PAPER TWO

1. PAPER TWO MCQ – Multiple Choice Questionnaire

2. What do you want from MCQ preparation? • Table as a group (get to know your neighbour) • Person nearest the aisle is spokesperson • Just FOUR items required • Only takes a minute or two

3. TUTORS’ Aims of MCQ preparation • Review format/content of exam • Flavour of questions • Practice (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 seminar • Overview • Content • Revision • Format

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 passed • 23% of candidates given merit

7. Overview MCQ • Just a few extra marks makes a large difference in your ranking compared to your peers

8. Overview MCQ • Questionnaire – (60% response rate – 90% passed) • Difficult!! (yet nearly 80% passed) • Appropriate questions • Extended matching items most difficult (and Summary Completion) • Time a problem • NOW 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)

10. CONTENT

11. Content • clinician • family physician • patient's advocate • gatekeeper • resource allocator • handler of information • team member • team leader • partner • colleague The Gatekeeper

12. Content • employer • manager • business-person • learner • teacher • reflective practitioner • researcher • agent and shaper of policy • member of a profession • person and individual

13. Content • Syllabus 32 pages long • 17 pages of general concepts for each defined area • 13 pages of appendices - checklist • 2 pages of references

14. Content - syllabus • Good medical practice and care • Generalist skills • The doctor-patient  relationship, communication and consulting skills • Professional, ethical and legal obligations • Population, preventive and societal issues • Information management and technology

15. Content - syllabus • Risk management • Monitoring of quality of performance, audit and clinical governance • Continuing Professional Development, learning, teaching and training • Working with colleagues • Organisational administrative and regulatory framework • Financial probity and business management

16. Content (example from syllabus appendix) Serious communicable diseases • Particularly, but not limited to, infections such as Human Immunodeficiency Virus (HIV), tuberculosis and hepatitis B and C • Means and control of transmission, awareness of diagnosis, investigation, management, consent for testing, issues of confidentiality and the implications to the patient of a positive result • Role of Public Health Services

17. Syllabus – help or hindrance • First direction for revision from College • A little vague in places but a useful starting point • Certainly worth a read to help identify areas of weakness

18. Content • Medicine - 65% • Admin. & Management - 15% • Research, Epidemiol. Stats - 20%

19. Cardiovascular Dermatology / ENT / ophthalmology Endocrinology / metabolic Gastroenterology / nutrition Infectious diseases / haematology / immunology / allergies / genetics Musculo-skeletal Paediatrics Pharmaco-therapeutics Psychiatry / neurology Reproductive / renal Respiratory all equal - 6% !! Medicine (65% of marks)

20. Implications for revision • DERMATOL / ENT / EYES – 6% of exam

21. Research/epidemiol./stats – 20% • Assessing the quality of care • Principles of audit • Understanding and application of the terms used in inferential statistics and evidence-based medicine • Knowledge 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 background • Identify areas of weakness • Prioritise these areas • Don’t spend time needlessly • Make use of review articles and publications such as ‘Clinical Evidence’

24. Revision

25. Revision

26. Revision

27. Revision

28. FORMAT

29. MCQ FORMAT – why change? • Congruence with education • Mainly PBL • Flaws in multiple T/F format • Rote memory vs problem solving • Benefits of newer formats • ?integration of factual knowledge / personal care

30. Format • <250 questions • EMQ - extended matching item questions • SBA - single best answers • MBA - multiple best answers • TAQ – table / algorithm completion • SCQ- summary completion questions (???) • Items per question will vary between 3 and 6 • Trial 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 COMPLETION • EXTENDED MATCHING ITEM • TABLE / 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 bathroom • administer inhaled budesonide • prescribe amoxycillin 125mg tds for 5/7 • administer inhaled salbutamol • prescribe paediatric codeine cough suppressant • administer 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 inhaler B Beclomethasone inhaler C Ipratropium inhaler D Salmeterol inhaler E Sodium cromoglycate inhaler F Oral theophylline G Oral steroid trial H Nebulised ipratropium I Referral for long term oxygen therapy

36. Summary Completion Questions - possible fill in the gap words (given in College instructions) • association • exclusion • sensitivity • bias • precision • success • difficult • safety • validity • error • selection • variables • blinded • questioned • typical • cohort • randomised • undertaken • demonstrated • reliability • unrepresentative

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: (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 artery Instruction: 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. Not requiring contraception Requiring contraception 3 --------- Combined oral contraceptive pill 1 ------- 2 ------- Medical management of menorrhagia: For 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

41. A Copper intra-uterine device • B Cyclical medroxyprogesterone acetate • C Cyclical norethisterone • D Inert intra-uterine device • E Levonorgestrel releasing intra-uterine system • F Mefenamic acid • G Nonoxinol ‘9’ • H Tibolone • I Tranexamic acid

42. OPSCAN SHEET

43. OPSCAN SHEET • Use only the pencil provided • Potential pitfalls • Wrong ID number • Skip a question?

44. MCQ Summary • Time is more important • 250 questions in 180 mins • 43 seconds per question • Answer everything – no negative marking • Practice, practice, practice (go over weak areas)

45. Practice • A composite paper giving examples of multiple choice questions is published from time to time, and is available from the RCGP Sales Office • Does not include many newer questions? • Also, • PEP, • Pastest

46. The End!!!!