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Introduction to Year 6

Introduction to Year 6. Dr Alice Lee AFP in Surgery, North West Thames, London Gold Medal Winner Dr Mohammad A. Fallaha AFP in Surgery, North West Thames. Structure. FPAS SJT Exams PACES Writtens PSA Firms Neurology Cardiology MSK GP Elective. Senior Med Senior Surg

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Introduction to Year 6

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  1. Introduction to Year 6 Dr Alice Lee AFP in Surgery, North West Thames, London Gold Medal Winner Dr Mohammad A. Fallaha AFP in Surgery, North West Thames

  2. Structure • FPAS • SJT • Exams • PACES • Writtens • PSA • Firms • Neurology • Cardiology • MSK • GP • Elective • Senior Med • Senior Surg • Acute Care

  3. Dr M A Fallaha, Intro to Year 6 Talk 2019 FPAS Deaneries(2019) Educational Performance Measure (EPM) = Educational Achievements (EA) / 5 / 43 / 2 / 50 Med School Performance Publications SJT Additional degrees Timeline • 14th October – January – local AFP recruitment – will discuss later! • 15th Jan – 12th Feb 2020 – AFP national offers • 30th September – 11th October 2019– Oriel is open for application • Third week of October – final EPM score available, which includes validated EA* • 6th December (for Imperial) – sit SJT • 5th March 2020 – Deanery allocations released • 2nd April 2020 – Final programme allocations released … *Based on 2019 timeline

  4. Dr M A Fallaha, Intro to Year 6 Talk 2019 SJT Friday 6th December 2019 Scoring • 70 questions in 2 hours 20 minutes (2 minutes / question) • = 50% score for FPAS Type 1 – 4 marks for each correctly placed item = maximum 20 per question, minimum 8 Type 2 – 4 marks for each correct item, maximum 12 per question Convert using wizardry (+maths) to score between 1 – 50* *most candidates get between 35 - 44 Type 2 Type 1 Option 5 Option 1 Option 1 Option 6 Option 2 Option 2 Option 7 Option 3 Option 3 Option 8 Option 4 Option 4 Option 5 Top Tips • Finishing the paper = success • Sinking time into one question? Move on • Start preparation at the right time (one month is fine) • The best preparation are the official mock papers online (there are 2) • Make a list of common topics (e.g. unsafe colleague) and read up on GMC Best Medical Practice • Four stems. “Please rank by: • Appropriateness of actions • Appropriateness of statements • Importance of considerations • Order of actions

  5. Exams Writtens x2: 5th, 7th March PSA: 11th March PACES: 19th, 20th, 21stMarch *Please note: last year’s exam dates

  6. Writtens Exam format • Two SBA papers • 150 Qs (each) • 3 hours long (each) • Content • Some from ‘national’ bank • Some from ICSM • Total mixture of content between 2 days • Can partially predict content (if one exam particularly specialty heavy)

  7. Writtens Practice • AS Notes – Med, Surg • PassMed • Question books? • Official mocks (from Faculty) • NICE Guidelines • What is the first line investigation / management? • Past paper bank (including from other medical schools e.g. Kings) • Repeats likely Advice • Don’t neglect palliative care, oncology, anaesthetics • https://www.palliativecareguidelines.scot.nhs.uk/guidelines/ • Pass/fail exam

  8. PSA Exam format • 60 Qs, 2 hours • Prescription writing 8 Qs, 10 marks each • Prescription review 8 Qs, 4 marks each • Planning management 8 Qs, 2 marks each • Communicating decisions 6 Qs, 2 marks each • Adverse drug reactions 8 Qs, 2 marks each • Monitoring drug therapy 8 Qs, 2 marks each • Data interpretation 6 Qs, 2 marks each • Calculation skills 8 Qs, 2 marks each Pass mark (11th March 2019): 62.5%

  9. PSA Practice • Don’t spend >1 month revising • Pass the PSA. William Brown. • https://prescribingsafetyassessment.ac.uk • Practice mock • Full length mocks x3 • Do them all multiple times • Similar topics every year • Speed is important • (PassMed) • National prizes to be won NICE BNF vs. Medicines Complete*

  10. PACES Exam format • One combined exam: Medicine & Surgery • Real patients • 9x 10 min stations + 22 min station

  11. PACES: General advice Advice • Practice in groups (like 5th year) • Examine patients & present • Make a list – common topics • Prepare a presentation for each common condition: • Definition • Causes • Investigations: bedside, bloods, imaging, special tests • Management Resources • Alistair Scott – PACES notes • Past PACES reports • Do not worry/obsess over them • Courses • Muslim Medics Finals Crash Course • Art of War • Mocks (Chelsea) • Books • Cases for PACES • Clinical Medicine for MRCP PACES • Clinical Cases & OSCEs in Surgery

  12. My PACES Medicine • Respiratory – Bronchiectasis • Cardiology – Prosthetic valve? • Neurology – Parkinson’s • Shorts • Systemic sclerosis • NF1 • Thyroid mass Surgery • Abdomen – renal transplant • Ortho – bilateral knee OA and TKR • I&I • LLL collapse • Large bowel obstruction • Epidural pack (what?) • Suture scissors • Chest drain trocar • Shorts • Vascular bypass • Fasciotomy scars • Liver cyst?

  13. PACES: Medicine advice Respiratory • Chronic conditions: • Bronchiectasis • COPD • Pulmonary fibrosis • Lung cancer (uncommon) • Pneumonectomy/lobectomy • Visit Royal Brompton? Medical shorts • Endocrinology • Thyroid masses • Cushing’s syndrome • Acromegaly • Rheumatology • Rheumatoid hands • Systemic sclerosis • Dermatology • Psoriasis • Neurofibromatosis • Ophthalmology • Fundoscopy (DM, HTN, retinitis pigmentosa) • AS Notes – PACES • Do a proper examination • Practice with friends using images of clinical signs

  14. PACES: Surgery advice • Clinical Cases in OSCES and Surgery • AS Notes - PACES • Practice with friends using images of clinical signs Surgery shorts • General surgery • Stomas • Scars • Vascular • Amputation • Varicose veins • Ulcers • Bypass surgery scars • Urology • Urostomy • Breast/plastics • Mastectomy • Breast reconstruction (different types!) • Skin grafts… • ENT • Tracheostomy Abdomen (gastro or renal) • Kidneys: • Renal failure • Polycystic kidneys • Renal replacement therapy: transplant, dialysis access • Liver: • Cirrhosis / hepatomegaly • Bowel: • Inflammatory bowel disease (+ scars, stomas) • Colorectal cancer (+ scars, stomas) • Stomas (must learn!) • Spleen • Splenomegaly • Renal attachment, haem wards (splenomegaly)

  15. PACES: Acute station Acute Care Station • Blueprint for station (from Dr Sam): • Read patient history & exam (max. 3 mins) • Domain 1: summarize history & exam • Domain 2: suggest likely causes • Domain 3: suggest investigations to perform & interpret them, explain treatment • Domain 4: explain management plan to patient • Revision: • Learn an AE spiel (you may not get to say it!) • Learn investigations and management for common emergencies (incl. doses?) • Practice explaining in lay terms • Resources: • Oxford Handbook of Clinical Medicine • Oxford Handbook of Foundation Programme

  16. PACES: Images & instruments Images (AS PACEs – radiology) • CXR – respiratory pathology (pneumothorax, lobar collapse, pneumonia), air under diaphragm • AXR – bowel obstruction • CT – renal stones, subdural/extradural haemorrhage, subarachnoid haemorrhage… Instruments (AS Notes - instruments) • Practice your spiel • “This is a ____ • I have seen this used during ___ firm…” • Instructions for use • Indications • Complications • Look at CX / HH box, Blackboard, Dr Sam’s lec

  17. PACES: History station • Direct opening question asking about patient background • Thank the patients for coming down • Use pen & paper if it helps you • Always ICE!

  18. Firms

  19. Cardiology • Try to examine:

  20. Neurology • Rehabilitation unit at Hillingdon Hospital = excellent • Try to examine:

  21. MSK • Rheumatology • Perfect the hand exam! • Try to examine: • Rheumatoid hands • Systemic sclerosis • Try to visit Hammersmith hospital – infusion unit, Renal building • Lots of patients with systemic sclerosis, severe rheumatoid, extra-articular manifestations e.g. lung fibrosis • Orthopaedics • Try to examine: • Osteoarthritis – knee, hip • Total knee replacement • Total hip replacement • Ask an ortho doc to review your examination (talk through it?) • Adapt your examination: cannot do certain tests on patients with hip replacements or knee replacements

  22. GP • Lots of patients with chronic conditions • Practice for the history station • Opportunity to examine: • Osteoarthritis • Heart failure • COPD • Surgical scars • Audit

  23. Dr M A Fallaha, Intro to Year 6 Talk 2019 Tips for Firms Senior Surgery By the end of the year, be confident examining: • GO TO THEATRE – opp. to get quizzed by consultant • Shadow F1 and SHO on surgery – attend emergencies • Review patients (ABCDE, fluids, analgesia, bloodwork etc.) • Strategic library afternoons… • Vascular • Varicose veins • Arterial / venous ulcers • General • Hernias (inguinal, femoral, other…) • Breast surgery patients • Head and neck lump examination • GI / transplant (HAMMERSMITH!) • Renal transplant • Abdominal scars • Stomas (including types and associated operations) Senior Med • Ask to do jobs! (#cannulamaster) • Look for DOPS opportunities early • Befriend the F1s • Clerk every patient (could be finals patient) • Cardio / Resp / Gastro patients • Cardio exam (murmurs, HF etc.) • Gastro exam (hepatic failure, renal failure etc.) • Resp exam (asthma, COPD, CF etc.) General • SIGN HUNTING in groups 2-3 max • If you have a suggestion for your colleague say it • Balance bookwork with firms (personally suggest 50:50 split) • Sign up to PassMed / PasTest for practice during firms • QUIZ EACHOTHER REGULARLY • Acutely unwell patient • A->E assessment • Obs + interpretation • Requesting investigations systematically • Interpreting results Acute Care • Be the FIRST to clerk patients • Come up with DDx + working Dx then present to senior • If offered, do a supervised primary survey of blue light patients • Sharpen ABG + catheterisation skills

  24. Elective

  25. Dr M A Fallaha, Intro to Year 6 Talk 2019 Elective Things you need to do: Things to think about • Experience • In specialty • In country • Different healthcare setting • Single centre vs multi-centre • Paperwork • Budget • Before you go: • Vaccines + OH approval • Elective approval forms (personal tutor + FEO) • Medical indemnity • Insurance • During • Learn • Keep a diary (+/- logbook) • ?Research • Take photos for the ‘gram • On return: • Elective report • +/- Extended elective report • +/- Sponsor elective report • Travel • Climate • Part of the world • Post-elective trips • Funding • Alone vs. with others Top Tips • Organise early on (you have finals and other things to be doing!) • Don’t leave vaccinations to the last minute • You don’t need to go somewhere exotic to have an incredible time • Use time after to catch up with non-uni friends

  26. Introduction to Year 6 Dr Alice Lee – alice.lee13@imperial.ac.uk AFP in Surgery, North West Thames, London Gold Medal Winner Dr Mohammad A. Fallaha – maf13@imperial.ac.uk AFP in Surgery, North West Thames https://tinyurl.com/howtoyear6

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