2 What do you want from MCQ preparation? Table as a group (get to know your neighbour)Person nearest the aisle is spokespersonJust FOUR items requiredOnly takes a minute or two
3 TUTORS’ Aims of MCQ preparation Review format/content of examFlavour of questionsPractice (difficult to do under exam conditions)Identify areas of weakness (go home and check answers)Some comparison with peer group (need to mark the paper here and now)
4 Plan for short seminarOverviewContentRevisionFormat
5 Overview MCQ May 2005 1622 candidates High reliability of the exam (comparable to any equivalent test worldwide)
6 Overview MCQ Mean 74% Standard Deviation 9% Pass mark 67% Merit 81% 79% of candidates passed23% of candidates given merit
7 Overview MCQJust a few extra marks makes a large difference in your ranking compared to your peers
8 Overview MCQ NOW more Single Best Answer questions Questionnaire – (60% response rate – 90% passed)Difficult!! (yet nearly 80% passed)Appropriate questionsExtended matching items most difficult (and Summary Completion)Time a problemNOW more Single Best Answer questions
9 Overview MCQ 3 hours and offered in May and October Tests established and recently discovered KNOWLEDGE of relevance to general practice(newer questions involve more and more APPLICATION of knowledge)
11 Content clinician family physician patient's advocate gatekeeper resource allocatorhandler of informationteam memberteam leaderpartnercolleagueThe Gatekeeper
12 Content employer manager business-person learner teacher reflective practitionerresearcheragent and shaper of policymember of a professionperson and individual
13 Content Syllabus 32 pages long 17 pages of general concepts for each defined area13 pages of appendices - checklist2 pages of references
14 Content - syllabus Good medical practice and care Generalist skills The doctor-patient relationship, communication and consulting skillsProfessional, ethical and legal obligationsPopulation, preventive and societal issuesInformation management and technology
15 Content - syllabus Risk management Monitoring of quality of performance, audit and clinical governanceContinuing Professional Development, learning, teaching and trainingWorking with colleaguesOrganisational administrative and regulatory frameworkFinancial probity and business management
16 Content (example from syllabus appendix) Serious communicable diseasesParticularly, but not limited to, infections such as Human Immunodeficiency Virus (HIV), tuberculosis and hepatitis B and CMeans and control of transmission, awareness of diagnosis, investigation, management, consent for testing, issues of confidentiality and the implications to the patient of a positive resultRole of Public Health Services
17 Syllabus – help or hindrance First direction for revision from CollegeA little vague in places but a useful starting pointCertainly worth a read to help identify areas of weakness
19 Medicine (65% of marks) all equal - 6% !! Cardiovascular Dermatology / ENT / ophthalmologyEndocrinology / metabolicGastroenterology / nutritionInfectious diseases / haematology / immunology / allergies / geneticsMusculo-skeletalPaediatricsPharmaco-therapeuticsPsychiatry / neurologyReproductive / renalRespiratoryall equal - 6% !!
20 Implications for revision DERMATOL / ENT / EYES – 6% of exam
21 Research/epidemiol./stats – 20% Assessing the quality of carePrinciples of auditUnderstanding and application of the terms used in inferential statistics and evidence-based medicineKnowledge of statistics and research methodology, sufficient for the critical appraisal of published papers.
22 Content - Revision Clinical areas fairly limitless Research, epidemiology, administration and management more defined in this exam.
23 Revision Considerable amount of work to be done (sorry) Need a good general backgroundIdentify areas of weaknessPrioritise these areasDon’t spend time needlesslyMake use of review articles and publications such as ‘Clinical Evidence’
29 MCQ FORMAT – why change? Congruence with education Mainly PBLFlaws in multiple T/F formatRote memory vs problem solvingBenefits of newer formats?integration of factual knowledge / personal care
30 Format <250 questions Trial questions = different papers EMQ - extended matching item questionsSBA - single best answersMBA - multiple best answersTAQ – table / algorithm completionSCQ- summary completion questions (???)Items per question will vary between 3 and 6Trial questions = different papers
31 Format Pictorial data - charts, photos (on the INCREASE) NO NEGATIVE MARKING
32 Question Examples SINGLE BEST ANSWER MULTIPLE BEST ANSWER SUMMARY COMPLETIONEXTENDED MATCHING ITEMTABLE / ALGORITHM COMPLETION
33 SBA- Single Best Answer, from May ‘98 In the management of croup in a 2y old child, which single treatment has been shown in clinical trials to shorten the course of the condition?place the child in a steam filled bathroomadminister inhaled budesonideprescribe amoxycillin 125mg tds for 5/7administer inhaled salbutamolprescribe paediatric codeine cough suppressantadminister inhaled tribavirin
34 Multiple Best Answer (MBA) A statement is followed by a variable number of items a specified number of which are correct
35 Multiple Best Answer (MBA) A 65-year-old male smoker presents with a gradual onset of breathlessness on moderate exertion, and a cough with clear sputum. Chest examination reveals general reduction breath sounds and the presence of a few rhonchi bilaterally. Spirometry reveals an FEV1 of 50% of predicted. Identify the three most appropriate therapeutic interventions to be considered following the British Thoracic Society COPD guidelines. Give THREE answers.A Salbutamol inhalerB Beclomethasone inhalerC Ipratropium inhalerD Salmeterol inhalerE Sodium cromoglycate inhalerF Oral theophyllineG Oral steroid trialH Nebulised ipratropiumI Referral for long term oxygen therapy
36 Summary Completion Questions - possible fill in the gap words (given in College instructions) associationexclusionsensitivitybiasprecisionsuccessdifficultsafetyvalidityerrorselectionvariablesblindedquestionedtypicalcohortrandomisedundertakendemonstratedreliabilityunrepresentative
37 Extending Matching Questions Extending Matching Questions (EMQ) in which a scenario has to be matched to an answer from a list of options. You may feel that there are several possible answers but you must choose only the MOST LIKELY from the option list.
38 THEME: Reduced Vision Option list: Instruction: (A) Basilar migraine (F) Occlusion of the central retinal vein(B) Cerebral tumour (G) Optic neuritis(C) Cranial arteritis (H) Retinal detachment(D) Macular degeneration (I) Tobacco optic neuropathy(E) Occlusion of the central retinal arteryInstruction:For each patient with reduced vision, select the single most likely diagnosis. Each option may be used once, more than once, or not at all.Items:1 A 75-year-old man, who is a heavy smoker, with blood pressure of 170/105, complains of floaters in the right eye for many months and flashing lights in bright sunshine. He has now noticed a ‘curtain’ across the vision of his right eye.
39 Table/Algorithm Completion Format often found in guidelines to advise on management decisions.You are asked to select the correct answer to complete the table or algorithm box.
40 Medical management of menorrhagia: Not requiring contraceptionRequiring contraceptionCombinedoral contraceptive pillFor each of the numbered gaps above, select ONE option from the list below to complete the algorithm,based on current evidence. Select ONE option only
43 OPSCAN SHEET Use only the pencil provided Potential pitfalls Wrong ID numberSkip a question?
44 MCQ Summary Time is more important 250 questions in 180 mins43 seconds per questionAnswer everything – no negative markingPractice, practice, practice (go over weak areas)
45 PracticeA composite paper giving examples of multiple choice questions is published from time to time, and is available from the RCGP Sales OfficeDoes not include many newer questions?Also,PEP,Pastest