1. Exams Farheen Ghafoor

2. Aims: Understand the MRCGP Information on additional exams e.g DRCOG Includes: exam format, fees, eligibility, test centre locations, useful resources, yada yada yada.

3. Compulsory (MRCGP)

4. MRCGP: Why – because you have to basically but remember you want to be a good not a crud GP! 2 exams: written + practical (3 rd part WBA) Written – Applied Knowledge Test (AKT) Practical – Clinical Skills Assessment (CSA) [Work Based Assessments (ignoring this bit!)]

5. AKT

6. 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)

7. AKT: HOW – computer based FEES – £441 (if AiT) ELIGIBILITY – ST2/3 only (soz nerds/nutters!) ATTEMPTS – max four

8. 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

9. 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.

10. 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.

11. Example picture: From RCGP AKT presentation A 32-year-old man has noticed painless non- itchy patches of hair loss on his beard area and scalp. Which is the SINGLE MOST likely diagnosis Select ONE option only. A. Alopecia areata B. Eczema C. Lichen sclerosis D. Tinea infection E. Vitiligo

12. 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

13. Example algorithm: From RCGP AKT presentation Non-hormonalHormonal therapy 1 _______2 _______ Combined oral contraceptive pill 3 _______ 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. Medical management of menorrhagia

14. 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

15. 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 ________

16. CSA

17. CSA: FORMAT – 13 consultations, 10mins each. Data gathering Clinical management Interpersonal skills WHEN – several different dates a year available WHERE – Croydon!

18. 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

19. Example scenarios: Depression with background of chronic illness Sick note requests Inappropriate requests for medication Vague symptom e.g. ‘tired all the time’

20. Optional (e.g. DRCOG, DCH, BIMM)

21. 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

22. Diploma of Royal College of Obstetricians and Gynaecologists

23. 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

24. DRCOG: HOW – written paper, don’t have to pass both! FEES – £ 380 (I think) ELIGIBILITY – any GMC registered doctor ATTEMPTS – max five

25. How I passed? Easy peasy…

27. 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

28. 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. 1.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

29. Example MCQ: 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 For each of the following, select true or false. In relation to Obstetric cholestasis: T / F I MADE IT UP

30. 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)

31. Diploma in Child Health

32. 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

33. 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.

34. 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

35. Example SBA: A 6-year-old girl has hereditary spherocytosis. Splenectomy has 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

36. Example EMQ: A.Kawasaki disease B. Measles C. Meningococcal disease D. Mycoplasma infection E. Pneumococcal meningitis F. Pneumococcal pneumonia G. Scalded skin syndrome H. Scarlet fever I.TB meningitis J. Toxic shock syndrome

37. 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

38. Example MCQ: 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 For each of the following, select true or false. At 12 month s of age a healthy boy born at term should: T / F FROM RCPCH WEBSITE

39. DCH: DCH clinical – 2 ‘cycles’, total of 8 stations: 1 st cycle – 4 x 6min stations (2x communication, data interpretation and oral) 2 nd cycle – 4 x 9min stations (clinical assessment, focused history/management planning, development and safe prescribing)

40. British Institute of Musculoskeletal Medicine (diploma)

41. 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

42. 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.

43. BIMM: What a kerfuffle eh?

44. 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

45. Any questions?

46. Good luck chucks (AND TA VERY MUCH FOR LISTENING)