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March 2007: Hot topics are best studied in revision groups

What is the most effective way to use a revision group?

How do you decide what the hot topics might be?

How can information be used most widely?

What is the most effective way to use a revision group?

How do you decide what the hot topics might be?

How can information be used most widely?

So-called ‘hot' topics, which every candidate tries to spot, are likely to come up in any of the exam modules looked at in previous articles in this series.

There are dedicated courses on hot topics, full of factual detail. These are popular among candidates and established GPs as a method of keeping up to date. One example is that run by NB Medical Education.1 There are also several useful books on the subject, such as those by Julian Kilburn2 and Louise Newson, Ash Patel and Rupal Shah.3

If crammer courses suit you, then fine, but remember that general practice is such a wide-ranging specialty that it is impossible to revise and recall every fact. This means that you need to choose your topics carefully. You should learn to work efficiently so that you cover as many areas as is practical. A revision group is invaluable for sharing large subjects.

Table 1, attached, contains example questions. You may find it helpful to draft an answer to question 1 before turning to the suggested answer, attached.

Think laterally

It is particularly worthwhile looking at areas that apply generically across many situations. Consider, for example, the evidence for alternative medicine. A few well researched articles from the BMJ or BJGP concerning the limited evidence for efficacy could be relevant and helpful when answering several of the written questions. In contrast, a specific paper on one of the countless clinical topics, such as osteoporosis, will be of no use if the topic does not come up, or, if you are fortunate and it does, the paper is likely to form only a small part of one answer. Thinking laterally, therefore, when answering many of the questions means that you could easily include a reference to alternative medicine treatments and their efficacy.

Research papers

Important emerging evidence should not be disregarded. The ASCOT study, for example, has changed the way the majority of GPs prescribe for their hypertensive patients, and so the rationale for this as well as a critical appraisal (such as the main strengths and weaknesses) of the study are worth considering. However, such papers are not that common – relatively few important research papers have significantly changed the way that GPs practise.

What research papers have changed the way you practise? For example, if you looked up an educational need after seeing a patient with a sore throat and saw that Professor Paul Little of Southampton University had written a lot about delayed antibiotics, you are more likely to recall this in an exam. You may be more likely to recall particular papers if they are written by someone you have heard of, or by a team at a hospital you worked at, or just happen to be from the city you currently work in.

The exam is carefully researched and prepared several months in advance of an exam sitting, so the emerging evidence might be several months out of date – except in the orals perhaps. This means that you can include a relevant article from the previous week's BMJ and it will have to be rewarded by the marking examiners, even though the marking schedule will have to be revamped.

Non-clinical hot topics

Issues that you find challenging can also constitute a hot topic. These might include the management of chronic kidney disease, along with practice-based commissioning,

PHQ-9s, the Chief Medical Officer's revised proof of evidence for poorly performing GPs, and patients' concerns about the adverse publicity about exaggerated QOF-related pay rises for GPs. Think about why these are a problem for you, how you deal with them personally, the implications for you, and the options you have. Hot topics therefore include non-clinical issues and are not just clinical areas found in journals.

‘Lukewarm' and ‘cold' topics

I think the term ‘hot topic' is a misnomer: there are huge areas of general practice that are ‘lukewarm' topics, such as hypertension, smoking cessation, obesity, primary CVD risk, revalidation, Shipman and death certification, or even ‘cold' topics, such as lack of evidence for evidence-based medicine, transcultural issues, risk communication, removing patients from lists, advance directives, the inverse care law, asylum seekers, confidentiality issues, diabetes, COPD and rationing, to name but a few. Debates in these areas are hardly new but they still cause difficulties and are therefore likely to be considered in the exam in some form or other.

The GP curriculum contains no hot topics but clearly states what areas a GP should cover in his/her training. Major guidance from NICE and SIGN and the NSFs may not be groundbreaking new evidence, but they clearly constitute a large source of evidence on which exam questions might be based.

Revision plan

The list of possible topics can always be expanded and may appear too daunting to contemplate. You have to look at how much time you have per week and how many colleagues you can share this task with. Concentrate on areas that are relevant to you, based on your own identified learning needs and your practice's significant events. This means that your list of hot topics will be different from those of your colleagues, but there will be some overlap.

Share these lists in your revision group. Most of the topics listed will be common sense, but to ensure that important topics are not missed, consider sharing out the past two years' BMJ and BJGP with your revision group? With some dedicated time (but not too much detail) you can soon create a list of themes, with some referenced to current literature, with up to five bullet points about each article. In the past few months' BJGP, there have been, among others, articles on screening for rectal cancer, antibiotics for sore throat, effects of the new contract on general practice, back pain, near-patient testing, continuity of care, to pick out just a few articles. These are all areas that are relevant to day-to-day practice.

If you select, say, diabetes as your topic to revise, then there is clearly a lot to consider. Your list should include the major – but old – national and international evidence, such as DCCT, UKPDS, HPS, CARDS and RENAAL, with a brief synopsis of the take-home message for GPs. However, apart from major randomised controlled studies, you need to look more widely for articles relevant to the subject. This might be a non-specific article about chronic disease management, and if so, this type of evidence will be applicable to all chronic diseases – not just diabetes.

Key points Table 1: Example questions Table 2: Example Question 1 part a Table 2: Example Question 1 part b Top tips

Think laterally
A few well researched articles on, for example, the limited evidence for efficacy of alternative medicine could be relevant and helpful when answering several of the written questions.

Sharing your list of hot topics with a revision group enables you to cover a much wider range of subjects more easily.

Further reading

1 Coales U. Get through MRCGP: Hot Topics London: RSM Press 2005


Dr Chris Elfes
GP, Swanage, Dorset, GP trainer, MRCGP examiner, nMRCGP assessor

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