9 Ways To Save Money As A Junior Doctor

Working as a junior doctor comes with lots of challenges – including balancing a busy rota with home life whilst also preparing for exams and assessments. Membership exams can be expensive and you may also be thinking about additional qualifications or diplomas to further your career options later on. In this article Dr Mahibur Rahman looks at 9 ways you can save money or increase your take home pay with little or no impact on your work life balance.

1. Claim all the relevant allowable expenses against tax. Many junior doctors don’t claim allowable expenses and end up paying more tax than they need to. All of the following are allowable expenses:

  • GMC registration
  • Indemnity
  • BMA membership
  • Royal College membership fees (e.g. Associate in Training membership for GP trainees)
  • Cost of sitting Membership exams if mandatory to your training (e.g. MRCGP)

To claim a tax refund / reduction you can either complete form P87 or contact HMRC directly if the amount is less than £2,500, or complete a self-assessment form for higher amounts. If you haven’t claimed in the past, you can make a retrospective claim going back 4 tax years.

2. Claim travel expenses. If you do any business mileage or attend a course whilst on study leave, you can usually claim travel expenses. This is particularly important if you are doing a lot of work related mileage (e.g. GP registrars doing home visits). If you work at different sites during your rotation, you can usually claim excess mileage when a particular hospital is further than your base hospital. Your employer may have rules on how to claim – e.g. submitting a mileage log, or completing a claim within 1 month of the journey so check that you meet the requirements and make sure you claim within the deadline. Claiming all your eligible business mileage could make a difference of several hundred pounds a year in take home pay (and in some cases over a thousand pounds a year).

3. Plan ahead to maximise your study leave / budget. You may find that there are courses organised by your deanery that are available at a lower cost for local trainees. Often places get filled quickly, so you may end up paying full price elsewhere. There may also be courses available for free e.g. some hospitals or organisations offer BLS + AED training without charge to local doctors. Try to use all your study budget and leave, as often it cannot be carried over from one year to the next. By planning ahead, you can ensure you can arrange swaps to get away for courses that are relevant to your development. Once you complete training, you may have no study budget and may also not get paid time off for courses.

4. Avoid paying for things that you can access for free as junior doctor.  Anyone working in the NHS can get access to thousands of journals via the OpenAthens account, and you can access hundreds of high quality e-learning modules free of charge via e-learning for healthcare.

5. Maximise the benefits of subscriptions you are already paying for. BMA members can borrow medical textbooks at low cost (just pay for return postage) – this could save you a few hundred pounds when preparing for membership exams. MPS members can access courses worth over £1000 covering communication skills, dealing with complaints, safe prescribing, dealing with difficult patient interactions and get free e-learning for the MRCGP AKT as part of their membership. MPS members an also get a discount on a variety of courses related to entering specialty training, MRCGP AKT, MRCGP CSA and GP careers.

6. Check if you can get a discount for working for the NHS. Lots of companies offer discounts but they are not widely advertised. E.g. Vodafone, Nando’s, Apple, EE. Some deals may be available for local service providers e.g. gyms / leisure centres. It is worth asking – if they say no, you haven’t lost anything!

7. Get cashback on things you are going to need anyway. Sign up to sites like Topcashback or Quidco and see if there is cashback available. You could end up getting a few hundred pounds back each year for a few minutes work – for example you can often get £50+ cashback on car insurance – an expense most of us are going to incur anyway! Cashback may also be available on flights, hotels, mobile phone contracts, broadband, utilities and more.

8. Get help from the government with childcare costs. If you have young children, you may be able to apply for the new Tax Free Childcare (TFC) scheme – this offers a 20% government top up towards childcare costs for children up to 12 years old – the maximum you can claim is £2000 per year per child. This is on top of the 30 hours free childcare that you may also be eligible for.  TFC can be used for registered childminders, nurseries, and even towards the costs of private schooling.

9. Get a TOTUM card if you are eligible (previously NUS extra). There are lots of discounts available for students with this card (e.g. discounts on Apple products, train / coach travel, car hire, restaurants, clothes shops etc.). As a doctor in training, you may be able to apply if your royal college is affiliated. Currently, trainees in GP, Medicine (RCP), Psychiatry, Radiology, Surgery, Paediatrics, Obstetrics, Pathology and Emergency medicine  are all eligible to apply as the relevant colleges are registered as educational institutions. The card costs £32 for 3 years, so only buy it if you are going to make use of the discounts. If you are not eligible for this, anyone working in the NHS can apply for the Blue Light card, which also offers many discounts (although not as many as the Totum card).

These are some simple ways that you can increase your take home pay or reduce some of your costs without eating in to your home life. If you have any other suggestions on ways junior doctors can save money easily, please do post in the comments!

11 tips to help you boost your Foundation SJT exam scores

The Situational Judgement Test (SJT) for final year medical students plays an important part in your ranking for the applications for the Foundation Programme (UKFP). Whether you have a great Educational Performance Measure (EPM) score or not, the SJT will influence which placement you get.

In this article, Dr Mahibur Rahman discusses some key tips to help you improve your score so you can get the placement that you want.

Continue reading “11 tips to help you boost your Foundation SJT exam scores”

How I got my 1st choice Foundation rotation – SJT preparation tips from a high scorer

The Foundation SJT is an important part in your overall FPAS ranking, and getting a good score will improve your chances of getting your 1st choice rotation. In this article, Dr Sarah Levy discusses how she managed to score 49.16 in the SJT (this is in the top 1% in the country) and her tips on how to do well in the SJT.

How I prepared for the Foundation SJT

I sat the SJT on the 1st December 2017 and probably first starting thinking about it at the end of October when I attended an information session run by my medical school where they discussed the format of the exam and gave advice on how best to prepare. I was fortunate to attend three further preparatory session delivered by my medical school, which involved running through various questions and discussing possible strategies for how to go about selecting answers. However, the main take-home message that I personally got from these sessions was that it is tricky to know how best to prepare for the SJT aside from practicing the official questions available online.

Test Quiz

I am inclined to agree that perhaps the most important thing I did to prepare was to do the official questions available online. I did these under exam conditions, including printing out the answer sheet example. This was useful to familiarise myself with the timings of the exam, and also with how to fill in the answer sheet (it is surprisingly easy to lose concentration momentarily and accidentally fill in the answers in the wrong order!)  I also bought one book with practice questions and borrowed another book, and spent perhaps around 8 hours in total working through questions from these books. I found that whilst some of the questions and explanations were useful, they were not hugely similar to the questions asked in the actual exam with some being far too easy and others being very difficult with unclear explanations which left me still believing my original answers to be correct. I also attended an Emedica SJT course (discussed in detail below), which proved very useful in my preparations.

Another resource that I found helpful to use in my preparations was the GMC’s “Good medical practice” document and the Ethical Guidance section of their website. The “GMP in action: GMC guidance brought to life” scenarios provided a huge array of different dilemmas that can come up in clinical practice (and in the SJT) along with explanations of how best to deal with them.

Retrospectively, having sat the SJT and achieved a score that I was very pleased with, I think that much of the “preparation” that I did was actually done subconsciously when spending time on the wards.

Female doctor explaining diagnosis to her female patient

Many of the questions I encountered in the SJT had similarities to the sort of situations that medical students witness when on clinical attachments. Whilst clearly these situations are not always dealt with in the correct way suggested by the SJT answers, I found it useful to have previously thought about such situations and how I might act if/when they were to occur in my own life. I also found it helpful during the test to think about doctors who I had found to be particularly competent and contemplate about how they might act in each given situation.

Emedica SJT course

I did the Emedica SJT course a couple of weeks before I sat the SJT, and found it to be a very beneficial experience. I was fortunate to be able to do the course a mere 20 minutes from my house but met others there who had travelled literally half way up the country to attend and also agreed it was worthwhile! Dr Rahman gave helpful hints and tips on how to tackle the SJT as well as reviewing core knowledge relating to ethics, confidentiality, consent etc.

We also went through numerous questions together and were given clear and concise explanations which I was able to learn from and later recall when answering similar questions. It was also useful to go through a mock SJT exam which again gave an idea of the timings required. The course was efficient and all the staff I encountered were friendly and welcoming. It also put my mind at ease and meant I was more confident on the test day itself. The most useful things I took away from the Emedica SJT preparation course were an improved awareness of the importance of good time management, a better familiarity with the different question types (including the newer ones) and how best to tackle them, and a sense of the importance of remaining calm on the day.

My tips for exam day

In terms of preparing for the day itself, I would recommend having a relaxed evening the night before to try and clear your head. This is probably good advice before any exam (although sometimes hard to take!) but I think it is especially relevant for the SJT which is not an exam that can be approached with fact-cramming in the hours beforehand. Personally I relaxed by phoning friends and family for a chat and reading a book before having an early night.

On the actual day, I made sure to have a decent breakfast and some coffee (but not too much!)  I found the exam itself to be tight for time, so it is important to read the questions quickly and ensure that you don’t run out of time at the end. For me, the latter “select 3” questions were quicker to complete than the initial “rank the 5 options in order of best to worst” questions. This may be worth bearing in mind when working out how best to manage your time during the exam.

Conclusion

In summary, from my own experiences of sitting the SJT, I would recommend specifically practicing and reviewing all the official questions available and thoroughly familiarising yourself with the format and time constraints of the test itself. I found the Emedica SJT course to be helpful and concise, and an important part of my SJT preparations.

Dr Sarah Levy scored 49.16 in her Foundation SJT and is now in her FY1 year in her 1st choice programme in the North Central and East London Foundation Programme!

10 tips for doctors starting a new post in GP training

Starting your first post in training or changing to a new rotation can be exciting, but it can also be scary and comes with lots of challenges. In this article, Dr. Mahibur Rahman looks at 10 tips to help you in your new post.

1. Ask questions, ask questions, ask questions!

Whenever you change to a different specialty, ward, practice or department, there will be lots of things that will be new to you. Some things will be specific to that ward (like where they keep specific forms), some will be specific to that hospital, department, practice – some will even be specific to each consultant or GP trainer you work with. If there is anything you are unsure of, don’t be scared to ask. When you start your first post in a GP practice, there can be lots of things that you may have never dealt with before (e.g. the electronic record systems) and it can take take to adjust.

You may feel shy or embarrassed, but it is important to overcome this and ask so that you can do your job properly rather than pretend you know what to do or where to go and then cause problems.

2. Eat, drink, take a break

It is easy to get caught up with all the requests from the ward, patients waiting to be clerked in the emergency department, or to get through clinic, home visits, admin and find that you have gone without any food, drink or a rest and it is almost the end of the day. The first few days, you may not realise as you are fuelled by adrenaline, but this is not sustainable. Make sure that you have some proper food, away from a desk at lunchtime. Stay hydrated with water, tea / coffee throughout the day. It is easy to be overwhelmed by all the different tasks on your list, but it is important to take a break for a few minutes to recharge yourself. Apart from a cardiac arrest or something of similar urgency, most tasks can wait 5-10 minutes.

3. Remember everybody is nervous

It is normal to feel nervous your first time doing anything in a new post – and the second, third, and fourth time in some cases! You won’t be the only one feeling nervous, so if you need some help or want to talk a procedure over with a senior colleague or look something up, it is fine! We won’t think less of you – in fact I prefer the junior colleague who admits when they are unsure and asks for help, especially early on. Remember we all had similar experiences when we started.

4. Medicine is a team sport

Looking after our patients’ needs will involve lots of team members. As well as doctors, there are the nurses, health care assistants, ward clerks, secretaries, porters, radiographers, cleaners, receptionists, practice manager and many more. Acknowledge the role others in the team play – say thank you, get to know them and they will help you when you need them. Bring in some treats for the nursing team on your main ward or the reception team in your practice once in a while and see the benefits!

 

 

5. Smile, and the world smiles with you

Although you may be tired and or stressed out, remember that your patient may be in pain, worried, scared, feeling sick and emotional. In most situations, a smile goes a long way make the patient a little more comfortable. Of course, there are times when you may need to avoid smiling e.g. if you are breaking bad news or if a patient is angry and they might mistake a smile as you not taking their situation seriously, but hopefully you will be able to recognise this early on. Similarly, your colleagues may be feeling tired or stressed if the shift is really busy – your smile may help lift them up and boost their morale a little bit.

6. Watch out for yourself and your colleagues

We all know that medicine can be stressful, and there are comparatively high numbers of doctors that suffer from things like depression, stress, alcohol and drug dependence. As well as looking after yourself and ensuring you seek help from your own GP if you feel you are becoming unwell, watch out for any signs that your colleagues might need support.

7. Don’t forget “My name is…”

Start every interaction with a patient with a polite, professional introduction, let them know your name and your role as one of the doctors in the team. It is not only common courtesy, but it will help start your consultation or assessment on the right foot.

8. Plan ahead

Try to meet with the other junior doctors early on and plan any dates when you need someone to cover your on call so you can go to a family event, or attend a course. Plan your holidays in advance and try to book a break – knowing something is booked can give you something to look forward to which can help you get through those tough shifts or difficult weeks.

9. Get familiar with the e-portfolio

Try to spend some time early on learning how to navigate the e-portfolio and putting in regular learning logs. You need to stay on top of the minimum requirements and complete all the assessments to get through the Workplace Based Assessment (WPBA) part of your MRCGP – remember this starts from ST1 and continues throughout the whole of training.

10. Wear sensible shoes

Whether you are in GP or a hospital post, you will be on your feet and do a lot of walking (and occasionally running in hospital) as a junior doctor. From doing ward rounds, taking emergency bloods to the lab, going to radiology to request scans, going back and forth to the emergency department to clerk in new patients, doing home visits in GP and going up and down stairs to respond to pager requests from different wards and running to cardiac arrests. Buying some smart but comfortable shoes will make a real difference by the end of a long day!

I hope these tips are helpful and I wish you all the best in your new job!

Please do add your own tips in the comments and share this with any of your friends who are starting GP training or changing jobs!

Dr. Mahibur Rahman is a portfolio GP and a consultant in medical education. He qualified as a doctor in 2001 and as a GP in 2007. He is the medical director of Emedica and is the author of GP Jobs: A Guide to Career Options in General Practice.

GP Recruitment 2019 – Key changes to weighting of SRA / Stage 3

The weighting of the different assessments as part of the GP recruitment process have changed for 2018/2019 recruitment. This article covers how the different parts are weighted, and how this compares to previous years.

Weighting of MSRA (Stage 2) and Stage 3

For 2018/2019 recruitment, the weighting of the MSRA has been increased, and the 2 papers are no longer equally weighted as in previous years.

The new weighting making up a candidates place in the national ranking after Stage 3 is now 60% (MSRA) and 40% (Stage 3). This is broken down as follows:

Professional dilemma paper (SJT): 40%

Clinical problem solving paper: (20%)

Stage 3 selection centre: 40%

In previous years, the NRO did not release the exact weighting of Stage 2 / Stage 3, although the 2 papers in the MSRA (clinical and SJT) were previously equally weighted.

Those doctors scoring band 1 in either paper in the MSRA will not progress to Stage 3 and those scoring 575 of more combined (the top 10%) will get a direct offer without needing to sit Stage 3.

For everyone else that is invited to Stage 3, the total rank will be based on scores from the MSRA + Stage 3  based on the weighting above. Anyone above the cut score will be ranked nationally, anyone below will be deemed not suitable for training. Given the new weighting, it is important to allow plenty of time to prepare for the MSRA, and to pay particular attention to the SJT, as the MSRA is now 60%, with the SJT worth twice as much as the clinical paper in the final weighting – this is not a simple pass / fail exam – you will be ranked based on scores against others so every extra mark matters. Try to do as many practise SRA questions as possible, and make sure you have done at least 1 full timed mock exam for each paper – many doctors find the exam time pressured.

If you don’t score as well as you would have liked in the MSRA, as long as you have been invited to Stage 3, you can still get an offer as long you perform well at Stage 3 – the key thing at this point is to practise all 4 stations so you can demonstrate the skills assessed to a high level. You can also increase your chances by being willing to consider more areas in your preferences.

You can read more about the 4 parts of Stage 3 and how to prepare here: http://gptraining.info/stage-3-assessment-preparation-tips

Try to do as much preparation to maximise your score in the MSRA – if you are running short of time, the Emedica SRA Crammer course will help you cover a lot of material in 1 day, help you improve your exam technique and boost your scores in both papers. It is particularly useful for the SJT (there are more than 4.5 hours of teaching on this paper).

Once you have completed the SRA, start to focus on Stage 3 – as you can improve your overall ranking by doing well here. The chances of getting a post are much higher in Round 1 compared to R1 re-advert or Round 2 as the later rounds only have jobs that could not be filled in Round 1. This means there are fewer posts, and some of the popular areas will have no jobs at all.

If you were invited to Stage 3, book a centre and date that is convenient and start preparing for the assessment. The more you prepare, the better you will do on the day.

Best wishes with your preparation and with getting a rotation!

Dr Mahibur Rahman

Medical Director, Emedica

9 tips to reduce stress and prevent burnout during GP training

9 tips to reduce stress and prevent burnout during GP training

GP training can be a challenging time with the pressures of the clinical workload, keeping up to date with your e-portfolio and WPBA assessments and preparing for MRCGP exams combined with responsibilities in your personal life. In this article, Dr Mahibur Rahman looks at 9 ways to look after yourself, reduce stress and prevent burnout.

1. Eat, drink, take a break

It is easy to get caught up with seeing patients in clinic or the wards and the associated paperwork (referrals, discharge summaries, drug charts, repeat prescriptions, etc.). If you are not careful, you could find that you have gone without any food, drink or a rest and it is almost the end of the working day. Stay hydrated with water, tea / coffee throughout the day. It is easy to be overwhelmed by all the different tasks on your list, but it is important to take a break for a few minutes to recharge yourself. Apart from a cardiac arrest or something of similar urgency, most tasks can wait 5-10 minutes. Make sure that you have some proper food, away from a desk at lunchtime – if you can get some fresh air as well as a change of scenery, even better!

2. Plan ahead

Early on in each rotation, meet up with the other junior doctors in your department, or meet with your trainer if you are in a GP practice, and plan out your annual leave and study leave. This way, you can arrange any swaps that are necessary to allow you to get the time needed to go on relevant courses, and to manage your annual leave. This is particularly important when you start planning to take your MRCGP AKT or CSA – planning ahead so you have enough time to prepare will reduce the stress of these challenging exams and improve your chances of passing both at the first attempt.

Try to arrange your leave so you spread your time off throughout the rotation rather than one long break early on. When you are doing a busy job, knowing that you have a holiday coming up can give you something to look forward to and keep you going.

3. Ask questions, ask questions, ask questions!

Whenever you change rotation during training, it can take some time to adjust to your new role and there may be lots of things that you are not familiar with. Some things will be specific to that ward (like where they keep specific forms), some will be specific to that hospital, or specialty, some will even be specific to each consultant you work with. If there is anything you are unsure of, don’t be scared to ask. You may feel shy or embarrassed, but it is important to overcome this and ask so that you can do your job properly rather than pretend you know what to do or where to go and then cause problems. One of the most stressful things you can encounter is trying to cope with things that are outside your expertise – take the pressure off by asking questions or asking for help!

4. A problem shared is a problem halved

Sometimes you will have to deal with difficult situations at work – an angry or demanding patient or a patient that deteriorates very rapidly or unexpectedly. It is important to recognise that the emotions from one encounter can be transferred to the next one. If you have a difficult consultation or situation, it can be helpful to take a short pause to reflect and reset your emotions, and discussing how you feel, and any lessons you can learn with colleagues or clinical supervisor can be useful.

5. Do some regular exercise

We all know the many benefits of exercise, but it can be difficult to fit it in when in a busy rotation. Not everyone enjoys the gym (or has time for it) – be creative in how you build exercise into your routine.  Some registrars cycle to work or even do home visits by cycle! Try going to get your patients from the waiting room rather than calling them in via the tannoy, or when in hospital, take the stairs rather than the lift. The main thing is to incorporate something regular – even small things can make a huge different to your physical and mental well being.

6. Watch out for yourself and your colleagues

GP training can be stressful and there are comparatively high numbers of doctors that suffer from things like depression, stress, alcohol and drug dependence. As well as looking after yourself and ensuring you seek help from your own GP if you feel you are becoming unwell, watch out for any signs that your colleagues might need support. The NHS GP health service also offers confidential NHS service for GPs and GP trainees in England: http://gphealth.nhs.uk/

7. Seek help early

If you are finding your clinical workload unmanageable, or are struggling with the e-portfolio, or having health issues or finding any aspect of training particularly challenging, it is important to discuss this early with your trainer. They are there to support you as well as supervise you and may be able to help you identify why you are struggling, or make changes that may help. If you are still struggling, you may find it helpful to approach one of your training programme directors for advice.

8. Find your work life balance

Some doctors may find that managing the balance between work and home life can be difficult if they have additional responsibilities such as young children, caring for parents, or if they have health issues themselves. Many doctors train less than full time for part of their training – it may be that the same person that would burnout at full time will really thrive working at 60% or 80% of full time. If this is something that you would like to consider, you should discuss it with your trainer and your programme director.

9. Work hard – play hard

We are doing a job that comes with a lot of responsibility and involves lots of hard work. It is important to actively make time to do something that you enjoy regularly to help your mind to unwind – maybe a hobby, playing a sport you enjoy or meeting up with friends. Making time to enjoy things outside of work can help relieve stress and improve your morale when at work.

Summary

We work in a demanding job, and the added pressures of learning logs, assessments and examinations combined with caring for our patients can add up. It is important to make time for yourself and your own well being – if you don’t look after yourself, you can’t look after anyone else. I hope these tips are helpful – if you ever have any issues during training please do reach out and ask for support. As well as local support, you may find the GP Training Support group on Facebook helpful for networking with other trainees, and I am always happy to offer any help I can.

Dr Mahibur Rahman is a portfolio GP and the medical director of Emedica. He runs the GP Training Support Facebook group – a community of over 9,500 doctors with an interest in GP training willing to offer free advice and support on any aspect of training. You can join the group at https://goo.gl/bcoMKt

The Specialty Recruitment Assessment (SRA) – what to expect and how to prepare

The Specialty Recruitment Assessment (SRA) plays in important part in the shortlisting and assessment process for 8 different specialties: GP, Radiology, Ophthalmology, Obstetrics and Gynaecology, Psychiatry, Neurosurgery, Child and Adolescent Mental Health Services (CAMHS) and Community Sexual and Reproductive Healthcare (CSRH). It is also known as the Multi Specialty Recruitment Assessment (MSRA).

It will be done entirely on computer, and consists of two parts lasting a total of 3 hours 5 minutes – a clinical problem solving section and a professional dilemma section. Each specialty uses the results of the SRA in a slightly different way in the recruitment process for ST1 / CT1 posts – in most cases, the score is used both to shortlist for interview / selection centre, but also carries over and makes up a part of your overall ranking (the rest coming from interview / selection centre). For applicants to GP or Psychiatry, an exceptional score (~top 10%) can lead to a direct offer without needing to attend the next stage.

Clinical Problem Solving

Stethoscope

This is a 75 minute assessment with 97 questions testing your clinical knowledge and ability to apply it in practice.  This paper is set at the level of knowledge expected for a Foundation Year 1 doctor at the END of their first year.  The paper is very broad, covering almost all the medical and surgical specialties.  There are a variety of question types, including:

  • Extended matching questions (EMQ)
  • Single best answer (SBA)
  • Multiple best answer (MBA) – there are up to 3 correct answers
  • Picture questions – this could include skin lesions, fundoscopy, blood reports, ECGs etc.
  • Algorithm questions – you may have to drag boxes into the right part of the algorithm or select the correct answer from a list. Algorithms could include BLS / ALS / important guidelines etc.

Question may relate to diagnosis, investigation or management of both common and important diseases as well as rare but serious presentations.

There are some example of the 2 most common question types (EMQ and SBA) below:

EMQ – Investigations for back pain

1. A 25 year old man is involved in a road traffic accident. He was on a bike and hit from the side. He did not want to attend the hospital, and was taken home by his friends. He now complains of severe pain in his lower back and cannot pass water. He has tingling in his legs below the knee. Select the most suitable investigation from the list.

A X-ray of the lumbar spine E Routine MRI scan lumbar spine
B X-Ray of sacro-iliac joints F Urgent MRI scan lumbar spine
C Routine CT scan lumbar spine G DEXA scan
D Urgent CT scan lumbar spine H No investigations needed

2. A 68 year-old woman with known osteoporosis. She has had a fractured neck of femur in the past after a fall in her garden. She now complains of pain in her lower back, but does not have much muscular tenderness. She has no bowel or bladder symptoms. She has no neurological symptoms. Select the most suitable investigation from the list.

A X-ray of the lumbar spine E Routine MRI scan lumbar spine
B X-Ray of sacro-iliac joints F Urgent MRI scan lumbar spine
C Routine CT scan lumbar spine G DEXA scan
D Urgent CT scan lumbar spine H No investigations needed

3. A 40 year old labourer attends complaining of severe low back pain after finishing his shift. He does not have any bowel or bladder problems, and on examination has a straight leg raise of 90 degrees in both legs. He has no other significant medical history. Select the most suitable investigation from the list.

A X-ray of the lumbar spine E Routine MRI scan lumbar spine
B X-Ray of sacro-iliac joints F Urgent MRI scan lumbar spine
C Routine CT scan lumbar spine G DEXA scan
D Urgent CT scan lumbar spine H No investigations needed

SBA – Allergic reactions

4. A 35 year old man has a severe allergic reaction while in hospital. He has no history of past allergic reactions. Which ONE of the following is most likely to cause a reaction WITHOUT prior exposure or sensitization? Select ONE answer only.

A. Peanuts

B. Hymenoptera stings

C. IV Penicillin

D. IV Contrast media

E. Latex

Answers and explanations are available at http://www.emedica.co.uk/sra-answers.html

Click the image below for details on how to access over 2000 realistic exam level questions to help you prepare for both papers in the SRA.

Professional Dilemma paper

Businessman looking at arrows pointed in different directions

This is a 110 minute assessment with 58 situational judgement test questions (SJT). Questions test judgement and decision making in a workplace context. It also assesses knowledge of important ethical and medicolegal guidance from the GMC. Questions assess 3 domains – empathy and sensitivity, coping with pressure, and professional integrity.

There are two types of SJT questions in equal proportion. The questions in section 1 ask you to rank 4 or 5 actions from best to worst in the context of a workplace scenario. The questions in section 2 ask you to select 3 actions that taken together make the best response to the situation. There are up to 8 options to select from in this type of question.

Sample ranking question:

You have just started a job as a medical F2 in a new hospital. Your partner has a chest infection, and is not yet registered with a GP and has asked you to prescribe antibiotics.

Rank the following options 1-5, 1 being the most effective / best option, 5 being the least effective / worst option:

A. Prescribe the medication as a private prescription, and arrange for your partner to register with a GP the following week.

B. Tell your partner to register with a GP locally.

C. Prescribe the medication on a hospital take home prescription with your partner’s details on it.

D. Prescribe the medication on a hospital take home prescription with one of your patient’s details on it.  Collect the medication from the hospital pharmacy.

E. Pressure one of your FY1 colleagues to write a prescription on a hospital take home script without seeing your partner.

Sample selection question:

You are an F2 in Orthopaedics. An 80 year old lady has a fracture of her right neck of femur. You have been asked to consent her prior to surgery but on talking to her she seems confused. Her daughter tells you she has dementia and this is confirmed in the notes.  She is first on the morning list.  Select the THREE most appropriate actions to manage this situation:

A. Ask her daughter to sign the consent form and state that she is the daughter.

B. Inform your consultant she has dementia and ask him to complete the consent form.

C. Encourage the patient to sign the form as the procedure is in her best interests.

D. Exclude any acute causes that could be worsening her confusion.

E. Discharge the patient as she will be unable to have surgery without consent.

F. Cancel the patient’s operation.

G. Ring the theatre to rearrange the list so this lady is lower down on the list.

H. Complete the consent form on the patient’s behalf as it is in her best interests.

Answers and explanations are available at http://www.emedica.co.uk/sra-answers.html

Preparing for the SRA

It is important to allow enough time to prepare for both papers – some specialties use the scores as part of a ranking process to determine eligibility for interview / selection rather than as a pass / fail criterion. In most cases the SRA score carries over to the next stage and is added to the interview score to determine overall rank so it is important to do as well as possible. Try to combine reading to cover the key clinical theory (Oxford Handbook of Clinical Medicine and Oxford Handbook of Clinical Specialties) and understand key GMC ethical guidance with practising sample SRA questions to develop exam technique and get a feel for the different types of questions. As you get nearer the time of the exam, you will benefit from doing a timed mock exam to get used to the pressure of the exam.

I hope this article has given you a clearer understanding of what to expect in this important assessment. I wish you every success with your revision and in getting a place on your chosen rotation.

Dr Mahibur Rahman is medical director of Emedica, and has helped thousands of doctors prepare for this type of assessment since 2007. He teaches on the popular Specialty Recruitment Assessment Crammer course which covers both papers. You can get a £20 discount on the course which carries 6.5 CPD credits by using the code srapass at http://courses.emedica.co.uk/acatalog/GP_ST_Entry_Stage_2_Exam_Crammer_.html 

10 tips to help you pass the MRCGP AKT exam

The MRCGP AKT exam is a challenging exam, testing applied knowledge relevant to UK general practice. In this article, Dr Mahibur Rahman discusses some key tips to help you prepare for and pass the exam.

  1. Understand the basics

The exam lasts 3 hours and 10 minutes, and consists of 200 questions. 80% of the questions relate to clinical medicine, 10% to evidence based practice, and 10% the organisational domain. The exam is computerised, and there is now access to a basic on-screen calculator if needed. The majority of questions are single best answer and extended matching questions. Other formats include algorithm questions, short answer (you type the correct answer into a box), video questions, and picture based questions.

  1. Fail to prepare, prepare to fail

Allow enough time to revise all material in the exam – most candidates need 3 or 4 months to be able to cover everything sufficiently well to pass the exam. A common finding amongst candidates that failed the exam is that they had not realised how long it would take to prepare, and did not have enough time to complete their revision. The curriculum is large and covers a broad range of topics – try to have a systematic approach to allow you to cover all the important topics adequately. The RCGP has produced an AKT topic review which details the key areas and subjects covered in the exam.  The MPS has produced a more concise checklist of key topics that frequently feature in the exam as part of their free MRCGP Study Guide.

  1. Focus on the clinical domain

Aim to spend the majority of your revision focusing on the clinical domain – this makes up 80% of the marks and questions (160 questions). Someone who scored very poorly in this area (under 60%) would usually fail the exam – even with 100% in the other domains. Overall, a poor score in this domain is the most common cause of failure in the AKT exam. This domain also takes the longest amount of time to cover as the bulk of the curriculum is focused on clinical topics. Questions from the clinical domain can include those relating to making a diagnosis, ordering and interpreting tests, disease factors and risks, and management. It is important to have a good knowledge of key guidelines – NICE, SIGN, BTS etc. for common and important disease areas as they are frequently tested.

  1. Revise core statistics and evidence based practice

10% of the exam is evidence based medicine, including basic statistics, graphs and charts and types of study. These offer easy marks if you make sure you have a good grasp of the basic concepts and can interpret common charts and graphs. Make sure you can calculate averages (mean, mode, median), numbers needed to treat, sensitivity and specificity as well as understanding absolute and relative risk, odds ratios, p values, 95% confidence intervals and standard deviation. You should be able to interpret scatter plots, L’Abbe plots, Forest plots, funnel plots as well as Cates plots. Finally, you should be able to understand the usage of common study types including cross sectional surveys, case control studies, cohort studies and randomised controlled trials.

  1. Don’t forget the organisational domain

This makes up another 10% of the exam, and is the area that candidates tend to do worst on. These areas can be dull to read, but learning about practice management, QOF, certification, DVLA guidelines and legal duties of doctors will not only get you easy marks, it will be useful when you qualify.

  1. Learn from other people’s mistakes

Read through the examiners’ feedback reports to see which topics caused trainees problems, as they are usually retested in the next few exams. Having analysed every feedback report published so far, it is interesting to note that the same subjects get featured repeatedly! In the last feedback report, there was not a single topic that had not already featured as an area of poor performance in a previous report.

  1. Make the most of your revision time

shutterstock_247056754Effective revision should combine reading with practising questions. Try to practise questions to time, as time pressure is a big issue with this exam – you have about 57 seconds for each question! If you get a question wrong, try to read more broadly about the subject to gain a deeper understanding. By relating it to a question you have just answered, you are more likely to retain the information. Concentration drops dramatically after an hour, so try to revise in chunks of no more than an hour at a time. Take a short break – even 10 minutes to make a hot drink, or get some fresh air is often enough to refresh you and improve concentration for the next burst of revision.

  1. Learn the subject, not the question

Some candidates approach AKT revision by picking an online revision service and then go through all the questions multiple times. This can lead to a false sense of security and ultimately failure in the exam. Repeating the SAME questions multiple times provides very little additional benefit. Often complex questions such as data interpretation are answered the second time by remembering the pattern rather than understanding the subject. In the exam, you will not get the same question, but a different one testing knowledge of the subject. While your mark will improve with each repeated attempt at the same questions, your knowledge may have only improved marginally (having seen the correct answers the first time, it is not surprising that you get most of them correct the next time). A better approach is to read up on the subjects and explanations after doing a set of questions, and then once you complete all the questions, move on to a different set of questions from a different service or book. This will give you a better idea of how well you have understood the topic and retained the knowledge.

  1. Read the question carefully

Many candidates that have a good knowledge base still fail the AKT by a few marks. This can be owing to poor exam technique. It is really important to read the question carefully to prevent losing marks for silly mistakes. This can relate to the instructions – some questions ask you to drag the right answer into a certain part of the screen. Clicking the right answer instead of dragging it will gain no marks. It is important to watch out for and to understand certain keywords – if the question asks for a characteristic feature, it means it is there in almost every case (90% or more) – whereas if it asks for a feature that is commonly seen in a condition, it only needs to be there in around 60% or more of cases. Some questions are negatively framed – “which of the following is not part of the criteria for diagnosing irritable bowel syndrome?” – candidates that fail to spot the “not” in this question could easily select the wrong answer despite knowing the criteria.

  1. Keep to time

To complete the entire paper, you have just 57 seconds per question. Try to be disciplined – if you are not entirely sure of the best answer, it is better to put down your best guess after about 55 seconds and move on. You can flag questions for review, so you could try to come back if you finish a little early to look at those are unsure of. By being strict with your time, you will at least pick up all the easy marks for topics that you have covered in your revision. Candidates that spend 2-3 minutes struggling with a few really challenging questions often end up unable to complete the paper. They may have missed easy marks from questions at the end of the paper that they did not see. It is useful to have some pace checkpoints – try to finish 33 questions every 30 minutes. At this pace, you will have completed 66 questions after 1 hour, 99 at 1.5 hours, and complete the whole paper with just under 10 minutes left to go over any questions flagged earlier.

Summary

The MRCGP AKT is a challenging exam with a significant failure rate – over 1 in 4 candidates fail each exam, with the long term mean pass rate around 73%. It covers a large curriculum, so it is important to allow enough time and to have a plan to enable you to prepare in a systematic way. A lot of the knowledge gained from preparing will help you not only in everyday practice, but also for the MRCGP CSA examination. By mixing reading with practice questions, you should have both the knowledge and the exam technique to allow you to pass well.

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He has been the medical director of Emedica since 2005 and has taught over 30,000 delegates preparing for GP entry exams, MRCGP and on GP careers. He teaches an intensive 1 day MRCGP AKT preparation course in London, Birmingham and Manchester that covers all 3 domains. The course includes key theory and high yield topics, exam technique as well as mock exams in timed conditions. You can get a £25 discount by using the code passmrcgp

Details of the course are available at http://courses.emedica.co.uk/acatalog/nMRCGP_AKT_Preparation.html

MRCGP AKT Course

10 free resources every GP trainee should know about

GP training can be a hectic time and comes with lots of expenses – you have to pay for access to the e-portfolio, MRCGP AKT and CSA, business use car insurance for home visits and more. However there are lots of useful resources that won’t cost you anything. Here are 10 FREE resources every GP trainee should know about!

  1. GP Notebook – useful reference site for quick access during consultations to check investigations and management options. I regularly used this during consultations as a GP registrar!
  2. Induction APP – handy directory with numbers for different departments in your hospital. Covers most hospital trusts in the UK, and includes local guidance documents from some sites.
  3. NICE CKS –  useful for quickly looking up a specific guideline – more user friendly than the main NICE site.
  4. BNF and BNFC online: accessible without registration and from a non-NHS connection e.g. your mobile phone. Easy search function if you need to check drug doses during a consultation. This is often kept open in a tab in the background for quick access.
  5. Medical calculators: – quick access to 20 useful calculators for a wide range of situations. Includes CAGE, AUDIT, Well’s, 6CIT,  HAS-BLED, GCS, CHADS2VASC and more!
  6. Bradford VTS website: – lots of useful resources especially for MRCGP AKT and CSA, including free CSA cases to practise.
  7. Pennine VTS CSA resources: – large range of free videos and cases for CSA preparation.
  8. gptraining.info – free articles on topics related to all stages of GP training including  hospital and GP placements, up to date pay scales with take home pay for ST1, ST2 and ST3, MRCGP AKT / CSA and GP career options including portfolio GP careers. 
  9. Patient.info leaflets – handy printable patient information leaflets for pretty much any condition you can think of.
  10. GP Training Support Facebook Group – largest FB group dedicated to GP training with daily revision cards for AKT and CSA, and regular videos and articles on all aspects of training. Get support and answers to your questions from over 9,540 friendly members including trainees in every deanery in the UK as well as trainers and educators.

Are there any other sites, apps or resources that you find really helpful or use regularly as a GP trainee? Please do share them in the comments.

10 tips for new doctors

Starting your first job as a qualified doctor can be exciting, but it can also be scary and comes with lots of challenges. In this article, Dr. Mahibur Rahman looks at 10 tips to help you in your first post.

1. Ask questions, ask questions, ask questions!

Even if you have spent a period shadowing the doctor you will be replacing, there will be lots of things that will be new to you when you start working. Some things will be specific to that ward (like where they keep specific forms), some will be specific to that hospital, or department, some will even be specific to each consultant you work with. If there is anything you are unsure of, don’t be scared to ask. You may feel shy or embarrassed, but it is important to overcome this and ask so that you can do your job properly rather than pretend you know what to do or where to go and then cause problems.

2. Eat, drink, take a break

It is easy to get caught up with all the requests from the ward, patients waiting to be clerked in the emergency department and find that you have gone without any food, drink or a rest and it is almost the end of your shift. The first few days, you may not realise as you are fuelled by adrenaline, but this is not sustainable. Make sure that you have some proper food, away from a desk at lunchtime. Stay hydrated with water, tea / coffee throughout the day. It is easy to be overwhelmed by all the different tasks on your list, but it is important to take a break for a few minutes to recharge yourself. Apart from a cardiac arrest or something of similar urgency, most tasks can wait 5-10 minutes.

3. Remember everybody is nervous

It is normal to feel nervous your first time doing anything as a qualified doctor – and the second, third, and fourth time in some cases! You won’t be the only one feeling nervous, so if you need some help or want to talk a procedure over with a senior colleague or look something up, it is fine! We won’t think less of you – in fact I prefer the junior colleague who admits when they are unsure and asks for help, especially early on. Remember we all had similar experiences when we started.

4. We all make mistakes – take responsibility

There will be times you won’t be able to find a vein to take blood, when you will attempt to cannulate 3 times and get nowhere, or fill in a form incorrectly. Own your mistakes. Admit it, apologise for it, and do what you can to fix it. Sometimes you will have to ask someone senior to help with this – this is part of your learning and we are all human. What you shouldn’t do is try to cover up a mistake, or shift the blame to someone else. Eventually this will lead to more serious problems.

5. Watch out for yourself and your colleagues

We all know that medicine can be stressful, and there are comparatively high numbers of doctors that suffer from things like depression, stress, alcohol and drug dependence. As well as looking after yourself and ensuring you seek help from your own GP if you feel you are becoming unwell, watch out for any signs that your colleagues might need support.

6. Medicine is a team sport

Looking after our patients’ needs will involve lots of team members. As well as doctors, there are the nurses, health care assistants, ward clerks, secretaries, porters, radiographers, cleaners and many more. Acknowledge the role others in the team play – say thank you, get to know them and they will help you when you need them. Bring in some treats for the nursing team on your main ward once in a while and see the benefits!

7. Smile, and the world smiles with you

Although you may be tired and or stressed out, remember that your patient may be in pain, worried, scared, feeling sick and emotional. In most situations, a smile goes a long way make the patient a little more comfortable. Of course, there are times when you may need to avoid smiling e.g. if you are breaking bad news or if a patient is angry and they might mistake a smile as you not taking their situation seriously, but hopefully you will be able to recognise this early on. Similarly, your colleagues may be feeling tired or stressed if the shift is really busy – your smile may help lift them up and boost their morale a little bit.

8. Don’t forget “My name is…”

Start every interaction with a patient with a polite, professional introduction, let them know your name and your role as one of the doctors in the team. It is not only common courtesy, but it will help start your consultation or assessment on the right foot.

9. Plan ahead

Try to meet with the other junior doctors early on and plan any dates when you need someone to cover your on call so you can go to a family event, or attend a course. Plan your holidays in advance and try to book a break – knowing something is booked can give you something to look forward to which can help you get through those tough shifts or difficult weeks.

10. Wear sensible shoes

You will be on your feet and do a lot of walking (and occasionally running) as a junior doctor. From doing ward rounds, taking emergency bloods to the lab, going to radiology to request scans, going back and forth to the emergency department to clerk in new patients and going up and down stairs to respond to pager requests from different wards and running to cardiac arrests. Buying some smart but comfortable shoes will make a real difference by the end of the shift!

I hope these tips are helpful and I wish you all the best in your new job – welcome to the medical profession! Please do add your own tips in the comments and share this with any of your friends who are starting as junior doctors!

Dr. Mahibur Rahman is a portfolio GP, the medical director of Emedica, and a consultant in medical education. He qualified as a doctor in 2001 and as a GP in 2007.