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GUIDELINES FOR CANDIDATES AND EXAMINERS

OCCUPATIONAL MEDICINE SPECIALTY EXAMINATION

FELLOW OF THE COLLEGE OF PUBLIC HEALTH MEDICINE
(DIVISION OF OCCUPATIONAL MEDICINE)
FCPHM(SA) Occ Med
Introduction
This document should always be read in consultation with the latest updated Regulations
for Admission to the examination for the FCPHM(SA) Occ Med (J une 2004). These are
available from the Colleges office in J ohannesburg and are also reproduced on the
Colleges web site. The reasons for writing and circulating this document are as follows:
1) To provide the latest interpretation of our assessment system.
2) To enhance the validity of our assessment methods.
3) To improve the reliability of our assessment methods.
4) To promote transparency concerning the assessment process.

The Grading System currentl y in use
The system presented below is a default system. It is used especially for the research
reports and the oral examinations. However, examiners may also use it for the short
answers paper and the essay paper in preference to the rubrics that are shown later on.
The candidate passes or fails on the basis of the overall average mark achieved. A pass
standard is the standard that is expected of a specialist and we call this standard 50%. A
distinction is 75% or above. The candidate scoring the highest aggregate will be
considered for the award of the SASOM medal only if he/she achieves an aggregate mark
of 70% or above and 65% or above in each exam component

Examiners will award a qualitative assessment for the answer or section (e.g. excellent,
clear distinction, or does not meet the expected standard and will then allocate a
percentage mark in multiples of 5 (at the request of the ECC of the Colleges). The possible
marks awarded are (marks typed in bold will be allocated more readily, if appropriate,
whereas those in italics will be allocated only rarely):

Excellent, outstanding, clear distinction: 75; 80; 85; 90; 95; 100
Very good 65; 70
Adequate, comfortable pass 60
Barely adequate 50; 55
Sub-standard 40; 45
Abysmal 0; 5; 10; 15; 20; 25; 30; 35
For the MCQ paper, and for the MMed dissertation mark awarded by Universities,
however, the percentage marks earned will be incorporated into the calculation of the final
mark as is and without modification. In addition, the marking of the two written papers is
somewhat different, making use of rubrics.

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WEIGHTING OF DIFFERENT PARTS OF THE EXAMINATION

The following section will replace weighting allocated in the section 16.5 of the
FCPHM (Occ Med) regulations dated June 2004. The different parts of the examination
are weighted in the final average mark as follows:
MMed dissertation (or long report/defence) 20/100*
Short report (e.g. case study) 12/100
Multiple choice paper 12/100
Short answers paper 12/100
Essay paper 12/100
Oral exam (questions and presentation) 12/100
Occupational medicine skills examination 20/100
* or the mark weighted accordingly for the long report and its oral defence where this option is permitted

Note that the candidate must obtain an average passing mark (50% or greater) for the
unseen sections namely the three written papers and the occupational medicine skills
examination marked together and weighted for this purpose as follows:

Multiple choice paper 12/56
Short answers paper 12/56
Essay paper 12/56
Occupational medicine skills exam 20/56

THE STRUCTURE OF THE EXAMINATION

I: THE FORMATIVE ASSESSMENT
Candidates are required to produce at least SIX formative assessment reports, one for
every 6 months of completed training, satisfactorily completed, for the examinations.
The assessments should cover the whole period of training. These formative assessments
should be in the required format, or one that is very similar (Appendix number 1). The
examinations office staff will send the formative assessments to the convenor as soon as
entries close.
The convener must, after consultation with a second examiner, either accept or reject
them, and thereafter inform Mrs Ann Vorster in J ohannesburg of the decision within 3
weeks of the extended closing date for entry for the examination.
If the formative assessment is unacceptable then the candidate will be denied entry to the
examination, which is why there is a need to communicate the outcome as soon as
possible.
It would be highly unusual to reject the formative assessments outright unless it is clear
that the candidate has had little relevant formal training. In such cases the decision to
reject must be ratified by the president of the College after due consultation.
The formative assessments are also taken to the examiners meeting after the examination
where they may be used to offer advice to candidates who fail and who require some
guidance from the examiners as to how they might best structure their learning
experiences before attempting to write again.

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II: THE SHORT REPORT
The short report (maximum 4000 words) must be in acceptable format. Instructions to
candidates are presented as Appendix 2. In practice a report would be acceptable if it
addresses an important issue and makes a compelling and well-supported case. The short
report could take the form of an occupational medicine clinical case study, clinical case
record review, a programme implementation or evaluation report.
It should be between 20-40 pages long (1 spacing, size 12 font and excluding title page,
summary, acknowledgements and bibliography). The short report should indicate the
name of the supervisor and the specific role of the student in relation to the contents of the
report.
The examinations office will send copies of the short report to each of the four core
examiners soon after the closing date for entry. Should there be more than 3 candidates,
the additional examiners will be requested to mark the short reports.

III: THE MMED DISSERTATION (LONG REPORT)
All candidates are required to submit the MMed thesis to their academic institution for
marking prior to sitting for the examination. This should be a long report (maximum 7000
words, excluding tables, figures, references and appendices) containing the results of an
analytical, quantitative, epidemiological study carried out by the candidate (see Appendix 2
for a more detailed guideline).
For the exceptional candidates who are required to submit a College long report rather
than an MMed dissertation mark the long report must be quantitative as above. In such
cases the examinations office will send copies of the long report to each of the four core
examiners soon after the closing date for entry. These examiners are asked to grade the
long reports and complete a score sheet for each and return these score sheets to the
convenor (Appendix 3).
Where a candidate submits an MMed mark for a dissertation in lieu of satisfying this
requirement, this latter procedure does not apply. Instructions to candidates are presented
as Appendix 2. In such cases, the mark must be submitted by the candidate with the
application to enter the examination.

IV: THE WRITTEN PAPERS
Three, written, closed book examination papers, each potentially covering the entire
syllabus which will be a combination of basic public health sciences and occupational
health sciences (occupational medicine, occupational hygiene and occupational health
service management), but collectively demonstrating an appropriate balance between the
different sections. Overall pass mark for written examinations taken as a whole: 50% with
a sub-minimum of 45% on any individual paper.
Multiple choice/annotate the diagram/ sketch a diagram style of questions
Short answer questions
Essay questions

a) The MCQ paper
This paper has 60 questions. Questions will be of the format illustrated in Appendix 4. This
will include an appropriate proportion of clinically oriented questions. The duration of this
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paper will be three hours.

b) Short answer paper
This paper has 12 questions of which candidates are required to select and answer no
more than 10. These are fairly specific questions each requiring an answer of about one
page and taking about 15-20 minutes to answer. The marking is done according to an
answer rubric along the lines presented in Appendix 5 or by using the default method.
The duration of this paper will be three hours.

c) Essay questions paper
This paper has four questions and candidates must answer any three questions to
demonstrate integrative skills. The duration of this paper will be three hours. There are a
number of purposes behind this paper:
to assess understanding of content
to assess written skills, i.e. structure and readability;
to assess ability to integrate content material across disciplines and/or sectors;
to evaluate skills at presenting a logical exposition or if appropriate a convincing
argument.

An answer sheet that is generic for all essays is presented in Appendix 6. Alternatively, the
default system of grading, described earlier on, may be used.
It is suggested that, for each answer, you spend 15 minutes planning your answer (rough
work should be clearly marked as such) and 45 minutes writing your answer.

V: THE ORAL EXAMINATIONS
An oral examination in two parts. In the first part (30 minutes), the candidate will be asked
to answer questions on any occupational medicine topic by a panel of 4 examiners. This
will test breadth of knowledge. Each examiner will be required to provide the question and
a broad outline of the answer to the convenor one week prior to the oral exam.
In the second part (40 minutes) the candidate will asked to make a 20 minute powerpoint
presentation of their approach to or solution of a complex occupational health practice
scenario, followed by 20 minutes of questions, This will serve as an integrative
assessment. The topic will be sent to the candidate together with the invitation to attend
the oral, i.e. after the written examinations have been marked. This will give the candidate
approximately one month to prepare. The candidate must bring their presentation on a
virus-free flash drive to the examination. The candidate will be assessed according to the
schedule outlined in Appendix 8.
The two parts may be conducted in any order.

VI: THE CLINICAL SKILLS EXAMINATION
The clinical examination is a central component of the oral examinations. Candidates will
be required to take an appropriate history and conduct a physical examination of a short
case. Candidates will be given approximately 45 minutes to do this. The candidate will be
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given 15 minutes to present the case. The candidate will be questioned by two examiners
for 15 minutes. They will be assessed according to the schedule outlined in Appendix 7.
The second component of this exam will be an OSCE (Objective structured clinical
examination) of 10 stations requiring interpretation of case studies, special investigations
(e.g. spirogram, audiogram, chest radiographs, allergy tests etc.) and photographs or
other visual material. These will be items that cannot be tested in the written or general
oral examinations. The duration of the OSCE exam will be 60 minutes. The answers will
be marked in a similar manner according to the rubric for short answers contained in
Appendix 5.

WHAT HAPPENS IF A CANDIDATE FAILS THE EXAMINATION?
Where a candidate fails to achieve an overall mark of 50% for the examination, or fails to
achieve a mark of >50% for the unseen components (as an aggregate mark for these) the
examiners may recommend that the candidate be exempted from repeating one or more of
the following sections in future attempts, provided that they have been passed at the
current attempt and that the candidate wishes this; and that the candidate attempts the
examination at the next available opportunity:
The short report/case study
The 3 written papers taken as a whole
The oral exam and clinical components taken as a whole
(The long report - if marked through the College)

In such cases the marks for the exempted sections must be carried forward to the next
attempt, and a distinction may not be awarded at that attempt. If the candidate is still
unsuccessful (i.e. aggregate mark is still <50%) then all components of the examination
must be re-taken at the following attempt.


FEEDBACK TO THE CANDIDATE

The conduct and outcome of the examination are confidential in the sense that details may
only be discussed with the candidate concerned. Candidates who require feedback should
request this after the examiners meeting, which follows immediately after the oral
examinations. This includes feedback on research reports marked by the College, in which
case the comments supplied by the examiners are given to the candidates, but with the
examiners name obscured.






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APPENDIX 1: THE FORMATIVE ASSESSMENT FORM

FORMATIVE ASSESSMENT OF CANDIDATES WHO WISH TO WRITE THE FCPHM(SA) OCC MED
EXAMINATION OF THE COLLEGE OF PUBLIC HEALTH MEDICINE (SA)
(Division Occupational Medicine)


This formative assessment should be carried out 6 monthly by the candidate and Head of Department (HOD)
or occupational medicine academic training convenor. The formative assessment provides an opportunity for
the candidate and HOD to regularly review the learning that has taken place, and that is planned for the next
6 months. The dates for completion of these forms are J an 31 and J uly 31 each year.

CANDIDATE S NAMES:
NAME OF INSTITUTION:
NAME OF HOD:
PERIOD COVERED: FROM: TO:


TABLE I: PLANNED LEARNING OBJECTIVES FOR THE PERIOD UNDER REVIEW

Learning objectives that were planned for the period being reviewed should be listed in the table below. This
section must be completed at the start of the assessment period, and in subsequent periods will simply be
copied from the plan drawn up at the previous period of assessment.
Exampl e:
ACTIVITY PLANNED MAJOR LEARNING OUTCOMES ENVISAGED
1. Two stats modules 20% of the outcomes listed under biostatistics in the College regulations Appendix A
2. Rotation at NIOH (3/12) Writing a study protocol
Reading and grading chest X-rays for silicosis
3. Attachment at hospital (2/12) Learning about the duties of the MS
Learning about the HIS and its strengths/weaknesses and how to improve it
Conducting meetings








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TABLE II: THE CANDIDATES SELF-ASSESSMENT OF THE LEARNING EXPERIENCE
Exampl e:
1. Two stats modules were attended, final mark was 83%. I feel I mastered all the topics covered but will need to
consolidate my learning about logistic regression modeling through practical experience by collecting and analyzing
suitable data. I could achieve this by constructing a hypothetical data set for a hypothetical study and then asking Dr X
to review the way in which I analyzed the data. I also need more experience using Stata, and such an exercise will be
helpful with this as well. I will incorporate this suggestion into my next learning plan.
2. The occupational health rotation at the occupational health centre (3/12) was useful. I developed a protocol for a
hepatitis B staff immunization survey that is now being implemented. In addition I completed Prof Whites ROLDS
course by distance learning and now feel reasonably confident that I will be able to read and interpret chest X-rays of
mine workers for silicosis.
3. The attachment at the hospital (2/12) was only partially successful. I was never permitted to actually convene and chair
any meetings, so although I have observed the process I feel I need to actually do it to be more confident. I will ask the
HOD if I might convene chair and minute some departmental meetings over the next 3 months and ask the staff of the
department to feed back and critique my performance.
Regarding the HIS I wrote up a description of the system and made recommendations to the MS. We held a 1 day
workshop with 40 participants at the end of the attachment in which participants identified those parts of the report that
were worth taking forward. They also identified a work plan for the implementation of these proposals. I feel, however,
that the workshop participants did not really accept some of the findings and recommendations that I thought were
more important, while dwelling on smaller issues that I felt were less important. One of the problems was that my
supervisor was not available to chair the workshop and so it was chaired by one of the MSs who is not involved with
the HIS. Also, although my report was ready 2 weeks before the workshop I would have preferred to have discussed it
with my supervisor before circulating it to the workshop attendees, but my supervisor was overseas at the time.








Table III should be completed by the HOD or occupational medicine academic training mentor/supervisor
after having met with the candidate to discuss the contents of Table II.


TABLE III: THE HOD OR ACADEMIC MENTOR/SUPERVISOR S ASSESSMENT OF THE LEARNING
EXPERIENCE
Exampl e:
1. I would support that the candidate designs and carries out this statistical analysis exercise and will ask the
biostatistician to give her help with assessment.
2. Good learning appears to have taken place. Since the candidate is especially interested in occupational lung disease, I
will try to arrange for a further attachment next year during which he should work on a project that will be suitable for
the dissertation.
3. The candidate can chair the monthly education committee meeting for the next 4 months. We will all meet between
each meeting to give feedback and advice.
E-mail could have been used to keep in contact with the supervisor: he however did not have e-mail access while
traveling. In future all staff who are traveling on business should arrange e-mail contact prior to departure if this is
deemed necessary.
The candidate would probably benefit from attending the negotiation skills module that is offered at the Business
School in three months time.



TABLE IV: THE CANDIDATES LEARNING PLAN FOR THE NEXT 6 MONTHS
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Exampl e:
MATTERS TO CARRY FORWARD:
1. To design a hypothetical project, generate a dummy data set and analyze it using Stata.
2. To prepare a protocol for a dissertation that involves reading and interpreting chest X-rays for silicosis screening.
3. To attend the Negotiating Skills module at the Business school.

NEW ACTIVITIES PROPOSED
ACTIVITY LEARNING OUTCOME
4. 6/12 rotation with the LA To learn about the way in which the LA carries out its environmental health
duties
To learn about the legislative framework in which these duties are carried out
To learn how to control prevent and measure air pollution
To assist with infectious diseases outbreaks that might occur
5. Module on outbreak investigation 100% of relevant learning objectives mastered
6. Module on environmental health 40% of content of environmental health in the College regulations


TABLE V: ADDITIONAL COMMENTS

a) FROM THE REGISTRAR:




a) FROM THE CLINICAL/SERVICE SUPERVISOR:






SIGNED:


____________________________ DATE _________________
(REGISTRAR)



____________________________ DATE _________________
(HOD)

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APPENDIX 2: GUIDELINE FOR RESEARCH REPORTS

Short reports

In practice a report would be acceptable if it addresses an important issue and makes a
compelling and well-supported case. The short report could take the form of an
occupational medicine clinical case study, clinical case record review, a programme
implementation or evaluation report. A rapid epidemiological assessment method would
be acceptable provided that the context is appropriate and limitations are fully discussed.
The length of the report is expected to be approximately 20-40 pages, but must not exceed
60 pages excluding the title page, indices, bibliography and appendices.
Suggested suitable short reports would include:
A detailed clinical case report and commentary of a patient with an
interesting/unusual clinical presentation (this should follow a standard clinical case
report as is reported in the literature)
A record review of all noise-induced hearing compensation claims in a factory
An occupational health service review/audit
An economic analysis of a medical surveillance programme with policy
recommendations
A detailed risk assessment of a workplace (with recommendations for interventions)
A KAP study of HIV/AIDS in the workplace

Long reports
For long reports that are submitted to the College for assessment, a formal
epidemiological study which explores an occupational health question is required in all
cases. The standard of work must be sufficient to convince the examiner that a publication
based on the work could be accepted (after editing) by an indexed peer-reviewed journal.
The length of the report is expected to be approximately 50-100 pages, but must not
exceed 120 pages excluding the title page, indices, bibliography and appendices.
Depending on the nature of the research, it may be possible to present shorter reports
than indicated and to do well.
Suggested suitable long reports would include an analysis of routine or descriptive data, a
cross-sectional, cohort or case-control study, a controlled intervention study or a
systematic review.
The structure should include:
Background
Objectives questions, or hypotheses of the investigation
A critical literature review
The population to which the results apply and, sampling methods
Methods of gathering and managing data and quality control steps (to maximize
reliability and validity of measurements)
Statistical methods used
Ethical issues
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Results
Discussion including main findings, limitations, concordance with the literature,
conclusions and recommendations.

NB!!!
In all cases the research report must include a copy of the ethics committee approval form
for the study. Failure to include this form or an exemption certificate if appropriate, will lead
to a compulsory failing mark for the report.
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APPENDIX 3: MARKING SCORE SHEET FOR RESEARCH REPORTS
THE COLLEGE OF PUBLIC HEALTH MEDICINE (Division Occupational Medicine)
The marks allocated per section are a rough guideline only and need not be followed exactly

NAME OF CANDIDATE:
TOTAL MARK
OUT OF 100 =

TITLE OF REPORT:




OVERALL
PRESENTATION:

(10)


INTRODUCTION AND
LITERATURE REVIEW
AND OBJECTIVES:

(20)


METHODS:
(25)



RESULTS
(25)



DISCUSSION,
CONCLUSIONS AND,
RECOMMENDATIONS:

(20)



FURTHER COMMENTS:



MARKERS NAME*:


*The markers name will not be divulged to any third party

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APPENDIX 4: THE FORMAT FOR MCQ QUESTIONS

THERE WILL BE NO NEGATIVE MARKING

Q1
With regard to the demographic composition of the South African population, which
ONE of the following statements is the most correct
a. 90% of the total population is over the age of 15
?
b. All adult women outnumber all adult men by a ratio of 3:2
c. Foreign born adults make up 40% of the formal workforce
d. 15% of the total population live in rural areas
e. Of the nine provinces, Gauteng has the highest population density

The answer to Q 1 is
e.


Q2
In a cohort study, 16 out of 20 workers who are exposed to a respiratory sensitiser
develop asthma symptoms whereas only 4 out of 16 who are not exposed develop
asthma symptoms. Which ONE of the following statements is incorrect
a. At least one expected value is less than 5 in the 2x2 contingency table
?
b. The positive predictive value is 0.80
c. The negative predictive value is 0.75
d. The odds ratio is 12.00
e. The relative risk is 3.20

The answer to Q 2 is
a.


Q

a.
b.
c.
d.
e.

The answer to Q is

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APPENDIX 5: A RUBRIC FOR ANSWERS TO SHORT QUESTIONS

Short questions are each marked out of 10 in units of 0.5 and the combined mark for the
ten questions is the mark for the paper as a whole.

This is just a suggested rubric for marking the short question answers. Examiners are
welcome to improve/adapt it as they see fit.

The answer is clear and correct in every detail: order, factual detail,
correctness, logical argument. This candidate has completely
mastered the concepts
10
The answer is clear and correct in most aspects. This candidate has
mastered the concepts reasonably well
8
There is some lack of order, factual detail, correctness, or of logical
argument in the answer
6-7
The answer has not covered what could be expected but has shown
some relevant knowledge or insight
5
The candidate has missed the point entirely but has shown
knowledge of some relevant detail
3-4
The candidate has not any idea of what was required, or left the
question blank
0





APPENDIX 6: A MARK SCHEDULE FOR ESSAY ANSWERS

Essays are each marked out of 100 each and the average of the 3 marks is awarded to
the paper as a whole. Please use multiples of 5 for each of the component marks
awarded.

Mark out of Mark awarded
Is the essay well structured and logical with an orderly set of
headings and sub-headings appropriate to the question, and
easy to read?
20
Is the content factuall y complete, i.e. accurate and covers
enough of the main items that one would expect?
50
Has the candidate shown the ability to integrate the material
across at least two domains of occupational health, and more
if appropriate to the question?
30


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APPENDIX 7.

MARKING GUIDE FOR EXAMINERS FOR CLINICAL CASES
MARK DESCRIPTION


Less than
40%


Please specify
mark within
this range
The candidate:
Fails to elicit most
OR
of the important aspects of the history and/or physical
examination, as would be expected of a competent specialist physician
Reaches his/her conclusions by fraudulent or dishonest means, in the examiners
opinion
OR
Displays serious disrespect towards the patient





40 45%


Please specify
mark within
this range
The candidate:
Fails to elicit some
OR
important aspects of the history and/or physical examination,
as would be expected of a competent specialist physician
Manufactures or finds features on history or physical examination which are,
in fact, not present. Examiners must satisfy themselves by their own
independent evaluation that this is the case
OR
Is unable to make a pathophysiologically plausible clinical assessment, with an
appropriate differential diagnosis, and a rational plan of further investigation.



52 - 69%
The candidate:
Successfully elicits most
AND
of the relevant aspects of the history and physical
examination, as would be expected of a competent physician. Examiners should
be satisfied that no important aspects of the history or physical examination
have been missed
15

Please specify
mark within
this range
Makes a pathophysiologically plausible clinical assessment, with an appropriate
differential diagnosis, and a rational plan of further investigation

70 - 74%


Please specify
mark within
this range
The candidate:
Successfully elicits all
AND
the relevant aspects of the history and physical
examination, as would be expected of a competent physician
Makes a pathophysiologically plausible clinical assessment, with an appropriate
differential diagnosis, and a rational plan of further investigation
AND
Demonstrates clinical maturity, insight and a breadth of experience and
knowledge



75-100%


Please specify
mark within
this range

The candidate:
Successfully elicits all
AND
the relevant aspects of the history and physical
examination, as would be expected of a competent physician
Makes a pathophysiologically plausible clinical assessment, with an appropriate
differential diagnosis, and a rational plan of further investigation
AND
Demonstrates clinical maturity, insight and an outstanding grasp of clinical
medicine, including both a broad and deep experience and theoretical
knowledge

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APPENDIX 8: A MARK SCHEDULE FOR THE ORAL PRESENTATION

Oral presentations are marked out of 100 using the following schedule. Please use
multiples of 5 for each of the component marks awarded.

Mark out of Mark awarded
Is the presentation well structured and logical with an orderly
and appropriate framework, and communicated effectively?
20
Is the content factuall y complete and integrated across at
least two domains of occupational health, and more if
appropriate to the question?
30
Has the candidate demonstrated the ability to defend the
contents of the presentation and answer questions
appropriately?
50





J anuary 2010