“Clinical reasoning plays a major role in a doctor’s ability to make diagnoses and decisions. It can be considered as the physician’s most critical competence.”
– RACGP KFP Exam Guide
If there is one word that brings on instant anxiety to a registrar pre-exams: it’s ‘KFP’. Why do they put us through it? What’s the point of it? How do I answer the questions? How do I prepare for it? And what’s the deal with over-coding!?
The Key Feature Problem (KFP) exam is a well-designed way to test your clinical reasoning skills. As a doctor thrown into a different scenarios every 15 minutes or so we need to be able to quickly adapt all our hard-learned knowledge and apply it to our patient’s specific needs. To help us make decisions right for the patient in front of us, we use skills in gathering and interpreting data, communicating, synthesising clinical signs and investigations, trialling treatment plans and making safe follow up. This process of critical thinking and weighing up all available evidence is called clinical reasoning.
How can you test clinical reasoning though? In the KFP exam you will be provided with a short patient vignette which is filled with unique clues ‘key features’ specific to them and their problem. For example, the patients age, gender, location, presenting complaint, associated features and past history. You will then be asked in question form – what would you do next? You will be required to synthesise the key features presented to you and, like you do in your daily practice, use them to decide what to ask, examine, order or manage next.
What can you do to improve your clinical reasoning? Reflect on every patient encounter and ask yourself – how and why did I arrive at this decision?
Clinical Reasoning in summary:
- The KFP exam is a test of your clinical reasoning skills
- Clinical reasoning is the physicians most critical competence
- Clinical reasoning is your ability to interpret all the specific clinical information provided to you and weigh up each piece of evidence before arriving at a decision
- You can learn clinical reasoning by reflecting on your patient encounters and asking yourself how and why you arrived at the diagnosis or decision that you did