The UNC Medicine Exam is based on topics covered in several core lectures during the clerkship: diagnostic and therapeutic reasoning during the first 3-week rotation and interpretation of Chest Xrays and EKGs during the second 3-week rotation. Part 1 will be given on the last day of the first 3-week rotation and Part 2 will be given on the Monday (or perhaps Tuesday) of the last week of the clerkship. Students rotating at AHEC sites will take the exams at their AHEC site; students at UNC will take the exam in Chapel Hill. You will be informed during the rotations about the exact time and location of the exams.
For Part 1 of the Exam students may be asked to:
- explain in plain English the concepts of prevalence, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, pre-test probability and post-test probability
- explain the interrelationship between all of the above concepts (e.g., calculate each value when given several of the other values; describe which values change with prevalence of disease and which can be considered characteristics of the test itself)
- explain in plain English the concepts of action threshold, observe/test threshold and test/treat threshold
- convert from probability to odds and from odds to probability
- determine which test has the best ability to "rule in" or "rule out" a given disease when given sensitivity, specificity and likelihood ratios
- calculate likelihood ratios when given information in a 2 x 2 table format
- calculate likelihood ratios when given sensitivity and specificity
- calculate post-test probability when given pre-test probability and likelihood ratios (by using long-hand math and also by using Fagan nomogram)
- calculate post-test probability when given pre-test probability and several likelihood ratios (linking several LRs together)
- calculate action threshold for using treatment when given net benefit of treatment, harm of treatment and harm of disease
- calculate observe/test threshold and test/treat threshold when given action threshold and sensitivity and specificity of test
For Part 2 of the Exam students will be asked to recognize and comment on:
Every concept on the Exam is listed above. Students who are able to do all of the above will do well on both parts of the Exam.