Guest writer: Dr Leela is a GP registrar completing her training in Hervey Bay and will soon be returning to Brisbane with her wonderful family. She recently successfully completed her FRACGP exams.
“A few people have asked me for exam tips so here it is. Don’t take it as gospel. There are a hundred different ways to study and pass these exams, this is just my way.”
How long to study for?
I studied formally for about 6 months before the written exams, probably somewhere around the 10-20h per week depending on what else was going on; sometimes more and sometimes less. However, I’m possibly not the most efficient and tend to get distracted by Facebook way too easily. From my experience, how much you “need” to study is a very individual thing. I did pass well, and to be honest I probably could have done less study and still have passed (but I’ve never been one to be happy with scraping though, and I was studying with the aim to further my knowledge and be a good doctor).
For the OSCE, I waited until the AKT results came out (so had about a month off) then got stuck into practicing cases with my study group (meeting for a couple of hours several times per week). I highly recommend study group by skype, especially for rural registrars or those with kids. It was essential for me in a rural area with no other nearby registrars sitting OSCE, and great to not waste travel time or worry about babysitters.
All of the exams require you to have knowledge – the KFP and OSCE require you to have some exam technique, clinical processing ability and experience, so sit them all together would be my advice. This lessens the time you need to be studying!
What to study?
There are 2 ways to study – to be a good GP, and to pass the exams. I mostly focused on things that would make me a better GP; but you need to study various things to pass the exams. I probably studied a lot of things that were less likely to be on the exams because I wanted to and likewise studied some things I didn’t want to because I had to. I made a list of things that normally I would not have to remember in day to day practice but that might be needed to be remembered for the exams. These I went over in the week prior to the exams (e.g. immunisation schedule, bowel/breast cancer screening algorithms, review red book).
Before you start, make a study plan. What topics do you want to cover? What are your weaknesses, what have you already covered? For example, as a female GP I see a lot of women’s health and a lot of mental illness, so I had already spent a fair bit of time going through these topics in my first year of GP. Subsequently, they got less time on my study plan. I was a med reg in a former life so the things I had a good grip on got less attention (just a quick flick through the latest guidelines to make sure I was up to date). I was very weak on men’s health, musculoskeletal medicine, and dermatology, so spent a bit more time on these. I was fortunate enough to have a facebook study group run by my RTP which focused on a topic per week and provide some suggested resources. I somewhat followed these but spent more time on some topics and less on others.
The strategy I used was spend about a week per broad topic, start with common presentations in that topic and make sure my history taking and diagnostic strategy/red flags was up to scratch (using mostly Murtagh’s – see below), look to see if there was a Check that covered that topic and do that, and then see if there was anything that I needed to spend more time on or look up the management of – which is when I would go to guidelines, AFP and/or how to treat articles.
Another tip is to use your patients. If you see something in the day that you’re not too sure about, go home and look it up or look it up between consults if you’ve got time. Pick something that you have seen in the day that you think you know well but haven’t looked at for a while and then go back and make sure you’re up to date and haven’t forgotten something. Apply what you have been reading about to your patients, e.g. if you read up about osteoporosis, think about who might need screening when you see your patients. Remember to suggest some opportunistic screening when they are there for other things and make sure when you are talking about treatment that you are using addressing all the non-pharmacological management strategies you have learnt about and not just prescribing a drug.
What resources to use?
These are RACGP exams so use RACGP resources. Checks and guidelines put out by RACGP are KEY resources. Do all the Checks going back at least 3 years and you may want to read selected Checks a little bit older if they cover an important topic as well (just beware of things going out of date). There are pdfs floating around of the older checks if they aren’t on GP learning. Checks are a great resource and useful for day to day GP as well as essential study for the exam (I just wish they were a little easier to search). Have a read through RACGP guidelines http://www.racgp.org.au/your-practice/guidelines/ – some are more useful than others. Read through the Red Book and use it in your daily practice.
Also available from the college are the lecture series DVDs, some are more useful than others. I found the ECG one really good, the dermatology and ophthalmology ones useful, and the examination ones somewhat useful. I don’t think I got to all of them though. You can borrow them from the RACGP library so don’t waste hundreds of dollars buying them. I don’t think they are an essential resource.
AFP is also good, read them as they come to you in the mail (I tended to run a bath and read them in the bath to cheat myself that I was relaxing). It is also easy to search them via google so if you are focusing on a particular topic it’s worth searching google for “AFP + PCOS” for example. (Beware this also usually comes up with the American AAFP which also sometimes has useful articles but not quite what you need for exams). You would have to study forever to be able to read all the AFPs so pick and choose. The AFP podcasts are useful to listen to in the car if you have travel time, some are getting a little dated though. The AFP thyroid issue in 2012 I would call a must-read issue (the 3-4 main thyroid articles anyway).
How to treat, medicine today and medical observer clinical updates are useful too, sometimes a little bit too much detail for what you need. I used these when I couldn’t find what I was after in Checks or AFPs.
Murtagh’s is worth looking through, not so much for knowledge (check more up to date guidelines for treatment please!) but for clinical processing/problem solving. Part 3 (in my 5th ed anyway,) or the problem solving in general practice part, I think is essential reading at some point in your GP training. I found it extremely useful when just starting. There is no other textbook like it, and it is really useful for working out some form of strategy for undifferentiated presentations of “headache” or “diarrhoea”, or “back pain” etc. Know your probability diagnosis, serious diagnoses not to be missed, and your pitfall/often missed diagnoses. What questions do you need to ask on history (a common KFP style question), what are your red flags? You do not need to read Murtagh’s cover to cover (but I think that over the last couple of years I have probably read most of it at some stage).
eTG should be something you are using in day to day practice. If you already have been you probably won’t need to study it as such. There may be some topics you haven’t really had a look at which are worth flicking through to find the more important things. Not an essential resource though.
Likewise patient information sources can be really useful for your own learning and something to use in the consult as opposed to study – http://patient.info/ and https://www.betterhealth.vic.gov.au/ are two I use regularly. You want to be a doctor that doesn’t just reach for the script pad but can talk about the non-pharmacological management as well and I find patient resources are a useful reminder to the non-pharmacological side of management as well.
The GPRA exam handbook I would definitely invest in or borrow if you can. It goes through the technique of the exams far better than anything else. Read it early before you start the study then read it again closer to the exams.
The state faculties of the RACGP run various exam prep courses. I figure if you’re going to pay the college $8000 you may as well pay them a few hundred extra to do their prep courses. They were useful for the technique of the exams.
I didn’t use Onexamination. I had a brief look at it but the questions were based on UK exams and used UK guidelines and resources which have some slight differences. If you want some Australian MCQs, the app dr MCQ had a good but small base of questions (although am not sure what will happen to it now RTPs have changed – it was run by Sturt Fleurieu I think and I have no idea if it still exists). I really don’t think there is much technique to answering MCQs – you either know the answer or you don’t. Just don’t psych yourself out by changing all your answers.
For OSCE find a study group of 2-3 members and just go through cases. We worked through the Susan Wearne clinical cases book and I think this is an essential reading. If you have time invest in the GPRA cases book but really if you have done Susan Wearne with a decent study group you will be right. Life skills to learn here are how to give feedback in a positive but constructive way. Don’t let your group members be too easy on each other. Take the good things that your group members do and give them positive feedback, and then make note of them and use them yourself. Likewise pull them up on anything that could have been done better “when you said this it felt a little bit confusing as a patient, maybe you could phrase it in this way”. There are some things in the Susan Wearne book that we thought were a little bit out of date or odd, so don’t take the suggested approaches as an absolute, discuss them and come up with what you think and agree on as a group. The timing is often the hardest thing about OSCE, so make sure you set your timers (2 ½ minutes for reading and 7 ½ for cases to account for time from moving from station to station and to allow for nerves).
For OSCE examinations use Talley and O’Connor chapter summaries if you’ve still got your med school copy for a basis (do not read the whole book) + there’s a hundred and one youtube examination videos done by med students. If you didn’t graduate med school in Australia ask a colleague – someone will have a copy of Tally and O’Connor! You will likely get one or 2 examinations in the OSCE. Unlikely (although I am told it’s a possibility) to be real patients with real pathology. If there are examination findings it’s likely to be something subjective and able to be acted (e.g. tenderness or reduced visual fields). Don’t forget your MSK examinations of the smaller joints – we got a foot in ours. Practice your examinations until you can do them without thinking. If you are trying to think what to do next you will run out of time.
There are various recalls and practice questions floating around, often poorly written. Use them to get a feel for the topics that are covered rather than spending great chunks of time on them. If something seems wrong or odd it probably is.
Use whatever resources your RTP is providing, they are trying to help you, at least for the pre-existing RTPs they have been getting registrars through the exams for a long time.
You will get sent a link to practice exams released by the RACGP about a month before the actual exams. Do these when you get them, and use them to guide the rest of your time. If there are significant knowledge deficits work on this, if you found you had technique issues answering the KFP questions, work on this as well.
Other useful resources:
These are some other resources I found useful and that are worthwhile being aware of. Pick and choose what you need to know.
- Men’s health – https://www.andrologyaustralia.org/health-professionals/clinical-summary-guidelines/ + the patient handouts. Something about the controversies of PSA screening, be able to discuss pros and cons of screening with a patient. https://www.nhmrc.gov.au/guidelines-publications/men4
- Sexual health: http://www.sti.guidelines.org.au/ and http://www.mshc.org.au/HealthProfessional/MSHCTreatmentGuidelines/tabid/116/Default.aspx#.Vm0OgNd-9eU. Also http://www.ashm.org.au/ if you really want to know more. There are Hep B and C FP articles somewhere that were useful too. I found this a really good hep B summary: http://crmpub.ashm.org.au/product/Decision%20Making%20in%20HBV%202015_71497B8BAFEDE211AB9F984BE173A384/HBV_DecisionMaking_Jan2015.pdf
- Cardiovascular– http://heartfoundation.org.au/for-professionals/clinical-information
- Stroke https://strokefoundation.com.au/what-we-do/treatment-programs/clinical-guidelines
- CKD http://www.kidney.org.au/health-professionals/prevent/chronic-kidney-disease-management-handbook
- Asthma http://www.asthmahandbook.org.au/
- COPD http://copdx.org.au/
- Menopause/Women’s health – http://www.menopause.org.au/for-women/information-sheets, https://jeanhailes.org.au/health-professionals/tools, The family planning contraception handbook is also worth the investment for day-to-day GP (I check it regularly in consults) but probably more than you need for exam purposes (order from Family Planning Queensland or your state based family planning website).
- Antenatal: http://www.ranzcog.edu.au/college-statements-guidelines.html
- Derm http://www.dermnetnz.org/, https://www.aad.org/education/basic-dermatology-curriculum/alphabetical-listing-of-modules
- Paeds – http://www.rch.org.au/clinicalguide/ (also comes as an app)
- Breast symptoms http://canceraustralia.gov.au/sites/default/files/publications/investigation-new-breast-symptom-guide-general-practitioners/pdf/inbs_guide_for_gps_v4_with_neo_headings.pdf
- Cancer screening http://www.cancer.org.au/content/healthprofessional/GP_Screening_Card_July2014.pdf
- Gastroenterology http://www.gesa.org.au/professional.asp?cid=26&id=51 (gesa also has some good patient handouts)
Topics not to forget about
- Driving – an understanding of how the system works and how to use the assessing fitness to drive book – you don’t need to know the specifics of individual diseases. Something to think about in your KFP and OSCE answers e.g. for an OSCE case checking the AFTD book and discussing driving might be part of your management for a case.
- Diabetes – hopefully having graduated from med school you have a good grasp on diabetes already. Read the RACGP diabetes guidelines and be aware of the controversies (GDM diagnosis). What do you need to brush up on? (For me it was the new drugs and initiating/titrating insulins – although the intricacies of insulin management is unlikely to come up in an exam). I think there is a recent AFP issue on diabetes and a recent diabetes Check – I would suggest reading these as well.
- Vertigo and dizziness came up a lot in our exams – have a good diagnostic strategy for vertigo (central vs peripheral causes and how to differentiate, diagnostic features of BPPV, acute vestibular syndrome/labrinthitis/neuronitis, Menieres, vestibular migraines etc., how to do a head impulse test, Hallpikes manoeuvre and Epley’s manoeuvre)
- Paeds – viral exanthems seem to come up a lot (know your key features of measles, roseola, 5th disease, kawasakis etc), likewise developmental milestones. Neonatal jaundice came up in our exam (know the difference between conjugated and unconjugated, causes of both, what would you ask parents on history). Know something about immunisations and be familiar with the schedule and the immunisation handbook.
- Travel medicine (not just vaccinations, what else should you be discussing with your patients, how do you assess their risk?). Fever in the returned traveller.
- Some emergency management e.g. BLS and anaphylaxis at a minimum especially for OSCE
- Aboriginal health – use resources provided by your cultural safety training, read the RACGP Aboriginal health guidelines, know about the aboriginal health SIPs/PIPs/CTG. For OSCE think about things like rapport (tell me about where you are from, your people etc), can they afford and/or access the treatment you are prescribing and utilising aboriginal health workers or local aboriginal health services.
Other exam websites and blogs/useful websites:
And finally, some fantastic OSCE tips by the most wonderful Genevieve Yates http://genevieveyates.com/medical-education-resources/racgp-osce-tips/
Thanks Leela for letting us share your great insights! Good luck everyone.
Thanks for the pictures: Collegedegree360, XKCD.com, and Webdonuts.com