01 Jul PEPEA/CAAKT Preparation

Are you sitting the RACGP PEPEA or CAAKT soon? You would be aware that the exam contains both clinical applied knowledge questions and situational judgment test (SJT) questions. You would be familiar with clinical applied knowledge questions, similar to MCQs. However, you may not be familiar with the SJT. The SJT questions are usually centred on attributes that a good doctor possesses, eg recognising and acknowledging distress, exposing concerns, ensuring confidentiality, professional behaviour and so on. If you are looking for tips on maximising your chances in the SJT, here are two:

1. Once you have read the stem – ask yourself “What would a good doctor do?” Before looking at the possible responses. This will help you to focus on the actual intent of the question, rather than get distracted by the detail.
2. When you are required to rate the appropriateness of various responses 1 to 5, rate the response that you would ALWAYS do as the top response, and also what would you do FIRST. There may be other responses that are appropriate, but they will come after that top response.

As an example:

Jodie is a 45 yo woman who presents after a recent admission to hospital for tubal ligation. She developed infection in her wound post operatively and is not happy and feels her treatment was sub-standard. She wants to know what she should do.

So ask yourself: What would a good doctor do in this situation?
A good doctor would probably explore and acknowledge Jodie’s concerns and the pain she has suffered, and see what can be done to help her – without apportioning blame.

Rank in order the following actions in response to this situation
(1= Most appropriate; 5= Least appropriate).

A. Get advice from your MDO
B. Put her in touch with the Health Complaints Ombudsman
C. Recommend she sue the hospital and the surgeon involved
D. Explore her experience and expectations of the operation
E. Arrange to get a discharge summary from the hospital.

Which of these responses will you do every time, and which will you do first? This is definitely D. You may also do 3 of the others, but not every time. You would never recommend she sue, especially not without doing all of the rest! So that answer ranks 5.

What would a good doctor do in this situation?
Which of the responses would you ALWAYS do? Which would you do FIRST?

Trust yourself, and good luck.

30 Apr Mastering exams in a COVID-19 world

E verybody’s well-laid plans have been thrown into disarray by the recent lockdown. Or maybe not.

What has changed?

The impacts of the pandemic have been felt across all aspects of our lives. Our clinical work has changed quickly, and some of these changes are likely to last a long time. Our personal lives have changed: who we see, how we shop, how we move about. Some of the changes we may perceive as positive, while others are more testing.

But let’s look at general practice exam preparation. How has it changed? Depending on how far off your exams are, the impact will be different, but below are some critical elements of exam preparation, and our take on the potential impacts.

Challenges and solutions

Daily immersion in GP practice.

One of the best ways to prepare for the exams is to be working in full scope general practice every day. You get exposed to the curriculum of conditions as patients walk through the door, and you get to practice clinical reasoning and examination in the GP context. You can look up guidelines and review evidence for conditions as you encounter them. One issue caused by the pandemic is the move to telehealth and relative reduction for most doctors in terms of the number of patients they are seeing, and the scope of the presentations. We are not able to practice our examination as often, as the nature of general practice has been altered.

Solutions – Keep working diligently and reflect on the patients you see. In addition, now might be a good time to ramp up your study of clinical cases, eg through Dr Susan Wearne’s “Clinical Cases for General Practice Exams” or the GPRA Clinical Cases book. Enrol for our “Crucial Cases” webinars and online program to work through 20 curriculum based topics to minimise the chance there are any gaps in your knowledge.

Study Groups.

Study groups in exam preparation provide tangible benefits, including sharing the workload, benchmarking your progress with peers, and giving you structure for your study. “Virtual” study groups over platforms like Zoom and Skype have been an option for a long time now, and are well established for use in the current lockdown. The only issue might be a lack of opportunity to practice physical examination techniques (on your study group and on real patients!).

Solutions – focus on the physical examinations you do get to do with patients, and practice doing them well. Practice timing yourself and get used to examining a body system in 8 minutes. Make sure that if you look at examination videos on the internet, that they are relevant for GP exams. View our Guide to Private Study Groups for extra tips.

Exam workshops.

It is, of course, best to undertake exam preparation in the lead up to your exams. But for many candidates, the delay in the RACGP exams has necessitated a revision of timelines. Thankfully, there are a variety of online and face to face workshops available, which are run by various organisations. We suggest that candidates focus on knowledge, skills and clinical practice first, and then focus on exam technique towards the end. We also caution against using question banks and mock exams as the primary technique to study and improve – these can only ever be a proxy, and are not a substitute for real learning and improvement.

Solutions – use the extra time you have before the exams to ensure you have covered the curriculum properly in your study. Prior to the KFP, enrol in our KFP Accelerated Program to work through the process for successfully answering questions in the exam setting. We prefer face-to-face workshops for OSCE preparation so real exam conditions can be replicated, but in the event that face-to-face is not possible, we are developing an online version of our workshop that will include the standard processes our participants find valuable – discussion, timed exam cases, and a full debrief.

Where to next

For a better understanding of what we can offer, see our exam prep events page. In the meantime, stay safe and best of luck finding your way through this shifting landscape!

21 Mar Breaking Through the Fellowship Goal

Here I am, on the other side of the river. After this hard and challenging swim, I finally reached the other side of the shore known as Fellowship.

I must admit that many times during this journey I truly felt defeated. Consequently, I also felt like giving up. I always however, held on to the most powerful element to succeed: I never stopped believing in myself.

I must acknowledge all those who supported me throughout my journey, my true friends and family members. I realise, however, that no matter who was around me, I had to be my own best ally and loyal friend. The choice was mine; I could betray myself and fail the exams again, or I could make a difference to my life.

“We can all make it to the other side of the shore.”

Anxiety and panic were my true enemies every time I sat the exams, regardless of my medical knowledge, my clinical reasoning or how much I had prepared. They were dark shadows lurking in the background, ready to pounce, invade and confuse my mind the night before the exams, and they would not leave me until I walked out of the exam venue.

The pressure was extreme, as I no longer had time to remain trapped in this exhausting turbulence of re-sitting the AKT and KFP repeatedly. It was at this time that I made a decision to stop, sit and think, before re-sitting, as I wanted to avoid committing the same mistakes. I decided to reflect about what I had to do in order to be able to reach the other side of the shore. It was at this point that I realised that anxiety and panic were nothing more than normal thoughts, and that they held no power over me. I also realised that anxiety and panic would only negatively impact on me if I allowed them to take over. So, I told myself: “It is forbidden to sabotage yourself again. What you make, build or produce depends on the quality of your thoughts; excellence in thoughts must be cultivated”.

“I realised that anxiety and panic were nothing more than normal thoughts, and that they held no power over me.”

Upon reflection, I concluded that being a GP is a challenging an immensely rewarding role. Therefore, the journey to reach Fellowship was very worthwhile. I had to change my perspective and instead of feeling defeated, I had to feel the waves against myself, not smashing me, but improving my knowledge and abilities. Becoming a GP is a lifelong experience, not a set goal.

1. Modify my approach to my exam preparation. My routine had been exhausting as I initially believed that studying long hours would prepare me better. Establishing a more balanced routine was mandatory, so I set up a plan throughout the weeks and scheduled my times to study, to work, to eat and sleep well; I even planned days off. The feeling of confidence was amazing while going through my schedule!
2. Stop judging myself, and stop being my own executioner every time I could not recall information. It is perfectly fine to review information repeatedly if it is a struggle to recall a topic, because successful memorising is based on repetition.
3. Go back to the basics. A true fact is that we all have gaps in our knowledge. We must humbly allow for time to review those gaps in detail, in order to maximise our learning in the science and art of being a GP. Filling in my gaps made the exams much easier to handle.
4. Lastly, I downplayed negative thoughts that hindered my knowledge and reasoning, thereby allowing me to fully focus my attention on the exam task. This made a meaningful difference, as I significantly improved my performance in the exams. It helped me to better understand the task, improved my working memory, helped me to avoid critical errors and boosted my scores.

 
My experience of achieving Fellowship has shown me that we can all be successful. We can all make it to the other side of the shore. It’s just a matter of being determined, organised, disciplined, focused, committed and resilient.

You can find an exam preparation program to suit your needs on our events page, or call us on 08 8366 3100 to speak with someone directly.

14 Feb The Predicament

I recently came across this article from 1998 and was struck by its continuing relevance. It explains that clinical decision-making is not often supported by the best evidence available. We know that GP patients with all of their complexities are often not included in randomised controlled trials. Our clinical decisions take into account much more about a person’s total circumstance than can ever be articulated clearly through that kind of research.

The article bemoaning the lack of appropriate evidence seems even more relevant given the latest information with regard to meta-analyses and positive publication bias. The Reproducibility project tried to replicate the findings of 100 major psychological studies once it was recognized that positive publication bias may have inappropriately led to the acceptance of many treatments as evidence-based. Less than half of the trial results could be reproduced. This is not to say the results were wrong – but it does highlight the risk of only publishing positive findings. A similar path has been taken in Medicine, with efforts to ensure all data from clinical trials is published, regardless of the results. This follows on from groundbreaking research led by Professor Jon Juredini highlighting the misrepresentation of data in determining the efficacy of SSRIs for treatment of adolescent depression.

It is often argued that we are not asking the right questions in the research that is undertaken. For example, we continue to have a disease focus in research – finding a miracle cure for a disease is far more appealing to funders of research than investing into support for high quality primary care. When the GP Co-payment was initially announced in the 2014 Federal budget, it was going to fund the Medical Research Future Fund, to the tune of $20 billion. Was this fund going to be about general practice, service delivery and effective care models? No – it was going to be about diseases. This stance appears to have softened somewhat, but really – take away money from general practice to invest in research on diseases?

I believe that one of the issues we have in general practice is the complexity and scope of the issues and presentations we deal with. It is just not possible for non-clinicians to understand what it is we do every day. One may also argue the same is even true for our specialist colleagues. Perhaps this shouldn’t come as a surprise, but it means that if we want research that will be relevant for our patients, we have to do it ourselves.

In the meantime, the words of John Hoey, MD remain relevant;

“In applying research findings at the bedside we need to make inferences that are logical and explicit. We need to think more and perhaps read less.”