagnosis”
Investigations have a limited role
and low specificity/sensitivity
FWTU in everyone
+/- FBE: WCC lacks sensitivity/specificity
U/S
CT
Certain conditions eg snakebite
Lends itself to listing by condition that is being assessed by the Ix
Eg
Snake Identification
CSL VDK
Not indicator of envenomation
Bite site
Preferred sample
Moistened swab
Urine
Less reliable
False +ves/-ves
Blood
Not indicated
Not used
Unreliable
Coagulopathy
Fibrinogen level – can drop rapidly after bite
- used to measure response to antivenom
D-dimer (FDP’s) – massively elevated
INR/APTT – elevated
Whole blood clotting time
FBE: platelets – may drop
Rhabdomyolysis
CK: concern if > ____
Urinary myoglobin – urine dipstick +ve blood (plus micro negative for
RBC)
Renal function – renal failure from obstructed tubules
& Potassium – hyperkalaemia
REMEMBER TO COMMENT ON TIMING OF Ix IF RELEVANT
Eg Snakebite
Initial Ix
If normal at __hrs
Repeat @
6 & 12 hrs post removal of 1st aid if no treatment given
During treatment to monitor progress
5. MANAGEMENT QUESTIONS
TRY & FIT UNDER THESE SUBHEADINGS:
TREATMENT
SUPPORTIVE
+ Communication
+ Consultation
DISPOSITION
POINT FORM IS BEST (& QUICKEST) way to answer
Eg “I would identify & treat… (eg) complications”
Then LIST in point form
Can state differential Dx at start – ie most obvious/serious causes
AIMS
1) ESTABLISH SEVERITY
Avoid using “qualifiers” like mildly/moderately/severely unwell
Just say: “The child/person is unwell”
Mx will depend on:….severity of particular illness
Eg DKA – pH, dehydration, conscious state
2) “My management…”
“…will include…”
“…will focus on…”
then list major issues
eg General
Setting
Resusc: ABC/IV/O2
Specific
Eg
DKA
-
Fluid – in detail
Insulin – in detail
Electrolytes – in detail
Ongoing reassessment/monitoring (incl CVC/Art line if severe)
“In detail” means
Amounts
Doses
When to start/stop/change
It’s fine to say:
“I’d follow the local protocol…”
“My routine practice is…”
6. ADMIN QUESTIONS –
GENERAL TIPS
Intro
Define Terms
Needs analysis
Background research
Internet, health dept, libraries, college and international sources
Fiscal considerations
Determine your own position
Involve all relevant stakeholders in workshops/discussions
Think DR, RN, pharmacy, radiology, GP, consumer, HITH
Develop
Implementation
Develop a plan structure/time frame for implementation
Evaluation
Feedback, surveying
Pt Satisfaction
Quality measures
Research
Education
Educate staff regarding outcomes
7. PROCEDURE OR PROTOCOL DEVELOPMENT
Intro
Experience required– credentialing of staff
Indications
Contraindications
Preparation
Pt explanation
Consent
Location
Staff
Equipment, Monitoring
Fasting status
Procedure
Universal Precautions
Method
Post procedure care
Disposition
Follow up
Documentation
Complications
Controversies/Pitfalls
Special Groups
Medicolegal
Audit
8. SITUATION MANAGEMENT QUESTIONS
Ie not just Mx of a medical problem
Usually: Situation management (see Admin Q’s)
Eg: Complaint, Violent patient, the intoxicated staff member
Aim:
Deal with the IMMEDIATE problem (usually a medical one)
THEN:
QA
Medicolegal
Mandatory reporting
OH&S
Often can include:
AUDIT
REVIEW
STAFFING
Other issues
Ie deal with main issue then take a step back and look at bigger picture