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

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 started GP ST1 in August 2017.

You can find out more about the Emedica online revision service for Stage 2 and get a 10% discount by using the code srapass at http://courses.emedica.co.uk/acatalog/Stage2prep.html

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.

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

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.

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

GP Training Payscales 2016 including GP Registrar Payscales

These are the current payscales for GP trainees in England and Wales in effect from August 2016 onwards. Current trainees in England will start to be moved to the new junior doctor contract from October 2016 onwards – we will publish an update if this is implemented, once full details are available.  For hospital posts, total pay will depend on the banding (jobs with more on call / antisocial hours carry a higher supplement). The GP Registrar supplement is currently fixed at 45% – this is for all posts when based in a practice, regardless of the year of  training, or the number of on call or out of hours shifts completed. Payscales for Northern Ireland are not yet published, but are likely to be similar to these. Payscales for trainees in Scotland are slightly higher.

GP Trainee Payscales 2016-2017

gptraining-pay-2016

If you are entering GP training from another training post, you should start on the paypoint with basic pay that is closest to your current basic pay. E.g. if your current basic is £29,500, you will move onto the StR Min scale, with a basic pay of £30,302 and so on. You will move onto the next point on the scale on the anniversary of your increment date (this should be on your last payslip). If you are entering training from a non training post, then you may be entitled to pay protection if you are in a nationally recognised career grade post (e.g. consultant, specialty doctor, staff grade). Career grade doctors moving from a local grade (e.g. trust grade, trust registrar, clinical fellow) do not get pay protection.

When you are on paypoint StR3 or higher (shown in cream above), you are entitled to an extra 5 days of annual leave – so you will get 30 days instead of 25 in addition to bank holidays (in hospital you may get 2 additional days leave per year). Please note that StR3 is NOT the same as being in your ST3 year. The paypoint is based on past NHS experience, NOT your year of training. For example, a doctor entering GP training straight from Foundation Year 2 will go onto the StrMin payscale during their ST1 year, then StR1 in their ST2 year, and StR2 in their ST3 year. They will have 25 days annual leave in all 3 years of the rotation. A doctor entering GP training having already completed 2 years of core medical training would start on the StR2 payscale (while in the ST1 year). They would have 25 days leave in this year. In the ST2 year, they would be on the StR3 payscale and get an additional 5 days leave, and so on.

GP Registrar Salary – Net Monthly Pay

Most GP rotations now have 16-18 months in general practice. As there are a lot of costs during the latter part of your GP training, we thought it would be helpful to look at estimated NET pay (i.e. take home pay after Tax and National insurance). This might help you plan and budget so you can meet the costs of sitting the MRCGP AKT Exam and MRCGP CSA Exam (about £2,100 together) as well as other final year costs such as CCT, indemnity etc.

gp-registrar-pay2016*These figures are estimated monthly take home pay net of income tax and national insurance. They have been rounded down to the nearest pound, and are based on a standard tax code.  As your pay may change during the tax year, the actual amount may differ. Pay in the first month of a new job is often lower as you may be put on an emergency tax code (BR) which may reduce your take home pay until corrected.  You can get an accurate monthly calculation here (external link).  These figures do not include deductions for the NHS pension – although you can put pension into the calculator to get an accurate amount. If you are paying into the NHS scheme, expect a take home pay around £200-£300 a month lower than the figures above depending on the paypoint.

GP Registrar’s medical indemnity will be reimbursed less the amount they would have paid for a hospital job.

Expenses claimable when relocating to start GP training

When starting GPST, if you have to move house (i.e. your new job is in a different area), there are certain expenses that you can claim.  These are covered briefly here, you can download the full guidance document here or at the bottom of the page.  If your first post is in hospital, you should contact medical staffing to get hold of the local expenses policy. If your first post is based in practice, then your local Primacy Care Organisation (Health board, Local Health Board or Area Team / Primary Care Finance) will usually reimburse you, either directly or via the practice. In some areas, the deanery deals with this centrally.  You should make contact to approve any large expenses before committing, and make sure you keep all receipts to claim back your money.  You may have to satisfy the relevant body that your house move is necessary.

So what can you claim?

Actual removal expenses

This includes the cost of moving your furniture and effects, and includes the cost of storing furniture during the move if necessary.  This includes ordinary household items such as bicycles, computers etc., but not items requiring specialist removal like your grand piano!  Removal of domestic pets are included, but not livestock (so you can’t relocate your whole farm, sheep intact!).  These costs can be upwards of a thousand pounds, and the HA will want three different quotes.  You do not have to accept the lowest quote, but you will only be reimbursed this amount (so if you wish to take a more expensive service, you pay the difference).

Costs of searching for accommodation

spending moneyYou can claim the cost of traveling to the new area to look for suitable housing.  One return journey and up to four nights accommodation and subsistence can be reimbursed.  This is paid at the same rate as when on study leave – about £75 per day maximum including accommodation.
 

Legal and estate agent fees

If you purchase a house in the new area, and it is your first permanent unfurnished accommodation there, or if you sell a house immediately prior to the move, you can claim the following fees:

  • solicitor’s fees
  • stamp duty
  • land registration fees
  • incidental legal expenses
  • expenses in connection with a mortgage or loan, including guarantee and survey fees
  • legal expenses incurred in mortgage redemption, and house agents’ or auctioneers’ fees
  • costs of a private survey
  • electrical wiring test
  • a drains test

Tenancy

If you rent furnished accommodation in the new area, you can claim the costs of a tenancy agreement, estate agents fees for referencing, and the cost of a drains test.  These expenses are not reimbursed to registrars who move into rented lodgings (a room in an house or flat).

Miscellaneous expenses grant

This covers some of the costs of moving into a new permanent accommodation, and include:

  • installing a television aerial
  • plumbing in a washing machine/dishwasher
  • connection of cooker
  • alteration of curtains and pelmets
  • cleaning of property
  • reasonable telephone calls made in the course of seeking accommodation

Travel allowance

One single journey from the old residence to the new area is covered, and one further return journey if you have to return to supervise the removal of your effects.  You should also be able to claim travel expenses for your interview.

There are many more allowances, and you can download the full guidance here. (from Department of Health website).

10 tips to help you pass the MRCGP CSA

The MRCGP CSA is a challenging exam, acting as an exit exam for GP training in the UK. In this article, Dr Mahibur Rahman discusses some key tips to help you prepare for and pass the exam.

  1. Understand the basics

The exam is based on a simulated surgery consisting of 13 cases played by simulated patients. The cases will include a range of disease areas and case types, with at least 1 child health case, and at least 2 cases that will significantly test prescribing knowledge. You will have 2 minutes to read the case notes before each consultation, and exactly 10 minutes for the consultation itself. There will be a different examiner with each simulated patient, assessing the same 3 domains in every case: data gathering (history and examination), clinical management (including diagnosis, management, follow up and safety netting), and interpersonal skills (clear explanations, empathy and sensitivity and having a patient-centred approach).

Each domain is graded as either clear pass (3 marks), pass (2 marks), fail (1 mark) or clear fail (0 marks). The total score from all 13 cases determines whether you pass or fail the exam. The pass mark is adjusted each day to take account for the level of difficulty of the cases, but usually ranges from 72-78 out of 117. The total score is the only thing that determines if you pass or fail – there is no minimum score in each case. A candidate that scored 9 in several cases could get 0 in some cases and still pass i.e. you pass or fail the exam as a whole, rather than individual cases.

  1. Join a study group

Forming a study group early on in your preparation for CSA – 6-9 months prior to your exam – can help in many ways. A good number to meet for a study session is 3 – one to be the doctor, one the patient, and one to observe and provide feedback. Some candidates find that being observed makes them nervous and affects their performance – having a colleague observe and be the “examiner” can simulate some of that pressure and over time, help to overcome it. It is also easier for someone observing and making notes to give useful feedback. Agree in advance the importance of being honest and constructive when giving feedback – some registrars feel shy to say anything critical and just focus on the positives when observing others. While this might make you feel good, it won’t help you improve.

Putting yourself in the role of the examiner with a clearly defined mark scheme can also help give an insight into the importance of clearly demonstrating the criteria in the different domains.

  1. Seek feedback regularly

Try to get feedback on your consulting whenever possible. This can be through consultation observation tool (COT) assessments, joint surgeries, during out of hours (OOH) sessions and also during tutorials. Video can be a useful tool – you can watch a few recorded consultations with your trainer, but it can also be helpful to watch some of these back later yourself to pick up on things like body language and non-verbal cues from the patient. It can be helpful to get different perspectives, so ask for other doctors at your practice to observe you and give feedback.

  1. Observe how others consult

shutterstock_98521166Try to do some “reverse” joint surgeries – where you sit in and observe your trainer and other team members consult. This can be a good way to pick up useful tips and good habits from experienced colleagues. You may have a doctor in the team that has a lot of women’s health experience, and may be able to tweak how you explain certain conditions based on their approach. Sitting in with the practice nurse during an asthma clinic might give you some ideas on things like demonstrating inhaler technique or discussing spirometry. Don’t feel that you have to do everything the same way your colleagues do – it is important that you consult in a way that is comfortable and natural to you. You may find that you can adapt your own style and add in what works from others.

  1. Prepare for challenging cases

It is important identify areas you find challenging and actively prepare for them. If you find it difficult to take sexual health history because you get embarrassed when asking sensitive but important questions relating to risk factors for sexually transmitted infections, you should practise this until you can do it confidently. If you do not see many women with gynaecological issues, you could go through important areas of the history and examination in a tutorial or with your study group. Equally, if you have not treated many patients with testicular problems, or erectile dysfunction, you should revise the key parts of the history, examination and management. Try going through the CSA case checklist in the MPS MRCGP Study Guide and go over any areas that you are not confident in. Practise telephone consultations as it can be challenging taking a history when you do not have some of the non-verbal cues that we rely on in clinic.

  1. Learn to manage your time effectively

You have 2 minutes to read the case notes, and exactly 10 minutes to get through each case. Candidates that regularly struggle to complete cases will often get a low score for the management domain, as they may not have had time to discuss treatment options, or to talk about follow up and safety netting. Try to get comfortable with getting through your consultation in 10-12 minutes the month before sitting the exam. You may still be on 15 minute slots, but try to use the last few minutes to type up your notes. It is very difficult for a candidate who regularly needs 16-17 minutes per case in surgery to suddenly shave several minutes from their consulting time in the exam.

  1. Remember all 3 domains are marked in every case

A common myth about the CSA is that it is all about communication skills. While good communication is an essential part of being a good GP, this is only a third of the marks in each case – the other two thirds relate to clinical areas.

Data gathering is about history and examination – it is important to be able to take a focused, systematic history. If you spend too long on the history by asking vague or irrelevant general questions you may find that you get a poor mark for data gathering, and also run out of time and get a poor score for the clinical management domain. Candidates often lose marks in this domain by failing to ask about relevant red flag symptoms to exclude rarer but serious conditions, or forgetting to request an essential examination.

There is a lot to cover in the management domain to get a clear pass – you need to allow enough time to go through the diagnosis, discuss management options, cover other important risks, and to discuss follow up and safety netting. This will usually take 3-4 minutes to cover well. You can also lose marks if your proposed management plan is not in line with current evidence – a good knowledge of current guidelines is very important.

In the interpersonal domain, you may lose marks if you do not build a good rapport, or take on board the patient’s agenda. Work on being able to explain investigations, diagnoses and results in clear, concise language without using technical jargon. Pay attention to both verbal and non-verbal cues – it is important to explore them as there may be an important symptom or issue that will only come out when the cue is explored.

  1. It’s not enough to know it, to get marks you have to show it

Examiners can only mark observed behaviours, so it is important to demonstrate your knowledge and skills clearly in each domain. For example, in the clinical management domain for a case of newly diagnosed Stage 2 hypertension in a 50 year old, a candidate that informed the patient that they would be “starting a once daily tablet for your blood pressure” would not get the marks for correct management. A candidate that made it clear that they would be starting the patient on a suitable dose of an ACE inhibitor would. Similarly, a patient with a transient ischaemic attack (TIA) with high risk of stroke needs to be seen within 24 hours by a specialist according to the current guidelines. A candidate that did not make the timeframe clear may not get the marks. For example, saying “I will arrange for the specialists to see you urgently” is unclear in this situation – as a 2 week referral is urgent, but not appropriate for a patient at high risk of stroke. Making it clear that you would arrange for the specialists to see the patient “within the next 24 hours” would be much better.

  1. Treat the exam like a regular clinic

Treat the CSA as a regular 13 patient clinic, with the benefit of a break halfway through, and without having to write up any notes on the computer. Do not do any acting – the only person doing any role play should be the simulated patient. You should be doing the same things you would do with a similar case in real life. Some candidates make up false options that they would never offer in real life or pretend to write a prescription rather than using the sample prescription on the table. This looks awkward and unnatural, and can be embarrassing when the patient points out that there is nothing there! Imagine the examiner is not there – do not look at them, talk to them, or try to engage them in any way – they are there to mark the case, not to influence the outcome. You should focus on the patient, and give them your full attention – just as you would in surgery. If you think there is a relevant examination, you should ask the patient if you can examine, rather than asking the examiner. If you would offer a chaperone for an examination in real life, offer one in the exam. Getting regular practice in your study group or in a joint surgery can help you get used to consulting with an observer in a way that does not affect your focus on the patient.

  1. Focus only on the case at hand

In an exam with 13 cases, it is quite normal to have 1 or 2 cases that either don’t go as well as you would have liked, or that include a rare or high challenge presentation. Remember that a bad performance in any case can be compensated by doing well in others. Just do your best to listen carefully to the patient, try to be safe, and to communicate clearly. At the end of the case, take a deep breath, clear your mind and go into the next case with a positive attitude – otherwise 1 poor case can go on to affect how you score on the next few and have a much bigger impact on your overall score.

Summary

The MRCGP CSA is a challenging exam with a significant failure rate. To pass, you need to demonstrate that you have the skills and knowledge to practise safely without supervision – from taking a structured history and focused examination to being up-to-date with your management. You need to show that you can communicate clearly and effectively with the patient, and engage them appropriately. Finally, you need to be able to manage your time well to get through everything in 10 minutes. Like any skill, consulting well improves with practise – you can get this by seeing patients in clinic, with your trainer in a tutorial and in a study group with your colleagues. Best wishes with your exam!

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He has been the medical director of Emedica since 2005 and has taught over 29,500 delegates including those preparing for GP entry exams, MRCGP and on GP careers. He teaches an intensive 1 day MRCGP CSA preparation course in London and Birmingham that includes key theory and high yield topics, exam technique as well as plenty of practise with professional role players in CSA exam conditions. 

Useful links and further reading:

MRCGP Exam Preparation: A revision guide for the AKT and CSA – MPS (includes CSA topic checklist)

Emedica MRCGP CSA Preparation course

Emedica MRCGP CSA Online package – video lectures, high scoring consultations + 52 CSA cases to practise (4 full CSA exam circuits):

MRCGP AKT Examination – an overview

The AKT (Applied Knowledge Test) is one of the assessments required to gain Membership of the Royal College of General Practitioners (MRCGP) and can be taken in ST2 or ST3 years of GP training. It is available 3 times each year, in October, January and April. Most candidates sit the exam for the first time at some point in ST2.

The examination questions are all drawn from the GP Curriculum, and the test is completed on computer at a Pearson Vue professional testing centre (there are centres all over the UK).

The exam lasts for 3 hours and 10 minutes and consists of around 200 questions. You can mark questions for review later to go back over those that you are unsure of.

The pass rate is variable and based on a set pass standard for each exam, with a variable pass mark that has ranged from as low as 67% to as high as 71.5% (average is around 68%). The pass rate has a long term mean of just over 73%.

Question formats

studying girlThe majority of questions are Extended matching questions (EMQs) and Single Best Answer questions (SBAs). Other question formats include Multiple Best Answer (MBA), Algorithm questions, seminal trial questions (focusing on important research relevant to primary care), picture questions, video questions and short answer questions.

The makeup of the exam is:

  • 80% – Clinical medicine relevant to GP
  • 10% – Critical appraisal / evidence based practice
  • 10% – Health informatics and administrative issues

The RCGP has produced a set of sample questions you can view the answers alongside the questions here.

Examiner’s reports

The panel of examiners produce a report after each sitting outlining key areas that canidates performed poorly at, and this is very helpful in highlighting important topics to include in your revision. You can access the reports from the RCGP website.