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11 tips to help you boost your Foundation SJT exam scores

Dr Mahibur Rahman

The Situational Judgement Test (SJT) for final year medical students plays an important part in your ranking for the applications for Foundation training (FPAS). 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.

1. Understand the basics
The exam lasts 2 hours and 20 minutes and has 70 questions, although only 60 of the questions are marked – the other 10 are pilot questions. Pilot questions are mixed in with the examined ones, so you need to treat them all as live questions.

There are two types of question – ranking and selection. In a ranking question, candidates will be presented with a scenario and 5 options – the options need to be ranked from best (1) to worst (5). This format makes up two thirds of the exam, with each question being marked out of 20.

Selection questions have 8 options, and candidates should select the 3 options that taken together make the best response to the scenario. This format is a third of the exam, with each question marked out of 12.

Sample questions for each type are given below:

Sample SJT ranking question
While working on the medical wards as an FY1 you are asked by a nurse to complete the discharge paperwork for a patient you are not familiar with. This includes a summary of the admission as well as drugs to be taken home when discharged. You are in a hurry and on the post-take ward round. The rest of the team is about to start discussing the next patient that was admitted overnight.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)
A – Ask the nurse what drugs the patient needs and the diagnosis, so you can quickly note this on the discharge paperwork and keep up with the ward round
B – Explain that you are busy at the moment but that you will come back and do it as soon as the ward round is complete
C – Sign the paperwork and ask the nurse to complete the summary and medication while you join the rest of the team
D – Check the patient’s notes and complete the paperwork with a summary of the admission and all required medication – you can catch up with the ward round later
E – Ignore the request. The nurse knows you are on the post-take round and can ask you later

Sample SJT selection question
You are an FY1 working in obstetrics and gynaecology. You see a lady on the labour ward who is having a massive postpartum haemorrhage. In the last few minutes she has become very unwell and is now unresponsive and continuing to bleed. From reading her notes you know she is a Jehovah’s Witness and has signed a form in antenatal clinic stating she declines all blood products even if her life is threatened. The midwife looking after her states that she asked the lady a few minutes before she became unresponsive if she would accept blood products if her life was threatened and again she said no. Her husband is holding his new born daughter and states you must do everything you can to save her even if that means giving her blood.
Choose the THREE most appropriate actions to take in this situation

A. Give blood products as this is an emergency and they may be life saving
B. Do not give blood products even if it means she comes to harm
C. Put aside the patient’s wishes as her decision suggests a lack of capacity
D. Explain to the husband that you have to respect the patient’s decision
E. Ask the husband to give formal consent on behalf of his wife to give blood products
F. Do everything else you can to save the patient’s life
G. Do nothing else as she will inevitably die without blood products
H. Contact your consultant and ask them for permission to give blood products in the best interests of the patient

Read the answer and details explanations on the main Emedica site.

2. Learn the domains being tested
The SJT questions are written to test whether you have the attributes deemed important to be a good Foundation doctor. These are divided into 5 domain areas. A good first step in your preparation would be to understand the key attributes and behaviours being tested. Learning what is being assessed will help you pick between options based on how well they demonstrate these attributes. The domains and some of the key attributes are:
Commitment to professionalism – punctuality, honesty, taking responsibility for own actions, challenging unacceptable behaviour, ethical practice, respecting confidentiality.
Coping with pressure – remaining calm and in control when dealing with difficult situations, good judgement, seeking support when required, dealing with confrontation appropriately.
Effective communication – sensitive use of language, adapting communication according to the needs of patients and relatives, using clear and understandable language, good written communication.
Patient focus – empathetic towards patients, showing respect to patients, putting the patient at the centre of care, providing reassurance appropriately, willing to spend time with patients and relatives, considering patient safety at all times.
Effective team working – understanding the roles of team members, willing to take direction, showing respect to colleagues, delegating and sharing tasks effectively, sharing knowledge and expertise with colleagues.
The full list is available in the official SJT monograph

3. Revise the core knowledge being tested
While the SJT does not test clinical knowledge, there are questions that assess knowledge of what is deemed to be good practice based on core guidance from the General Medical Council (GMC). Most of this comes from Good Medical Practice and some of the explanatory guidance published by the GMC. This includes areas such as confidentiality, maintaining boundaries, care of children and younger people, raising concerns, end of life care and advanced directives, and even the use of social media. The SJT asks you to answer what you “should do” rather than what you “would do” – i.e. what does the guidance say a good doctor should do in the ideal situation. This is much easier to do with a good working knowledge of the key guidance.

4. Spend time on the ward
A useful technique to deal with scenarios in the SJT is to try to picture the situation in your mind. This is much easier if you have spent lots of time on the wards. Try to observe how the doctors communicate with patients and relatives, how the team interact with each other, and the roles of different members of the multidisciplinary team. If there are areas from the GMC guidance that you are unclear about, it can be really helpful to talk through potential issues with a junior doctor – they may have encountered similar situations in real life and can talk you through approaches they used to deal with it.

Test Quiz

5. Work through the official practice paper
The official Foundation Programme SJT practice paper is a complete 70 question SJT paper. There is an interactive version that you can do on a computer, and also a paper version. Doing the paper version, and getting used to completing the paper marking sheet will help familiarise you with the format and improve speed on the day. There is a marking key with detailed explanations so you understand the rationale behind why some questions are ranked the way they are.

6. Read the scenario carefully
Sometimes keywords have a big impact on the best response in both ranking and selection questions. Try underlining important words as you read. For example, your approach may differ in a situation where you suspect inappropriate behaviour compared to when you are certain of inappropriate behaviour. This small difference might change where you ranked waiting to gather more information, compared to raising an issue with a senior colleague for example. For ranking questions, there are different types of question – most ask you to rank from most to least appropriate, but some ask you to rank according to the order in which you would do things, how important considerations are to the situation or how much you agree with different statements.

7. Use only the information provided in the question
In some scenarios there will be limited information. In real life, it might be possible to get clarification or gather more information from the patient or a colleague. In the exam, your answers should be based only on what you are told in the scenario and the options. Do not make any assumptions – an incorrect assumption may lead you to a poor response.

8. Look at all the options before assigning any rankings (ranking questions)
For ranking questions, it is important to go through and consider all the options before you start deciding on the order. If you read the first option and decide it is a “bad” option, you may mentally place it last. This may then impact your thinking when reading other options – you may not remain objective and could end up fitting other options around the preconception that option A is the worst. The ranking questions are comparative not absolute – so rather than “good” or “bad”, it is about comparing one option to the other possibilities – “better” or “worse”.

9. Make sure your choices make sense when taken together (selection questions). In the selection questions, all 3 options that you select should be looked at together as a combined response to the scenario. In some cases you can eliminate options if they would contradict each other or would not make sense when taken together. If you are confident that an option that suggests seeing a patient when a chaperone is available is correct, then you could eliminate another option that suggested seeing the patient immediately without a chaperone. A good way to check if your answer is likely to be correct is to read all 3 options back together and see if they make sense together. If they don’t you should consider changing at least one of the options.

10. Double check you have marked the correct options. The SJT paper is machine marked so check that you have marked the answer sheet correctly – transcription errors are a silly way to lose marks. In ranking questions, if you accidentally marked option A and option E as the best options (rank 1), you will be awarded zero marks for BOTH these options. In the selection questions, if more than 3 options are marked, the total score for the entire question will be zero. If you transcribed the answers to question 1 to the box on the answer sheet for question 2, it would be possible to accidentally mark all the later questions in the wrong box and have a serious impact on your overall score.

11. Keep to time
To complete the entire paper, you have just 2 minutes 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 and move on. You will still get marks for answers that are not perfect but close to the best answer. For ranking questions, you get 8 marks for the worst possible ranking. If you are fairly close, but not quite perfect, you can still get 16 or 18 marks. Spending an extra 2 minutes to get the perfect answer may only increase your score for that question from 18 to 20 (2 extra marks) – whereas using that 2 minutes to answer another question will get you at least 8-20 extra marks. Even worse – the question you spent a long time on could turn out to be one of the pilot questions, and so carry no marks.

Summary
The Foundation SJT plays an important part in determining where you will be placed for your first two years after qualifying. Understanding the attributes that are being tested, and learning the core GMC guidance will give you the basic tools to help you prepare. Practising sample questions and getting used to the format and time pressures will help you to get the best possible score on the day.

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He is also the medical director of Emedica. Emedica has been offering courses to help medical students prepare for the Foundation SJT since 2012. We have helped students from every UK medical school prepare, with 97% getting one of their top 3 rotations in 2017.

Foundation SJT Course

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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 5,700 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.

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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 and a consultant in medical education. He qualified as a doctor in 2001 and as a GP in 2007.

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Preparing for the Foundation SJT – how I got my 1st choice Foundation programme

The Situational Judgement Test (SJT) is sat by all final year medical students in the UK. In this article Sarah Brown explains her tips for effective preparation and how she managed to get a place in a very competitive area.

It contributes towards 50% of your Foundation Programme score; the other 50% is comprised of your Education Performance Measure (EPM), which is based on your performance in medical school, and any additional points from a previous degree (up to 5 points) or publications (up to 2 points). As you may be aware, the difference in EPM scores between the highest and lowest ranking students is only 9 (i.e. the student in the lowest decile will receive 34 points, whilst the student in the highest decile will receive 43). However, the scores available from the SJT range from 0-50. Why does all of this matter? Understanding the system is important as it allows you to allocate your time wisely in the final year. It is very easy to become overwhelmed by the vast amount of information there is to learn for your final MB, and some students end up leaving the SJT to the last minute. However, as the SJT is so heavily weighted, it will play a huge part in determining which deanery (Unit of Application) you get. Some deaneries are more competitive than others and you may find yourself thinking that you don’t need to do particularly well in the SJT to get into the deanery that you want, however, the ranking doesn’t stop there. Once you are allocated your deanery, you then rank the jobs within it, and this too is based on points. Therefore, if you want to get into your first-choice deanery and get your first-choice job, doing well in the SJT is crucial, regardless of how competitive your desired deanery is.

On a personal note, having studied in Manchester for 3 years, and Northern Ireland for 5 years, I was eager to move back home to London for my foundation years. With the average foundation programme score required to get into North West London being between 84-86, doing well in the SJT was an absolute priority for me.

Resources I would recommend for the SJT

Whilst many medical schools, and even the SJT foundation programme itself suggest that you can’t revise for this exam, there is a lot that you can do to prepare for it. My own medical school provided little teaching on the SJT, and advised us just to use the mock exam on the SJT foundation programme website. Whilst this may have worked for some people, I didn’t feel comfortable taking this risk, as I was used to using books and multiple online resources for my medical school exams. However, a lot of people had warned me against using books and courses as they aren’t written by the UKFPO and could be misleading or inaccurate. Ultimately, I decided to try a variety of different materials to help me prepare for the SJT, so that regardless of my score I would know that I had tried my best. Here are the resources that I used and would recommend:

Emedica – Foundation programme SJT preparation course

I chose to attend the Emedica SJT course having read one of the posts on their blog that was written by a medical student who had previously scored badly in the SJT and subsequently went on the course before resitting the exam and scoring well. Their website is also full of complementary and appreciative reviews from medical students who have attained very good SJT scores. This was enough to convince me to go, and I’m so pleased that I did.

The course is run by Dr. Mahibur Rahman who has been involved with the SJT exam not only for medical students, but also for entry onto the GP training programme. He is extremely knowledgeable about the exam and his passion for medical education is very evident in the way he delivers the course. It is incredibly informative, helping you to understand how the SJT works, the different question types, and how to tackle each of these, which is fundamental to doing well in the exam. The course ended with a mock exam, complete with full explanations, and marks that are extrapolated to give you an idea of what your score would be.

Although this is a one day course we also received free access to the Emedica SJT questions, which allowed me to put into practice what I had learnt during the course. The advice and support continued via email in the lead up to the exam, for example, reminding us of the importance of exam technique. This course boosted my confidence more than any other resource that I had used, and I walked into the exam feeling assured that I had done all I could do to prepare for this exam.

Passmedicine

I had an online subscription with Passmedicine for my finals revision, which also included a section on the SJT. This was a valuable resource with over 200 questions, allowing you to practice the high yield topics that come up time and time again. It also provides you with good feedback as to why your chosen answer was correct/incorrect.

SJT Foundation programme website

This site allows you to print off a mock exam and practice answering the questions to time on the answer sheet (which isn’t as straight forward as it sounds). The benefit of doing this is that on the day of the exam, you are comfortable with the layout of the paper, and by the time you have done the mock exam a couple of times, you get a feel for how important it is to stick to time in order to complete the exam.

GMC ethics guidance

The GMC website has a section on their publications that is helpful for any deficits in your knowledge, for example, the intricacies of consent and confidentiality. However, some of their guidelines are lengthy and I wouldn’t recommend reading through every guideline from start to finish as this would be very time consuming.

Preparing for the SJT

The key here is starting early. I would recommend attending the Emedica course well in advance of your SJT exam date, as this gives you time to refine your technique and get plenty of practice in. I would suggest accessing the material available on the SJT foundation website, especially the mock exam (which you should practice under exam conditions if possible). Do as many MCQs as you can in the run up to the exam, as this helps you get into the right mind-set. Spend time on the wards: you can envisage nearly all of the scenarios in the exam happening in F1, or you may have had direct experience of them already. Remember that the only resource that is truly accurate is the UKFPO, so if you come across questions from other sources that you don’t quite agree with, use these as discussion points with friends.

The day of the exam

Taking a Test

It is really important to be well rested for this exam, as it is long and mentally taxing. Make sure you get a good night’s sleep the night before and eat well on the day. Have a practical plan in mind for how to tackle the exam: for me, this was to keep to time and to transfer my answers directly to the answer sheet (there is no time to go back). Read into the details of each question e.g. if they tell you that the patient lacks capacity, this is for a reason! Try not to dwell on difficult questions, as this will only take time away from other questions that you might be able to get full marks on. Finally, trust in the preparation you have put in.

Good luck! 

Sarah Brown, Final year medical student, Queen’s University Belfast

Sarah Brown had an SJT score of 47.52, and was allocated a place in her 1st choice foundation programme, North West London. Dr. Brown is due to start here FY1 post in August 2017.

Foundation SJT Course

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Specialty Recruitment Assessment (SRA) tips from a high scorer – how I got a direct offer for my 1st choice rotation

The Specialty Recruitment Assessment (SRA) is used by various specialties as part of the recruitment process for training posts. It has been used longest for GP training. In this article, Dr Amelia Thompson explains how she got a score high enough for a direct offer while juggling studying with caring for 2 young children and working in Malawi!

I applied for GPST in 2012 in my FY2 year, scored band 3 for both papers at stage 2, but was unsuccessful at the Selection Centre. I had heard it was easy to pass, so I felt pretty confident and didn’t do too much preparation. Naturally I was devastated. General Practice was all I really wanted to do. However, my husband had just been offered a job internationally, so I decided to take some time out of formal training, and get some more experience through volunteering. The planned one year away turned into five, we started a family, and I worked in public hospitals in Rwanda and Malawi. However, I was keen to reapply for General Practice and aimed for the August 2017 intake.

I signed up to the Pastest question bank 5 months before the January exam- I knew I would have to start preparing early with 2 children under 3. I slowly worked my way through the question bank, doing about 2-3 hours a week and making notes of and rehashing weak areas. We were still living in Malawi and our internet was terrible, so I managed to get hold of a few books of practice questions from Pastest and ISC Medical.

By the beginning of December I realized I hadn’t really made much progress and was still achieving the same average score when doing the mock exams. I really wanted to qualify for the Direct Offers Pathway. As we were still in Malawi, travelling back for the Stage 2 already meant leaving the family behind (my youngest was 12 months and still nursing), doing an overnight flight, arriving the day before the exam, doing an Emedica course for stage 3, and flying back again the following day. I REALLY didn’t want to have to travel back twice in a 4 week period, but I just didn’t think I could compete to get into the top 10% that went straight through to a direct offer.

So I started doing 3 hours of revision a day. I was at home with the kids at this stage so I managed to do an hour at lunch while they were napping and then 2 further hours in the evenings. Daily. I took a 3-day break for Christmas and that was it for 6 weeks until the exam. I did about 200 questions per day, would make a note of the key areas to revise, and at the end of each set of specialty questions I would write notes (using screenshots of answers, NICE guidelines, Patient UK professional reference, Emedicine, etc). I worked my way through the entire question banks of Pastest, Emedica, and BMJ On Examination, and then I started again, doing all the ones I had answered incorrectly, and then again for the ones I had got wrong a second time! And when I had done that I did mock exams for the last week, and went over and over my revision notes. By the beginning of January I was scoring about 85-90% on mock exams but I still didn’t think this was high enough to qualify for Direct Offers. So I just resigned myself to doing as best I could and praying a lot! I scored a total of 610, qualifying for direct offers, so I am thrilled to have got this far and hopefully will get my first choice job!

Some tips for SRA revision:

  1. Don’t underestimate the difficulty of the SRA, start studying early, and do as many questions as you can afford to. It will pay off.
  2. All the question banks were good, and it is great to get used to as many formats as possible. Emedica was the closest in format and wording to the actual exams and the mock exam papers have questions that are not included elsewhere in the bank.
  3. Work through one specialty at a time- questions follow common themes and the repetition will help consolidate your learning. Aim to go back over the ones you answered incorrectly within 3 days- you’ll be surprised how easy it is to get them wrong again and doing it within this time frame will help it stick!
  4. For the SJT, you just need to practice, and practice some more- you will start picking up on subtle wording differences that will make prioritisation so much easier.
  5. When you start doing timed papers, make sure you do a few sessions with the 2 papers back to back. I was not expecting the SJT first in the exam, and that threw me. I was nearing the end of my concentration by the end of the clinical one- so get used to doing a 3-hour exam.
  6. Do lots of timed papers. I was expecting to have at least a 20-minute window at the end of each paper to check them through but in the exam this was more like 7-10 minutes.

Tips for the exam:

  1. If you are travelling a long way Pearson locations around Heathrow and other airports get booked up quickly, so act fast!
  2. Get there early, or consider staying in a hotel nearby the night before. Walk to the test centre before the exam, partly to clear your head and calm nerves. They may let you book in earlier than your slot too, so it’s worth deciding if you want to do that.
  3. Double check your appointment and ID the night before.
  4. Take some water and a non-messy, non-salty snack with you- you’ll be able to pop out for a short break if you have time.
  5. If you come out of the exam feeling it was awful, don’t give up hope!! I came out of the SRA thinking I had probably got about 60%, based on my experience of the mock exams. You probably did better than you think!
  6. If you don’t qualify for the Direct Offers Pathway, DO THE EMEDICA GP STAGE 3 REVISION COURSE. I did it immediately after the SRA because I couldn’t afford to travel back before the stage 3 yet again. I failed the stage 3 Selection Centre 5 years ago, and after the doing the course now I can not only see why, but also without it I just wouldn’t have had a clue as to what the examiners were looking for! Good Luck!

Dr Amelia Thompson scored 610 (~top 1% in the country) and got a direct offer in her 1st choice area. She starts GP ST1 in August 2017.

You can find out more about the Emedica online revision service for Stage 2 and get a 20% discount by using the code srapass at http://courses.emedica.co.uk/acatalog/Stage2prep.html

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GP career options: an overview

Once you have finished training, there are many career options open to you. Some are obvious – become a principal in a partnership, take a salaried post, or work as a freelance (locum) sessional GP. However there are other options that you may not be aware of, or may not have considered. These include the Flexible Careers Scheme, the GP Retainer Scheme or even becoming a full time Out of Hours (OOH) doctor. What you decide to do will depend on your personal circumstances, including factors such as whether you are single or in a relationship (and what your partner is doing), your finances, the opportunities in the area you wish to work in and how you like to work.

This article will outline the different options in brief. More detailed articles on each option will be published soon.

Freelance (Locum) Sessional GP

This option gives you the most control over where and when you work, and can potentially be very lucrative. You are self employed, so are responsible for your own tax, national insurance and pension contributions. You can either arrange sessions yourself with practices locally, join a chambers, use an introduction service or work through one of the many GP locum agencies.

Salaried GP

This option will provide you with a fixed timetable and a fixed income. You are an employee, so have certain rights and protections (sick pay, holiday pay and maternity / paternity), and you will not have to worry about tax, NI or pension contributions as this will be taken care of by your employer. Pay varies according to region and from practice to practice.

Partnership / Principal

This option provides stability and is often very attractive financially, although it is a big commitment and you may have to “buy in” to become a partner. You will share responsibility for running your own business. This option often gives you the most control or say over how the practice develops, but also comes with the most responsibility. As well as clinical work, you will be responsible for the business – this can include management, staff, the building and ensuring you meet all the legal requirements in the running of the practice.

GP Retainer Scheme

This scheme often suits those who wish to work part time only. You can work a maximum of four sessions, and if you wish to do extra work, this must be approved. Practices get some of your salary costs reimbursed, and contracts are usually for a maximum of 5 years. The contract includes protected time for CPD.

Out of Hours GP

Many GPs still do some OOH work as it is now well paid, and you can often choose shifts that suit you. This may be an attractive option for new GPs to combine with another option (e.g. salaried or one of the part time schemes). However, some doctors may choose to work for some time as full time OOH doctors, working for PCT or one of the private companies that have taken over OOH provision in some areas. This is extremely well paid (up to £140k per year for 40 hours per week), but the downside is that you will always be working in the evenings and weekends, in what can be a more stressful environment than daytime practice. Working nights / weekends may suit some people (to fit in with family commitments), and there is usually scope to work part time if necessary.

Options, options, options

compassAs you can see, the end of your training is just the beginning of a new journey in General Practice. You have many choices, and your preference may change as your circumstances do. Remember that choosing one option does not usually close the others off to you, so you may locum for a few months or years to see how different practices work, before taking a salaried job. At some point you may choose to join a partnership or combine one of these options with other part time options as part of a portfolio GP career.

For the more adventurous among you, you might think about working abroad, volunteering in the developing world, or even combining luxury travel with work by becoming a ship’s doctor. These options will be looked at in another article.

There is no “one size fits all” solution – none of these options are better or worse, it is about finding what suits you and your situation – this may change over time. You should discuss some of these options with your trainer a few months before the end of your GP Registrar year.

Dr Mahibur Rahman is a portfolio GP and the medical director of Emedica. He is the author of “GP Jobs – A Guide to Career Options in General Practice”. He will be teaching at the Life after CCT: GP Survival Skills course which includes a session with practical advice about different GP career options for new GPs.

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MRCGP Workplace Based Assessment (WPBA) in GP Training

Workplace based assessment (WPBA) is one of the 3 components of the MRCGP exam.  In this article, Dr Mahibur Rahman provides an overview of WPBA – what it covers, how to gather evidence for it, and when you need to complete certain milestones.

What is WPBA?

WPBA is a continuous assessment process throughout the 3 years of GP training. It is designed to support development through feedback on various competences both in hospital and GP posts.

It is based around 13 areas of professional competence:

  1. Communication and consultation skills – use of recognised consultation techniques to communicate effectively with patients
  2. Practising holistically – using physical, social and psychological context to provide holistic care
  3. Data gathering and interpretation – effective history taking, choice of examinations, investigations and their interpretation
  4. Making a diagnosis and making decisions – a conscious, structured approach to decision making
  5. Clinical management – recognition and management of common medical conditions in primary care
  6. Managing medical complexity and promoting health – aspects of care beyond managing straightforward problems, including management of co-morbidity, uncertainty, risk and focusing on health and well-being rather than just illness
  7. Organisation, management and leadership – understanding the use of computer systems in practice, change management, and the development of organisational and clinical leadership skills
  8. Working with colleagues and in teams – effective team working and the importance of the multi-disciplinary team
  9. Community orientation – management of the health and social care of the practice population and local community
  10. Maintaining performance, learning and teaching – maintaining performance and effective CPD
  11. Maintaining an ethical approach to practice – practising ethically, with professional integrity and a respect for diversity
  12. Fitness to practise – the doctor’s awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk, and taking action to protect patients
  13. Clinical examination and procedural skills – competent physical examination of the patient with accurate interpretation of physical signs and the safe practice of procedural skills

These competences are assessed in different ways throughout training, the idea being that you should achieve the standard expected of a qualified GP in all of them before you complete training.

How do I meet the requirements for WPBA?

You will need to gather evidence that you have achieved the competences using various tools. Some are used only in the GP setting, some only in hospital while others can be used in both settings. The tools are:

Tool Hospital GP
Case-based Discussion (CbD)

A structured interview assessing professional judgement in clinical cases – based around real cases you have seen.

 ☑ ☑
Consultation Observation Tool (COT)

A review of patient consultations by your trainer – either video recordings or direct observation in a joint clinic.

 ☑
Multi-Source Feedback (MSF)

Collection and reflection on feedback from colleagues on your clinical and professional skills. This is from clinicians only in hospital, and both clinicians and non-clinicians when in GP.

 ☑ ☑
Patient Satisfaction Questionnaire (PSQ)

Feedback from at least 40 patients on your empathy and relationship building skills during consultations.

 ☑
Clinical Examination and Procedural Skills (CEPS)

Assessment of various clinical examination skills and competence in performing key procedures – this includes intimate examinations.

 ☑ ☑
Clinical Evaluation Exercise (MiniCEX)

Assessment of clinical skills, attitudes and behaviours in a secondary care setting – based on direct observation of your interaction with a patient for around 15 minutes.

 ☑
Clinical Supervisors Report (CSR)

A short, structured report from your clinical supervisor looking at the competences in 4 clusters: relationship, diagnostics, management and professionalism. This is usually completed for each hospital post, although it can be used in GP posts.

 ☑ (☑)
Learning Log

This is your personal learning record and should be used to reflect regularly on learning experiences. These can be linked to relevant curriculum headings.

 ☑ ☑
Personal Development Plan (PDP) 

This is used to allow you to demonstrate that you can assess your learning needs and plan actions to meet them. Items in the plan should be reviewed with evidence to demonstrate that you have achieved them.

 ☑ ☑

Are there a minimum number of assessments I need to complete?

You will usually meet your educational supervisor every 6 months for a review of your progress. You will be asked to complete a self-assessment prior to each meeting. The guidance of how often each tool should be used is shown below – remember that the quality of entries and assessments is as important as the quantity. Some doctors will need to do more than the minimum to reach a suitable standard. The minimum evidence given here is based on a 3 year rotation with 18 months in hospital and 18 months in practice for a full time trainee.

Year of training Minimum evidence
GP ST1

Prior to 12 month review

 6 x mini-CEX (if in secondary care) / 6 x COT (if in primary care)
6 x CbD
2 x MSF (each with a minimum of 5 replies from clinicians plus 5 non-clinicians if in primary care)
1 x PSQ (if in primary care)
CEPS as appropriate
1 x CSR from each hospital post
GP ST2

Prior to 24 month review

 6 x mini-CEX (if in secondary care) / 6 x COT (if in primary care)
6 x CbD
1 x PSQ (if in primary care and not already completed in ST1)
CEPS as appropriate
1 x CSR from each hospital post
GP ST3

Minimum prior to 36 month review

 12 x CbD
12 x COT
2 x MSF (each with 5 clinicians and 5 non-clinicians)
1 x PSQ

Less than full time trainees, and those on 4 year rotations (including academic trainees) have different requirements – you can read more about this here: http://www.rcgp.org.uk/training-exams/mrcgp-workplace-based-assessment-wpba/less-than-full-time-trainees.aspx

Summary

WPBA is an important component of the MRCGP, and alongside the MRCGP AKT and CSA, assessed readiness for independent practice as a GP. It also offers a way to record your learning, gain feedback on areas to improve and to provide evidence of your achievements. It is important to keep on top of the different learning tools and gather the necessary evidence in a timely manner so you can successfully progress through training.

Further reading:

RCGP WPBA overview: http://www.rcgp.org.uk/training-exams/mrcgp-workplace-based-assessment-wpba.aspx

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Talking to relatives – what to say and how to say it

Talking to the families of your patients can be one of the more difficult parts of your life as a doctor, but you can make it one of the most rewarding. It is part of everyday life for doctors to be asked to discuss a patient’s care with a relative or carer. In this article, Dr Mahibur Rahman looks at some key things that can really help, whether you are breaking bad news or just updating the family on management plans.

Be prepared

You need to be fully aware of all aspects of the current situation before beginning a discussion with a family – incorrect information can produce problems later on. Arrange a time (even if it’s only five minutes later), and go over the case notes to remind yourself of exactly what has happened, what is happening now and what is going to happen. If you are breaking the news of a patient’s death, make sure you know as much about the events surrounding the death as possible (cause, time, people present etc.). Consult with other members of the team (especially nursing staff). If possible, ask someone to hold your pager while you deal with the relatives. Make sure you get permission (where appropriate) from the patient to discuss their care with relatives.

Set the scene

It is essential that any discussions take place in a suitable environment – ideally a quiet side room or office where you won’t be disturbed. Holding a discussion around the bed is very rarely a good idea. There should be adequate seating for everyone. Standing when you are talking to someone can give the impression that you don’t have much time, and need to rush off somewhere else. Try to bring a member of the ward staff with you – someone who can stay afterwards and explain or reinforce anything that you said.

What to say.

Honesty is one of the factors that relatives values the most when dealing with doctors. They need the truth to make their personal adjustments and their plans. Make sure that you do not stray from the facts, and if you are unsure about something, NEVER make it up. Instead, offer to find out and leave the details with the ward staff, or arrange another meeting.

How to say it

At all times, be polite and patient. Remember that the family will be under great strain. Explain things in language that the relatives can understand, avoiding medical jargon as much as possible. The relatives are much more likely to understand “your father has had a stroke”, than “the CT scan has shown an ischaemic CVA”. Where the family have a grievance about anything do not be defensive and never raise your voice – this will make the situation worse. An apology a day keeps the lawyers away.

Say it again, Sam

You may have to explain things more than once, and relatives sometimes have their own ideas about what is going on. Allow them to air their concerns. Always ask if they would like you to go over anything, and offer them a chance to ask questions. The wording of this is very important – saying “is there anything I haven’t explained clearly?” is better than “is there anything you didn’t understand?”. Although having essentially the same meaning, the first does not demean the relatives in any way, where the second might be taken as an insult to their intelligence.

And in the end.

Finally, leave a means of contact if they want to follow up your discussion – this can be by leaving a message with the ward clerk or a member of the nursing team, or via your pager (only give this out if you genuinely don’t mind relatives bleeping you – it is usually better to call them so that you are properly prepared for any conversation).

You will find that family members are often very grateful for the time you take to discuss their relative’s care. And doing this well will give a huge boost your job satisfaction.

Summary

Here are some of the keys to successfully dealing with family members or carers.

  • Look and speak the part
  • Make sure you know the case well – read over the notes carefully
  • Turn off your phone and hand over your bleep so you aren’t disturbed
  • Use a quiet room with adequate seating
  • Explain the facts clearly, avoiding medical jargon
  • Offer to go over diagnoses and management
  • Leave time for relatives to ask questions
  • Offer to find out things you don’t know
  • Make notes and record what was said in the patient’s notes

This article has been adapted from one first published in Februray 2005 and is reproduced with the kind permission of Hospital Doctor, who retain the copyright.

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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 6 different specialties: GP, Radiology, Ophthalmology, Obstetrics and Gynaecology, Psychiatry and Neurosurgery. 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.

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

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 some 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 

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Foundation SJT tips from a high scorer – how I got my 1st choice Foundation programme

The Foundation SJT is an important part of the application process for entering the Foundation Programme (FPAS). In this article, Niamh Rogers explains how she managed to score amongst the top 2% of over 8,000 candidates that took the SJT for Foundation Programme entry in her year. She scored 45.42 and got a place in her 1st choice Foundation Programme, Northern Ireland.

Foundation SJT

The Foundation SJT

The Situational Judgement Test (SJT) is an exam that is now faced by all final year medical students hoping to gain a Foundation Programme training place in the United Kingdom. As the exam itself has only recently been brought in as a method of selecting candidates to training posts, a lot of speculation and anxiety surrounds the test. The fact that the SJT accounts for 50% of all marks available means that for most students this exam is the single most determining factor in allocation of foundation schools and house officer jobs. I was lucky enough to achieve a high score, placing me in my first choice deanery with my choice of jobs. Here is my experience of preparing for the situational judgement test and hints and tips for performing well on the day.

Emedica Foundation SJT Course

I booked one SJT preparation course, Emedica, to tackle the SJT. I choose Emedica because although the SJT is new for medical students, it has been used for doctors in GP training since 2007, and Emedica has been running courses for it since it began. As my SJT assessment date was in December I made sure to book the earliest course in October to give myself sufficient time to practice.

The course itself was excellent and gave me both the confidence and knowledge to know how to prepare for the exam. Emedica explained the different types of question styles, how to go about structuring your time (in what was an extremely time pressured exam) and to rank each option for the question at face value.

The mock test at the end of the day was a good insight into the process of the exam and the mark obtained was translated into points like in the real SJT.

Preparing for the Exam

The SJT isn’t an exam you can cram for! Speaking from the biggest crammer of every exam going, I soon realised that the SJT was more a “way of thinking ” than something you could learn with intense days of revision before the test. As I was revising for medical finals and doing A&E placements I knew that I would have to schedule some time to practice questions. I found that by doing around 30/45 minutes of questions 3/4 evenings a week, after I had finished revision for the evening, very manageable.

This is where going to the Emedica SJT course came into its own. There are vast numbers of SJT books with hugely varying quality between them. The Emedica course provided you with a question bank that was split into smaller sections- perfect for completing small stints of practice. The questions accurately reflected the content, length and difficulty of questions in the exam.

Initially I didn’t practice timed- I wanted to thoroughly understand why each option was in the order stated. I felt that by understanding why exactly the options ranked in a certain order , it would give me a better insight into what the exam was testing. With about two weeks to go I started timing myself and always tried to use blank answer sheets so that it would become second nature on the day.

I printed out the sample paper online along with a blank mark sheet, and over the course of my revision I did this exam x3 times. I felt that repeating questions helpful as often I was getting the same questions wrong .

Two other SJT books I found useful were Situational Judgement Test for the Foundation Years Programme by Dr Omar Taha and Dr Mizanul Hoque and Get Ahead ! The Situational Judgement Test. These were handy to have in your bag whilst travelling or having a spare few minutes when you could look at question or two.

Exam Day

In order to focus for the exam I had an early night’s sleep, went for a run that morning and made sure to have a good breakfast before the exam. The exam is long and timing is a big factor. I made a mental note of what question I should be on at 30 min intervals and wrote this down on the front of the exam paper when I sat down. Make sure you use the bathroom before you start as the exam is 2 hours 20 minutes long!

I highlighted key words in each question (each word is used specifically as the exam is developed by subject experts and psychologists) . I numbered my order on the exam paper and once happy with my answer, transferred it to the answer sheet. I found using a ruler helped focus my eye and made sure I wrote my answer in the correct box. I went through the paper systematically. I circled some questions that I felt I could spend more time on and returned to them at the end.

In summary, the SJT is a high stakes exam that can be prepared for. Practice little and often can boost your score and give you confidence on the day of the exam. Being extremely familiar with the format of the paper and the answer sheet and preparing mentally to focus for an intense 140 minutes are key factors to succeeding in the SJT.

Best of luck!

Niamh Rogers

Final Year Medical Student Norwich Medical School

Niamh  scored 45.42 (within the top 2% in the country) and got a place in her 1st choice Foundation Programme, Northern Ireland.

Foundation SJT Course