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Four Principles of Effective Learning for Medical Students
At medical school, you will be faced with large volumes of content than you need to understand and memorise, in a relatively short space of time, particularly around exam season. We think it’s best to shorten the time needed for this revision by using effective learning methods. By following these methods, we hope you can not only boost your grades, but spend less time revising and more time following your other passions too! One aspect of medical education that can be quite tricky is figuring out how to strike a balance between the content you learn in lectures, and the real-life application of these concepts. We’ve found that using the ‘FAIR’ system helps make this transition from lecture theatre to ward much smoother. The FAIR system is as follows: * Feedback * Activity * Individualisation * Relevance Let’s take a look at each of these principles below: ## 1. Feedback Presenting your first patient to a senior colleague can be daunting. You will be nervous before doing it, but remember, every doctor once had to present their first patient to their senior at one point. So rather than viewing this as a terrifying situation, try to view it as a learning opportunity. You have the chance to talk to an expert about a patient, and ask them for feedback about the information that you have given. Imagine how much you could learn by repeating this process compared to reading a textbook, or sitting in a lecture theatre! For these conversations to be as helpful for you as possible, remember to be receptive to feedback. The more receptive you are, and the more willing you are to learn, the more you can take from the situation. Try not to take offence to any constructive criticism, your senior is trying to help you become the best doctor you can be!  Our top tip for this section would be to get as much supervised practice as possible. Ask your colleagues in senior years or your friends to do some [CPSA/OSCE practice](https://quesmed.com/mla-questionbank/) prior to your exam. Being receptive to feedback will help you to make minor adjustments that can help to both impress your examiner on CPSA day, and better treat patients when you get the chance to. ## 2. Active Learning Many of you reading this have probably heard this phrase mentioned by your peers, or even lecturers in the past, but what actually is active recall and why should you be using it? Active recall is a revision technique, not a learning technique. You must already understand information before trying to apply active recall to it. Let’s take medications involved in nephrology as an example. If I asked you to explain the mechanism behind potassium-sparing diuretics, could you? Some of you reading could recall that information with ease, others maybe not at all. However, if you could recall the information, but it required a bit more effort than a simple answer, your active recall is now working and being strengthened. Every time you practise active recall, in theory, you decrease the amount of time needed to recall a particular piece of information. Okay, great, but how can I use active recall? I couldn’t use active recall to teach myself the mechanisms behind the different classes of diuretics, however, I could use active recall to test myself on how well I knew the different classes once I had studied them. Active recall works on the principle of remembering information that you knew at one point in time, without using notes or a book to help you remember it. Anytime we take a test, we practise active recall. We have to recall information stored in our long-term memory to apply it to the question. Question banks, flashcards and quizzes are all revision methods that use the power of active recall. What revision methods should I base the majority of my revision on? * Active recall quizzes * Active recall flashcards * Active recall question banks The opposite of active recall is passive revision. This is learning that doesn’t lead to much learning, leading to inefficient revision sessions and often longer time spent revising. Not ideal! Here are some revision methods that we should try to spend less time on: * Reading * Highlighting * Watching videos Note how we said that the points above are revision methods that we should avoid, not learning methods. For example, watching videos and reading can be great learning tools, but not revision tools! Have a look here for some more information on active recall research on [active learning](https://www.ucl.ac.uk/teaching-learning/publications/2019/aug/active-learning)  So why is it important to use effective revision methods? The information you learn or will learn at medical school is cumulative, meaning it remains relevant throughout your profession. Let’s face it, no matter how dull or interesting a topic of a lecture may be, retaining the information after having had the information verbally drilled into you for a couple of hours seems pretty impossible. Instead, you want to try and foster curiosity and discovery, and actively seek out methods to address the gaps in your knowledge. Active learning describes a broad range of learning activities, from student-patient clinical workshops to testing yourself using various [medical exam question banks](https://quesmed.com/overview/#qbank). Essentially, it means that rather than just simply listening to your lecturer and making notes, you participate in interactive learning techniques that make you think actively about the topic. Below summarises the key differences between the two learning methods. ### Active Learning * Generating your own learning strategies * Questioning gaps in your knowledge to gain understanding * Adopting feedback to improve your learning outcomes ### Passive Learning * Waiting for instruction or direction * Blindly accepting facts and making notes * Ignoring feedback It can be challenging to consistently think about how new information and skills can fit into your existing knowledge. So when you come across a certain piece of information that you think is worth noting, instead of just consuming it and carrying on, why not stop and try to recall what you just learnt? There are many interactive learning tools and [online resources](https://onlinelibrary.wiley.com/doi/abs/10.1111/tct.12092) available to you (e.g., [technology-enhanced learning](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849979/)). These are intended to supplement your university lessons and can provide more informal and engaging exercises designed to promote independent learning and develop clinical reasoning skills. [Other useful tools](https://www.bmj.com/content/365/sbmj.k663?fbclid=IwAR1LukffG9m_kBFsfKkW1B-zfmSWjEzpHrbkQb270m415T8N1HJhFm50fxg) include the use of visual aids such as concept maps, mind maps and [interleaving](https://effectiviology.com/interleaving/#:~:text=Interleaving%20is%20a%20learning%20technique,of%20question%20at%20a%20time.). ## 3. Individualisation Remember that everyone learns in different ways. The techniques that your peers swear by may not work for you at all! You may have a friend who only uses textbooks and achieves top grades in every exam, while another friend who has sworn never to buy a textbook yet still manages to do well. Our top tip here is to find what works for you, and to try new ideas as well. Don’t be afraid to give different revision techniques a try. We constantly learn how to improve our learning - think about it like a skill you can develop, rather than a routine set in stone. Your university may not cater to your preferred learning styles, but feel free to look elsewhere for other resources. Whether that may be through talking through topics with friends, watching [case-based videos](https://www.youtube.com/c/QuesmedTutorials), or making [flashcards](https://quesmed.com/) or any other active learning method that helps promote your learning. ## 4. Relevance Ever been told by your tutors to spend more time on the wards? Despite this becoming a meme, there is some truth to it. We tend to remember concepts better when we have actually seen them, or remember conditions better when we can think of a real-life patient. The information you read or learn must be **relevant** in order to stick. When you meet patients for the first time, try to come up with questions you’d like to answer about their condition. By finding the answers to your questions, you become more alert and receptive to new information, allowing your brain to absorb information readily.  For example, let’s say you’re on placement as a 1st year medical student and on a gastroenterology ward for the first time, seeing a patient who has been admitted with alcohol excess. The doctor you’re shadowing will ask you why alcohol-dependent patients are prescribed vitamins such as thiamine (vitamin B1). You may think that they may be deficient in the vitamin, and leave it at that. That doctor, then, informs you that the reason thiamine is needed in such patients is due to the impaired thiamine absorption that occurs in the intestine due to alcohol damage. Although this information may seem irrelevant at the time, you may find yourself trying to answer a multiple-choice question about the vitamin needs of an alcohol-dependent patient, with thiamine as an obvious answer. Yes, you may have remembered this by studying the topic, but more often, you’ll find yourself being able to remember where that knowledge came from, and how it was applied in practice. As such, throughout your medical training, it is important that you continuously reflect on the relevance of a topic and how you can translate your learning experience into effective practice. The outcome of this will be a better appreciation of the ways in which you can take information from the learning environment into the clinical environment. ## Conclusions We have summed up the above key principles of effective learning into a comprehensive, memorable FAIR structure to allow medical students to improve their knowledge and clinical expertise through discipline and a commitment to learning. By applying the elements of the four principles, we are confident you can become a more well-rounded and mindful student, capable of addressing the many challenges that lie ahead with confidence. ## How Quesmed Applies the Principles of Effective Teaching Whether you’re preparing for an AKT or an CPSA exam, you can rely on the next-generation learning platforms available at [Quesmed.com](https://quesmed.com/) to help you learn medicine the smart way. We offer a comprehensive array of thousands of questions and flashcards, 10,000 medical school exam questions, 15,000 flashcards, and hundreds of video tutorials on our dedicated website and offline mobile app. Register, choose a plan and embark on your journey through medical school with a useful interactive learning platform designed by experienced medical professionals.
How to make the most of your first clinical placement
So your first placement is looming, it's all been academic up until now! It's time to see some real-life patients and spend some time in the real world and learn how to be a doctor! It might seem scary but placement is one of the most valuable things you'll do in medical school, so it's important to make the most of it! ## Tip 1: Turn up! Your first placement is often a radically different working environment to your previous time at university. You might have spent a lot of your time in lectures, tutorials and doing small group work. Placement exposes you to a unique learning environment that can sometimes be chaotic and overwhelming especially as you are just finding your feet and trying to absorb as much information as possible. Placement is essentially a practice run for employment as a doctor. Even if there isn't a specific activity or place you are scheduled to be, there is always something or someone worth seeing in hospital so it's always worth turning up to find some opportunities for learning. ## Tip 2: Find your supervisor Know who your supervisor is and try to make contact with them right at the very beginning of placement. Find out your supervisor's timetable, e.g. what clinics they do on what days – so you can make the most of spending time with them. Usually, you are sent your supervisors contact details through your medical school administrator. If not, consultants usually have a secretary who will know their exact whereabouts and be able to guide you! You can generally find a consultant's secretary via the hospital switchboard or by asking other team members. Top tip - You might like to research your supervisor, who is often a senior consultant, and see what their specialist areas are. Showing interest in these areas will help your supervisor cater any teaching or activities towards your personal development needs. This is exactly how you would approach your Educational/Clinical Supervisors when you newly graduate too so it's good to get into the habit now! ## Tip 3: Shadow an FY1 You will be a Foundation Year 1 (FY1) doctor soon enough, and spending time with a doctor in their first year or so will give you a whole new, very real, perspective on clinical medicine, what life is actually like as an doctor and how to survive your first job. Following a consultant is all well and good, but when you qualify, you won't be chairing MDTs or performing 6-hour surgeries – you'll be running around the wards siting cannulas and prescribing anti-emetics – so shadow these tasks! Being "on-call" with a junior doctor is particularly useful as this is often the most fast-paced time as a doctor. You'll get to see lots of patients and perform all the tasks you'll be expected to do in just a few years' time! ## Tip 4: Study on the go Bring study materials with you. There can be "downtime" as a student, where doctors are busy doctor-ing, and there's maybe not much interesting stuff to be doing – make sure you're not sitting doing nothing! Bring revision materials with you, and use any spare 10 minutes to look up a condition you saw on the ward round, revise the dosing of an antibiotic, or swot up on your vascular anatomy. Regular revision is the secret to passing finals! Downloading the Quesmed app ensures you always have revision resources such as our question bank, at your fingertips – and we're available offline too so you can still use the app even when connected to the ever-questionable NHS wifi!  ## Tip 5: Be proactive As a medical student, you're already equipped with many useful skills for the hospital environment. For example, offer to perform observations for the nursing staff, help the phlebotomist on their rounds, grab the NEWS chart for each patient on the ward round, porter a patient to their x-ray, and phone the laboratory. Although these opportunities might seem "boring" and possibly not technically your job when you become a doctor, they make you very much part of the "team" and give you a better understanding of how the whole hospital system works. For the more assessment driven among you, lots of seemingly "simple" tasks like taking observations often come up in your end of year OSCEs! ## Tip 6: Take notes For example, if you're attending a ward round, keep a brief (anonymised) list of patients and presentations you've seen. You can refer back to this later and explore the presentation as part of your revision. It's often easier to remember the ins and outs of a condition when you can relate to a real patient. Bring a small notepad with a hardback so you can write "on the go", or take your phone with you to note down important points. ## Tip 7: Practice! Medical student placements are a place to practice everything you're learning and become a natural at those OSCE/CPSA stations! Examine patients, take histories, and perform tasks such as venepuncture and cannulation. Many hospital patients are bored and welcome the opportunity to share their stories with someone. It's also useful to examine a "surprise" patient where you don't already know the examination findings! This will give you confidence in your diagnostic abilities and become super confident when it comes to OSCE exams. Use Quesmed's OSCE/CPSA platform to revise the points to visit in a particular station before seeing a patient, or even team up with a colleague and find a patient who will allow you to practice, with mark sheets and all!  ## Tip 8: See patients! See as many patients as possible! You want to become a natural at speaking to patients from all walks of life, with all types of conditions. Ask a senior doctor if they can observe you speaking to or examining a patient - or ask if you may present a patient on the ward round or to the consultant. You'll pick up tips and tricks and the important things not to miss for specific presentations. ## Tip 9: Enjoy! Enjoy the experience! Placement is fun, fast-paced and often the best learning experience in medical school. Placement may seem daunting, but it's often the most high-yield learning experience on your journey to becoming a doctor. Hopefully you now feel a little more prepared and know how to make the most out of your first hospital placement.
How to prepare for your medical school finals
Finals are looming! Where do you start? How do you prepare? Your medical school finals may be the most important exam you’ve ever sat. Here are some key tips on dealing with exam revision and getting through that final step to becoming a doctor. ## Know what you need to know This might seem obvious, but before you start any revision, you need to know what you need to know! Your medical school will have a syllabus with intended learning outcomes (ILOs), which you can print off, so you know exactly what you need to know for finals. These can be split into topics, body systems or otherwise. You can also use this as a checklist, ticking off or highlighting topics as you have revised them. It’s also useful to know the format of the exams you’ll be sitting in advance – for example, single best answer, practical examinations, oral examinations or written examinations. Find out how long each exam lasts and how many questions are expected. This way, there will be no surprises on the day! If you graduate from 2025 onwards, you’ll need to sit The United Kingdom Medical Licensing Assessment (UKMLA), a standard examination designed by the General Medical Council (GMC), which every graduating medical student will have to pass to practice in the UK. This is based on the GMC’s “[Outcomes for Graduates](https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes-for-graduates)”. For more information, read our blog article on [The UKMLA: What is it and what does it mean for me?](https://quesmed.com/) and watch our [video](https://www.youtube.com/watch?v=UCGTJgZJAUM) on our YouTube Channel for more. ## Make a revision plan Calculate how long you have until finals, and split your time up accordingly. Depending on your time, you might spend a week on each speciality – e.g. cardiology, respiratory, gynaecology. If you’re short on time, prioritise important and high-yield topics that are likely to come up in examinations. Learning every tiny detail about every condition you’ve been taught about is unachievable! Identifying which topics you find most difficult can also be beneficial - as we’re prone to tactically avoiding studying these. Instead, you might want to study these first, or early on in your revision schedule and study the topics you enjoy more later on when you might feel less motivated. ## Identify your revision style Plan how you will revise and identify your favourite revision style – be it flashcards, video content or drawing mind maps. You might like to use several different revision styles to mix things up. Spaced repetition is one of the most effective revision tools – whereby you view a key topic or fact at increasing time intervals until it has become committed to memory. Using mnemonics and mind maps are fun ways to remember key facts. The funnier (or ruder), the easier they seem to recall. We all know the cranial nerves one…  ## Revise on the go! Regular revision and consolidation is key. Using any spare moment, for example on your commute or whilst waiting for your takeaway pizza, to smash some revision. Using app-based revision tools like [Quesmed’s app](https://app.quesmed.com/) enables accessible spaced repetition of key facts and topics. Read our blog article all about Quesmed, and why it may be your number one revision tool. ## Study together! Studying with a study buddy or in a small group can boost motivation, help you pick up tips and mnemonics from others, and may also be beneficial for mental health if you’re the kind of person who needs human interaction! In addition, group studying is great for testing each other formally or informally using example questions and mock tests. Check out the [Group Study](https://quesmed.com) function on Quesmed's app.  ## Attend revision lectures Specific revision lectures run by your medical school or elsewhere are an excellent way to revise and consolidate high-yield topics. During finals season, Quesmed runs regular live [revision tutorials](https://app.quesmed.com/tutorials) on key topics likely to make an appearance in your finals. These are typically run in the evening and are also recorded and uploaded onto the YouTube channel, so you can watch them back at your leisure. Video or audio content can be played in the background when you’re cooking, tidying or commuting, helping you to utilise spare moments to squeeze in some more knowledge. ## Practice with mock tests Practicing mock tests not only gets you into “exam mode” but also aids in time management, exam technique and familiarises you with the examination format. [Quesmed](https://app.quesmed.com/register) has several UKMLA AKT mock tests containing unseen questions that can be taken under timed conditions, just like the real exam. Once you’ve completed a test, you’ll receive your total score and a breakdown of your scores divided by speciality. In addition, you can go back to each question to review the explanations for each choice and look up any relevant notes. ## Remember to take breaks and have a life! It’s important not to let studying take over your whole life. Make time to engage in the things you enjoy. Make sure you have regular breaks, eat healthily and keep fit. Healthy body = a healthy mind. In particular, ensure you’re getting plenty of good quality sleep, as sleep has been shown to aid in consolidating facts. It might seem like an all-nighter before the exam is a good idea, but this is highly likely to hinder your performance in the examination. Don’t feel bad about an unproductive day; we all need a day off now and then!  Medical school finals really aren’t that bad; with a little preparation, revision becomes easy, maybe even enjoyable! Good luck with your finals and your future career! 
Quesmed: Why It Was My Number One Learning Tool
When I started medical school, I faced an endless struggle with how to tackle new styles of exams I was unfamiliar with. How could I prepare for my SBA/UKMLA exams while juggling lectures, tutorials, and placements? How do I even begin to practise for my CPSA/OSCEs which had seemingly endless different station types? I decided to use an online learning platform. That's where I found Quesmed - an incredibly useful method of learning that allowed me to consolidate all the learning materials I needed with a few taps on the screen. Sounds good? I've broken down all of the features of the Quesmed platform below to show you just how useful it can be during your medical school studies. ## Why I chose Quesmed as my online learning platform Online learning tools such as Quesmed have repeatedly proven their ability to make our lives easier as medical students. Whether it's free time on the wards or a lengthy commute, having interactive learning materials at hand makes it far easier to study. So out of all available online learning platforms, why did I choose Quesmed? First things first - Quesmed is a multifunction platform. It links a huge array of learning resources in one compact, integrated system accessible on both the website and mobile app.  With a few swipes on their Question Bank platform, you can start doing questions, read relevant notes, assign flashcards to your daily feed and watch tutorial videos. As you progress through the platform, the system understands what concepts you're weak on and suggests daily flashcards to keep you on track. Personally, I found that regularly answering questions and reading the accompanying notes and flashcards the most helpful. This feature helped me pull together all the information I needed both for my own learning and for exams. ## The Question Bank  Quesmed's Question Bank has made my life as a medical student a lot easier. I loved how the online learning platform had both [pre-clinical](https://quesmed.com/anatomy-preclinical-medicine/) material like anatomy and physiology as well as more complex [clinical material](https://quesmed.com/mla-questionbank/) every UKMLA condition and presentation. The sheer breadth of questions was amazing, covering every single possible speciality and learning objective I needed to know for exams. A great feature they have is that you can choose between core, medium and hard questions. This helped me develop my confidence early and allowed me to progress through the bank one step at a time. Each question has with it an explanation of the correct answer. If I were to answer a question wrong, I would read the accompanying notes, which allowed me to direct my learning to my weaker areas. This was super helpful when I came to the wards, as I could justify my decisions when asked questions by senior doctors. Finally, I really enjoyed how the book of notes and questions linked together. Quesmed has a fantastic section of notes available that covers all medical UKMLA AKT core conditions and presentations. These notes are progressive and explain each topic to you in detail. Once you reach the end of a chapter, you'll be prompted by a "Start Questions" button which lets you test your newfound knowledge! ## OSCE Platform  CPSAs or OSCEs are known to be some of the most challenging exams in medical school. You're expected to go through simulated tasks under time pressure with a senior doctor watching your every move while being expected not to be phased by nerves. The stations on the [Quesmed CPSA platform](https://quesmed.com) were incredible. It literally had everything - from history taking and communication skills to ABCDE stations and procedures. The best thing about the OSCE platform? The stations are extremely similar to the actual exam, allowing you to revise every possible scenario. You could really tell that a lot of thought was put into them as they had lots of twists and turns, just like the real thing.  It was also very useful to use it to revise with friends. Before I used Quesmed, I used textbooks and simplistic PDF mark schemes. Now, I just log on to the app, select a station (and timing) and pass my device to my friend, who can examine me on any station I need. After the session, I can go back through the app to see where I went wrong, which allows me to monitor my performance during multiple OSCE practice sessions. Another incredible thing about the OSCE platform is the Group Study mode. I sometimes use it when my friends and I are in different placements, and we can connect via an in-built video link within the platform to revise. I also really enjoyed the 'Find a Study Buddy' feature as I can just log on and find other people keen to revise online (sometimes through dedicated Mock OSCEs that Quesmed runs frequently). Lastly, the video OSCE guides really stood out for me. In addition to the classic examination stations, I loved how realistic the communication skill videos were and they really helped me prepare for difficult communication stations that came up in my actual OSCE (look up the [Explaining Medication Error](https://youtu.be/iD_KpaIn1O0) on Youtube to see what I mean!) ## Quesmed's Social Media While not an actual product, Quesmed's social media is worth highlighting as I found myself returning to it regularly for revision (and some excellent memes)! They post one multiple-choice question on their Instagram, [@quesmed](https://www.instagram.com/quesmed/), each morning. These are very useful, as they really push my ability to actively recall information that I may have gone over weeks or even months ago. I always try to answer the day's question when I'm out and about, and I sometimes do them with my medic friends and compare answers. They also post really useful 'cheat sheets' that have quick summaries on different conditions, which I've screenshotted and saved to my notes. These summaries are great for having a skim through whilst on the way to a lecture or tutorial. ## Conclusion It wasn't until I moved onto my third year of medical school that I was able to crack the code with regards to finding a personalised revision method that worked for me. I discovered that I am an active learner and need a good mix of methods to stimulate my mind. Quesmed helped me find that mix. With all the questions, notes, videos and flashcards at my disposal, I could finally excel at my studies and apply my newfound knowledge to clinical practice. You need to work out your own balance and discover what works best for you. I think you will find that interactive online learning is the best way forward, and having an app like Quesmed, which compiles everything into one app, is the easiest and most effective way to learn at medical school. I hope it helps you save time that you can use to have fun, explore other interests, and enjoy life as a medical student! ## About the Author Tiarnán is a third-year medical student at the University of Plymouth with a keen interest in medical education, marketing and social media. He currently works with Quesmed as Social Media and Marketing Lead.
UK Medical Licensing Assessment (UKMLA) Exam Ultimate Guide
## What is the UKMLA? The UK Medical Licensing Assessment (UKMLA) is a standardised medical licensing exam in the United Kingdom. You can think of it as a UK equivalent to the USMLE, which is an American standardised medical licensing exam that you must take if you wish to practise medicine in the United States. If you would like to see our YouTube video summarising the main changes, click [here.](https://www.youtube.com/watch?v=UCGTJgZJAUM) The idea behind having an exam like this is to ensure all medical graduates qualify to the same standards. This is because currently, medical schools are otherwise allowed to set their own finals exams, and to some extent, curricula, which means there can be slight variance in what you study and how you are assessed depending on which medical school you go to. The UKMLA will align all medical schools to the same curricula and provide a consistent style and form of examination. The UKMLA is designed to assess the knowledge and skills of medical graduates to ensure that they meet the required standards for safe and effective practice as doctors. It is a new exam that the [General Medical Council (GMC)](https://www.gmc-uk.org/education/medical-licensing-assessment) has introduced from 2024 onwards, and this post goes through what the exam is, who has to take it and how to prepare for it! ## Who Takes the UKMLA? The UKMLA is taken by all medical graduates who wish to practise medicine in the UK, regardless of whether they trained in the UK or abroad. This includes international medical graduates (IMGs), and those who are completing their medical degrees in the UK. For medical students in the UK, you will sit the UKMLA around the time you have your finals exams. Some medical schools implemented a ‘pilot’ UKMLA exam in the 2022-2023 academic year to give students an idea of what the exam will be like. For International medical graduates, it will eventually replace the PLAB (estimated to take place in early 2024) and you can consider the terms interchangeable for the purposes of this blog post, especially when we get to the format and content of the exam, whereby the PLAB blueprint will be replaced by the UKMLA content map. ## Exam Format The UKMLA consists of two main components: the **Applied Knowledge Test (AKT)** and the **Clinical and Professional Skills Assessment (CPSA).** For UK-based medical students, these are the equivalent of ‘Finals’ and ‘OSCEs/OSLERs’ respectively. For IMGs, these are very similar to PLAB 1 and PLAB 2 respectively. The AKT is a written exam that assesses your knowledge of **medical science, clinical reasoning, and professional practice.** For UK medical students this will be two 100 single best answer (SBA) question exams, taken on a computer, with each exam lasting 2 hours long. This would be the equivalent of PLAB 1 and you will see that the content maps reflect that. The two papers will examine clinical topics in the following [format](https://www.medschools.ac.uk/media/3103/ms-akt-sampling-grid-updated-2023.pdf).  On the other hand, the CPSA evaluates your clinical and professional skills through a series of practical assessments. This part of the exam can take place at various clinical sites and is designed to reflect real-life scenarios. You will be given time to read a brief which will lay out a clinical scenario and ask you to perform a certain task(s). In most UK medical schools this is referred to as an OSCE/OSLER, or PLAB 2 for IMGs. ## Content The GMC have produced a [content map](https://www.gmc-uk.org/-/media/documents/mla-content-map-_pdf-85707770.pdf) covering each specialty that will be examined in the UKMLA AKT and CPSA, consisting of core presentations and conditions for each. Although a long document, please don’t be alarmed - in the UK this is very much aligned with your medical school curricula and similarly if you have trained abroad this is likely to be the case too. The content map is based on the GMC’s ‘Outcomes for Graduates (2018)’ (reference), the GMC’s ‘Generic Professional Capabilities Framework (2017)’ (reference), and lastly, common scenarios you may face as a Foundation Doctor working in the UK. The Outcomes for Graduates refers to three themes which helped shape the UKMLA content map: 1. Readiness for safe practice 1. Managing uncertainty 1. Delivering person-centred care Additionally, the content map is then organised into six main domains: 1. Areas of clinical practice 1. Areas of professional knowledge 1. Patient presentations 1. Patient conditions 1. Clinical and professional capabilities 1. Practical skills and procedures Here’s an example of what you can find in the content map. At Quesmed, our knowledge library is aligned to the UKMLA, covering exactly what you need to know for the exam:  ## Exam fees In terms of cost, for UK medical students this cost is covered in your tuition fees. For IMGs, the cost of taking the UKMLA may vary, so it's important to check the GMC website for the most up to date information. ## Resits The UKMLA is a pass/fail exam. If you don't pass the UKMLA on your first attempt, you can resit the exam. However, there may be limitations on the number of resits allowed, and you'll need to meet certain eligibility criteria. ## UKMLA Preparation Having a quick read of some of the official guidance on the UKMLA that we have referenced in this post will help familiarise yourself with the format and content of this exam. When you see the list of conditions and presentations you need to know, on a first-read, this may seem quite overwhelming - however, don’t be alarmed - it is very likely your university curriculum is already largely aligned to the UKMLA content map. ### Cover/uncover method When approaching SBA questions, let’s first start with the cover/uncover approach. With this method you should cover the answers first, and this will allow you to break things down a bit more in the question. Have a look at the question below, we have deliberately covered the answers:  Here you can see that you have someone with an ejection systolic murmur loudest on expiration at the left intercostal space which radiates into the carotid arteries, and without looking at the answer you can probably tell that it's most likely to be aortic stenosis. Then when you uncover and then you find that AS is one of the options you can select it with confidence knowing you are probably right.  Let’s look at a harder question - have a look at the question below:  So this is a question that asks a lot and the point here is that if you look at the answers first you may freak out because there’s quite a bit of text so what I suggest is that you cover once again. Read through the question - this person has weight loss, a cough, bloody sputum and he's a smoker - could this be lung cancer? They are also feverish, sweating, more thirsty than usual, finding it difficult to pass stool and confused. Could this be lung cancer with something else, like a complication of lung cancer? So in this scenario the latter group of symptoms is suggesting hypercalcemia - the patient is passing more urine, they’re constipated and confused, and the clubbing goes hand in hand (pun intended) with lung cancer.  The answer here is hypertrophic pulmonary osteoarthropathy, which is associated with squamous cell lung cancer.  This is a hard question so don't worry about it if you didn't get it but it's important to recognise that if you break things down, you may first come to the conclusion that this is probably lung cancer and it could be that it's related to something else. You could also figure out that it's related to hypercalcemia and then if you have all the information you will know B is the answer. Here you require a lot of steps to get the diagnosis but if you break it down and cover the answers first, you can take a bit more time to think about it without being stressed by lots of wordy different answers. ### Location – GP v Emergency Emergencies are very important and the emergency curriculum is important for examiners to assess your practice so if on day 1 an emergency happens you escalate accordingly. There's lots of guidelines that are very helpful such as ALS guidelines but also the back of the Oxford handbook I've always found very useful and as a junior doctor I used to look into it in my first couple of months as an F1 doctor. It’s important to understand what's in the question and the clues that will help you to answer it correctly. If you are in an outpatient or GP clinic that is different from the emergency department. For example if you're in the clinic the question will test knowledge of long term treatments, when you need to escalate and when you need to do things a bit more urgent. Whereas in the emergency department it will focus on A-E, and making sure that the important complications are dealt with early. The other aspect of demographics is knowing who the patient is so if it's a 70 year old you will have a different differential diagnosis to a 20 year old, so make sure that when you're looking at the presenting complaint you consider your differentials first and then which features are those that help make the diagnosis because lots of questions will ask you to weigh between different things, some of which could be completely unrelated. ### Investigations Investigations form quite a big chunk of most exams and you’ll often be asked to differentiate between definitive investigations to confirm the diagnosis or, the next best or initial investigation. For example a tissue biopsy in coeliac disease is the best or gold standard investigation, however if you were in primary care the initial investigation you may do is a panel of bloods including anti-tTg antibodies. Sometimes it's helpful to use guidelines for that however sometimes you have to use your clinical judgement. The other way to approach these questions is thinking ‘what will harm the patient most severely’ in the first instance. What you're doing here is trying to make sure that you can tell the examiner that you know what's safe and you know what you need to rule out early in terms of complications and that you are safe to manage patients on your own, and with help and escalating appropriately. A framework mnemonic I use for investigations is BBBII - not the catchiest but it helps me remember that the first thing to do is to check the background: history and examination, then bedside tests like ECG or blood glucose. Then you have blood tests, imaging, and invasive investigations - the point is we're usually opting for the least invasive stuff early which causes the least amount of harm and then the more invasive stuff later on. Similarly with management. After taking into account urgency, you are always trying to make sure to do the conservative stuff first then consider medical options and then surgical and that's how we think about management options in clinical practice too e.g. in emergencies again A-E first and then everything else. ### Exam technique As for the best practises for answering SBA there is a lot to say about exam technique and the key is to make sure that you are prepared so that on the day you have come through this many many many times so that you are not stressed. You probably will still be stressed in any case but this hopefully will give you a bit more about how you can minimise that on the day. ### Time management You have about a minute to answer each question and you have to balance between trying to answer questions quickly but also reading them properly and considering your options appropriately. What you should be doing early on in your revision is taking your time with questions, trying to think through the answers thoroughly, and then closer to the exam you should be going through timed quizzes to simulate the exam environment. Balancing between time management and taking in the question will come with practice and if you're not getting it early on that's fine it will come after a few weeks or months of work, so make sure you have enough time to make that transition from very slow reading to slightly faster and trying to work within exam conditions. ### Demographics For medical exams it’s quite useful to have some rules of thumb in your mind about different demographics because it allows you to raise your index of suspicion for certain diseases. So if the question mentions ‘a 22 year old athlete collapsing’ the first thing you are or hopefully will be thinking is ‘is this hypertrophic obstructive cardiomyopathy’ because it's something you may have come across before. It's fine to have that initial thought in your head but you need to make sure that you are thinking about the rest of the question and whether or not it supports or doesn't support your diagnosis. ## Conclusion So that’s everything that I wanted to cover on the UKMLA exam and how to approach answering the questions you will be encountering in the AKT part of it, thanks for listening and if you have any further questions our email is in the description. With over 12,000 AKT questions and 250 practical CPSA stations, Quesmed is the single best resource for preparing for the UKMLA and your medical school finals. Our SBAs and CPSA stations cover all of the core presentations and conditions in the content map. We have 4 brand new UKMLA mock exams with input from students who sat the pilot UKMLA last year. Look out for lots more content from us which will help you with your UKMLA preparation and follow our socials for updates. We wish you the best of luck here at Quesmed! ### References * General Medical Council (GMC). UK students' guide to the MLA. https://www.gmc-uk.org/education/medical-licensing-assessment/uk-students-guide-to-the-mla * General Medical Council (GMC)(2020). Outcomes for graduates, plus supplementary guidance. https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates * British Medical Association (BMA)(2021). The UKMLA: change is coming, what you need to know. https://www.bma.org.uk/news-and-opinion/the-ukmla-change-is-coming-what-you-need-to-know * [UKMLA AKT: Everything you need to know for UK Graduates and IMGs - YouTube video (UKMLA vs PLAB)](https://www.youtube.com/watch?v=UCGTJgZJAUM)
Top 5 tips for approaching your final year at medical school
Congratulations on getting through to your final year of medical school! After many years of studying medicine, the thought of starting your first job as a doctor can be quite daunting. Add to that your day-to-day clinical attachment, UKMLA AKT and CPSA exams, and additional exams such as the Prescribing Safety Assessment (PSA) and Situational Judgment Test (SJT); it can get a bit too much to think about! That's why we've set out the top 5 tips to help you get through your final year and take you one step closer to being a doctor! ## Tip 1: You are only expected to know the basics by the time you graduate  In the past few years, you have come across a lot of medical knowledge through seeing patients, reading and attending lectures. However, one of the main issues of 'drinking from the fire hose' of medical knowledge is that you're never quite sure which information is important to remember for your day-to-day life as a doctor. Do you need to know that a common cause of osteomyelitis in sickle cell disease is Salmonella? Or that neuromyelitis optica is associated with aquaporin-4 antibodies? The truth is that the more niche material you'll come across is essentially just 'good to know' rather than 'need to know'. This sort of information sometimes comes up in your written exams, but you will not need to know about it during your time as a foundation doctor. At a professional level, your seniors will expect you to do the basics: be on time, bring up results, order and review investigations and generally ensure that any concerns are fed back in a timely manner. In terms of knowledge, you will be expected to know and practice the core aspects of medicine that relate to commonly encountered scenarios and emergencies: * Principles of emergencies (the first steps to do prior to involving your seniors, like taking bloods, or performing an ECG) * Principles of advanced life support (including administering good CPR) * Interpreting blood tests, ECGs and chest x-rays * Understanding the rationale of requesting investigations and prescribing treatments for your patients * Procedural skills like bloods, cannulas and catheters * Communicating effectively with patients, families, and colleagues. That's it. You're not expected to make a diagnosis of acute intermittent porphyria at 3am on a night shift (although that would be quite cool to see!) All you need to do is engage with the curriculum to understand the above key principles, and you will be more than fine to start as an effective, useful member of the clinical team! ## Tip 2 Remember that where you do your foundation training doesn't matter in the long term  Applying for foundation jobs can generate a lot of anxiety for medical students in their final year. There is just so much uncertainty about where you will be placed and whether this will impact your career in the long term. The truth is that it really doesn't matter where you go for foundation training. All foundation programs in the UK are regulated by the GMC and provide similar clinical experiences. In all programs, you will have six different rotations in various medical or surgical specialties (including a community placement in F2). The main focus is to develop competence in basic clinical and non-clinical skills such as communication and teamwork. At the end of the two years, all doctors will be expected to achieve the same competencies. Sometimes you might like to choose specialties that you might like to pursue as a career. If you don't manage to do those specialties during your foundation years, don't worry! You can always do them during an 'F3 year' (a commonly-taken "year out" after F2) and during your core training. In summary, it doesn't matter where you end up for foundation training. Clinical training is very long (!), and there will be many opportunities to pursue your interests during and after your foundation training, wherever you end up for the next two years! ## Tip 3 Be aware of key deadlines for the year  There is much to keep up with in final year, let alone the extra assessments you must pass! Make sure to familiarise yourself with the key deadlines on the UKFPO website so you can prepare in advance for the application forms you need to fill in and the exams you need to sit. Generally speaking, you can sit the Situational Judgement Test either in December or January. Delivery of the Prescribing Safety Assessment exam is usually decided by your individual medical school, so it's worth checking in beforehand to see when you'll be sitting it. ## Tip 4: Focus on active learning for your written/OSCE exams At this point in your medical school career, you've likely come across a study method that works for you! Final year is about bringing together all the information you've learnt throughout your years at medical school and focusing on any gaps in your knowledge so that you can graduate as a competent foundation doctor! That said, there's a lot to do in final year, so it's important to use your time wisely. Active learning is the most efficient way to revise and review lots of information in a shorter period of time. Many studies have shown that 'active learning', where you engage deeply with the material, is the quickest (and most long-term) form of learning in many different fields. The most well-established way to test yourself is through a question bank, for example, Quesmed's [QBank](https://quesmed.com), which allows you to work through relevant clinical scenarios to understand which differentials, investigations and management plans are appropriate for a wide variety of presentations. Another powerful way to revise is by going through spaced repetition flashcards, which help you drill down the key facts you need to remember to aid your problem-solving. For CPSA/OSCEs, practice is absolutely key. We recommend investing time in finding a reliable study partner or group to practice scenarios, examine patients and gain feedback on your performance. You can also use our dedicated [OSCE/CPSA platform](https://quesmed.com) as a source of interactive mark sheets, progress tracking and videos to familiarise yourself with tricky OSCE stations! ## Tip 5: Enjoy your last year as a student!  Becoming a doctor is a long journey with many hours spent revising or working unsociable hours. It's worth remembering that this is your final year as a student, where you are very much in control of your own schedule. Therefore, it's important to focus on your mental health by taking regular breaks, seeing friends, going on holiday or doing whatever helps you relax. Additionally, if you have any particular medical (or non-medical) interests, now is the time to explore that interest!
The Quesmed Complete Guide to MRCP Part 1
So you want to start your MRCP diploma journey but aren't quite sure where to start? Continue reading for a full guide on everything you need to know about MRCP Part 1, the first of three exams that need to be passed in order to achieve the MRCP diploma. ## What is the MRCP Part 1? MRCP Part 1 is a written exam taken by doctors who have completed a minimum of 12 months of postgraduate medical experience. This includes both UK-trained doctors and international medical graduates (IMGs). The purpose of MRCP Part 1 is to evaluate a candidate’s understanding and knowledge of common and important disorders, as well as clinical sciences relevant to medical practice at a level appropriate for entry to specialist training. ## Who undertakes the MRCP Diploma? MRCP Part 1 is the first exam on the journey towards the MRCP (UK) Diploma. You must have at least 12 months of postgraduate medical experience before applying to sit the exam, which usually means waiting until completion of FY1 in the UK before applying. The MRCP Diploma is a post-graduate diploma designed to test the skills, knowledge, and behaviours of a doctor who wishes to undergo medical speciality training in the United Kingdom. Many doctors - within the UK and abroad - undertake the MRCP diploma even if it is not a training requirement in order to provide additional value to their portfolio, but also to develop their skills and knowledge further. In order to achieve this qualification, you have to sit and successfully pass three exams: * MRCP Part 1 * MRCP Part 2 Written * MRCP Part 2 Clinical , also known as PACES Any doctor who wishes to start specialist registrar training in the UK within a physician or medical training programme must have completed all parts of the MRCP diploma in order to enter the relevant specialist training. The specialities where MRCP is a requirement are reproduced below:  ## Exam Format - MRCP Part 1 The MRCP Part 1 examination is designed to test the doctor’s knowledge of clinical science as relevant to their medical practice. The aim is to ensure the candidate understands common and important disorders that they may come across during their specialist training, at an entry level. The exam is currently completed electronically and is comprised of two papers, each with 100 questions in a best of five format, where one answer will be the single best answer. There is no negative marking, and each correct answer is awarded a single mark. If taken in the UK, you will sit the exam at home and will be monitored remotely whilst doing so; if taken internationally, the exam will be sat at a test centre. ## What is the style of MRCP Part 1 Questions? In the MRCP Part 1 exam, the questions are usually single-step logic with succinct stems; the focus of the question is usually on immediate next steps or basic sciences. This is as opposed to the two-step logic with more complex clinical reasoning and longer stems where more information is provided for the candidate to integrate and synthesise in order to come to a conclusion; this is the type of question you will encounter in the MRCP Part 2 written exam. Therefore, the questions tend to ask one of a handful of things: * What is the most likely diagnosis? * What is the next step in management? * What is the best or next treatment? * What is the best investigation? * Or some basic sciences question, such as drug mechanism of action or mode of inheritance There will always be 5 options, and one option will be the best answer, though the other 4 options will often be a close match and possibilities, hence single **best** answer. Here are some example exam questions to help you understand the format a bit better! In the question below, you can see the question mainly asking about the most appropriate treatment for ESBL. This question is testing the candidate’s understanding of clinical microbiology and drug resistance.  This next question illustrates how a question that wants to test core sciences principles, such as genetics, may be phrased. Here, through the past medical history and background, the candidate is expected to determine the underlying diagnosis as MODY3, and use this to answer the question about the gene that is most likely affected. The logic in this question is more two-step, and as such this may be considered a more difficult question, however the core of the question remains basic sciences and has less of a clinical focus, making it more similar to what may be encountered during the MRCP Part 1 exam.  Finally, the question below is an example of a question aiming to test a candidate’s ability to put together limited clinical information to come to a reasonable best diagnosis.  At Quesmed we have worked closely with the best physicians who have taken and successfully passed the MRCP exams in order to develop over 4500 questions as part of our [MRCP Part 1 Question Bank](https://quesmed.com/mrcp-part-1-question-bank/) that are based on themes from previous papers. What Specialties are covered in MRCP Part 1? The subject of the questions is based on a careful blueprint designed to ensure that an appropriate range of medical knowledge is tested. Therefore, each speciality or subject area being tested is given a rough proportion of the total number of questions available across both papers, as displayed in this table. For example, across both papers, one would expect to answer approximately 14 questions on Cardiology, and 8 questions on Geriatric Medicine.  ## MRCP Part 1 Exam dates and Fees Plan ahead as there are only fixed dates when you can sit the exam, published by the Royal College of Physicians. Application deadlines are usually several months in advance of the exam itself, so it is imperative to check ahead of time so you do not miss out on your desired date.  You should check the current fees directly on the [RCP website](https://www.mrcpuk.org/mrcpuk-examinations/part-1/exam-dates-and-fees) as it may be subject to change. Results and unsuccessful attempts Results are published online, 1-2 months after completing the exam. The results release dates are available on the Royal College of Physicians website, so you have an idea of when to expect to hear if your attempt has been successful or not. The pass mark for the MRCP Part 1 examination is 540. Most candidates will score between 200-800; the minimum score is 0, and the maximum score is 999. This score is scaled, such that it is calculated by taking into consideration not only the number of questions the candidate has correctly answered, but also the relative difficulty of the question and the exam. Once MRCP Part 1 has been passed, the candidate then has 7 years to complete the remaining sections of the MRCP Diploma - MRCP Part 2 written, and MRCP Part 2 PACES. If unsuccessful, candidates are permitted a maximum number of 6 attempts. If the exam has not been passed after 6 attempts, then the candidate will need to be supported in additional training with appropriate evidence before further attempts are allowed. ## How to prepare Everyone prepares differently, and there is no single right or wrong answer, but here are some tips that may help you as you plan your revision strategy! At Quesmed, we have worked closely with expert physicians to develop over 4700 Questions as part of our [MRCP Part 1 Question Bank!](https://quesmed.com/mrcp-part-1-question-bank/) These are based on themes and topics that have appeared in previous exams. Alongside our questions, we have generated a dedicated reference textbook that you have access to as part of your subscription. This textbook covers all the key topics that you will need to know about prior to sitting your MRCP exams, and has been developed carefully with the MRCP blueprint in mind. Here are some useful tips to get you started with your revision: 1. Start early. - Don’t underestimate the depth and breadth of topics covered in this exam. Starting well in advance gives you a buffer for unexpected hurdles. 2. Plan your revision. * Set timelines and goals. * Be aware of the range of topics covered by the exam as discussed above, and ensure your revision strategy covers these specialities 3. Do as many practice questions as possible * Practice questions should be the core of your revision, especially questions that cover previous exam themes * Take time to read detailed explanations on why your answer is correct or incorrect to further guide your revision and fill in any gaps 4. Diversify your study materials. - Don’t rely on one single resource - Obtain a good reference textbook or get access to a detailed online knowledge library to synthesise your revision notes 5. Take mock tests - Taking tests in timed conditions can help you replicate the exam experience and get used to the time pressures you may face in the exam 6. Use official resources where available. - The Royal College of Physicians publish sample questions on their website. - These are a great way of getting used to the types of questions asked and can also be used as mock tests. 7. Study groups and flash cards. - Join or create a study group! - Discussing topics and testing each other can provide different perspectives and help in clarifying doubts. - Flash cards can be an invaluable resource to allow you to test yourself on key topics quickly. 8. Breaks and Health - Remember to take regular breaks and maintain your health. - This is a marathon, not a sprint. We normally recommend 3-6 months of target revision, depending on your clinical commitments. ## References - [MRCP Part 1 Examination Overview](https://www.mrcpuk.org/mrcpuk-examinations/part-1) - [MRCP Part 1 Exam Dates and Fees](https://www.mrcpuk.org/mrcpuk-examinations/part-1/exam-dates-and-fees) - [How to Complete Your MRCP Part 1 Application](https://www.mrcpuk.org/mrcpuk-examinations/part-1/how-complete-your-application) - [MRCP Part 1 Exam Format](https://www.mrcpuk.org/mrcpuk-examinations/part-1/format) - [MRCP Part 1 Sample Questions](https://www.mrcpuk.org/mrcpuk-examinations/part-1/part-1-sample-questions)
The Quesmed Complete Guide to MRCP Part 2
Well done on getting through MRCP Part 1! This was your first step towards achieving the MRCP Diploma and may have also been your first post-graduate examination since qualifying as a doctor. Continue reading as we go through everything you need to know about the second part of the MRCP Diploma, MRCP Part 2. ## What is the MRCP Part 2? MRCP Part 2 Written is an exam taken by doctors who have completed MRCP Part 1 successfully. This includes both UK-trained doctors and international medical graduates (IMGs). The purpose of MRCP Part 2 is to evaluate a candidate’s ability to integrate clinical presentations alongside test results in order to determine diagnoses and management plans. ## Who undertakes the MRCP Diploma? MRCP Part 2 is the second exam on the journey towards the MRCP (UK) Diploma. It is completed after MRCP Part 1, which candidates are eligible to attempt after having had at least 12 months of postgraduate medical experience (which usually means waiting until completion of FY1 in the UK). The MRCP Diploma is a post-graduate diploma designed to test the skills, knowledge, and behaviours of a doctor who wishes to undergo medical speciality training in the United Kingdom. Many doctors - within the UK and abroad - undertake the MRCP diploma even if it is not a training requirement in order to provide additional value to their portfolio, but also to develop their skills and knowledge further. In order to achieve this qualification, you have to sit and successfully pass three exams: * MRCP Part 1 * MRCP Part 2 Written * MRCP Part 2 Clinical, also known as PACES Any doctor who wishes to start specialist registrar training in the UK within a physician or medical training programme must have completed all parts of the MRCP diploma in order to enter the relevant specialist training. The specialities where MRCP is a requirement are reproduced below:  ## Exam Format - MRCP Part 2 Written The MRCP Part 2 Written examination is designed to test the doctor’s knowledge of clinical medicine as relevant to their practice. The aim is to ensure the candidate understands common and important disorders that they may come across during their specialist training, at an entry level. The exam is currently completed electronically and is comprised of two papers, each with 100 questions in a best of five format, where one answer will be the single best answer. There is no negative marking, and each correct answer is awarded a single mark. If taken in the UK, you will sit the exam at home and will be monitored remotely whilst doing so; if taken internationally, the exam will be sat at a test centre. ## What is the style of MRCP Part 2 Questions? In the MRCP Part 2 Written exam, the questions are usually complex, with long stems requiring the candidate to integrate several pieces of clinical information, including the results of investigations, in order to come to the correct answer. The questions may require the candidate to apply two-step logic frequently, for example by first coming to the diagnosis based on the information given, but the question being about treatment rather than the underlying diagnosis. These more complex question stems are designed in order to mimic clinical reasoning and clinical medicine as may be experienced in clinical practice; this is in contrast to Part 1, where the stems are usually shorter, with single-step logic, and a greater focus on clinical sciences. Therefore, the questions in MRCP Part 2 Written tend to have a slightly more clinical focus, asking the candidate to either make a diagnosis or identify the next best step in management, treatment, or investigation. There will always be 5 options, and one option will be the best answer, though the other 4 options will often be a close match and possibilities, hence single **best** answer. Here are some example exam questions to help you understand the format a bit better! In this question below, the candidate is expected to integrate the patient’s history, including social history, alongside examination findings, in order to first come to the underlying diagnosis of enterobiasis. The question, however, requires two-step logic; rather than asking what the diagnosis is, it asks what the definitive treatment would be for the patient.   This next question illustrates a more complex stem. The candidate is provided with a clinical history but also investigation test results. The candidate must use this information in order to answer the question, which again relies on two-step logic; first, coming to the conclusion that the underlying diagnosis is most likely Coeliac disease, and then using this to answer the question itself about the most likely long-term complication.   At Quesmed we have worked closely with the best physicians who have taken and successfully passed the MRCP exams in order to develop over 2000 questions as part of our [MRCP Part 2 Question Bank](https://quesmed.com/mrcp-part-2-question-bank/) that are based on themes from previous papers. What Specialties are covered in MRCP Part 2? The subject of the questions is based on a careful blueprint designed to ensure that an appropriate range of medical knowledge is tested. Therefore, each speciality or subject area being tested is given a rough proportion of the total number of questions available across both papers, as displayed in this table. For example, across both papers, one would expect to answer approximately 9 questions on Haematology, and 19 questions on Infectious diseases.  ## MRCP Part 2 Exam dates and Fees Plan ahead as there are only fixed dates when you can sit the exam, published by the Royal College of Physicians. Application deadlines are usually several months in advance of the exam itself, so it is imperative to check ahead of time so you do not miss out on your desired date.You should check the current fees directly on the [RCP website] (https://www.mrcpuk.org/mrcpuk-examinations/part-2/exam-dates-and-fees) as it may be subject to change.  ## Results and unsuccessful attempts Results are published online, 1-2 months after completing the exam. The results release dates are available on the Royal College of Physicians website, so you have an idea of when to expect to hear if your attempt has been successful or not. The pass mark for the MRCP Part 2 Written examination is 454. Most candidates will score between 200-800; the minimum score is 0, and the maximum score is 999. This score is scaled, such that it is calculated by taking into consideration not only the number of questions the candidate has correctly answered, but also the relative difficulty of the question and the exam. All components of the MRCP diploma must be completed within 7 years of the candidate’s first successful attempt at the MRCP Part 1 examination. If unsuccessful, candidates are permitted a maximum number of 6 attempts. If the exam has not been passed after 6 attempts, then the candidate will need to be supported in additional training with appropriate evidence before further attempts are allowed. ## How to prepare Everyone prepares differently, and there is no single right or wrong answer, but here are some tips that may help you as you plan your revision strategy! At Quesmed, we have worked closely with expert physicians to develop over 2000 Questions as part of our [MRCP Part 2 Question Bank](https://quesmed.com/mrcp-part-2-question-bank/]! These are based on themes and topics that have appeared in previous exams. Alongside our questions, we have generated a dedicated reference textbook that you have access to as part of your subscription. This textbook covers all the key topics that you will need to know about prior to sitting your MRCP exams, and has been developed carefully with the MRCP blueprint in mind. Here are some useful tips to get you started with your revision: 1. Start early. - Don’t underestimate the depth and breadth of topics covered in this exam. Starting well in advance gives you a buffer for unexpected hurdles. 2. Plan your revision. * Set timelines and goals. * Be aware of the range of topics covered by the exam as discussed above, and ensure your revision strategy covers these specialities 3. Do as many practice questions as possible * Practice questions should be the core of your revision, especially questions that cover previous exam themes * Take time to read detailed explanations on why your answer is correct or incorrect to further guide your revision and fill in any gaps 4. Diversify your study materials. - Don’t rely on one single resource - Obtain a good reference textbook or get access to a detailed online knowledge library to synthesise your revision notes 5. Take mock tests - Taking tests in timed conditions can help you replicate the exam experience and get used to the time pressures you may face in the exam 6. Use official resources where available. - The Royal College of Physicians publish sample questions on their website. - These are a great way of getting used to the types of questions asked and can also be used as mock tests. 7. Study groups and flash cards. - Join or create a study group! - Discussing topics and testing each other can provide different perspectives and help in clarifying doubts. - Flash cards can be an invaluable resource to allow you to test yourself on key topics quickly. 8. Breaks and Health - Remember to take regular breaks and maintain your health. - This is a marathon, not a sprint. We normally recommend 3-6 months of target revision, depending on your clinical commitments. ## References - [MRCP Part 2 Examination Overview](https://www.mrcpuk.org/mrcpuk-examinations/part-2) - [MRCP Part 1 Exam Dates and Fees](https://www.mrcpuk.org/mrcpuk-examinations/part-2/exam-dates-and-fees) - [How to Complete Your MRCP Part 2 Application](https://www.mrcpuk.org/mrcpuk-examinations/part-2/how-complete-your-application) - [MRCP Part 2 Exam Format](https://www.mrcpuk.org/mrcpuk-examinations/part-2/format) - [MRCP Part 2 Sample Questions](https://www.mrcpuk.org/mrcpuk-examinations/part-2/part-2-sample-questions)
The Quesmed Complete Guide to MRCP PACES
Well done on getting through MRCP Part 1 and MRCP Part 2 written! You will have no doubt worked hard to get to this point and you are one step closer to achieving the full MRCP diploma. One final obstacle stands in your way - MRCP Part 2 Clinical, or PACES - and this is your guide to conquering the last hurdle! ## What is the MRCP Part 2 Clinical (PACES)? MRCP Part 2 clinical, often referred to simply as PACES, is a practical exam taken by doctors who have completed MRCP Part 1 and Part 2 written successfully. This includes both UK-trained doctors and international medical graduates (IMGs). The purpose of PACES is to test the candidate’s ability to perform clinical examination and consultation skills to determine underlying diagnoses and synthesise management plans. ## Who undertakes the MRCP Diploma? MRCP PACES is the final of three exams on the journey towards the MRCP (UK) Diploma. It is completed after MRCP Part 1 and MRCP Part 2 Written, which candidates are eligible to attempt after having had at least 12 months of postgraduate medical experience (this usually means waiting until completion of FY1 in the UK). The MRCP Diploma is a post-graduate diploma designed to test the skills, knowledge, and behaviours of a doctor who wishes to undergo medical speciality training in the United Kingdom. Many doctors - within the UK and abroad - undertake the MRCP diploma even if it is not a training requirement in order to provide additional value to their portfolio, but also to develop their skills and knowledge further. In order to achieve this qualification, you have to sit and successfully pass three exams: * MRCP Part 1 * MRCP Part 2 Written * MRCP Part 2 Clinical or ‘PACES’ Any doctor who wishes to start specialist registrar training in the UK within a physician or medical training programme must have completed all parts of the MRCP diploma in order to enter the relevant specialist training. The specialities where MRCP is a requirement are reproduced below:  ## Exam Format - MRCP Part 2 Clinical (PACES) The aim of PACES is to ensure the candidate understands common and important disorders that they may come across during their specialist training, at an entry level, and how to manage them practically. In order to do this, PACES is designed as a practical, face-to-face ‘OSCE’ style examination designed to test the candidate’s ability to perform essential clinical skills across 5 stations lasting 20 minutes each. In total, you will meet 8 patients across these 5 stations (called ‘patient encounters’). Some of these stations are further broken down into 2 x 10 minute components. Each station is separated by a 5 minute rest, and each station is examined by 2 examiners. This format is referred to as the PACES carousel, pictured below.  The exam consists of the following stations: * 4 Examination stations: * 6 minutes for the examination, where the candidate has to perform a clinical examination of one of the major organ systems * 4 minutes for a structured viva where the examiner asks the candidate, usually, to summarise their findings, present a likely differential diagnosis, and also a management plan * 2 communications stations: * 10 minutes for the entire station, covering a range of possible topics, including difficult consultations such as breaking bad news or health behaviour change, as well as ethical and legal dilemmas * There is no viva - 2 Consultation stations: * 15 minutes for the consultation, where the candidate has to take a focused clinical history and perform a focused clinical examination, followed by an explanation of the likely diagnosis and next steps to the patient * 5 minutes for a structured viva, where the examiner usually asks the candidate to summarise the case, provide a differential diagnosis, and management plan ## Exam Marking - MRCP Part 2 Clinical (PACES) As you rotate through the carousel, you hand one examiner at each station an envelope containing your marksheets. There are 16 marksheets within your envelope, one for each examiner, covering each patient encounter. A typical marksheet for the examination stations is shown below and the full range can be downloaded on the [Royal College of Physicians’ website](https://www.mrcpuk.org/document/paces-marksheets-sample-2023). The examiner will take out the relevant marksheet at the start of your station and begin assessing you when you start.  At each patient encounter, one of 7 key clinical skills (A-G) are assessed by the examiners. You should note that not every skill is examined at every station, as some of the skills may not be relevant in the station. This is why you may notice some of these skills being absent on some of the marksheets. These skills are as follows:  The examiner has to decide if they have seen the skill demonstrated or not, by scoring each skill as ‘satisfactory, borderline, or unsatisfactory’. The marksheets provide some explanatory text that may help the examiner make their decision; for example, as you can see below, finding clinical signs that are not present may result in an unsatisfactory mark being awarded in the physical signs (B) clinical skill:  ## MRCP PACES Exam dates and Fees Plan ahead as there are only fixed periods of time (known as ‘diets’) when you can sit the exam, published by the Royal College of Physicians. The exam happens at hospital sites and the Royal College will almost always place you at a site away from your base hospital. You should therefore be prepared to travel, which can sometimes be quite a distance away. Application deadlines are usually several months in advance of the exam itself, so it is imperative to check ahead of time so you do not miss out on your desired date. You should check the current fees directly on the [RCP website] (https://www.mrcpuk.org/mrcpuk-examinations/paces/exam-dates-and-fees) as it may be subject to change.  ## Results and unsuccessful attempts Results are published online, 15 working days after the last exam within the diet. The results release dates are available on the Royal College of Physicians website, so you have an idea of when to expect to hear if your attempt has been successful or not. In order to pass the MRCP PACES exam successfully, the candidate must: * Obtain a minimum score of 130 out of a possible 172 * Not fail any single clinical skill (i.e. a minimum score needs to be achieved for each clinical skill) It is therefore possible to fail an entire station and still pass PACES if the overall score and each individual clinical skill has been passed. Your results will be summarised on a matrix provided to you after the exam when results are announced. As you can see in this example matrix below, each encounter is scored, but the overall pass mark is determined by the candidate meeting the minimum mark across each individual clinical skill, plus an overall score of at least 130.  All components of the MRCP diploma must be completed within 7 years of the candidate’s first successful attempt at the MRCP Part 1 examination. If unsuccessful, candidates are permitted a maximum number of 6 attempts. If the exam has not been passed after 6 attempts, then the candidate will need to be supported in additional training with appropriate evidence before further attempts are allowed. ## How to prepare The PACES revision materials at Quesmed are a great place to start your revision; with over 100 simulated clinical videos of typical encounters you may come across in the exam, as well as a dedicated reference textbook, it is a great place to get a sense of what you may come across and to kick-start your revision. But PACES is a difficult exam and your approach should be multi-faceted. To help you on your journey, we spoke to some top-performing doctors who completed the MRCP diploma for their tips and tricks when it comes to preparing. Here is what they advised: * Leave plenty of revision time * Ideally, you want to spend at least 6 months preparing for this exam * This will give you plenty of time to not only learn the theory, but also start putting into practice what you have read * Make sure you plan your revision strategy at the start so that you cover everything you need to in the time you have allowed for your revision * Practice makes perfect * Practice, practice, practice! * Practice on real patients that you see on the medical take - approach them as you would a PACES patient by being systematic and thinking, ‘What else would I do if I were to encounter this patient in the exam?’ * This allows time spent at work to be effective revision also * But you don’t need to practice on patients alone; patients are a great source of clinical signs but it can be difficult to perfect your systematic, seamless examination skills on hospital patients * Therefore, don’t hesitate to practice on your friends, family, and teddy bears! Getting your examination slick and effortlessly under 6 minutes is all about repetition, and healthy individuals (or teddies!) are a great way of perfecting this * Seek out a PACES teaching group at your local hospital, and if there isn’t one, meet up with your colleagues regularly to go and see relevant patients on the wards * By performing examinations or consultations as part of a group, you will gain confidence in performing in front of others and remaining calm and collected when being observed * Watch Videos * The Quesmed PACES revision tool will allow you to see a lot of the clinical signs and presentations that you will encounter in the exam from home * It also provides a detailed reference textbook, which can help you learn the theory that will underpin your exam performance * Obtaining a subscription to an online revision tool like this will help you take your revision to the next level and allow you to reinforce the signs and presentations you are seeing on real patients in hospital * Don’t neglect the theory * Good practical skills as well as the ability to formulate diagnoses and synthesise management plans depends on a good understanding of the underlying medicine * So, don’t depend on in-hospital learning alone * Find a good PACES textbook and learn the theory as well * Then, put the theory into practice every day at work * Time yourself * Whether that’s through a formal mock test set up at your hospital, or through roping in friends and family - you should practice your skills under the time limits that you will face in the exam * Remember, 6 minutes is a very short time to perform a full examination, and you need to be able to perform the examination effectively with minimal effort or much thought; this is so that you can really focus during the limited time on the clinical signs you are seeing, rather than what the next step would be in your examination * Breaks and health * Remember to take regular breaks and maintain your health * This is a marathon, not a sprint * Seek support from your friends, family, and colleagues at work if you are struggling ## Getting ready for exam day Here are some checklists for you to go through before and on the day of the exam to ensure you are ready for the day! Before the exam day: * Review the [rules and regulations] (https://www.mrcpuk.org/mrcpuk-examinations/regulations) of the PACES exam * Print and check your admission documents sent to you * Plan your route to the exam centre and ensure you leave plenty of time for transport delays * Ensure your photographic identification is ready to come with you - this needs to be an appropriate ID with your full name, signature, and photograph * Ensure the name on your admission document matches the name on your ID, and contact the RCP if not as soon as possible * Ensure you have leave arranged from your hospital to attend the exam On the exam day: * Arrive in advance of the exam start time - an hour before the reporting time on your admission document * Be aware that your bags, coats, and devices will have to be stored in a separate room * Make sure you are dressed appropriately in a smart manner as you would for work, in clothes that allow you to move freely to examine patients (avoid tight or excessively flowing clothing) * You can bring your own stethoscope but other equipment will be supplied if required; if you have any other medical equipment with you, you should let the lead examiner know and they can advise whether or not you should take it in with you * Be aware of anything that might make it more difficult for you to demonstrate empathy and understanding in stations that require communication skills, for example a facial veil or dark glasses. If you do not clearly demonstrate these abilities, examiners will mark the corresponding skills as unsatisfactory ## References - [PACES exam format](https://www.mrcpuk.org/mrcpuk-examinations/paces/format-0) - [PACES exam dates and fees](https://www.mrcpuk.org/mrcpuk-examinations/paces/exam-dates-and-fees) - [How to prepare for PACES](https://www.mrcpuk.org/mrcpuk-examinations/paces/preparation-0)