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My name is Yu. Um Last year I was applying for core training I need at the M SRA and I didn't realize there was much free material out there on the web. So I got plenty contact him with mind the bleep um to try and give some more information for everyone on how to approach this exam that's used for lots of different specialties, but in various ways of the application process just as I and demystify everything. Um So we had a few sessions and we actually created a whatsapp group chat for those who haven't joined just as a platform as well to support each other. And I've seen everyone's been very active on it with their oral applications, which makes me very happy. And then hopefully, you've had your questions answered initially earlier on. Um Dan was quite an active member of whatsapp group chat because he was flying for GP um training for the winter term. Um And he like shared some really good insights after his exam itself and on Reddit and he's also successfully got into GP training. So, congratulations Dan. Um because he was so helpful, we got in touch with him, whether he could do a session just to talk us through how he approached the M sra and did so well in it. So without further ado, I'm gonna hand over to him and yes, this session will be recorded on youtube and a medal for those who want to have a look. But over to you, Dan, oh my God on youtube as well. OK. Thank you very much, Yui for organizing the event and inviting me and introducing me. Um So I'll introduce myself for everyone who most probably do not know me. Um My name is Dan. Um So I've actually studied medicine initially in, I'll, I'll tell you a bit about myself. I studied medicine initially in Romania. Um And at a certain point, I decided that I want to have a bit more and I've done the USM the United States medicine license exam and I got really good scores as well. And then I moved to Germany. And before practicing medicine there, I started um coaching and teaching and advising for uh Ambos. That's a professional company and an online platform for teaching for the U Assembly. Um So I've done that for about one year. Then I practiced in Germany for two years. Then I moved to the UK about seven months ago, eight months ago and uh started studying for the M sra um about three months before the exam. Then I took it um until then I was in Surrey in Free Park Hospital doing a trust grade, uh, uh, job. And, uh, yeah, and II took the M SRA and I got a really, you know, I, II got place 73 out of the 3200 candidates that took the exam. And then, uh, you invited me to speak and I'm, I'm here to share with you some of, uh, what, what I think is, is basically a recipe on, on how to succeed in those exams. Because I think a lot of time those exams, they don't really translate into, you know, being a good doctor that the fact that you can take the exam doesn't necessarily mean, um, that the, the fact that you got a high score doesn't necessarily mean that you are good at your job and it, it should, it's also vice versa. So, the fact that you are a very good doctor or an excellent doctor doesn't mean that you can take exams really easily. And there's kind of a way to crack those exams down and break them down in order to be able to just really score high in them. It doesn't matter what you do as long as you follow the recipe or at least that's the way that I do them and it's always successful. It doesn't matter, you know, which exam is in front of me. And, uh, that's what I want to share with you today. Um, and the way that I do it is less um powerpoint presentation. That's something that specifically does not function well for me, um I love to do mind map. So I've done a mind map and then I'm just gonna go with you through the mind map and thank you for the, take you through the different points and explain them to you. I'm gonna do it relatively fast, not slow. Um because there's so much material to cover and then afterwards we're gonna have AQ and a session. So you can ask me um to elaborate on the points that you find much more important um or that you want to have more information regarding them. Um So without further ado, let's do that something which is uh wolf mentioning is that when I share with you the, the presentation or the, the, the mind map, I actually cannot see this screen. It's in possible for me. Um So I won't know what you're writing that's gonna be for about 25 30 minutes, I guess. Um I'll try to go as fast as possible and you, if you see if there's any technical problems, if there's any issue, then you can just, you know, pop on. Um and let me know. Um Yeah. OK. So let's go to show that screen, do that. OK. Fine. You can just let me know that everybody sees the mind you're ready. OK, fine. So people can see it. Fantastic. OK. So we have to branch here. Um We have the clinical question, uh scenario. So those questions and that's gonna be the main part of my conversation or my talk. And that's because that's the, that's the, the majority of what can be said is, is related to that topic. And the small part of the small branch, which is, um, as you can see, vastly smaller than the other one is the SAT. And that's because there, there's honestly not too much to talk about it. Um Not at least in the way of presentation, but we'll get to that. And then we can elaborate in Q NF if you need anything else there as well. So regarding the clinical questions, uh first of all, I think, let's touch the resources which uh is the part that people, um you know, they, they struggle the most because there's so many resources out there. Um So for the clinical questions, I found past medicine the best by F and White. Uh So past medicine, um not only the, the body of knowledge really corresponded to the exam or corresponded the most to the exam. Um But also the style of writing, the way they wrote the questions was very familial with the exam itself. Um Then I've also done in America, which I personally wouldn't recommend. Uh I didn't like the way that the questions will be there. And even more importantly, I didn't like the explanations. Um And then I also took the, I, I've done the emissary official study material, which was honestly nothing like the real exam. And it, it was a bit of a surprise for me to, to, to, to study from the official M SAR a material, the one that they published and then coming to the exam and on the the exam day to see that it's not even you know that there was no correlation, it was just vastly different from one another. So when it comes to the resources, I would say past medicine, um there's also M CQ Bank. So M CQ Bank, the challenge with them is the the layout. So the way that it is actually visualized, you know, the way that they not the way that they wrote the questions, but the explanations um are out there in a way which is not really easy to follow or to access again when you want to repeat the the explanations. So if you are going to do only one resource or focus on one resource, I would definitely say past medicine, that's the best one. And then if you think that you have gained enough knowledge in past medicine and you just want to work on your test taking skills, you know, you just want to see if you can take those questions again in another format and the same information being questioned in another way, then you can go to the M CQ bank. So again, in order to build up kind of a branch you know, or flow chart and best medicine. And after the best medicine, you go to the M CQ bank and I don't think you need to do more than that in order to score really high. And then get also, you know, the place that you wish to go to um in your whatever training that you wish to do. So that was about the resources, let's break down the starting process. So those two points that are very important to make here um there the body of knowledge and those, the test taking skills and those two are very different from each other and they are complementary, but they are not the same, they are very different from each other and I cannot stress it enough. The body of knowledge is the information that you have. When you finish reading, you know, you your resources. And when you've done all of the questions and the information that you have in your brain and test taking skills is how you wield, how you use, how you twist and bend the information to fit the questions they ask you and it's important to remember or to realize, to understand that the those tho those exams like the M SRA and also the USMA the same in that sense that the, the reason why they do them is not in order to test necessarily your body of knowledge or it is, but they kind of come from the, you know, they want to already imagine that you have the body of knowledge, you have the information, you understood it. But then they want to see that you can apply it on a real life scenario, which would be a medical case. And that's the clinical scenarios. And therefore they write the questions which have the same information, let's say, for example, co pd information they write in so many different ways in order to see if you can actually recognize some information in various forms and shapes. Um So that would be the test taking skills. And it's important again to realize that those two are different. And at a certain point, even if you have 100% of the information, the knowledge in your brain, you wouldn't be able to score above average if you don't know how to take the exam, if you don't know how to break up the question. Um That being said, let's continue with um elaborating on each one of them regarding the body of knowledge, you have, sorry, there's a lot of booms outside of my window for some reason. Um I hope that you can hear them regarding the body of knowledge, you have best medicine. Um And I also use the ambos, that's the company where I used to be an employee. Um And they have a fantastic kind of summarizations of every disease. And a lot of time past medicine wasn't enough for me. And then I just used ambos as a complementary resource um to just get a, a better kind of understanding of what is happening there and have it very well organized. Um But you can use whichever resources are functioning for you. Um Now you need to make sure that you understand the information fully and that's important because again, they're not gonna, so some questions are gonna be pure knowledge, but a lot of them are gonna be the concept that stands behind it, right? So again, if we go to the example of CO PD, they want to understand what is restrictive, even uh constrict obstructive uh respiratory disease, right? They want to know that you understand what's the difference between them and they're going to ask you about it in various ways. And therefore you need to understand um the, the knowledge though, not only to memorize it because if you only memorize it, you wouldn't be able to, again bend it, twist it, use it, wield it to your needs when you face the question that is in front of you. So it's not enough to memorize questions. It's important to understand what stand. Uh It's important to understand what stands behind the information that you're reading. And I think that's a, I wouldn't say a mistake but it's kind of this default mode that we have of, oh, I know how to memorize it. It's fine now. No, you need to understand what stands behind it. You need to really fully grasp it and know now memorization um very important in this exam, especially when it comes to all of those vaccinations or, you know, you, you have kind of flow charts of what do you do at which stage regarding treatments and so on. Um for example, Crohn's disease, they would ask you, you know, what do you do now that the patient didn't react or didn't respond to ABC treatment? What's deal that would come? Uh A lot of that would come up a lot when you, um when you do, uh not only COPD but asthma in asthma, they ask it a lot, what's the next stage of treatment? And you know, the do parts um or BP, for example, they would ask you what is the target of the BP in this or that in various ways. Um And it's extremely important to understand even though it's very pain, um painful um to, to understand or to memorize those stuff because you just have a table and it's very boring to memorize it. But those are the three questions. So those are the easiest questions that you're actually gonna get in the exam. So once you have, you know, for example, the BP targets and you take it and you memorize it and you write it on the paper again and again, until you can, uh until you can take it, you know, and shoot it directly whenever they ask you about it next time you're going to see this question about the BP target, you're gonna be able to answer it very easily and very fast. And those are three questions. So it's very important to, to understand. OK, this is a table that is standing in front of me. I really don't want to memorize it anyhow, I'm gonna forget it. But, you know, don't hate the players, hate the game and this is the game You need to memorize those stuff and, and that's basically also 50% of those clinical scenarios. It's just memorization and the other 50% would be to understand the information fully. Um Don't memorize everything, just memorize what is high yield. So for example, if you have hao or if you have any, I don't know um a health disease, cardiological problem, then probably memorizing um S two in S two, you hear this crescendos historic normal is not gonna be the thing that's gonna give you the examples. A lot of other information there that's gonna be more important. Oh, sorry, there's a lot of information that's gonna give you the answer itself. So you don't have to memorize all of the smallest details that you don't actually think gonna give you the question. You need to see the pattern of the questions that they give you and there is a pattern always and they want to, they focus on certain topics that are, that will come in the exam much more often than the others. And then afterwards, so going back, we have the body of knowledge, we understood it fully. Then we memorized the high topics and then we have the repetition, the repetition you can do. Um However you want to do it, II use flash cards. I use ACI use them since I mean, uh the age of 21 when I entered med school, I started using AC and that, that works fantastic for me. Um, and the thing with repetition is that the, the I, again, I wouldn't call it a mistake, but it's kind of a, a waste of resources is that people have a topic again, let's say CO PD. And then they know that they get about 30% of the questions related to CO PD incorrectly. So they would go back and study the entire topic of CO PD or C or whatever you want, whatever you have. And the best way to do it would actually already on the first go after you understood the topic properly and you still got the question incorrectly. You stop, you reflect upon it, you understand why you got it incorrectly and you put it either on a piece of paper or a document, whatever, or you put it on your anti flash cards. And then when you finish the entire preparation, you can go on and repeat it and in this way, your going to use very little time in order to repeat a very high percentage of questions or information that you would constantly get in correct and then you would get it correctly. So the way that I used to teach my student or the way that I study myself is that you do that, and then you see that from answering 65 to 70% correct questions, you get to that stage of repetition, which is about two weeks before the exam. And then all of a sudden after you finish the repetition again, I don flashcards, you start answering 90 95% correctly because that was that small bit of information that you would never answer correctly. And you could only focus on that without going to the entire topic. So that's, that's a massive plus. OK, that um being talked upon will go to the test taking skills. Um So with test taking skills is a bit more vague. It's more difficult to discuss it. Um What you need to do there is to ask yourself, what do they actually want from me? Why, why did they ask this question in this manner? So I remember in the exam day, I got a question of um, a person with probably P ES pulmonary embolism and they wanted to ask, what's the next thing that you need to do? And actually all the answers were correct. You know, it was g, it was D dimer, it was act apa, it was whatever, whatever you want. Um And the correct answer, I believe at least was just measuring BP to see that it's not decompensating and entering, you know, hypotensive shock due to the pe and why I'm telling you this is to understand that in this question, they actually, uh, they knew that I'm having the information. You know, you finished your F one, you were in fy two, your fy three, you're taking this exam and they know that you already know what to do. But they want to see that you understand what's the best next action to take. And in this case, it would see that it is not actually decompensating acutely and that you need to treat it right now. And that's, you know, a life saving thing that you need to do. You'll see also in past medicine, they really play on this topic when they give you, um people that have cardiac issues, uh for example, arrhythmias and then you, you would have, you know, five different options to choose from what is the correct answer and the correct answer would be a lot of time. Do. Now cardio version give him now shocks because he's becoming hypotensive and you know, they give you a massive stem of a question, they try to confuse you. But if you understand what they really want from you and you can answer it without going through throughout all of this f you can just kind of dissect through this thickness of information that they give you, you're not distracted and you can answer it very correctly, very fast and very precise. Um So I would recommend maybe not at the beginning but kind of, you know, you're already at the 50% of your preparation. You, you've done half of fast medicine or whatever question bank that you choose to use. Um And then when you start getting questions incorrectly after you've done already, 50% of them start asking yourself with every question which is incorrect. Why? And then if it's, you didn't have that information that memorize it, then memorize it. If you didn't understand it because obstructive and restrictive, then understand it. Um, and so on and so forth. It could also be just the presentation you will not familiar with it. You know, it could be that they give you, um a very good example would be that they, they play on skin cancers and they give you a presentation of a cancer that you already know, but you didn't know that it can present in this specific way that, you know, if it's, if it's a white skin cancer or it, it's the color of your skin, it can also be Melanoma even though you would imagine that it should be more brownish blackish, whatever, you know, it doesn't matter if, if I incorrect on this one, but that's the bottom line that you need to understand why you got it incorrect. And then to, to actually approach that address. That. Um the second thing is time management. Um you need um to read very fast and that's something that you can practice. That's something that you can actually walk upon. Um a lot of people, even native English speakers or not native English speakers, they just read the questions relatively slowly. And the way to practice on that is just to calculate how much time you would have in the real exam and then to put it up on your questions and then do them. And I think with the M sra you have all the clinical uh clinical questions, you have less than one minute per question, you have like 1.0 point 70 seconds or I can't remember anymore. But you, you, I would just put it um on a timer and then I would do the questions as if I'm under time restrictions. And via that, you practice reading faster and you also practice your brain into scanning the question and not necessarily reading all the information and you can filter out all the information which is unnecessarily that being said with time, you would also start understanding which topics and which questions you do need to read fully because you already know that they set traps there and you need to read the entire topic and which questions are very specific or, or very straightforward, very direct. And you can just directly jump into the answer. Now, when we got, when we get to the point of actually choosing which answer is correct. Um I have specifically a theory of a method which I'm using. It's, it's called, or I coined it as the he or exclusion process. Um, in which you read the question, they ask you something, either you already know the answer and then just hit it. You don't even need to search for it. You already know what's gonna be the answer and then just look for what correspond with the answer or you don't know what's the answer. And if you don't know what's the answer, then you're going to start doing an exclusion process in which you need to stay very calm because it's very easy to not become in it. And then through that place of calmness, understand why this and this and this is incorrect. So for example, if we go back to the question with the pe, um I didn't know which answer is correct, right with the pulmonary embolism because all of them were correct, like doing a C DDM LC TPA, uh everything that is correct. ABG whatever you want. Um But excluding all of those with what is the most appropriate next step to do in order to ensure that I conduct a safe, you know, very productive clinical assessment of the patient. I understood that it's best to do BP. Um And that would be, for example, again, with, um I, if we take CO PD just to give another example, they could ask you what's the antibiotic that you would probably use in this scenario. Um, and then they would give you a list of antibiotics. And let's, let's say that you don't really know which antibiotic is the best for CO PD because it's also varies, you know, uh, local trust or whatever. Um, and then you think, ok, this, they wanted you to use macrolide or whatever, or Vancomycin. I don't know. And you can think, wait, I know that the bacteria which is most prominent with CO PD is I and I know that this antibiotic is not gonna be effective for this bacteria. And therefore you can exclude it. And by this, you usually get very fast to already two options and then you need to choose between those two options. And then even if you don't know which one of them is the correct one, you already created a scenario where you have 5050. So there's a very high possibility and probability that you would get the answer, correct. OK. I hope that was clear. Um Talking about an may be another time. That's a, that's a very big topic and we can do a webinar just for that. But there are different ways that you can do. Uh there, there's a different cards, you know, there's different flash cards that correspond to different topics. So for example, for the pure memorization for the principal concepts and so on. Um right, we talked already about this one, the one with the questions maker. So basically that was the test taking skills and that correspond to everything which we already talked about. Um something that I cannot emphasize enough is the pretest week or general um preparation. And that's something that I saw that specifically in the UK. Um For some reason, people don't really emphasize and in the USA I know that they really do. And it's a cultural thing though. And I think that it's specifically in this scenario, it's very appropriate to do. You need to have a dedicated period. And that would be a time frame in which you can just sit and study for the exam um without being interrupted because there is we uh there's actually a scientifical terminology for that because they studied how to study for exams. And I don't remember it right now, but it's, it's the power of um being in the flow. Uh If we say it in lay terms and not scientifical terminology, the power of being in the flow with the exam, there is something about being able to sit for one week, two weeks before the exam and every day do about eight hours, 12 hours, how much you want to do, how much you can do. Um And this compiles and kind of build upon each other in your skills in a manner that you cannot do if you break your preparation to just three hours a day. So of course, before the exam, if you start studying one month, two months, three months before the exam, that's the way you do it. You do every day, 23 hours and then on the weekends you study more. But before the exam itself, I would highly recommend you to try to organize as much free time as possible. The way that I managed to do it was about 1.5 weeks before the exam. And then I had the 34 night shifts and then I had five more days and you kind of culminate all of your task, taking skills and you shop and, and hone them in that time. And you also take all of the body of knowledge and your me and the memorization and you manage to squeeze it in your brain in a way that you would be able to access it much more easily in the test day because you just saw it recently in a way and manner that is just not accessible to the human brain if you have mastered this topic four weeks ago. But that was a singular topic and you messed up another topic, let's say three weeks ago. But if you kind of refresh those topics adjacent to each other in your brain, the uh you see it in real life, the, the they really a synapse between all of the topics and they combine and then it doesn't matter which question they give you in a random order. It doesn't matter what's the topic you're able very fast to deduct. What's the topic, what do they ask me? And what do they want me to answer? And this just doesn't come so easily if you don't have this pre dedicated period because then it's kind of scattered in your brain in various areas and it takes a lot of time to access that information, time that you really don't have in the exam. Um Another very small thing that I want to talk about is the organization be meticulous about it. Um A lot of people don't do it and it's important to do it. It's the same as if you're a gym person and you go to the gym, you're not just gonna train something, you're gonna have a plan, you're gonna have a build up, you're gonna have exact numbers and it's the same with the exam. Once you start and you're already 12 weeks into your exam, you're gonna see exactly how much time you need in order to cover all of the topics because you have already a rhythm and you know how many topics and how many body of knowledge and questions and memorization and flesh counts you can do in one day while you also have your shift, you know, um or on your weekend and you would be able to roughly build a flow child or a schedule for how much time it will take. You to do everything and with that, you can actually organize it. So when you look at my preparation and I don't have it anymore. So I cannot show you um about two months before my exam. I've built exactly how many questions I have in past medicine and how many questions I want to do in other Cubans and how many questions uh topics I really want to repeat and, and flash cards and so on. And I had a child of what I need to cover every single day in order to get to the test day already covering everything. And that plus a buffer of 2 to 3 days in order to be able to fit in all of those unexpected scenarios. Like you got sick, you were on call for a long time and then the day afterwards you didn't manage to study and so on, right? Um Just a small quill of mine is talking about mindfulness in those presentation. Um I think that, well, well, at least for me, it functions excellently. Um One of the reasons that I believe that I do well in exams is that I practice mindfulness before the exam. I practice generally. But when I'm in this preparation dedicated, I'm actually practice mindfulness much more. Um And this gives me the ability in the exam day to be one with the exam as much as it sounds dramatic. This is the reality of it. I managed to come to the exam and sit it and while I do the exam, I see how my emotions are rising and I'm able to let them go. So, for example, the exam starts with the S JT. Um and when I started doing this, I was, you know, 10 questions into the exam. I was just sitting there and I was thinking, oh my God, I just have no idea what happens if I don't know what to do. I, this exam is gonna be rubbish. It's gonna be a disaster. Like, uh what's gonna be the placement that I'm gonna get in? Round two. There's already not enough places anyhow. And this was really in my head in the exam while it's under time restrictions and that's a very unhealthy thing to have. And that's through and then through that mindfulness quality that I had in that moment, II managed to, uh, again being a bit dramatic hijack my brain and say, well, it doesn't really matter what you feel right now. You need to do the exam and you have only one go at it or that's how II thought it, you know, when I started the exam, you actually have more goals in the M sra you can do it as many times as you want, but I didn't want to do it. I wanted to pass it at one go and I wanted to do it then and then, um, and then get a placement and I said to myself, it doesn't matter what you have in your mind, the future doesn't matter, the past, doesn't matter, just be now and heal and then I really managed to let it go and just do the exam. And I think it's something that really happens to a lot of people, they get very stressed in the exam itself. Um, another thing that I wanna say, um, regarding the dedicated time and that's something that I really, I really love people. I really love to see people do that because the results just they speak for themselves. Um a few days before the exam start doing mock exams, right? So plus medicine have them built in. But sometimes I, I've done also a mock exam of my own accord um with M CQ Bank and the S JT also from the M CQ Bank. So what happened is that about seven days before the exam? I wake up on the same time that I wake up in the exam itself in the exam day? Mm I drink the same amount of coffee. I eat the same food and I have exactly the same routine in order to be able to let my body know this is what's gonna happen in the exam day. And then you are able to tweak your own physique and your own mind and your own rhythm to how it would be in the exam itself. And by optimizing it, you do get extra points because you there and your body knows exactly what to do. You don't need to go to the toilet. You don't need to drink more coffee. You don't need to do anything else. You can just focus on the exam and that's because you already managed to let your body know this is how it's going to be. And the mock exams are very important because they would give your body and your brain the ability to go through the exam before the exam itself under the same conditions and to be able to stimulate uh sorry, to simulate that in a manner that would make you understand what you need to do in order to pass it with success, right? Or with, with optimization and a better score. Um OK. So that's the pretest week and the mock exam. And let's go to the S JT right there. There's not a lot to say about the S JT. Um It's, it's really just doing as many questions as possible and try to get as much as possible from them. So let's start with the resources as usual. Um I've done the practice questions from the UK Foundation program website. I'm not really sure if I can recommend it. It was definitely not bad, but at the same time, it wasn't excellent. I've done the past medicine one and I really didn't like it. II thought they were just inconsistent. Um I've done the M CQ all of them and I can highly recommend them. I think they're very good and uh it could really give me this, this insight to what's gonna be in the exam and how they want me to think. I've done the E Medica also. I didn't like them and the official M sra study material, I've done them as well and I found them to be again, like UK foundation program kind of, yeah, it's hitting the spot but it doesn't give me what I need in order to really progress in this exam. Um talking about the technique, um the easiest way to do it is to understand that they'll the they're gonna give you answers or scenarios that are not realistic, they're gonna give you answers that are not correct and they know it, they don't care about the fact that the answers are not correct. They want you to grade those answers according to what is the most correct one, which concept topple the other one. So for example, they want you to know or they want you to show that the concept of patient safety is more important than your own wellbeing. And then they want you to show that the well being is more important than helping your colleagues. Oh It doesn't really matter. The bottom line is that there the line of concept, right? And they always repeat each other like they would be safety, doing good medicine, doing safe medicine, um patients, autonomy, patient um um the ability of patients to decide whatever treatment they wanna have being, um, a good colleague, um, and so on and so forth and they would want you to kind of understand which one of them is gonna come above the other. And that's the way to think about it. Not which one is correct and incorrect because many times they're gonna have questions with answers that none of them is correct. Really. You wouldn't do it in real life. But they, they want to see that you understand what concept is more important than the other and in which cases they switch. So there are scenarios in the M sra where the concept like patient safety would switch and your wellbeing would be a more important concept. Um And those scenarios are very clearly outlined, but they don't say it when you read the explanation, but it is important to be aware. So you can build your own algorithm and flowchart. Now, the easiest way to do it is um to, first of all understand which one is the most correct, that's usually, or 95% of the time, very clear which one of them is the most correct one and it's 90 80% clear which one of them is the least appropriate. And then you start need to play in the middle and you don't need to get all of them correct in order to get most of most of the points, you just need to get the first one, the last one and some in the middle. Now, the way that I went about with those exam is uh with those questions to ask me, what do they want me to be? And the so, so when I started, I got actually a very low score um in those questions. And that's also expectable um as a person who doesn't come from the UK and I didn't practice in the UK before. Um And then I went to Reddit, like all of us and people told me that you need to imagine that the A NHS is the perfect universe and a, you, a team player. And um you need to give your absolute utmost energy and everything and whatever in order to be in the NHS. And that got me more points, but still, it wasn't enough. And then I understood that the, the exam doesn't really want you to answer that the exam want you to imagine that we are living in this harmonious em amazing environment in which your well being in the NHS come together and they feed upon each other. So the way that I imagine coming to the question was, what would be the optimal scenario in an optimal universe in an amazing, without fault, no mistakes in HS, how would I function there? And that also means that your well being is on the top priority of the list. So a lot of time you would see there was a question of, you didn't manage to do this, but you have a dinner with, um, your fiance. What do you do? Because the other doctor didn't come to the handover. And then you need to think, well, they don't really want me to sacrifice everything for it. They just want me to do it in a safe manner so I can continue to live my life because that's also important. So, kind of combining those and then understanding that they feed upon each other in this exam in the way that they see it, that would be, that would be the probably that would be the correct answer. Um And that's about it. Ok. So let's go here and stop sharing, right? Ok. I hope that that was clear. I hope it was helpful. Um And now I guess we get to the Q and A. Um Thanks so much Dan, are you able to see? We've got quite a lot of questions coming in. Do you just want to start going through them? Happy to open in? And that just does say um regarding question banks um past me in the me are definitely ones that we use, but we're not endorsing any because um we're impartial. So there are other questions as that stands experience, but there are other available resources as well. Ok. Um Wow, there's a lot of questions. Um First one, where can we find the official past papers also? How long are the questions stands in the clinical section. OK. Um So the official papers you get them when you sign up for the exam. Um and then they would be on the oral or you can also find them if you just write official M sra information or a question bank in the official M sra um questions on Google and then you have them. Um the question banks. Uh the question stems were actually very short. Um In the real exam, it was much shorter than past medicine. Um It wasn't one sentence, like many people told me it would be um it was about 2 to 3 sentences every question. Um I agree with them, but it also depends on the type of questions. So there are questions where they give you a list of conditions and that list of conditions they asked multiple times regarding um for instance, it'll be a case of different type of skin rashes and then they'll describe which one it is but like they are very brief like dsai and then some will be a bit longer than others. Yeah. Is that correct? Would you agree with that? Yeah. No, for sure. There, there are some questions that are much longer but then they would ask the same, they would put it the same stem but different question three or four times uh different questions, but correlating to the same stem. Yeah. Um Are good question. Are there images or ecgs in the exam? Not for my memory. What was your experience then? No, nothing, nothing. I didn't see anything. No, no, there were, there were not any images. I don't remember seeing anything. I think from my memory. Reading the blueprint last year. It could possibly be, but it doesn't mean you're guaranteed to have it, but not that we're aware and we're not, uh we're not allowed to um tell you exactly what's in the questions. But I guess we can just briefly say what our experience was. Um Karen, this is quite a long one. So briefly, how long did you spend preparing for the exam? Um I almost covered it all in terms of the past medicine question back. I feel I need to go back through all the topics to refresh and consolidate with two months, be a good period to consolidate the knowledge of get done. And um yeah, for how long did you spend? Right. So I started about three months for the exam um while having a full blown rota and doing nights and everything on weekends. Um I do think it's enough time, especially if you already done past medicine. Um Probably again, we, we come back to the topic of, you know, ii if we would do flash out or if you would kind of take that information that you are not good at while you did the first pass and then put it somewhere that you can come back to. This wouldn't take you a lot of time um to repeat it and then to have this repetition, that being said, two months is a long time if you've already finished this medicine. So you're definitely in an excellent position to go very quickly through the topics that you feel that you need to repeat it the most. And then do you know those, the document all the flash cards that you want whatever you use in order to repeat those topics and, and then like I said, and presented before, understand why you need to repeat them if it's about specific topics in subtopics, in that topic and that kind of double down on that thing and understand it or memorize it. Um, again, you would see it a lot with, um, BP that you, you could do BP questions thousands of them and you just would never get them correct or you would get only 25% of them correct. But the moment that you memorize the table with the BP target, you just can't get it wrong anymore. You, you have to get it right. You have to succeed. Um, and that would be the bottom line. Um, how many times did you do pass med, um, Dan. And did you use knowledge? T um, I've only done it once. Um, I'm not a believer in doing it more than once. I don't think it's effective. I don't think it makes any sense. I think that if you've done it once already, then you're supposed to know the information and if you don't know it, then you need to put it on the again fresh cards or whatever. Um, and the most important thing is that once you do a question bank more than one time that you, that then you lost this aspect of test, taking skills. Um, and in that sense, it's much better to do two question banks once you finish one of them in order to be able to see the question in a different, in a, in a, in a different way. This topic, um, because if you repeat it then you can to fall back into this. Oh, I know it. I click it and it's biased. You don't really like, you don't necessarily know this topic if, if you've done the question twice, even if you've done it the first time, three months ago, um, you're still gonna have a vague understanding of what they want from you. And in this way your brain gets into, I wouldn't call it lazy mode. But in this, I'm just, you know, I'm sitting, it's, it's very comfortable. I know this question bank. I know how they ask questions. I know what they want from me. And it's very unhealthy to be in this place. It's much better to be on edge when you take those exams and to always feel that you don't know enough rather than being in the comfortable place. That, that's my personal um view of it. And then uh again, which is the best app for preparing for the M SRA I feel. How would you respond to that? Dan. Um uh definitely a multitude of a, I don't think that uh you know, if we compare it again to the U assembly, um there, you would have kind of this top two platforms and for sure everybody do them and that's mostly what they do. I think when it comes to the M SRA, there's really an array of stuff that you can do and different features would be better for you. Um, I specifically, like I said, I use best medicine. I use the Medica, I use M CQ Bank and those are all my three main ones, but I've also used, um, ambo a lot. I also used AC KC um, topics. They just, one doesn't show how to go, go on them. Um, so I don't think there's one best app to use and generally speaking, I think you kind of need to find a and that's unfortunate that there's not one source that is really toppling all of them in that sense, but that, that's the reality of it. Mhm. Um, fine. Yeah, I agree. And everyone learns differently. So we are providing this as a way, I guess, like downside just to give because last year when I did it, I've not knowing anything. It feels like very much a stab in the dark, we'll play around them as well because what for us may not work for your learning method, but this is what we find useful and, oh, interesting question. Which subreddit would you use apart from doctors? UK? Ok. I have an answer for that but just a second. Uh, going back to the whatsapp group, the, the whatsapp group was really a lifesaver. Um, I have to say because on the day when the, the exam dates opened, I was out of the UK. Um I wasn't in the UK. Um And I really needed to have a good exam date. That's because I've done four night shifts before, right? So I had to have a buffer so I can repeat the information and I entered the entire day in order to see when do they come, you know, when do they pop up the, the exam dates? And at the certain point, I just said to myself, like enough, I'm not gonna do it anymore. It didn't come up and then somebody, so I was just like at the balcony reading a book and then at the certain point, somebody actually wrote in the whatsapp group guys. It's already out and, and through that, I managed to get a really the, the slot of my choice and that was really, really good for me. Um So the whatsapp group was a lifesaver though. Um subreddit. Uh No subreddit, no reddit in your dedicated period. Don't enter Reddit. Um unless if you have questions for the MSR um cause it's just gonna be a distraction. Just focus on the exam. Don't use any other subreddit or whatever. Uh That would be my answer. Um II don't use any other uh subreddit except for doctors. UK, I don't, I don't know, I'm not aware that there are any except for the GP ones. Well, well, I'm also a member. OK. Which question about representative for the clinical questions? II, I found in a paradoxical way that the past medicine, even though it was written differently from the real exam for some odd unexplained reason. It still kind of gave me the skills to answer the questions in the real exam. Um, the question stem and the length and the formulation, I guess it would be in medical. Um, yeah, thank you. And, um, what would you say are the high yield topics that we should definitely cover for the M sra clinical topics? Um Well, uh I can't really answer that from the top of my head. Um uh You, you would see it in the question bank, right? Because those questions would come back again and again, especially if you do two question banks, then you would see that certain topic is just have an overlap and they would be asked many times over. So, uh CO PD asthma, um uh BP targets and so on and so forth. But no, from the top of my head there's no way I can answer that. There was a lot of high topic. Um, one of them that came up just before I entered the exam. I, there were new questions on the question bank. Um, it was about, um, I can't remember now but, but the bottom line is that like you, you would figure it out while you do the exam. That's fine. Like you, you don't need to know it beforehand and there's no list of high topics, to be honest. Um, I would go on a limb here and say that the high topics are the one that you lack knowledge in the, um, because probably you need the technology in order to score those points. Um, so the questions that you don't know would be the highest deal for you, but some topics will just repeat it themselves many times over. Um, and, and you would figure it out. It's not like you, you, you, you would see it in the question banks themselves, um, in terms of proportions of questions, how many are about genetics? Then? Genetics? None. Like very little. II don't remember any questions about genetics. So, uh mainly very little, I guess. Uh, I don't remember any epigenetics or genetics or anything. Yeah. OK. Do, do you remember any? I think it's definitely worthwhile knowing the basics because if you think about it, it's a pool of questions that get asked. So not everyone will be answering the exact same questions when you sit the exam and if that is covered, whether you have any is a different question. But it doesn't think if one person did not have any genetics questions in the past, it'll definitely not come. Yeah. Is all I can say. Oh, I think, I think maybe they mean the, the Mendelian shot, right? The one that you have X and Y and what comes out of that? OK. Th those, ok, those, uh, I didn't have any in my exam but they were covered in every question bank. So, II assume that they would be in the exam of many people. Yeah. Um Ruth if someone is starting now, is it too late to get a good score with a regular ro to schedule of daily? 9 to 5? So what, when is the, the exam would be in January? Right? Um So you would have most of November, you have December, you have a bit of January. Um Well, it, it really depends on what you wanna do, right? Like, well, what's a good score for you? And what do you want to apply to and how fast you are in the, in studying. Uh, don't forget those also. So the holidays coming up and you leave in Christmas and what not? And how much of that are you gonna spend with your family? How much of that are you gonna spend studying? Um, many people scored very high with 22 months. Um, only ii, specifically needed three months. I'm, I'm a slow loner. I'm not the first one. I do need more time than the others. I know that and that's how I also computed it, you know, in the, the time frame. Um, but you would only know if you start studying. Now. Another thing about the M sra don't forget that you can sit it twice and it doesn't cost any money. Um, so you can also just study regularly. Um and then take it once and then sit it again and then do you know your dedicated period and, and, and study for it more properly if you feel that you cannot um get a high score. Um but I would recommend don't say it as black and white. Um Just take, for example, two weeks, study very properly in those two weeks and then take, you know, a few hours to think. Can I actually score high? Can I get a good score? Um or not? Um And you would be the only one who can answer that? Mhm. I think that's a good, that's a very good summary actually. Yeah. Um II did your average performance on past and reflect how you perform in the real exam. Um Current scoring 60% on average for first attempts. Oh II that's fine. II only got 70% in my false pass and that, and that's again because what I've done is, oh, just you disappeared. Um uh got me off balance. Um What I've done is going through the 1st, 1st pass without doing almost any repetition. And then after finishing that and having 70% I have done all of my young flash cards or again or whatever system function for you. It really doesn't have to be an flash cards there. The thing that functions for me and then I've done the repetition and, and really in, in 10 days, I started scoring 90 95%. Um And that was because I used that system. So initially, I only got 70% on the first pass. Um And still I got top, top 10% are in, in the country. I mean, that's fine. It, it doesn't reflect as long as you have that period, which is dedicated in which you can use the information that you already gathered and put it together into one piece. OK. Um D can you hear me? I don't know what's happened to my camera. I can hear you but I can't see you. Yeah, I'm afraid I've disappeared, but I am here and Karen, I am not currently working as I am on a career break. So I've done past medicine almost once. I intend to study 10 to 12 hours per day. Would that be excessive? We're doing the exam two months away. If I take it on the last day, I'm worried about burning out quickly, but I'm keen to do everything to get to my preferred training program such as the way. Um, I think it's fine. I think it's definitely ok. I don't necessarily think you would bone out as long as you have a good routine. So for example, you wake up, you do something and then you sit for three hours, four hours and then you take a one hour break and then you sit for another four hours, um, or three hours and then you're taking another three hour break and then you're sitting for another two hours and then you have every seven day, you take one day in which you're off. And I would highly recommend to plan that one day. So for example, to know exactly what you're going to do, which friends you're going to meet which activity what you want to eat. Um, and in this way, it would be a very full day, very fulfilled day. Um, and you would be able to rejuvenate yourself. I definitely think that if you have two months, uh, e especially that it's a very short exam to study for relatively speaking, if you compare it to some other exams to take us much more time, um, you, you, you have the ability to take those two months and even if you get a bit burned out, it's still not to that degree that you wouldn't score high. I ii highly think, I definitely think that you can do it. That's my, again, it depending on how you, you know, you study in your rhythm. But I think it's possible. Yes. Yeah. Um, I hear Dan Karen. Um, happy to help. I just think, yeah, the exam is, II guess of relative importance. But remember just to do nice things and like it's not the be all, end all. Um, did you use past med to make sure you were covering all the topics or is there more specific breakdown of topics? Um Like I said, every different question bank has some topics that the other ones do not ask and there's a lot of overlapping between them. Um Thi this is again, my personal preference. I would ii used best medicine and I felt eventually that it was the the main contributed to, to my preparation. Um It didn't cover all the topics but also as I it depends, you need to think what's your goal? Because if you're aiming, I never aim to be number one. You know, like if you think what, what's your aim? And uh my aim is always, I'm trying to be realistic about, about it. I'm not trying to understand 100% or no 100% of the information. I'm trying to know 85 to 90% and to know it 100%. And that way, consistently, I can always go 90% more or less, you know, 85 90% of the exam. And in that manner, you know, that you're going to get consistent scores all the time, doesn't matter which day of the exam you're going to take it because some days would have those questions. The other days would have those questions. II, hope it makes sense. Ie me has not recommended that. Um, I wouldn't say it's not recommended. I have a friend who, so I'm going to GP training in Cambridge and one of my best, best friends also got a uh a place in Cambridge and he is now there. Um And I basically, I followed his advice and he actually used the emer and he really liked it. Um Emera didn't function for me. Um The, the way that I am or my knowledge, I needed something different and past medicine was just the thing that really talked to me and functioned for me. So, so using knowledge t in past medicine, um II found it uh II hope that nobody from past medicine is gonna heal me. Um II found it a waste of time. Um It's very nitty like kind of he splitting um nitty picky um focusing on very specific topics that are very basic and uh very interesting. Nevertheless, wouldn't necessarily show up on the exam or even if they show up on the exam, they wouldn't necessarily give you the, the question, right? Because that's, that's the bottom line. You need to have enough information in order to consistently know how to answer the exam. Uh the question in the exam. So for example, II started using the knowledge tutor initially. Um And I remember there was a ha question, the um hypertrophic cardiomyopathy. And um um there, there was something with like an S two S one sound, I can't remember it anymore. And I really, II literally spent seven hours on, on breaking that specific fact down and understanding it and putting like 100 like 20 s only on that specific fact. And then in the exam itself, I never needed to know it in order to answer those questions correctly because I knew already the answer from the stem itself. Um So, so I wouldn't recommend it. I would recommend it. Uh No, you know what I was just, I wouldn't, II think that you can do, in my opinion, you can do a better job with the information which is out there um in whatever form and manner that you want to have your body of knowledge taken from. Um And you can find that information that you need rather than letting that, that knowledge t feed you with information that might be or not be relevant for your preparation, given your knowledge. Um A and what you need to know in order to pass that exam or to, to score high or you know what to, to answer that correctly. My personal experience. Thanks s and, and to attempt questions, would you re recommend being random or by topics? Um Wow, that's really good. Um, there's a certain point where you do. So, what have I done? I've done random. I've done random though because I already relatively speaking and, and again, it doesn't translate to being a good doctor or not at all. But relatively speaking, I have a very good body of knowledge. I'm coming to this exam because I've done the USM. Um, even though it was four years ago, step two and seven years ago, step one. but I didn't feel that I need to go topic wise in order to be able to answer them. I, II felt that it's better to do it random because that way your brain is getting, you know, getting the, the, the scenarios that actually gonna be in the test and obviously taking them in a random order, gonna be much more difficult and already taking them topic wise. Um, but I've only done that once I've passed about 50% of the exam. Um, the, the question bank. Uh, I haven't done it from the beginning. So there's a certain point where you start understanding, you know, like you do, for example, you have 100 questions for one topic. I've done 50 then I skip to the other one. And then after I've done 50% in all of them, I kind of flipped it and I started doing random in order to be able to train in it that being said, certain topics, um, especially given that II am an I MG. Um Certain topics were extremely weak or from my side because the way that you do them in Germany, for example, Gyno. So O OBGYN, the way that you do it in Germany was very different, um, exam wise and guideline wise and the, the way you do it in the UK. Um And hence I really needed to go through out the like II needed to go through this topic without um random model, but just going one question after another in the same topic in order to understand, to orient myself, what is even happening here. Um So you need to assess, you know, if we summarize my answer, then you need to assess what's my level of knowledge. Um Do I need to go um topic wise or can I just completely scramble it from the beginning, from the middle way? Um And can I do it to all of the topics together or is there a certain topic where I have to focus on initially and then I can scramble them? Um Hopefully, that makes sense. Thank you all very much for joining us. Um There's no more questions. I think we should probably send that um time um sign out. But lastly, I want, fortunately something's happened with my camera and, but I want to say just a huge, massive thank you for d for giving up your time on a Sunday evening and sharing this with us. What works so well, um for you and again, congratulations on getting you at GP job as well in Cambridge. Thank you. Thank you very much. And my, my, my great pleasure being here. I, I'm really, I'm really happy to do that. Thank you very much for inviting me and organizing this. It's, it's massive, like. Thank you very much.