How to: the Exam
Exams are one of the constant hurdles of medical life.
Reproduced here are Dr Neil Long’s summary notes from the recent Regional teaching at the Northern Hospital about the fellowship exam, as well as tips regarding the Primary Exam from Cynthia
Primary exam:Primary Viva tips pdf
The Biggest hurdle – an interactive lecture about the different phases of exam preparation and how to go about it
- Most importantly of all, everyone has an opinion on how you should study. Remember you have been through 100+ exams all on your own. Whatever revision method works for you carry on.
- Decide if you are going to cram revision into 6 months, or a full 12 months. Think about whether you are working full time, part-time and what are your family commitments.
- Talk to your significant other or friends. Everyone will need to make sacrifices while you revise and having their support is important. You also need to plan time out to spend with them so you can unwind. I sat down with my partner and stated she would need to be like a 1970s house wife, fortunately after some furrowed brows she understood what I was saying and was able to support my exam campaign. Don’t underestimate how much friends and family are impacted by your revision.
- Make a revision plan and stick to it. Here is an example plan from Sir Charles Gairdner Hospital.
- You will quickly see there is not a lot of time to go into vast depths on each topic therefore join an exam group, this will help keep you on track but also help discuss concepts or areas where people constantly make mistakes. There are also not a lot of MCQs out there so this is time well spent in your group quizzing each other.
- Talk to examiners to give you the tips on the high yield topics and how best to answer the questions. Understanding the game is half the battle. For example with a hypotension question there is no point writing “1. IV access, 2. Noradrenaline” Everyone knows noradrenaline has to go IV, the examiner will get annoyed. Better still write “Noradrenaline 1-10 mcg/minutes titrated to a MAP of 65”. Remember to think how can I write the most succinct information on one line. Anything outside these lines will not be marked and the first answers will be marked in order.
- Write your own questions. now you do not need to go over the top here but at least try it a few times. You will be amazed at how long it takes and what short cuts you take. For example, an MCQ is hard to write, when you see a table it is so much easier to create. This is exactly what the examiners do. Once you start noticing how to they would think you read the textbooks with a different mindset.
- Textbooks. Now this divides opinion, some of us read them cover to cover, while others will never open one. We have a list of recommended textbooks and as Joe Lex states ‘it is worth you reading one cover to cover at least once during your career’. For those that despise textbooks I would recommend using one to reference when you are struggling with an answer or concept particularly with MCQs. Also its worth looking at all the tables, as mentioned in point 7. This is where the examiners’ lists will come from.
- Go on a course, there are a few around and we have a list of courses. Speak to colleagues before signing up, they are varied and slightly different in style, they also cost a lot of money and some are better value than others.
- Practise, practise and practise. This sounds stupid but the best advice I got was from Jo Dalgliesh an examiner in Melbourne who gave me a Nike enema when I’d only done 2 full practise exams 2 months out from the written. By the time the exam came I had done 3o full papers to time and was able to complete a paper in 2.5 hours. By doing the exams you will see what your common mistakes are, what the examiners are looking for and your answers will become more concise.
- As per point 3 from above, make sure you have the support of your loved ones.
- Although your knowledge should have been tested in the written, now is not the time to take your foot off the break. The OSCE sometimes feels a bit like the hunger games and they can ask you about anything in the curriculum. They want to combine your knowledge with everyday practice.
- Consider going on an OSCE course or at least making sure you have done one full OSCE set, preferably a three day event. Doing one and then getting feedback does not prepare you for the mental fatigue and stamina required for a full three days.
- Develop a coping strategy for when you bomb on a station. Remember not even the prize winners make it through unscathed. It is important to keep going over the three days and to enter each station hungry for those FACEM letters.
- Develop a strategy for stress, particularly on the day. I don’t believe anyone had a heart rate less than 120 about a minute before stepping into the exam corridor. My technique was using mindful square breathing (hey whatever works for you) or doing the “power pose” outside the room (see the TED talk – Fake it til you become it).
- Develop a framework for the different OSCEs but not a script. You need to know an approach to breaking bad news or a complaint but you also need to come across as a caring human being. The examiners will not like it if you come across pre-formatted or like a robot.
- Do what the tasks ask for. Nothing more and nothing less. It was my technique to read the tasks first, then the start of the question. Finally pick out the discriminators, i.e. its late at night, a rural hospital, your talking to a consultant/intern/registrar.
- Remember your agenda may not be the same as the examiners agenda. Listen to the cues, if you get asked a question, do not dodge it, they are trying to get you marks.
- When the one minute warning goes, change tact, either thats summarising or asking if there are any other questions but you must make sure you have left the room with a consultant plan. Do not tell the intern 20 different management strategies without summarising and giving them a to do list.
- Practise, practise practise, it does become very personal and you can feel like you are always being attacked but the more stations you do the better you will be on the day answering them. Who else gets this much attention to learn while getting paid at the same time (think of the positives).
Other wise words:
- James Winton on LITFL
- EDExam interviews OSCE confederates and Andy Buck
- EDExam written fellowship advice with Luigi Marino and Andy Buck
How to: talk the talk
Presenting in front of our peer group is usually about as fun as pulling teeth, but it is a valuable experience – both for the speaker – in the act and practice of information transfer, and for the audience – a chance to receive new information and new ways of thinking about existing problems.
Dr Hans Hollerer provided his take on how to deliver impactful presentations. Review his talk:
There are plentiful guides to public speaking online.
Key points from the following TED video – skip to around 5min
- limit the number of key ideas (this suggests one only – a bit of a hard task in medical presentations)
- give people a reason to care
- build your ideas with familiar concepts
- make your idea worth sharing
Acid-base and Fluids
Acid-base and its practical application, according to the quantitative (Stewart) approach + the effects of fluids on acid-base.
- pH is determined by the need for electrical neutrality
- Strong ions and weak acids determine acid-base, not H+ and HCO3-
- The Stewart approach allows you to quantify the contribution of different abnormalities (e.g. lactate) on metabolic acidosis
- Fluids have an effect on acid-base – saline is strongly acidotic and therefore may not be the most sensible choice!
If you want to learn more on the ‘ideal’ generic fluid, have a read of this post by Josh Farkas on the Emcrit website.