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.

January 23, 2018January 23, 2018

GP Recruitment 2018 – 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 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 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 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.

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 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

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

December 18, 2017February 7, 2018

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

December 1, 2017December 28, 2017

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

August 27, 2017November 14, 2017

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”

August 7, 2017February 7, 2018

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!

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!
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.
NICE CKS – useful for quickly looking up a specific guideline – more user friendly than the main NICE site.
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.
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!
Bradford VTS website: – lots of useful resources especially for MRCGP AKT and CSA, including free CSA cases to practise.
Pennine VTS CSA resources: – large range of free videos and cases for CSA preparation.
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.
Patient.info leaflets – handy printable patient information leaflets for pretty much any condition you can think of.
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.

August 1, 2017August 1, 2017

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

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

8. Don’t forget “My name is…”

9. Plan ahead

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.

July 31, 2017July 31, 2017

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

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 1^st choice foundation programme, North West London. Dr. Brown is due to start here FY1 post in August 2017.

July 7, 2017July 7, 2017

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:

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.
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.
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!
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.
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.
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:

If you are travelling a long way Pearson locations around Heathrow and other airports get booked up quickly, so act fast!
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.
Double check your appointment and ID the night before.
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.
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!
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

September 5, 2016September 13, 2016

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.