Studying for your clinical exams

Exam tips by Dr Genevieve Yates

This content has been kindly provided to us by Dr Genevieve Yates from her popular blog

  1. The process (eg. structure of the consultation, safety-netting, patient explanations, examination skills, formulation of a differential) is just as (and sometimes more) important than knowing the exact diagnosis. Getting the correct 'answer, e.g diagnosis, does not mean you’ve passed the station. Conversely, getting the wrong 'answer' doesn’t mean you’ve failed the station.
  2. Don’t forget your basic communication skills and end up rushing through the doctor/patient interaction, worrying about time. When appropriate, use silence – think and listen, then speak. Remember that the 'patient' may be anxious, teary or angry. Be aware of your own emotions. Allow 'patients' to express their emotions. Bolster their self-confidence. Involve 'patients' in decision making. Make certain your non-verbal cues match your words.
  3. READ THE QUESTION! I know this has already been mentioned but I can’t emphasise it enough! Familiarise yourself with various Instructions for Candidates – you must follow these instructions to score marks and knowing how many tasks you have to do will help you manage your time. Pay close attention to whether you’re instructed to discuss issues with the 'examiner' (this can be done quickly and using medical jargon) or with the 'patient' (need to use a patient-centred approach / appropriate language while still showing off your knowledge to the examiner. A useful technique is using the correct medical term then explaining. E.g. “The tests show that you have a condition known as 'x'. This means “blah blah”. Have you got any questions about this?”
  4. Learn to ignore visual clues during the exam. This can be one of the hardest things to adapt to as we gather a lot of information about our patients from their external appearances. The role player will probably be a different age and body shape to the 'patient' and may even be a different gender. While the role playing examiner will try to give you appropriate non-verbal cues (facial expressions/ body language etc) not all of them are great actors, so it may be hard to gauge (but try your best to work it out). The best way to prepare for this is by doing mock stations with your colleagues, friends and family.
  5. Don’t assume that there won’t be any clinical signs if asked to examine a 'patient', thinking it is a healthy 'role player'. It might be a real patient with real signs! On the other hand, don’t invent signs to fit with your presumed diagnosis (this sounds obvious but you’d be surprised how many people do it!)
  6. If the 'patient' presents with symptoms of anxiety or depression, it is worth requesting the results of a depression/anxiety rating scale as part of the examination component. It may not be available, but can be very helpful if it is.
  7. You have to say it aloud to score marks, you cannot just imply. Verbalise actual diagnoses, test names, medication names etc. if you know them. Talk through your examinations as you go.
  8. If you’re not sure about something, say what you think it is and admit you’re not certain, then follow it up with something like, “I will look it up on 'x' website” or “I’ll discuss it with 'x' specialist”. This shows that you’re practising safely and may make the difference between passing or failing the station.
  9. When in doubt, talk about: patient education, support and counselling, lifestyle modification, patient information handouts, follow up plans and safety netting.
  10. Physical examination – don’t forget: General appearance, BMI, vital signs.
  11. If you’re not getting anywhere with the history and you’re feeling a bit lost, you may find it useful to do a systems review. One mnemonic that may be of use in the OSCE is SYSTEMS:
    S – Sleep
    Y – Your weight (loss / gain)
    S – Symptoms – constitutional (eg. fever, malaise)
    T – Travel history
    E – Eating (diet / appetite)
    M – Mood
    S – Sexual health.
  12. Once you’ve finished a station, put it out of your mind. Don’t ruminate – you can’t go back and change it. Focus on the next station. Take a deep breath and use your three minutes reading time to plan it out.
  13. Use the rest stations (11mins each) to clear your mind and relax your body. You may want to find and practise a 10 minute meditation or relaxation exercise for this purpose, especially if you are prone to performance anxiety.
  14. Don’t overdose on the lollies or the water provided at the rest stations. Your performance will not be enhanced by a sugar high, and while keeping hydrated is good, you don’t want to be busting to go to the loo!
  15. On a similar note, have your usual caffeine intake on the day of the exam – not more, not less. It is not the time to be going through caffeine withdrawal, nor the time to drink a triple espresso for the first time.
  16. While it is an artificial and stressful set up, and you need to learn how to play the exam game, remember that the aim is to assess whether you are a safe and competent GP. The best preparation you can do is by being as good and conscientious a doctor as you can every day with your patients. Ask structured histories, examine your patients properly, give good patient education and always make follow-up plans and safety net. Then come into the exam and be your usual GP self!
  17. Remember: “We are what we repeatedly do. Excellence, then, is not an act, but a habit.” Aristotle
  18. My final tip – try to avoid traumatic brain injuries in the month leading up to the exam. (If you’re interested in reading about how I came to be doing my OSCE with six facial fractures and left temporal lobe contusions… click here)

You may also like to check out gpexamsupport.com.au

Good luck everyone!

(These views are my own, not those of my employer, North Coast GP Training, or the RACGP. Thanks to Nispa Krongkaew for her contributions to the above list.)

 

Exam tips for trainees by Dr Penny Wilson

This article has been kindly provided by Dr Penny Wilson, from her popular blog.

There’s been a bit of discussion in the twittersphere recently about an online sharing of study resources and tips for exam candidates under the hashtag #GPexams13. What a brilliant idea! As someone who has recently sat and passed my RACGP exams, I thought I’d share my experiences and give you my top tips to make your study period as productive and stress free as possible. Obviously everyone has their own study methods so this may not work for everyone, but I hope it will help give you some ideas to get you started.

1. Learn as you go along

The general practice setting is the perfect place to inspire learning. As you come across clinical questions you don’t know the answer to, write them down and use them as a basis for further reading. Information sinks in so much better when it relates to a real life situation so don’t waste those opportunities.

2. Give yourself enough time

Cramming for a week before exams might have worked back in the old uni days but I wouldn’t recommend it for the fellowship exams. With the sheer breadth of knowledge required, a last minute cram is a sure fire recipe for panic. The amount of time needed depends on the individual and how intensively you want to work during the study period, but most people I have spoken to agree that leaving yourself 3 to 6 months is probably about right. Some people find it useful to take a week of study leave before the written exam. You could also take leave before the OSCE but you might find that it’s best to carry on working all the way up to the OSCE and use your patient consultations to hone your exam technique.

3. Misery loves company

Keeping in touch with other registrars who are also sitting exams has numerous advantages including; having others to bounce ideas off, having input from people with different experience or expertise, pooling of resources and ideas and being able to have a rant about work/study with those who know what you are going through. Being accountable to others is also a good study motivator. I was in a study group of four people and the most efficient number is probably between 3 and 6. If you are geographically isolated or prefer to study on your own you can still access peer support through Skype, Twitter, the GPRA 'find a study partner' page , or have a chat to your RLO.

4. Have a plan

It is my understanding that the content of the RACGP exam is theoretically proportioned according to the presentations seen in practice, based on the BEACH data. It is worth having an idea of what areas are likely to come up a lot in the exam (eg respiratory) and which things might only have one or two questions. You can then formulate a list of topics to cover. This will help you identify the biggest gaps in your knowledge, allocate your study time effectively and make sure you don’t miss anything.

We divided the topics up between us and each week prepare a couple of pages of notes on our allocated topic. We would then meet up to discuss the topics, gossip about work and take turns demonstrating our culinary skills over dinner. It’s a pretty comprehensive list so we felt pretty well prepared for the exam and are now benefiting from having a great set of reference notes for use in day-to-day practice.

5. Familiarise yourself with the exam format

It would seem that exam success is partly due to knowledge and partly due to knowing how to answer the questions. I’d recommend that you attend any exam preparation workshops run by your RTP as this will help you get used to the type of questions you’ll encounter in the exam. There are also workshops in different states run by the RACGP so check the website for details. GPRA also runs exam preparation webinars by people who have recently sat and passed the exams – see the page here.

Also, do have a go at some practice exams. There are a few accessible through the RACGP website, and the RACGP online learning portal gplearning including an online demo exam and you might be able to get hold of some old papers floating around from some of the registrars who have recently done the exam. Beware that some of the hand-me-down practice exams are quite old so the questions aren’t particularly up to date.

When it comes to the OSCE – practice practice practice, preferably with one or two other people and a stopwatch. The time management for short and long cases takes a bit of getting used to. Make sure you read the question carefully, as short cases might ask for history and exam, history and management, management only, interpretation of results or any combination of the above. You won’t get points for a perfect management plan if the question doesn’t ask for it so don’t waste valuable minutes. For long cases, we found it helpful to have a standard template on an A4 piece of paper which you could quickly scribble out during reading time so you don’t miss anything. For example, you might write down the following headings: HPC, PMH, allergies, smoking, drugs, medications, social history, FH, examination (vital signs, systems, MSE if relevent), investigations (bedside, lab, imaging, special investigations), management (short, medium, long term, medication, lifestyle, referral) and safety netting.
Clinical Cases for General Practice Exams by Susan Wearne is a good textbook for OSCE practice. Sample cases from The general practice clinical cases book can also be found on the GPRA website.

6. Don’t forget to enrol!

Exam enrolment dates for each year can be found on the AGPT website.