Letter: Revalidation questions must be relevant

Dear Editor

My heart sank when I saw the sample question from 'PEP CD-ROM' reproduced on GP's front page (GP, 12 May).

Nothing seems to have moved on from the crass multiple-choice questions that used to be in the MRCGP exam 20 years ago.

Here are five questions about appendicitis, none of which is directly relevant to the patient sitting in my surgery complaining of abdominal pain.

Does the urine have white cells in it? Yes, so it's probably a UTI, but I can remember being taught that if the inflamed appendix is adjacent to the bladder, this can result in pus cells in the urine.

Is appendicitis commoner in pregnant women? I haven't the foggiest, though I suspect not. In any event the answer will not influence my clinical diagnosis if the patient is pregnant.

Is appendicitis the commonest non-accidental emergency in childhood?

I beg your pardon? How on earth does that relate to the child sitting in my surgery with tummy ache?

Are 70 per cent of appendicitis cases retro-caecal?

I am sure there is an answer to this, but I am not sure whether my patient is in that 70 per cent.

Is fever an early sign in appendicitis? I expect so, but I'm not clear where that comes in my diagnostic process.

Surely the purpose of knowledge tests is to ensure that mature GPs are keeping up to date with new information.

Trying to find out what we might have been taught 30 years ago has precious little to do with my ability as a GP to diagnose appendicitis on the well-founded techniques of a good history and examination of the patient.

Dr Peter Maxwell Bull, Crediton, Devon.

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