Update: I have written a general question bank for Intrinsic Role questions. Click here
From ongoing conversations with trainees, I have the sense that the Intrinsic Roles portion of the new curriculum is too often brushed over or misunderstood. Professionalism can be thought of an amorphous skill set; something that develops by osmosis over years working in a clinical environment. There is the misconception these skills are merely competencies you pick up as you go, largely informed by experience and commonsense. To some degree this is true, but professionalism development is also based on specific learned skills and concepts which are reinforced through daily practice and experience.
As someone who spends a lot of time musing over educational theory, considering how this could fit into a question and answer based format has piqued my interest. This guidance is based only on my interpretation and best guesses of how these questions could be presented . I have no inside information from RANZCR, just what is available through the website and webinar information session. I do not have an affiliation with the examiners committee and I am not an examiner. As a disclosure, I sit on the Clinical Radiology Curriculum Assessment Committee which has a role in reviewing Work-Based Assessments and research outcomes of training.
Based on guidance from RANZCR, Intrinsic Roles related questions will account for 5% of the overall marks awarded for the OSCER examination. It doesn't seem like much, but lets do the math. Each OSCER is 8 cases, worth 10 marks each, therefore each OSCER is worth 80 marks. If Intrinsic Roles are expected to account for 5% of the grade, this roughly equates to 4 marks per station. As a reasonable guess, each candidate could expect a minimum of one question on Intrinsic Roles per OSCER station.
Looking at what has been released so far, we can infer that OSCER questions have a set marking guide with a rubric to assist the examiners in awarding marks to candidates in a standardised fashion. As such, questions will need to have a semblance of a correct answer. Additionally, the OSCER has been designed as a capstone exam, meaning that it should (in theory) be testing knowledge that reflects the candidates training journey to becoming a specialised radiologist: it should go beyond what a sensible intern or resident should know. From this, we can deduce that questions related to Intrinsic Roles will be drawn from concrete knowledge and concepts, will be more radiology specific and elevate in difficulty beyond basic patient-doctor interactions.
What are intrinsic roles?
Intrinsic Roles as they apply to the RANZCR training program can be considered as the professional skills which we would consider a "good" radiologist to have. These are the inherent skills that clinical radiologists ideally need to deliver safe and effective healthcare to our community, and work well within the collaborative team-based environment which is modern healthcare.
Development of the new RANZCR curriculum has been largely informed by the CanMEDs Framework, authored by the Royal College of Physicians and Surgeons of Canada to give clarity to the concept of an effective clinician. The model comprises of seven roles, which the clinician must develop to create the wholistic clinician.
At the model's heart, is the medical expert role, which encompasses the knowledge and expertise clinician gained over years of training, study and practice. Radiodiagnosis skills, patient management, pathology, anatomy, physics - they sit in here. Surrounding this, there are six additional intrinsic roles, which have formed the first six groups of outcomes in the syllabus:
The seventh group of outcomes relates to cultural competency. The development of this intrinsic roles is of the utmost importance for Australian and New Zealand clinicians given that we are striving towards cultural safety and inclusivity for our patients and colleagues. Indigenous health across both countries, as well as skill development for working within rich multicultural environments, is key to effective care, and is rightfully included within the outcomes. Expect this to be examined.
How can I prepare for this part of the OSCER?
As with any exam preparation, planning, knowledge gathering and practice will be key. I am a strong advocate for working with the syllabus/learning outcomes, and given the great unknown that is the new exam format I think this is a good place to start. I would suggest giving it a read over to get a sense of the types of concepts which fall into Intrinsic Roles.
You might find printing the outcomes and annotating a good way to think through and brainstorm questions, either by yourself or with your study group. When you are in case based tutorials, take a moment to think if there is an Intrinsic Role question that could fit into the case. This technique would also be useful for brainstorming pathology, anatomy and physics questions.
For example, let's brainstorm some intrinsic roles questions for a 50 year old female patient with newly diagnosed lung cancer.
Outline the role of that an Lung Cancer Multidisciplinary Team could have in the management of this patient.
The patient is planned for a lung biopsy and does not speak English. She appears frightened. How would you approach the consent process in this patient?
The patient is of Aboriginal heritage. Outline the role cultural support staff (e.g. Aboriginal Liaison Officers) could have during the patient's engagement with the radiology department.
You notice that the image quality on lung cancer studies is often degraded by motion artifact. How would you design an audit to assess this?
When deriving intrinsic role questions, you can see that there are some overarching concepts and themes which can be plugged into various scenarios. The value of an MDT can be considered across different oncology subspecialties and chronic diseases. Cultural safety is important for all patients (especially those from Indigenous communities), and therefore could pop up an any OSCER station. Audits and research are the backbone of evidence based medicine, therefore are also widely applicable. Some concepts may be OSCER specific (e.g. managing non-accidental injury detection in paediatrics, ethical issues specific to women's imaging) but overall many of your preparation for Intrinsic Role type questions will be set-pieces development. Intrinsic roles, after all, are a common thread throughout your practice and not specific to a single case or modality.
RANZCR Welcome Webinar 2023 - embedded sessions on overview of intrinsic roles (from myself) and cultural safety drawn from the 2022 RANZCR Faculty Forum
Watch this space ... practice questions are in the works