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Last-minute preparation for the written MRCGP papers

A few minutes' reading and careful preparation can drastically improve your mark, says

Dr Patrick Clarke

s MRCGP looms,

preparation can seem a daunting task. The knowledge base for general practice is immense.

It is impossible to know everything. Fortunately examiners know this too. There is little time left to cram in any further information.

A little thought at this late stage about how to answer the variety of questions can reap rewards. Think about how to answer the questions. This is a skill that will ensure you excel in your MRCGP.

Luckily this is an exam unlike any you will have taken before. Much of the MRCGP tests your ability to think and problem-solve. You can know everything about a subject and still not pass.

The secret is technique and to think broadly. This article covers a few last-minute techniques. With just a few minutes' reading and preparation, you can drastically improve your mark.

The exam tests breadth not depth of knowledge so you'll probably want to think about the questions in terms of the categories.

Interpreting GP literature

When a question asks you to 'give the evidence of' do not despair. If you cannot quote papers, think of a situation where you have dealt with such a patient. Demonstrating an understanding of the evidence is more important than an ability to list authors.

Your knowledge of how to treat such a patient will have come from your peers, textbooks, your trainer,

the practice and your personal experience. If you cannot remember an author, quote where you saw the article.

There are many sources, so think about referring to the BNF, BMJ, BJGP, Clinical Evidence and NICE. Hot topic courses are an ideal way of gathering last-minute evidence. Don't forget to discuss your views and appraise the evidence.

Evaluating and interpreting

a paper

You usually have about an extra 30 minutes to read the various articles but check this at the start of the exam. Practice is the key to these questions.

You need to work out a framework of your own for critiquing a paper. A variety of books can help you such as MRCGP, Approaching the Modular Exam.

You need to know the basics of the hierarchy of papers, bias, confounding variables, sensitivity, specificity and so on.

These questions are not as hard as they look. Break papers down into cross-sectional studies, cohort studies, case-control studies, randomised control trials, reviews and qualitative papers.

The books tell you the strengths and weaknesses of each and how to critique them.

A little practise makes these questions much less threatening. They can often be the easier marks.

Questions testing your ability to problem-solve GP scenarios

Think broadly. I tried to combine all my various frameworks. Think of the Pendleton and Neighbour models, a basic medical history and a physical, psychological, social model.

A possible framework on which to base your answers

 · Presenting complaint: ideas, concerns, and expectations (to get marks, you need to elaborate)

 · History of presenting complaint; past medical history

 · Drug history

 · Social history: occupation, family, smoking, alcohol

 · Examination

 · Differential diagnosis; explaining this to the patient

 · Checking understanding

 · Relevant investigations

 · Management: think about social and psychological and involving the patient as well as medical; think about enlisting the help of other members of the primary health care team, patient leaflets, self-help groups, citizen advice bureau; think long- and short-term

 · Safety-netting

 · Opportunistic health promotion

 · Time management

 · Housekeeping for yourself

 · Factors relevant to patients, doctors, general practice, and society; include limitations

 · Ethics including beneficence, non-maleficence, autonomy, consent, confidentiality, equity

Work out your own answer plan. Questions are marked on a series of constructs: usually five per question with an equal number of marks for each one.

If you focus on just one area, you may run the risk of only earning a fifth of the marks.

Write in note form, legibly, and with headings, lists and bullet points. Don't forget to read the question.

New question formats

Make sure you are familiar with the variety of questions in paper 2. Again, this paper does not test pure knowledge.

For many of the extended matching questions and the 'fill in the blanks' (summary completion) questions, you can work out the answers.

As a result, they will take longer. You need to be aware of this to ensure you complete the paper. There is no negative marking so make sure you answer all questions.

Look for examples in the RCGP exam regulations book and in the variety of textbooks and GP newspapers. One final tip: don't forget how to calculate sensitivity and specificity.

Practical tips

 · Look at the past papers and read through the examiners' comments on the RGCP website

 · Make sure you know how to critique a paper

 · Prepare answer plans for the variety of questions in the written paper

 · Ensure you know the format of paper 2

 · Look at the RCGP exam regulations handbook

 · Don't panic ­ examiners don't expect you to know everything about everything

 · Carefully read the questions ­ otherwise marks can easily

be lost

You can know everything about

a subject and

still fail~

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