NEW CURRICULUM

THE EXAMINATION FOR REGISTRATION TO PRACTISE MEDICINE IN SRI LANKA [ERPM]

The Examination for Registration to Practise Medicine in Sri Lanka

Objective:

To assess,
a) the core knowledge in clinical subjects with particular reference to problems prevalent in Sri
Lanka.

b) the skills and competence required, for training and to shoulder responsibilities, as a preregistration
house officer (intern medical officer).

Eligibility:
a) should be a citizen of Sri Lanka.
b) should possess a MB BS degree or equivalent qualification obtained abroad, recognized by
the SLMC.

Components:
There are two parts – Part A and Part B.
Part A is the written component containing multiple choice questions – (MCQ) papers.
Part B is an interactive assessment in clinical/practical problems.
ERPM Part A – Written papers

There will be three papers.
Paper 1:
Objective: – Testing the core knowledge in clinical subjects
Question type – True/False MCQs
Composition –
Medicine and Psychiatry- 15
Obstetrics and Gynaecology- 15
Paediatrics- 15
Surgery- 15
Total No of questions 60
Duration: 2 hours and 30 minutes

Marking –
Each question will have five responses. The correct response will score +1 and the wrong -1. The
negative marks will not be carried over to the next question. The range of marks would be 0 to 5 for
each question.
Paper 1 will carry 300 marks.


Paper 2:

Objective: To assess the ability of the candidate –
a. To interpret data in a given clinical scenario and to draw conclusions.
b. To take decisions regarding initial managements on clinical scenarios on practical problems
in the context of facilities and resources available
in hospitals in Sri Lanka.

Question type: Best response type MCQs – (Best of five)

Composition:
Medicine and Psychiatry -24 (18+6)
Surgery -12
Obstetrics and Gynaecology -12
Paediatrics -12
Total No. of questions 60

Marking:
Each question will have five responses. The correct response will score +5. There will be no negative
marks. Paper 2 will carry 300 marks.
Duration: 2 hours.

Paper 3:
Objective: Testing the core knowledge in selected para-clinical subjects:
Question type: True/False MCQs
Composition:
Forensic medicine -10
Community medicine -10
Clinical pathology -10
Total No. of questions 30

Marking:
Each question will have five responses. The correct response will score +1 and the wrong one -1. The
negative marks will not be carried over to
the next question. The range of marks would be 0 to 5 for each question.
Paper 3 will carry 150 marks.
Duration: 1 hour and 15 minutes.

A Pass in written papers (Part A):

Total marks available:
Paper 1 -300
Paper 2 -300
Paper 3 -150
Grand Total -750
Pass mark -50%
A candidate should obtain a total of 375 from the three papers to pass Part A.


The Clinical subjects (in Papers 1 and 2) can be passed separately by obtaining 300 marks out of 600
available, without passing Paper 3. Paper
3 can also be passed by obtaining 75 marks out 150 without passing the Papers 1 and 2.
A candidate has to pass all 3 papers in Part A to proceed to Part B.

ERPM – Part B

Objective: Assessment of:
a. skills in consultation and clinical examination.
b. ability to cope with common medical emergencies and forensic problems.
c. knowledge in nature and the scope of community health services in Sri Lanka.

Eligibility:
All who have passed Part A of ERPM within the preceding two years of the date of the clinical exam
for which they opt to sit.
e.g. Those who have passed the Part A of ERPM in July 2006 should sit for Part B before July 2008.
If 2 years have elapsed after passing Part A, before sitting Part B for the first time, then the candidate
has to re-sit Part A in full. A candidate has to pass the ERPM (both Part A and Part B) within five
years of sitting for the Part A examination for the first time. He or she will not be allowed to sit the
examination thereafter.

Components:

Part B
This will have two components:
a. Clinical section
b. Orals

1. Clinical Section of ERPM Part B

Objective:

To assess the ability and competence in:
a. history taking,
b. clinical examination,
c. drawing conclusions, planning management, and explaining to the patient about the illness
and the proposed plan of action.

This section has six stations. There will be 2 sets of three stations each, as shown in the figure below.
Each station will be assessed by two examiners independently. Candidates will start at one station and
then move round the stations at 20 minute intervals until they complete the set.

There will be a three minutes interval between each station. At the end of a set there will be a short
interval and then the candidate will move on to the next set.

Clinical Stations 1, 3 and 5

Objective:

These stations will assess the candidate’s ability to gather data from the patient, assimilate the
information, discuss the differential diagnoses, and examine and/or look for physical signs in the
system(s) and/or area(s) as directed by the examiners. Candidates should also be able to:

a. map out the preliminary management plan, and
b. explain this to the patient.

Clinical Station 2

Objective:
This will assess the candidate’s ability to examine a particular system, interpret physical signs, and
discuss the possible diagnosis(es). There will be two patients, an adult and a child. Any two of the
following systems – Cardiovascular, Respiratory, Abdomen and part of the Nervous system will be
given at this station. For example, if the examination of the adult patient is in one system, the
paediatric case would be in one of the other three.

The candidate will be examined by a physician and a paediatrician at this station.

Clinical Station 4
Objective:
This aims to assess the candidate’s ability to examine surgical short case(s)/ “spots” and
examine/discuss a gynaecologcal problem. The candidate will be examined by a surgeon and a
gynaecologist at this station.

Clinical Station 6
Objective:
To assess the ability of the candidate to take an obstetric history, examine a pregnant lady and discuss
the proposed plan of management with the examiners and with the lady.
Marking in the Clinical Stations 1 to 6:
Each examiner will mark independently, out of a possible 100 marks.
Pass: A candidate should obtain a minimum average mark of 50% to pass the clinical section. Any
candidate who gets 30% or less from any 4 examiners will fail the entire clinical section. He/she has
to re-sit the entire clinical section. The clinical section will either be preceded or followed by the orals
in Emergency Medicine, Forensic Medicine and Community Medicine.


Orals:

Station 7

Emergency Medicine
Objectives:
To assess the knowledge of the candidate in managing common Clinical Emergencies in Medicine,
Surgery, Paediatrics and Obstetrics and Gynaecology.
There will be a panel of 2 examiners from any two of the above specialties.

Each examiner will question for 7½ minutes. Each will mark independently out of 50 and a candidate
should obtain a total of 50 (50%) to pass this section.

Station 8
Forensic Medicine
Objectives:
To assess the ability of the candidate to deal with common Forensic problems
There will be two Forensic Specialist examiners. Each will mark independently out of 50 and a
candidate should obtain a total of 50 (50%) to pass in this section.

Station 9
Community Medicine
Objectives:
1) To assess the knowledge of the candidate about the common public health problems and services,
available in Sri Lanka.
2) To assess the ability of the candidate to plan out management with regard to common public health
problems.

There will be two examiners who will mark independently out of 50. The candidate should obtain a
total of 50 (50%) to pass this section.

Passing Part B of ERPM

A candidate can pass the Part B in full by scoring 50% (with not less than 30% marks from 4
examiners) in the Clinical Section, 50% in Emergency Medicine, 50% in the Forensic Medicine, and
50% in Community Medicine.
He/she can also pass section by section.

Examples:

Clinical Station 1
“A fifty year old male complains of fever and cough of four weeks”

The candidate will be expected to take a relevant history for about nine minutes in the presence of the
examiners eliciting the salient features in the history. Then he/she will discuss with the examiners the
possible differential diagnoses, relevant physical signs to be looked for, and perform examination of
the patient as directed by the examiner. He should be able to mention appropriate investigations and
then explain to the patient the proposed management. Depending on the clinical scenario, the time
allowed to take the history may vary.


Clinical Station 2

Case 1
“A twenty year old female with weakness of both lower limbs”
The candidate may be asked to examine the nervous system of the lower limbs and discuss the
physical signs elicited.

Case 2
“A ten year old boy with mitral stenosis and regurgitation”
The candidate may be asked to examine the heart of this child and will be questioned on the findings.
Clinical Station 3
“A child of five years with failure to thrive”
The candidate will be expected to take the history from the mother and child, discuss the differential
diagnoses, and then explain to the mother the proposed plan of manangement.

Clinical Station 4

Surgical:
“A patient with scrotal swelling and another with a lump in the neck”
The candidate may be asked to examine these swellings and discuss the findings.

Gynaecological
“A forty five year old lady with menorrhagia”
The candidate will be expected to take a history from the patient and then discuss with the examiner
how he or she would arrive at a diagnosis.

Clinical Station 5
“A 60 year old patient with progressive dysphagia for three months”
The candidate will be expected to take a full history and then discuss with the examiners the salient
features, differential diagnoses and proposed investigations.
He/she will also be expected to obtain an informed consent for any invasive investigation / surgery.

Clinical Station 6
“A forty year old grand multipara”
The candidate will be expected to take an obstetric history and do a relevant examination and discuss
the findings with the examiners and then explain to the patient the proposed line of management.


Emergency Medicine – Station 7

“A middle aged man admitted in an unconscious state, known to be a diabetic taking Insulin”
The candidate may be asked to describe the immediate measures to be taken.

and

“A man knocked down by a vehicle on the road, is admitted in a collapsed state”
The candidate may be asked to describe the immediate management.

or

“A baby is asphyxiated at birth”
The candidate will be asked to demonstrate resuscitation with a mannequin provided.

and

“A mother who has delivered a baby in the labour room has a retained placenta”
The candidate would be asked for the management of the patient as a House Officer.

Forensic Medicine – Station 8

“A photograph of a middle aged man with injuries”
The candidate may be shown a photograph of self-inflicted wounds and expected to recognize them
and may be questioned on that further. The candidate may also be shown a skull with a fracture and
expected to identify the sex and discuss the possible causes for the injury seen in the skull.

“Specimen of a cirrhotic liver found at a postmortem examination”
The candidate may then be shown a liver and expected to describe the specimen and draw
conclusions.

Community Medicine – Station 9

“There is an outbreak of diarrhoea in a MOH division”
How will you investigate as the MOH? What are notifiable diseases and how do you notify them?

Scheme for implementation of the new proposals of the New Format of the ERPM

1. The revised new format will come into effect from January 2006.

2. All applicants for the new format will sit the examination as proposed above.

3. Candidates who have sat the Old Format would not be allowed to sit the new format until 2007.

4. The old format was scheduled to be terminated by the end of 2005. However, on the appeal of a
large number of candidates, two exams would be held in 2006. There would not be any further
examination of the old format thereafter.

5. The candidates who have sat before September 2004, will have to complete the ERPM MCQ
examination before September 2006.
a.) If they have not completed the MCQ section before September 2006, they have to sit for Part A
of the New Format thereafter.
b.) If they have passed all the written papers before 2006, but have not completed all the
clinical/viva voce sections, they can sit for Part B. If they have passed the orals in Forensic
Medicine and Community Medicine in the Old Format, they would be exempted from these
subjects, but they have to sit for the clinical section and the Emergency Medicine section.

SUMMARY

1. A new format of the ERPM came into effect from January 2005. Some new proposals have been
made. They will come into effect from the next examination. The old format will only be
continued until 2006.

2. The new format will have 2 parts. Part A – Written papers and Part B – Clinicals and Orals.

3. The written component has three papers. Eligibility to pass will be decided on by the total number
of marks obtaining from all three papers.

4. Subjects to be tested will be Medicine and Psychiatry, Surgery, Obstetrics and Gynaecology,
Paediatrics, Community Medicine, Forensic Medicine and Clinical Pathology.

5. Therapeutics may also be tested with the clinical subjects.

6. Medical Emergencies will be tested in orals with either General Medicine or Paediatrics and
Surgery or Obstetrics/Gynaecology. Therapeutics may be examined in the written papers, clinical
section and Emergency Medicine. Community Medicine and Forensic Medicine will be tested in a
written paper and in the Orals.

7. A candidate has to complete Part A before sitting Part B.

8. Paper 1 with 60 questions will have 4 sections – 15 questions each in Medicine, Surgery,
Paediatrics, Obstetrics and Gynaecology.
Paper 2 will have 4 sections and 60 questions – Medicine and Psychiatry – 24 questions, 12
questions each in Surgery, Paediatrics and Obstetrics and Gynaecology.
Paper 3 will have 30 questions, 10 each in Forensic Medicine, Community Medicine and Clinical
Pathology.
Those who sit for Part A can obtain a pass by obtaining 375 marks out of the maximum 750 marks
in Papers 1, 2 and 3. Papers 1 and 2, together, and Paper 3 can be passed separately by obtaining
50% of the available marks.

9. Part B has 4 sections, namely the Clinical Section and Orals in Emergency Medicine, Forensic
Medicine and Community Medicine.
It can be passed section by section. The clinical section cannot be passed station by station.

10. Only the new format will be held from January 2007 for all the candidates.