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Get a head start and overcome exam hurdles

Dr Patrick Clarke offers his insight

into the challenges for August starters

Even the forms for applying for the MRCGP exam can be a little daunting. They come as two booklets ­ one for the exam as a whole and one as a logbook for the video. You will need to complete the evidence of competence in cardiopulmonary resuscitation. You will also require passport-sized photographs and a £260 cheque for each module you plan to sit.

Multiple choice question paper

This exam comprises of a number of different question formats. Many candidates will not be familiar with the extended matching questions. It is essential to get some practice in these: there are various books now available that give examples. The MRCGP examination booklet also gives you examples of each format.

Be aware that the exam questions now take quite a lot longer than traditional MCQs. There is no negative marking so it is essential you give an answer for every question ­ even if it is a guess.

It is the hardest part of the exam to prepare for. The college has produced a set of interactive educational self-assessment programs on CD-ROM: PEP-2000 and PEP-QB which will help you to identify areas of weakness. Some of the courses will cover the MCQ as part of the programme. As well as covering clinical areas and administration, the paper also involves some critical appraisal, research methodology and statistics.

These questions will certainly require a little practice.

Written paper

This is usually a three-and-a-half hour exam. It usually consists of 12 questions, each 15 minutes long, and an additional 30 minutes to read the presented material. It was the longest exam I have ever taken and one I would only like to sit once. The exam technique is essential and, fortunately, it can be learned.

The questions require a wide breadth of thinking rather than specific knowledge. You can still obtain a very good mark without necessarily knowing everything about a topic, as long as

you use one of the learnt answer constructs.

The best way to prepare for this part of the exam is in a study group and doing practice questions.

Video consultation skills

Hopefully, you should be regularly videoing consultations. Your trainer will play a valuable role in constructively discussing your consultation skills. It is wise at this stage to familiarise yourself with some of the variety of models such as those of Pendleton and Neighbour. Mapping of the consultation is also a useful process building in a structure.

My tips for this stage in the preparation:

 · Practice is the key and you should

be videoing at least one surgery a week very soon.

 · Your trainer is the key to success in this part of the exam and will be able to guide you through the analysis and appraisal.

 · Get a list of the college criteria. There are 15 criteria possible for each consultation. I kept a copy on my desk for easy reference. Twelve are essential performance criteria ­ you need to demonstrate each of these in four out of your seven consultations. Three of the 15 are for merits and obtaining enough of these will enable you to get a merit.

 · Concentrate on getting cues as this to me is the hardest of the non-merit criteria to achieve.

 · Don't panic ­ most of the videos I submitted were obtained in the few weeks before submission.

 · Get your consultations appraised at any opportunity such as by other registrars, your VTS, courses and your mid-term assessment.

 · With preparation, this can be potentially one of the easier parts of the exam. There is no limit to the number of consultations you video in preparation, but it is time-consuming and good organisation is essential.

 · Examinations do not necessarily need to be visible on screen ­ a lens cap or curtain will suffice ­ but the tape must be kept running.

 · I found I needed at least 15-minute appointments.

 · Emergency surgeries and patients

who were new to me often obtained the most criteria.

l'Those things you say....consultation skills and the MRCGP examination' is a video-training package which is an excellent aid in the consulting skills assessment.

Oral

This is a long way off and certainly not worth getting worried about at this stage. There is plenty of time to prepare between the writtens and the oral ­ especially if you have not reached burnout.

For many candidates, it is a daunting module. It does, however, have the highest pass rate ­ about 90 per cent.

Join a revision group

An ideal way to prepare for MRCGP is with a revision group. I cannot overstate the help I obtained from my local group. Between the four of us we obtained two distinctions and two merits. By practising questions and generally talking through relevant topics, you can speed up learning ­ essential with a curriculum that has no boundaries.

For the three months before the exam we met once a week after our VTS day release for a couple of hours.

The following are a list of areas we covered that were particularly helpful:

 · Critical reading

 · Hot topics

 · Useful websites such as Bandolier (www.jr2.ox.ac.uk/bandolier), the RCGP site and Swansea 'Hot Topics' (www.swansea-mrcgp.co.uk/topics.php)

 · Courses

 · Practice papers ­ particularly useful with feedback from the RCGP website

 · Answer plans in preparation for the written paper

 · Mock orals

 · Video analysis

 · Ensuring we were all focusing on the right elements

It is not essential to have a study group but it can make a big difference. It also eased the boredom of exam revision and made me realise that everyone is in the same position.

Finally, it is a long way to go, and this is just a list of suggestions. I personally knuckled down with only a few months to go and I found this was more than enough.

But don't be complacent ­ preparation at an early stage can make a huge difference.

Useful resources

·Kilburn J. Answer Plans for MRCGP. Abingdon: BIOS Scientific Publishing, 2000

·Sandars J, Newson L. MRCGP ­ Approaching the New Modular Exam. Knutsford: PasTest, 2002

·Chana et al. The insider's guide to the MRCGP oral exam. Oxford: Radcliffe Medical Press, 2003

·Skelton J et al. Those things you say....consultation skills and the MRCGP examination. Oxford: Radcliffe Medical Press, 2003

·Rughani A. The MRCGP Workbook. Sheffield: Fulwood Publishing, 2003

·The MRCGP Examination Booklet sent with the application form

·The college website (www.rcgp.org.uk) ­ contains a number of past questions; more importantly, however, it discusses marking and why candidates succeeded or failed

·Courses ­ will often cover answer plans and model answers

·Books on critical reading

·'Hot Topic' books and courses

·BMJ, BJGP, Drugs and Therapeutics Bulletin, and a medical newspaper such as Pulse

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