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Good evening, everybody and welcome to our webinar about preparing for the MRC S part B exam. I'm Mr Yasuo and I'm a consultant surgeon here in London. I'm also chairman of the Court of Examiners for the Royal College of Surgeons of England. And I also convened the MRC S part B exam in the Middle East. And uh the purpose of this webinar really is to um help with preparing for the part B MRC S exam to give you some advice and guidance about what to expect in the exam and uh hopefully how to perform well within the exam. Our main aim is really to get everybody uh prepared um and not be surprised about how the exam is run or what to expect if they are sitting the exam. Just a general overview of the examinations for the MCS part B. It is held in the, in England and it is held in many centers internationally. Um It is held three times a year in Cairo and um twice and maybe three times next year in India. The centers are New Delhi Mumbai and there is also another center that may be opening uh in addition to Hyderabad, it's also held in Kuala Lumpur in Malaysia and uh Abu Dhabi er once a year. Um we have uh two speakers today to help us um uh give you the guidance and advice. And the first speaker is uh Professor Richard Tunstall, who is the head of the Clinical Anatomy at Warwick Medical School is also director of two medical education companies and is an examiner for the MRC S. He's also the lead anatomist for the MRC S part B exam. He's also involved in the quality assurance of the Royal College of Surgeons of England and the Intercollegiate Board of Surgical examiners. He's actively involved enhancing the national standards in clinical anatomy education, quality assurance and organize it in both international and health care related companies. Richard offers a very diverse um uh you know, audience and he including undergraduates and postgraduates and the wider community including pupils, patients, the UK, Police and the team GB athletes. He's won numerous awards for excellence in education and to his own company. Uh Cli Limit Richard also transforming medical education standards and patient care in Albania and the Balkans University. He's a recognized author has his own book, a Pocket Tutor Surface Anatomy, which is in second edition at the moment and he's benefiting educators and learners around the world. He's also won the Medical British Medical Association Book Award. He's also an author for the section of thorax and Surface Anatomy on both the 41st 42nd and forthcoming 43rd edition of Grey's anatomy textbook, which I'm sure you're all familiar with. Uh In addition to uh Richard, we have also um Sarah Abrahim who is a general surgical trainee. She's completed her core surgical training in the east of England Deanery is currently a breast surgery registrar at the Royal Free Hospital. She has recently scored highly at the national recruitment for registrar training and accepted general surgical training in Northwest London Deanery. She works closely with the College, the Royal College of Surgeons of England and he is an ambassador for the college and he's also the co founder of Ace Medical and Surgery. Um and you can access the website which may be helpful to you. She also delivers national courses to guided entry into surgical training at the core and registrar level. Um The end of this session, you'll have the opportunity to ask all the panelists and me um questions that you feel um you would want an answer or you're not very clear upon and we will pick the questions and hopefully answer as many as we can. Before the end of this webinar, it won't take much of your time and then we can get started and I'll ask Professor Tom still to start his presentation. Thank you and good evening. So I'm going to talk to you as an MRC S part Bowski examiner and I'm going to talk about how you might consider preparing for the assessment. You've just had an introduction to me. Um So you've heard most of this, but I'm Professor and Chair of Clinical Anatomy at the University of Warwick. And in relation to this presentation, I'm MRC S Osk Examiner and have been for the past 16 years and I'm now also the broad content area lead for anatomy for the osk. So how do you prepare for the MRC SS OS? Well, I'm going to talk to you about this in several different sections. I'm going to talk about preparing for the level and content, prepar, preparing for the format, preparing for the examiners, some station specific advice and a few final tips. So this should take about 10 or 15 minutes. So feel free to make notes and if you have questions, put them into the chat and we can address them afterwards. So firstly, preparing for the level and content of the exam, the examination is intercollegiate, meaning it's run across the Edinburgh Glasgow is and England Colleges. The link uh posted here is a useful link because it takes you to the intercollegiate MRC S exams page where shared information is published on the exam relating to its level and its contents to be clear from the start. The MRC S exam is an integral part of early surgical training and it's required for progression to higher surgical training in the UK. The assessment assesses trainee surgeons over a broad range of surgical conditions and importantly, it's set at the level expected of around Act two or ST two or in other words, the entry point into higher level training. So we're not examining specialism or specialist knowledge at this point, it's general surgical knowledge. So to tease out those important points, this is an exam for early surgical trainees and training. And it's centered around the UK. It's got a broad coverage, it will cover multiple surgical conditions and it's set around the CT two ST two level. If you review the Intercollegiate web pages, then you will see there are various documents, this documents useful. This document will allow you to get to know the content of the exam and the documents entitled to guide to the Intercollegiate MRC S examination. It's in PDF format. It may be updated in coming months but the updates will be minor. So do have a look at this and get used to the exam format, the content and within here you will find details of the curriculum and the various areas that you are required to know. So the MRC S part Bowski examines four areas, anatomy and surgical pathology, applied surgical science, and critical care, clinical and procedural skills and communication skills. And this involves giving and receiving information and also history taking. So this is a common question. When is the best time to sit the MRC S examination? Well, that may depend on your personal circumstances, it may depend on where you're located in the world. But there is a publication on this that came out several years ago, looking at when it's actually the best time to sit this exam for UK candidates in particular, importantly, you should sit the exam when you have prepared and when you feel ready to do so, the publication shows that actually ct one appears to be the optimal time to sit the examination, but of course, sitting it earlier or later, you can still be successful. Next, I'll talk about preparing for the format of the examination and again review the information on the intercollegiate web pages, but also review the information on the college web pages where you will be sitting the examination here. I've just provided a link to the English College relating to their information on the examinations. Rest assured that this assessment is standardized and it is quality assured. And by this, I mean that the questions are standardized across colleges and quality assured the expected answers or requirements of a of a performance are also standardized and quality assured as is the marking, as are the examiners both in their training and actually what they're doing on the day when you see them. So these are things that you should not worry about during your preparations. Just be assured by this, that the exam is standardized and quality assured the exam consists of 17 stations. So be prepared for this and be prepared for the length of the examination. So each station is 10 minutes in length. And on top of that, there's a minute transit time between each of the stations. So this can be for some a tiring exam. So you may wish to practice answering back to back questions in different subject areas. And for example, taking histories doing examinations across a prolonged period of time. So within these 17 stations, there are eight knowledge based stations, three anatomy, two surgical pathology, and three applied surgical science and critical care. And there are nine skills stations, two history, one, communicating to a patient, one, communicating to healthcare professional, three physical examination and two generic skills stations where you will be expected to demonstrate skills. On top of that, the two communication stations that are listed above. So the patient and the healthcare professional communication stations also involve a preparation station ahead of it. Within the intercollegiate documentation, you will find a table that looks like this. So don't worry if it's a bit small on your screen, you'll be able to see a larger version within the PDF available on that web page. The stations I've just talked about assess you across different domains of performance. The first one being clinical knowledge and its application. The second being clinical and technical skill, the third being professionalism. And this includes areas such as decision making, problem solving, situational awareness, and judgment, organization and planning and patient safety. And the final domain is communication. And this table shows you how each of the stations are mapped against these different domains. So importantly, get to know which domains are tested on which stations doing this will help you understand better what's required of you within the different types of station. Now, the stations are 10 minutes long. This means that they consist of one minute of reading information about the station and this is done outside of the station. You will then enter the station and many stations will then have nine minutes. So if it's an anatomy station or physiology or sorry or pathology, then you will have nine minutes of questions with resources. However, there are different formats of station timing, so be prepared for this. So one example might be a physical examination station where you have one minute of reading outside the station. But once you go in the station, you will have six minutes to take a history or to physically examine the patient. After six minutes, you will be stopped by the examiner. You will be asked to summarize your findings and you will be asked questions. So practice questions and tasks using the different station timings. This will give you a much better understanding of the time limits and parameters that you have and what you must achieve within that for the two communication stations, the communicating with a patient and communicating with a healthcare professional. These are often classed as giving and receiving information stations. These will also include a preparation station beforehand. So how this works is that you'll have a minute outside the preparation station to read what the station is about. You will then have nine minutes in the preparation station and this is where you will be reviewing notes or information. You can make your own notes on this which you can then take into the next station. So you will leave the preparation station, wait outside the next station for one minute, then go into the station and conduct the task with the notes that you have made. What we suggest for this is you practice reviewing and making notes on patient cases within nine minutes. So make sure you're working to this time limit. It's good practice. Next, I'll talk about preparing yourself for the examiners. Now, this might sound a little bit strange but from feedback, when we talk to the candidates after the exam, we're often aware that candidates aren't always prepared for how the examiners may come across. Importantly, the examiners are positive and supportive of you as candidates, we want candidates to pass. However, even though we want you to succeed, we can't help you succeed. You have to demonstrate your skills, professional behaviors, abilities, et cetera within the station. So remember we're there in a positive supportive manner, but we can't really help you succeed when you go into an examination station, be prepared for how abruptly the station can start. So when a candidates come in, examiners simply need your ID number which will be provided by the college. They do not need anything else. So if you go into a station, just say I'm 1234, the examiner writes it down, confirms it. You then get on with the station. So there's no name needed. There's no handshake, there's no greeting. This can to, some people appear a bit abrupt and a bit rude. It isn't meant to be. It just means you've got plenty of time to get on with the station. Once you're performing in the station, examiners will ask you questions, they'll listen, they will observe and they will often appear neutral or non confirming. So if a candidate gives me an answer, I don't say yes, I don't say that's correct. I may just say thank you and ask the next question again, this can appear quite neutral and quite blunt and you might be uncomfortable with this, but it's simply just part of the exam format that examiners are expected to adhere to. So don't let these behaviors put you off. Also, don't let examiners facial expressions put you off normally in my day to day teaching and work life. I'm actually quite a smiley person who, um, is personable and people detect that. However, in the exam, I'm not, I have a poker face. So don't let that put you off if you see it in other examiners as well. And a few points of note, examiners will not say that you're correct or incorrect. So prepare yourself for that many like me will just say thank you and move to the next question. Examiners will not tell you which answers could be improved. Candidates ask me that. Where can I improve? I can't tell you that. I can't say, oh, you didn't do so well. On this question, examiners will not talk to you in some stations. That's because they are there to simply observe your performance. And examiners will not talk to you if you finish early. So if you answer all the questions in the station in six minutes and there's three minutes remaining, then the examiner may say that's the end of the questions we now need to sit here in silence again. Don't let that put you off trying to think of something that takes you away from the exam and just allows you to relax before the next station. So some station specific device and this isn't clues or anything to do with what you'll see there. This is generic advice relating to a few different station types do not try and guess the content of the exam. Remember the exam tests a broad range of knowledge, skills, attitudes and behaviors, and all of these are required to demonstrate your broad competence at the level of the exam. If you try to guess the content and think, well, they're not likely to put head and neck in. I won't look at that. Then this can actually trip you up, be aware that information is presented in various formats. In the exam, we show images in anatomy. So these are photos uh in anatomy, we shower histological pictures or pathological pictures. We show patient charts, we show patient notes and we will of course show medical images. X ray ct MRI being common. What we suggest is you practice reviewing various presentations of information under time pressure. It's really important you do this for history and physical examination stations do practice reading and following information or instructions carefully that may sound obvious. But there will be clear instructions outside the station as to what you are required to do under exam stress, this can be difficult to take in. So before you get to the stressful point, practice reading this type of instruction or information and then summarizing it. And you must remember do that within the one minute time frame. Also practice conducting the core parts of a focused patient history or physical exam in six minutes. So do it under time pressure and maybe do it observed as well. Get a colleague or a senior to observe you doing this six minutes is a short time, particularly when you're being observed and it's under exam stress and practice presenting core findings in a very focused manner. Remember, you've only got three minutes at the end of these stations to present your core findings and have some questions asked for anatomy. We use images of real human tissue, it's plastinated. So to some people, it may not look real, but it is, we also use images of real bone. The anatomy component of the exam tests your knowledge of core structures. We are not testing surgical view anatomy. We're testing to see if you're competent across all regions of anatomy. So do you know where things are, do you know who their relations are? Do you know what they do? Do you know what happens when it goes wrong? So ensure you can identify co anatomy from a range of different views. Levels of dissection also make sure you can identify anatomy on a living subject that includes things like anatomical planes, regions, landmarks and anatomy related to clinical examination. Now, we will show you cross sectional images and sectional anatomy will be tested in different stations. You will be shown for example, CT and MRI as you may expect, but we will also show you images of real human cross sections. The upper image being an example of that don't be stressed when you see this, don't be concerned. It's simply a colorful, more detailed version of an MRI and we will test you on generic skills. Now, unlike the picture you see here, you will not be performing this on a patient live in the exam, but there will be models that allow you to do certain things like this to do. Practice demonstrating the core steps of practical procedures. Make sure you follow the station instructions. These will clarify to you what you need to do and which steps can be skipped. So for example, it might say, assume the patient is consented. So take that as read, do not reconsent the patient and there will be other instructions as well that tell you what you can skip and where you should start and be prepared for examiners to ask you questions as you're working. And again, you may wish to practice this. So conduct a procedure that you may expect to be in the assessment and have a colleague asking you questions while you're doing it. Now, for the communication preparation base, you could practice reviewing patient notes and summarizing core information. Make sure you review in the exam, make sure you review all the notes provided and when we give you notes, they will reflect a real world situation. So they might be out of order, they might be shown in the handwritten font. Do not let this put you off. Remember, it's reflecting what you'll see in practice. So my final few tips before I finish practice being asked and answering questions, verbally, many of you will ask yourself questions in your head or you'll read them. That's fine. But the exam is primarily an oral examination. So make sure you have a mechanism for practicing this. Always answer the question that's asked easier said than done under stress. But do make sure you listen to the whole question I have many candidates hear me ask the first five or six words of a question and they launch at me with an answer, but they don't wait for the full question to evolve. So often the answer they give me is incorrect and it's wasting time than doing that. Now, you can ask examiners to repeat questions. We're very happy to do that and please avoid answering questions with the phrase. Is it, this is it X you need to tell us what it is. You can't ask us as examined as questions. And also please try and avoid giving multiple answers or hunting for information. When you do that, it makes you look under confident in your knowledge. And I in many cases, you don't really know the answer. You're just giving me five or six answers, hoping one that sticks. If you don't know something, simply ask to move on and return to the question if possible. So it's a really important point. Don't waste time if you really don't know, just say, can I move on and can I come back later if possible? The scenarios and questions we design are not or we write are not designed to catch you out or trick you. Some candidates feel this they're not. So if you become lost or confused in the exam, be prepared just to stop for a moment, take that moment to think what you're doing what the question was and maybe ask the examiner to repeat what that question was. Prepare yourself for this. Now, this may sound strange but things do go wrong, prepare yourself for an entire station going wrong. That doesn't matter because there is no killer station in the exam. What matters is what you do next, forget it and move on. So be prepared for this to mentally just say hm that went wrong, leave it, shove it and give the next station your best performance. If you let it defect you for the next station and the one after and the one after that will therefore probably increase your chance of failing. So I'll leave you with this. Be confident in the exam. Be confident in your knowledge and you can practice doing this. You can rehearse this. The exam assesses many of the attitude, skills, behaviors and knowledge that you use and should be using in your daily work. So that should help you feel more reassured about what you're doing. Now, I'll finish there and if you do have questions, please type them into the chat and we can address them after and I'll now hand over to Zara. Ok. Um Thank you, Richard. Um that was very comprehensive and very clear and very sound advice for my experience of attending many exams and observing many candidates. Uh We'll move on to Sarah Abraham uh for her presentation and don't forget you can put the questions online and we will answer them at the end. Thank you very much and thank you for that. Uh Professor Tonsil, that was a great overview of the exam. Uh I hope everyone can see my slides. So, just a little bit about myself, um, as I've already introduced, my name's Sara. I'm a surgical registrar in London. And I recently did MRC S part B and successively, um passed on my first attempt last year. I work closely with the college as R CS England Ambassador, which allows me to go into schools and spread my passion for surgery as well as, er, work with core trainees. II did my core surgical training in the east of England and that is predominantly when I did my MRC S exams. I'm also a co-founder of Ace medicine and surgery which helps, er, other trainees get into surgical training, both at a core trainee level and at a registrar level. So the first thing I'd like to talk about is success and failure. Er, doing postgraduate exams can be quite daunting for many people, uh particularly as they have other things going on in their life and, er, work can be very busy and, er, for someone that found part a, a little bit more tricky. Um I was definitely geared up to ensure that when it came to part BI was very well prepared and similar to a lot of you. Today, I came to the webinar. I learned about a bit more about the um exam and then I went away and consolidated and thought about my revision structure. So professor to has already spoken in detail about the exam. As you're aware, it's um an OSK type er exam which is focusing on real life clinical scenarios. There are a number of skills that you'll be assessed in and they include your clinical knowledge. So that's your anatomy, your pathology, your applied surgical science and critical care, as well as your communication and then also your practical and procedural skills. We've already looked at the matrix in the previous um talker, but just to show it again here. Er So each section is out, each station is out of 20 marks. And as you can see, this shows that there's a number of different areas where you can also obtain marks, for example, your professionalism and your communication, as well as the clinical knowledge and the clinical and technical skills. So that's really important when you're thinking about preparing for your part B. So I just want to jump in and talk about my exam day experience. I sat the exam at the R CS England Head headquarters, which was lovely. Um I ensured that I was there with ample time before the exam. Just a few things from my experience that I noticed. Um you are going to be waiting before the circuit starts in a room with other candidates. Er So be prepared for that, particularly if you're more nervous or apprehensive. Um make sure you've thought about those techniques that you're going to use to prepare yourself mentally to start the, er, part b, er, be prepared with food on the day. It's a long day, er, with lots of different stations. So I brought some foods and snacks with me whilst waiting in that room before, er, the circuit started. Um, as professors said, some of the examiners are there to be neutral, they will not give a response or nod their head or say yes, that's correct. So, be worried that the type of examiner will vary from station to station. Er, that means that some people, uh, some people come across, um, very, er, very welcoming and others are just, uh, there taking, listening to your responses. Remember each station is discrete variable and, er, don't be thinking about the previous station when you move from one station to the next, it is a long day. Um, of course, there's a number of stations to get through and so it can get a bit stuffy. So make sure you dress accordingly and you dress professionally as well. You have a rest station as well. And so you can use that to clear your mind to stretch, er, just to think about the next stations that you've got coming up. Um, it's a great time to use that, um, to, er, ensure that you're ready and energized for the stations. After that, after the ones that you've already had, you may find that you start on a rest station, for instance, you may be provided with paper. Um whether it's to write any notes for summarizing in the station or in the station prior to preparation station, I think this is really key because particularly if a patient, for example, in a history taking is telling you their name and date of birth. Um in the midst of the station, it can be easy to forget er certain details. And if you write them down on the paper, when it comes to summarizing it at the end, you have a note of everything that you've, er, spoken about through, er, the, er, station. Remember to keep your answers succinct. Don't just talk for the sake of talking. Um, if you're not sure, just say, um uh can I come back to this and move on? It's important, you understand the question before jumping to an answer. And I would say that's particularly the case for questions, for example, in the pathology station or uh the Applied Sciences Station, you may be pressed for time. And as Professor Hansel said that you may start um being asked, er, questions or being asked for your ID as soon as you go into that station. And so don't be put off by that and don't be put off if you're hesitating with answering a question and the examiner wants to move on, there's a lot of other marks to obtain and you can always come back to something. Um if you have time at the end of the station. So preparation, preparation is essential to succeeding in the part B and it's important that you have a structured and disciplined approach to cover all aspects of the exam. So, revision er revision, there's the first thing is thinking about your vision structure and timings. Er we all have different ways of revising. Er some people like to er work away slowly when it comes to revision. Others are crammer. Like my, I work best under pressure. I took about three months to work well uh to revise for MRC S part B. Although I did have some time off during that time, um including study leave to ensure that I could prepare effectively revision resources and Familiarization is also key. Again, this will include, there's a number of different things available. Um just from a quick Google search, whether that's question banks, er, whether that's through the syllabus that is provided by the Intercollegiate College, um whether that's also through attending um Anatomy Dissection day. So I know R CS England um have certain days when they do that um or other courses, for example, that the, er, the Rocos put on or er, Doctors Academy, for instance, do another one. It's important with the part B that you're consistent and dynamic in the way in which you revise, um especially with something that is an ay um you need to keep practicing. So, um ensure you have a good revision timetable and you think about your time, it can be tricky when you're still working at the same time as focusing on revision. So it is important, you understand the exam format, know the number of stations, um, how many stations for each, er, different topic and the types of stations, um, familiarize yourself with the reading times, um, on what's, um, managing your time and expectations effectively, er, be aware of rest and preparation stations so you can utilize them, er, for, uh, best on the day. We've already spoken about the different types of stations, er, whether that's practical skills or commu commun er, communication skills and each type requires different preparation and different amount of time. So, for example, I knew that anatomy was something that I needed to focus a lot more on, which meant that in my revision timetable, that was the bulk of my revision early on. I knew that because I was a course surgical trainee, I was doing a lot of the procedural skills, a lot of the examination and communication on a day to day basis. So I could spend less time on that. But I had to ensure that I still uh followed the syllabus in terms of everything that needed to be covered. Familiarizing yourself with the syllabus is important, ensure you cover everything. Um, as professor said, don't leave certain topics out, make sure you understand the depth of knowledge required for all the different modules, develop a regu regular study, set schedule. Um Consistency is key, as I've mentioned previously, tips for revision. The most important er, revision technique for me was group study. This can really, really help um enhance your understanding and ensure that you, er, perform well when it comes to the examination, as well as that teaching concepts to others is a very good way to reinforce your own understanding. How did I find studies, er, partners, er, if you are in a, a hospital you can look around and find if there's any other junior doctors that you can work with, um, you can do zoom calls with, er, to after work or during, um, during or day to day to see if you can work together in terms of pre preparing for MRC S. Again, it's also important that you regularly self assess the way in which you are, um, er, the way in which you are, er, working, the way in which I did this is that with my colleagues, I would ask them to give me some feedback, what they thought my weak areas were. So, for example, if it was anatomy and if particularly it was head and neck, I would then ensure I take a few days, go away, look through, er, some anatomy and then come back to the group study sessions so that we could fire, quick, quick fire questions with one another. And that helps to really focus your revision. Um It's very easy as we all know to just keep revising what we know best rather than focusing on the parts that we probably find a little bit more tricky. So some of my top tips, um anatomy books are great. Um This one, in particular Clinical Atlas of Human Anatomy, I found to be um very useful. It has some great photos and um in the exam as well when it comes to the images they provide. Er, but sometimes the anatomy, um the direction of the photos is not as straightforward and I felt that this book in particular helped er look at the anatomy from different po um points of view and different angles. Um If you're like me, I there's no such thing as over preparing. I wanted to ensure in terms of my er procedural skills, I was up to date and I knew what I was doing and I was confident on the day. So I did er, buy a few bits and pieces on Amazon. I'm sure if you have simulation er centers at your hospital or if you ask about if they have any um old um suturing materials or if you get hold of some knotty materials, then you can practice that. Um So I bought a few things which allowed me to prepare for my knot tying and my suturing. So that on the day, I felt confident whilst doing it and also answering the questions that the examiners threw at me at the same time A I, we live in a world of a I, it's important that we can use that to the best of our ability. I found that particularly helpful. For example, um, of course, there are textbooks and there's a lot of information with regards to the different types of, um, websites that you can use to learn whether it's the anatomy or the critical care or applied sciences. Um, with history taking, if I felt that I was missing something or I wanted to know about, I said, think about my differentials A I is great. Um, you, you can use chat PT to help you um summarize some questions and put them into your notes. Uh So that's something that I found particularly useful communication. So, communication is a great deal of the MRC S exam particularly because it is an osk type situation. And so like I said, a study b or a few of them is really important, organize time to practice with them regularly. So I would revise with different people, er, some from my hospital, some that I've met through medical school that were also doing the exam. I would uh, do sessions, er, different sessions with different people so that I varied what I was doing and that really helped ensure that I was practicing. Um, again and again, every day, give each other feedback, be critical. What could they improve on whether it's their communication their summarizing, er, their ability to be succinct with their answers. So, just a little bit more about improving those communication skills, er, learn to summarize your findings concisely. I think that's something that, er, can be off putting when you've taken a history or if you've examined a patient and you're in an exam setting, er, you've done all these things and you've got some positive and negative findings and then putting it all together in a timely and concise manner. So, really do you work on that role play is important as well? So practice those common patient scenarios, um such as history taking or explaining a diagnosis to build your confidence. Um, breaking bad news as well can be tricky for some candidates, particularly if they find it difficult from communication point of view as well. So really do work focus on that in terms of role play, er, breaking bad news to, er, to patients. And the best way to do this is actually if you ask your seniors in the hospital, er, whether you're on, on call shift, if you have them, if you have some downtime, er, people that have gone through the exam previously, who can get, um, who can, you can learn from and you can build on your own knowledge. Thus far, sometimes I found that recording, reviewing my performance was also quite useful in terms of identifying areas for improvement and tracking my progress. Er, for example, if I was revising at home and I wanted to practice examination. Um I could still act it out and I could record it and then watch it back and look at it against um, the, er, what would be um, a mark scheme in terms of what points I would ensure I would need to get. And that way I could make sure that I'm, er, becoming more slick with my performance every time I do it, focusing on empathy and clarity is also really important in terms of effective communication. So ensure you understand the patient's pers perspective and communicate clearly without using medical jargon, practical scenarios. So familiarize yourself with those common procedures. So for example, suturing knot tying er techniques, um putting in chest strains, you will be asked questions too as well as showing that you can do the steps of the procedure. So show that you are able to multitask, especially if you're running out of time, um gain as much hands on experience as possible. So again, in a clinical setting, that's best um practical exposure is the best way to ensure that you know what, how to do it on the day because it's second nature to you find out if in your hospital there's Simula simulation labs. So if they have a model already available that you can uh practice examinations on and that will help your skills without the pressure of real life scenarios, uh there's a number of procedural videos, you only need to go on youtube or use a number of the resources that are available online uh to help you review um step by step guide in terms of how to do a certain procedure and help reinforce your learning. So the best revision practice is dynamic, um whether it's mixed practice, so different topics on the same session, um otherwise you'll burn out if you consistently do the same thing again and again, er, spaced repetition, repetition is key, particularly in things like er um practical procedures and examinations, teaching others. That's a great way of ensuring, you know how to answer a question and understanding the topic as well, so that you're not thrown off if something that you've learned has been asked in a different way on the day of the OSK mind mapping, thinking about how much, you know, uh that's also a great way of consolidating all your knowledge, uh regular assessment. So utilizing the resources and uh other trainees or seniors around you, asking them for feedback and simulating the environment. Er, I think that's really key as well, particularly as you get close to the exam, er, maybe doing with an, a, a friend or a group of friends um who may be sitting in the exam around the same time as you um putting together a mock that you guys can do. So that way you can prepare and feel confident on the day. So night before less is more, look after yourself uh before the exam. Um I know many of you will have already done part A by now. And so we will know how to prepare yourself best for that exam. You can if you want to review some key points and summaries, er, remember to look at, look over the location of where your exam is, er, timings, traveler, make sure you drink and sleep and eat well and just be calm and recharge and be prepared for the day of the exam. Um On the day of the exam arrive early check travel, ensure that there's no, uh there's no no cancellations to tubes or anything like that on the day. Have your documentation and ID to hand, take your time and focus, er, think about when you're preparing, you've got that minute to read the scenario. As Professor Tunstall said, if they've said, um, only examine cranial nerves, er, 789, then read that and think about that before you go in, er, being, making sure you break down. Uh what they're asking you in that preparation, er, minute will really help with your confidence, going into the station, be positive and confident. Um If a station doesn't go as you planned, then remember, um you can put it to one side, you can still do well in the exam. If you um put that to one side and move forward with a good attitude, just remember to relax and smile and um wishing you all the very best. And if you have any questions, please don't hesitate to get in touch. Er, this is uh my Twitter account or via my website. Thank you very much. Uh Thank you very much, Sarah, uh, very comprehensive, very practical um guidance there for the exam. And uh surprisingly, um, it's amazing sometimes how candidates can go wrong just because they haven't re read the instructions carefully. Now, I'm mindful that some of the um beginning of the presentations, I think some participants couldn't see the slides but the uh session is recorded and will be available on the med platform once the webinar is over. Um I think we can now go through the questions and um I'm just going to have a look and we'll just go in order really. And I think there's been several questions about, can we tell our name to the patient during the introduction? There's nothing wrong with doing that but sometimes the better way to do it is to just introduce your role. So if the scenario says that you're the core trainee on call, you can just say uh good morning, I am the core trainee on call. Do you mind very much if I examine your knee? Um and you start your er scenario, there's also some confusion about uh do you greet the examiners or do you shake hands and do things like that? Um Cultures vary. The exam is international and um what we tend to do is just the examiner will say good morning, good evening, whatever it is and ask for your candidate number and then they will tell you to, you can start the examination or carry out the exercise. Um, and that's what you should do. I think, um, you know, some cultures you need to and a few minutes greeting the examiner and so on and I think that is completely unnecessary. Um, and so, you know, just to treat it as if you are in real life, you walk into a station you um carry out the exercise. Um, again, read very carefully. Do you need to consent the patient? Do you have they had an anesthetic, you know, local anesthetic infiltration or not? All these things are very important and just spend time on it. Um I think um there's another question, do you need to take anything to the exam with you? Uh The answer is no, the only thing you may need for hygiene reasons is your stethoscope. Uh If you don't have one, there will be one provided in the station if you need it. Um, I think pictures in the anatomy station, er, Richard, do you want to answer that? Um, yeah, the question is, how many pictures should we expect in a single anatomy station? And the honest answer is it varies. Um We provide enough pictures that it allows us to obviously test the content. Um, normal range is between two or three maximum we'll have might be five or six. But you, you can assume that there will be the appropriate number of pictures for the station and for what we're testing. Thank you, Richard. Um The next question I think is about a current foundation trainee asking, is it better to attempt soon after the part A or wait until core training? Maybe you could answer that. Sarah. Would it be too challenging straight after? No, I think uh it's best to do it after, if it, if you can do it after part A because the knowledge is fresh and you can take what you've applied in the written exam and move that forward to the OS. And I felt that I did best doing that as well because I could work on what my um basis was from the previous exam. Uh Thank you. Um Next question is about, er, real patients and um actors. It, you can have a selection of both. Uh We tend to try and use actors more nowadays. Uh But even if we use real patients as both are equivalent, they're very well trained. Um And they're all not there to trick you and you just need to be doing exactly what the instructions say in the scenario. Um There's a question about the marking scheme. I think this, er, is sometimes people are obsessed with how the marks are allocated and so on. Er, believe me, the, the exam is structured in such a way that it is uh the fairest exam you can ever sit and uh you have to be a very good doctor, both professionally communication wise, skill wise and knowledge wise to pass. And the way the marking is is every station that you have marks allocated to all these domains, basically professionalism, skill, knowledge and everything. Um So that's, that's the way the marking is done. There's a lot of rumors out there about percentages and you know how many percent pass and how many percent fail. It's all of non factual and no relevance and it does not happen. Um I think uh do we need any examination tools? We've answered that you just uh can bring your stethoscope with you. Um There was a question about uh when will we hear which date our exam will be for the October sitting? Now, are you able, I mean, most of the examination bookings are done online. There is currently the online website is being restructured and changed. And so there may be a transition period where you'll have to wait before they can confirm your booking and your allocation to whatever date you've asked. But from uh once the new website is all ready and up and running it, it will be straight away automatic like you can choose when and where and you know that sort of thing and you'll get a immediate answer about whether your booking has been successful or not. Um The question about procedure skills or antibiotic, given after abscess drainage and general antibiotic guidelines in the UK. Well, maybe you can answer that. Uh, Sarah. Yes. I mean, I think, II don't think you can go if you've done a abscess in as part of your procedures, er, skill and you end by saying that you, you may give some antibiotics. I don't think you're going to be marked down for that. I think if you think that's, um, wise in that scenario, then that's fine. I don't think, er, necessarily, um, there's an issue with that as such. Yeah, I think that's a good answer. Uh, in general, what I'm trying to advise most candidates is to, you know, move away from this idea about every word you say is a mark or a mark taken away because there's a lot of controversy sometimes in clinical practice and as long as your whole behavior, professionalism, your knowledge within that station was within the general expected level. Um, then there is no reason why you should not do well in that station. Um, and I think, you know, abscess, you know, some people will add on and say, well, if there's a lot of cellulitis, I'll add the antibiotic and, you know, and so on and so forth. You know, if it's a specific organism, if it's a tuberculous abscess or something, then the patient needs antibiotic. But, you know, so it varies. So in general, whatever answer you give to that, it still would be correct. So, um there's another question about, tell me more about procedure skills required for the part B uh Richard. Do you want to answer that or? Yeah. So the the procedure and skills are generic skills for surgery. Um And if you go to the document, I've shown my presentation, the IC BSE document, it will give you details of the range of procedural skills. Yeah. And in general, there won't be skills that you should not have acquired from your normal clinical practice at the level that we recommend you enter the exam. Uh There's a question about um whether talking to the examiner during the physical examination days. Now, as we've highlighted and both speakers have highlighted, you're being examined in those bays uh according to what you actually do, not what you actually say. So if you're talking to the examiner and saying, I'm palpating the liver and I can't feel a liver edge, but you're not actually doing it, you're getting no marks. So if you're talking to the examiner about flexing the knee or extending the knee without actually doing it correctly, then there is no marks. You can wait to the end until the examiner about it all which is the normal or some people lack the confidence. They wanted to say it as they're doing it. But the examiner will not mark or take away marks according to what you say, they will be looking at what you're doing. So that's the way to think of it. Um, regarding history taking, is it wise to interrupt the patient if the information they're giving is irrelevant? Um, what do you think, Richard? Um, I would reflect that question back and say, how do you know it's irrelevant, the patient's giving you information. So there's no guarantee. It's irrelevant. That's an assumption. Yeah, I think that is quite correct. I think the problem is some people enter this exam thinking that they have heard of this scenario before. And so they start making judgements on what the actors or the patients tell them. And as we've mentioned several times that the scenarios change, um the instructions are very clear, nobody's trying to trick you. And if you're assuming things that are not there in the station at the time you're doing it, then you will go wrong. Yeah. And so whatever their patients or actors are telling you just treat it with respect because that's probably relevant and you're wrong. Uh There's more questions. When do we say this to the examiner for completion? I would also like to do a pre R examination and so on. Yes, you can do that. There's no problem with that. Um uh If they ask you directly, then you must say it because there will probably be a mark for it. If you add it on, then that's fine when examiners stop us. If they notice that we're doing unnecessary examinations what they will do is they will interrupt what you're doing and tell you to read the instructions. So if the instructions actually tell you go and examine the knee or the left knee and you go in examining the patient's face and pulse and BP and so on, they will tell you, stop, read the instructions again and that's your clue that you're doing something wrong. Um, can we get back to the steps of the examination at last if we forget at the beginning? Uh Yeah, if you, if you, if you don't know a question and you say, I don't know and the examiner moves on and you remember the answer and you've got time at the end, you can tell the examiner they will only give you a mark for it if you have not received the answer with the other questions they've asked you and they will be the judge of that. Ok. What is the pass rate results of that from my previous exam? The examiner was a bit slow. So time ended up without completing the questions. Uh This is a two way street. Uh The examiner is the same examiner for 40 candidates a day. Uh And so all candidates have had the same experience. So there's no real problem. But the reason they're sometimes slow is probably the way you are maybe answering their questions and that's why they are slow to make sure that you actually heard the question correctly. Sometimes the candidates just keep on answering answers and answers that are not been asked. And so you're wasting time and they will not interrupt you. So you have to be careful, you must answer exactly what they've asked you. And there's more than sufficient time for all these patients. If a procedure is stationed, like an abscess is written, patient is already, of course, you don't need to take the consent. Again. We've just mentioned that um as a candidate from a participant from India, what's considered as a pass, a pass is a pass. As I said, don't concern yourself with the structure and the marking of the exam. What you concern yourself is preparation, good performance and clear communication and understanding of exactly what you're required to do in the exam during examination steps can be common to the examiner about the findings or about the next step. Um We sort of partially answered that, but if you want to add on Sarah to my answer before, yes. So um we you can say what you're talking to the patient during examination. And uh you can talk about the findings when you summarize at the end essentially. Yeah. And I think as I said, the physical examination, you're being examined on physical examination, not on what you're saying. So if you don't know how to do a certain test and you're doing it incorrectly, you would not get the mark even if you describe it perfectly OK, so that's the difference. Um Do we have to add ice component to history taking? I don't know what that means. Um I think it's referring to ideas, concerns and expectations. Oh right. OK. Um Let's go ahead. Yeah, I mean, if it's required and good practice within the context of the station, then yes, you should be asking those questions. OK. Um Good. Um Which A I platform would you recommend? Do you have any recommendations Sarah for it? I mean, I just use Chat GBT in terms of helping me um sort of structure history taking and examinations. Sometimes it's just quick fire in terms of going through lots and lots of resources online. You do have a syllabus as Professor Tonsil mentioned. So always look, refer to that as your first point of call, but this is just something else that I used. Yeah, I mean, all the platforms are very, very good. I mean, I use them for quick answers about things that I've forgotten myself. Yeah. So you can use A I it's very, very helpful. Uh There's a question about abdominal examination, hernia orifices, genitalia and pr as we've said, you follow exactly what the instructions tell you and you won't go wrong. Yeah. And if you want to add and you're unsure, you can tell the examiner, I want to examine the hernial orifices or the genitalia or pr and they'll tell you. Thank you, but that's not necessary. And so you don't then have to do it. So don't be in the dilemma about it. Uh during a procedural station suturing if it's written, patient is anesthetized. Ready. Uh Yeah, if it is written, it's ready and they've had their local anesthetic, then that is it. They've had their local anesthetic. You can take it as a given. Yeah, you don't need to be even mentioning it because that's what the examiner knows that you've been told uh in critically ill patient examination. Can we talk to the examiner asking about patient vitals, X ray findings, et cetera? Um Do you wanna answer that, Sarah? Uh So again, they, you won't speak out loud and explain what you're doing as you're doing it and they will give you certain findings along the way. So you might get patient charts, drug notes, um ECG whatever it is and then you will comment on that if they ask you a question. Yeah, I think you, you have to be, you know, read the instructions very carefully and you know, there's no point if the, if the scenario tells you that the patient is breathing well and has no airway obstruction, you can't go in there and start talking for 10 minutes about how you would secure the airway. You get no marks for that. Yeah. So you have to read the instructions very carefully and just answer specifically exactly what the question is. Um I think the last question is, do we get a break in between the exam. Yes, you have a minimum of two rest stations in the whole circuit and in the rest stations you'll have tea, coffee, water, juice, whatever, you know, biscuits sandwiches and maybe sometimes even more than that in some, uh, overseas, uh, venues. So that's, uh, you can make use of all of that dress code is the clinical dress code there below the elbows. No rings, watches and, um, you know, just follow the clinical dress code that is prescribed and available as her NHS rules. Um Have I missed any questions? Did any of you see any questions that you wanna answer? That looks good. Yeah, I think we had a finish time of seven o'clock if I'm correct. Um, well, thank you everybody for your participation. Uh We wish you all the best and we also hope that you'll sit the exam through our college here in England. We hold the exams, as I said in many areas internationally. And so there will definitely be a center that is more available, um, easier to get to from wherever you are in the world. And certainly if you're in the UK, you'll have ample opportunity in many cities in the UK. Uh Thank you very much and thank you to my cos speakers and the organizers of this webinar. Thank you.