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Passnotes

How to shine in the simulated surgery exam

This challenging and varied exam will test both your consultation and clinical skills– Dr Mei Ling Denney advises how to pass it

The last ever MRCGP simulated surgery exam is almost upon us. The exam will be held in New Hall, Cambridge, on 4-6 July and provides an alternative to the video as the current test of consultation and clinical skills. After this exam, candidates will either have to submit a video for MRCGP or take the clinical skills assessment of the nMRCGP.

What to take

Before you set off from home make sure you have your doctor's bag containing your usual medical equipment, such as a stethoscope, ophthalmoscope and so on. These will not be provided at the exam.

You may also wish to bring the BNF – although textbooks and other items of reference material are not permitted. Dress professionally, as you would for a normal surgery to increase the realism, but make sure your clothing is comfortable.

On the day

Allow enough time to arrive before the time stated in order to be present for the candidate briefing. On past occasions candidates have been delayed by a flood of people arriving at Cambridge railway station and taking all the available taxis.

When you arrive you will be asked to register. There will be members of the admin team and exam marshals on hand to show you where to go, and address any problems you may have. After attending a briefing session for candidates, you will be shown to your consulting room, where you will remain for the duration of the exam. You leave your mobile phone outside and switched off to avoid distraction and risk of disqualification. You must also leave books or revision materials outside. There is usually a safe place where these can be stored – speak to a marshal about this if you need to leave your belongings somewhere secure.

Getting going

Once inside your room there will only be a minute or two for you to settle in before the exam starts. Case notes giving you any necessary past medical history and drug history will be available on a folder on your desk. Make sure you read the relevant notes before each new patient arrives. There are no computerised notes.

At the sound of a bell or whistle, one roleplaying patient will enter the room accompanied by an examiner. The patients may be from different social or ethnic backgrounds and may even be disabled.Try to consult in a patient-centred way, without losing sight of the clinical problem. You have 10 minutes for each consultation – don't overrun on time as marks are awarded for:

• information gathering: history-taking and examination• doctor-patient interaction: including the patient's agenda• communication: including explanation• management: including anticipatory care.

The simulated surgery will last just over three hours in total, and will consist of 12 different cases, most of which have some degree of complexity. The scenarios are written by experienced examiners, who are also practising GPs, and will be typical of those found in UK general practice. However, childhood problems will be portrayed by third-party consultations and you will not get any patients who cannot speak English, or patients who are very ill. You will not need a chaperone, as you do not need to perform any intimate examinations.

Tips for success

• Treat your simulated patient with respect, show empathy and preserve their dignity. • Focus on the patient's problem when performing your clinical examination. Do not assume either that examination is unnecessary as it is only an exam, or that examination has to be of the whole body system.• Inquire about psychological or social problems, as well as the medical.• Allow enough time to formulate and explain your management plan.• Ignore the examiner and do not ask them any questions.

Afterwards

At the end of the exam wait in your room until a marshall tells you that you may go. Make sure you have taken your personal belongings with you, but leave any exam materials in the room. These are confidential – you will have been asked to sign a statement acknowledging this before the exam starts.

The pass rate is usually 70-80% and if you feel you did not do well in one or two of the consultations, try not to worry. Focus on the bits that you did achieve, and try to find something relaxing to do after the exam. With luck you will have a great sense of achievement when you find that you have passed a testing exam full of variety and challenge.

Dr Mei Ling Denney is deputy convener of the simulated surgery exam and a GP in Peterborough

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