Medical Examination Preparation Guide for Year 6 Students

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