Exams Farheen Ghafoor
Aims: • Understand the MRCGP • Information on additional exams e.g DRCOG • Includes: exam format, fees, eligibility, test centre locations, useful resources, yadayadayada.
MRCGP: • Why – because you have to basically but remember you want to be a good not a crud GP! • 2 exams: written + practical (3rd part WBA) • Written – Applied Knowledge Test (AKT) • Practical – Clinical Skills Assessment (CSA) • [Work Based Assessments (ignoring this bit!)]
AKT: • FORMAT – 3hr, 20o questions, SBA, EMQs etc 80% core clinical medicine 10% evidence based practice 10% ethical and legal issues • WHEN – Oct, Jan and April each year • WHERE – nearest centre Derby (Pearson Vue)
AKT: • HOW – computer based • FEES – £441 (if AiT) • ELIGIBILITY – ST2/3 only (soz nerds/nutters!) • ATTEMPTS – max four
Example SBA: A 17-year-old student suddenly develops chest pain and dyspnoea after a morning swim. There is hyper-resonance and decreased breath sounds on the right side. Which is the SINGLE MOST likely diagnosis? Select ONE option only. A.Asthma B.Pneumothorax C.Pulmonary embolus D.Left ventricular failure E.Pulmonary haemorrhage From RCGP AKT presentation
Example EMQ: From RCGP AKT presentation A. Berry aneurysm B. Cerebral glioma C. Drug induced D. Graves’ disease E. Ischaemic stroke F. Multiple sclerosis G. Myasthenia gravis For each patient described, select the SINGLE MOST likely diagnosis from the list of options above. 1. A 35-year-old man who is a non-smoker, suddenly develops a severe headache and double vision. His right pupil is fixed and dilated.
Example EMQ: From RCGP AKT presentation A. Berry aneurysm B. Cerebral glioma C. Drug induced D. Graves’ disease E. Ischaemic stroke F. Multiple sclerosis G. Myasthenia gravis For each patient described, select the SINGLE MOST likely diagnosis from the list of options above. 2. A 48-year-old woman has transitory double vision towards the end of most days. She smokes 10 cigarettes/day. She has vitiligo and hypothyroidism.
Example picture: • A 32-year-old man has noticed painless non-itchy patches of hair loss on his beard area and scalp. From RCGP AKT presentation Which is the SINGLE MOST likely diagnosisSelect ONE option only. A. Alopecia areata B. Eczema C. Lichen sclerosis D. Tineainfection E. Vitiligo
Example data: From RCGP AKT presentation Which SINGLE study suggests the WEAKEST association between increased whole grain intake and a risk of type 2 diabetes? Select ONE option only A.Fung B.Meyer C.Montonen D.NHS1 E.Van Dam
Non-hormonal Hormonal therapy 3 _______ 1 _______ 2 _______ Combined oral contraceptive pill Example algorithm: Medical management of menorrhagia From RCGP AKT presentation For each of the numbered gaps above, select ONE option from the list to complete the algorithm, based on current evidence. Each option may be used once, more than once or not at all.
Example algorithm: From RCGP AKT presentation A. Cyclical norethisterone B. Copper-bearing intra-uterine device C. Inert intra-uterine device D.Levonorgestrel releasing intra-uterine system E.Medroxyprogesterone acetate F.Mefenamic acid G.Nonoxinol ‘9’ H.Tibolone I.Tranexamic acid
Example free text: From RCGP AKT presentation Which SINGLE vitamin is administered to reverse the anticoagulant effect of warfarin? Give ONE answer only, typing on the line Vitamin ________
CSA: • FORMAT – 13 consultations, 10mins each. Data gathering Clinical management Interpersonal skills • WHEN – several different dates a year available • WHERE – Croydon!
CSA: • HOW – role play patient scenario in ‘GP room’ • FEES – £1481 (if AiT) • ELIGIBILITY – ST3 only (must pass AKT first) • ATTEMPTS – may need approval from deanery to extend training time
Example scenarios: • Depression with background of chronic illness • Sick note requests • Inappropriate requests for medication • Vague symptom e.g. ‘tired all the time’
WHY BOTHER? • Reinforce learning e.g. if doing relevant job • Improve knowledge in area if little experience • Have interest in the specialty • Looks good on CV
DRCOG: • FORMAT – 2 papers, each paper 1 1/2 hrs Paper 1 SBA ( 30) + EMQ (18) = 30% + 12.9% Paper 2 MCQs (200) = 57.1% • WHEN – April and October each year • WHERE – nearest Nottingham
DRCOG: • HOW – written paper, don’t have to pass both! • FEES – £ 380 (I think) • ELIGIBILITY – any GMC registered doctor • ATTEMPTS – max five
Example SBA: A 41yr woman in the first trimester of pregnancy presents requesting an investigation to rule out Down’s syndrome in her unborn baby. From the following examples, which test is best described as being a DIAGNOSTIC test for trisomy 21? Select ONE option only. A.Nuchal translucency scan B. AFP, beta HCG and PAPP-A serum levels C. Amniocentesis D. Combined test (NTS and triple test) E. AFP serum levels alone I MADE IT UP
Example EMQ: A.Pregnancy B.Ovarian cancer C.Fibroids D.Endometriosis E.Cervical cancer F.Imperforate Hymen G.Polyps For each patient described, select the SINGLE MOST likely diagnosis from the list of options above. A 16yr old girl presents complaining she has not started her periods. She has also been having severe monthly abdominal pain for some time. On exam she is noted to have developed secondary sexual characteristics. I MADE IT UP
Example MCQ: For each of the following, select true or false. In relation to Obstetric cholestasis: 1. Patients normally present with jaundice 2. It is caused by the build up of bile acids 3. Treatment includes vitamin C and ursodeoxycholic acid 4.Affects approx 5% of pregnancies 5. Resolves after delivery of baby T / F T / F T / F T / F T / F I MADE IT UP
TIPS: • Do after Obs + Gobs job if you can (not essential though as I did mine 2/52 into mine but helps) • Do squillions of questions (read over weak topic) • Guess! (MCQs it’s 50/50, no negative marking) • Answer in head first (for EMQs then look for answer in list, if there you are probably right)
DCH: • FORMAT – written paper and clinical exam Written paper – MRCPCH Part 1a (same as paeds) Clinical exam – DCH clinical • WHEN –part 1a – Oct, Feb and June DCH clinical – April and August • WHERE – nearest Sheffield and Birmingham
DCH: • FEES – MRCPCH Part 1a = £218 • DCH clinical = £350 • ELIGIBILITY – aimed at GP registrars • ATTEMPTS – If pass Part 1a can do max 3 clinical before have to repeat Part 1a.
DCH: • MRCPCH part 1a – 2 1/2 hr paper • 12 EMQs, 15 MCQs(T/F) and 48 SBAs • (total 108),(total 75) and(total 192) = 375 • Topics include development, milestones, child protection etc
Example SBA: • A 6-year-old girl has hereditary spherocytosis. Splenectomyhas been advised. Her parents are particularly concerned about risks to her health in adult life. Which of the following represents her greatest risk in adult life? Select ONE option only. A. Gallstones B. Haemochromatosis C. Lymphoma D. Meningococcal septicaemia E. Pneumococcal septicaemia FROM RCPCH WEBSITE
Example EMQ: F. Pneumococcal pneumonia G. Scalded skin syndrome H. Scarlet fever TB meningitis J. Toxic shock syndrome Kawasaki disease B. Measles C. Meningococcal disease D.Mycoplasma infection E.Pneumococcal meningitis
Example EMQ: Select the SINGLE MOST likely diagnosis: 1. A 10-month-old infant presents with a 1-day history of a confluent blanching rash which started on his face and now covers his entire body. He is miserable with conjunctivitis and fever of 38.5º. The illness started with runny nose and cough 5 days previously. His 3-year-old brother has recently started nursery. FROM RCPCH WEBSITE
Example MCQ: For each of the following, select true or false. At 12 month s of age a healthy boy born at term should: 1. Be dry by day 2. Cruise along the furniture 3. Feed himself with a spoon 4. Plays peek-a-boo 5. Use a 2-word phrase T / F T / F T / F T / F T / F FROM RCPCH WEBSITE
DCH: • DCH clinical – 2 ‘cycles’, total of 8 stations: • 1st cycle – 4 x 6min stations (2x communication, data interpretation and oral) • 2nd cycle – 4 x 9min stations (clinical assessment, focused history/management planning, development and safe prescribing)
BIMM: • FORMAT – written paper and clinical exam Written – 1 hr paper of MCQs, EMQs and SBAs – 2 hr paper of short answer questions Clinical – case book (pre-exam), 10min OSCE and 30min CBD on case studies submitted • WHEN – written February and clinical April • WHERE – St George’s, University of London
BIMM: • HOW – submit case book (before written paper of cases seen personally within 2yrs), pass written before attempt clinical. Pass all. • FEES – written paper = £200 • clinical exam = £450 • ELIGIBILITY – GMC license to practice and completed foundation training.
BIMM: • What a kerfuffle eh?
USEFUL RESOURCES: • www.derbygpvts.co.uk/training_library.htm • RCGP • NICE • SIGN • Pastest books / online questions for exams • OnExamination online questions for exams • RCOG greentop guidelines • RCPCH guidelines