preparation for the national exam - rcp london

Preparation for the national examwhat to expect in your first year of qualification and Q&A with a newly qualified PA

Faculty of Physician Associates student conferenceThursday 27th September 2018

Jamie Saunders MSc PA-RPhysician Associate in Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust

What’s going to be covered?

- Format of the national exam- SBA- OSCEs

- (My approach to) Preparing for the national exam

- PGY1 (Postgraduate Year-1) and what to expect

- The future…

- Q&A

#FPANationalConf2018


Format of National Exam

Part 1 – SBA/MCQ Paper- 200 questions- Mixture of single best answer and multiple choice questions (one single answer only)

- SBA takes place on the same day, in different locations across the country- You will be asked to attend a set location and at a specific time- When you arrive you will be asked for present you ID (driving licence or passport or other validated

photographic identification)- After this you will be placed in a holding area whilst all other candidates are checked in and you will get to

have your final chat with your friends

- The exam itself is split into the morning session and the afternoon session- You will sit 100 questions in 2 hours in the morning- Followed by an hour (or so) lunch break- You’ll then back in the afternoon for another 100 questions in 2 hours


Single Best Answer (SBA) / Multiple Choice Question (MCQ)


Cardiovascular 12%Respiratory 12%Gastroenterology 12%

Neurology 9%Psychiatry 9%

Endocrine 8%

Reproductive 7%

Urinary/Renal 6%MSK 6%

Dermatology 5%ENT 5%

Haematology 3%Infectious Disease 3%

62% = 124 questions



Part 2 – Objective Structured Clinical Examination (OSCE)- 14-bay OSCE stations

- stations are 8 minutes long plus (2 minutes reading time) = 10 mins per station- each one will be equally weighted- all station have a total of 35 marks

- The total achievable marks for an exam will therefore be 35 x 14 = 490 marks- The pass mark will be calculated during the day using borderline regression and could potentially vary from

eg 40% (for a difficult station) up to as high as 80% (for a straightforward station).

- Candidates must pass the total calculated pass mark for the exam AND at least 10 out of 14 (71.4%) of the individual stations.


Objective Structured Clinical Examination (OSCE)


40% consultation skills (5-6 stations)

- History taking - Mr Smith has chest pain, please take an appropriate history

- Information giving- Mrs Clark is planned to have a colonoscopy for a change in bowel habit and has some questions. Please explain the

procedure to her.- Shared decision making

- Mr Kale is known to have T1DM and has come to you for review about managing his insulin.- Motivational interviewing

- Miss Tooley has come to you and reports a drinking problem. Please give advice.- Triadic Consultation

- Mrs Howarth has brought in her son who has a cough.- Dealing with conflict

- Mr Turner is unhappy with a recent encounter with his GP- Breaking bad news

- Mrs Davis has recently come in to hospital due to jaundice and has been diagnosed with pancreatic cancer- Telephone consultation

- Mr Jones has become drowsy on the ward. You have answered a bleep. - Written communication




30% examination skills (4-5 stations)




20% procedural skills (2-3 stations)

- Handwashing- Scrubbing, gloving and gowning- Urinalysis and interpretation- IM injection- SC injection- Venepuncture- Sterile fields and blood cultures- Perform an ECG- Peak flow / spirometry- ABG sampling- Catheterisation- Cannulation- Suturing- Speculum and cervical cytology- Preparation of IV drugs- Manual handling

20% procedural skills (2-3 stations)

- NG tube insertion and confirming positioning- Wound care and dressings- ENT and skin swabs- Urine dipstick- Pregnancy testing on urine- Check a BM

Source: GeekyMedics




10% emergency management (1-2 stations)

- Basic life support- Choking child- Immediate life support

- Airway management- Recognition of basic arrhythmias

- Apply oxygen and nebulisers- SIM man scenarios- ABCDE approach- Initial seizure management- Recognition and management/reversal of poisoning- Manage electrolyte disturbances- Fluid resuscitation in shock- Sepsis management- Basic first aid e.g. nose bleeds


Preparation for the national exam (my approach)

Start early- You need to get on it from Day 1- Leaving things to tomorrow / next week just doesn’t cut it- Cramming at the last minute is also a disservice to you, your consultant and ultimately your patient

My study plan…

Two conditions a day - MAX! - 1 specialty for the first condition - then spend 1-2 hours in the evening (after Uni/Clinicals) learning that condition- Then dinner- then a completely different condition for another 1-2 hours

- If you try to learn Asthma and COPD in the same night you will muddle up the treatment options in your head

- You also need to keep on top of your university assessments / pharmacology and prescribing / a life



Clinical presentation (signs and symptoms)- being able to differentiate a strep pneumonia from a legionella pneumonia based on the history and symptoms- and remember, weight loss isn’t always cancer – read the entire question

- COPD, TB, Coeliac disease, Diabetes mellitus, Hyperthyroidism, Addison’s disease, Chronic kidney disease – to name just a few – but a malignancy should always lead to screening questions AND are there any red flags in the history

What to expect on examination- Coarse vs fine crackles- Reduced vs dull percussion- Rebound vs abdominal guarding- and all that lovely neuro jargon that I struggled to get my head around

- remember, the exam is unlikely to say “the patient has complete unilateral sensory loss to this level”- but rather that “the patient can’t feel their right arm and right leg”



Differential diagnosis- why you would pick one condition over another, based mainly on textbooks presentations

- central abdominal pain, that radiates to the right iliac fossa vs. sudden onset right iliac fossa pain

Diagnostic tests for the condition- for example you need to know which test to order to confirm the diagnosis of Cushing’s disease – yup, it’s a 2A

condition, you still need to know that you need to do a dexamethasone suppression test

- or you’ll need to be able to understand the results from a test- e.g. why somebody ordered an oral glucose tolerance test for a patient with prominent supra-orbital ridges and

an enlarged tongue – 2B condition – and what the diagnosis is…



And finally, pick an answer- remember, it’s a mixture of MCQ and SBA

- MCQ are 5 different answers which can’t all be true- SBA are 5 answers which are all technically correct, but which one is the best correct answer given the clinical

scenario

- My advice…- cover the answers- read the WHOLE question- think of an answer for yourself- then uncover the answers

- But for the love of God, PLEASE read what the question wants from you- You will be given a clinical history and then asked…

- what is the next best step- what is the gold-standard diagnostic test- what is the most likely diagnosis



Notes…

Are you a paper or computer person (I was both…)


Preparation for the national exam (my approach)Antibiotics

Don’t just learn the antibiotic treatment for each disease, learn what class they belong to AND other antibiotics in that class. The answers may not give you co-amox and clari for your treatment of CAP but a different antibiotic in that class of antibiotics to test your understanding

AntidepressantsSSRIs, SNRIs most definitely and be aware of TCAs/MAOIsParticularly the initiation of antidepressant medications

Antipsychoticsboth 1st and 2nd generation

Anti-hyperglycaemic drugsMerformin and so-on, as per NICE guidelines for indications and dose increase / add-on therapy

DiureticsDifferent classes and indications


Preparation for the national exam (my approach)Hypertension meds

as per NICE guidance on managing HTN, as well as in elderly and diabetic and pregnant patient

Antiplatelets and AnticoagulationAspirin indications and dosageClopidogrel indication and dosageWarfarin vs DOACs [NOACs]

Heart Failure medicationsSymptom relief vs. increasing life

Asthma and COPDYou’ve just got to know the stepwise management for adults and kids, no way of buttering it up, need to know it inside out as per BTS guidelines


Year 1….


The Future…

REGULATION IS COMING

But I don’t know when…so please don’t ask me…


Right….time for some Q&A…

[email protected]

preparation for the national exam - rcp london

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