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Hello, everyone. Welcome to our fourth evening update. I'm Helen. I'm from the six trainee committee. Um Just before we start, I wanted to mention our conference, which is in just two weeks time. Um Unfortunately, it's sold out. But if you are coming, I just wanted to highlight the trainee session which is going to be on the Friday morning. Um with lots of hard to reach topics. Um Also wanted to mention we're gonna have a trainee drink session with a golf simulator, help us five on the Thursday PM, but at 6 30 AM on the Friday, bring your running gear to do the 66 K. So tonight, I've got a really important talk for you on preparing for the victim exam. Um And two speakers have currently given up their time to come and speak to us. So first we have Doctor Rhoda Sundaram who's going to talk to us about examiners viewpoint of preparing for the exam. Um She's the lead our way for Scotland and a consultant at the R A H in Paisley. And then we have Dr Duncan Young who's going to give us a candidate's viewpoint. Um And Duncan is in the final two weeks of training as a dual anesthesia and intensive care registrar. So it should be good talk tonight. Thank you for joining us and I will hand you over to Doctor Syndrome. Thank you, Helen. Thank you so much for giving me this opportunity. So I'm just going to present my slides now. Um So I have a disclaimer and as Helen said, um, I'm the lead Ari for Scotland and I'm a fiction examiner and I work in Peace Lee. Um, all the material on my slides is from the chicken website because I'm an examiner. I only share ing the content that's already on the thicken website. I myself have not sat the chicken in its current form, but I did sit and passed the D I C M which in 2006 was a non compulsory exam and it was conducted by the R C O A and at that time, we didn't have the chicken and it was called the Intercollegiate Board for training intensive care medicine. And it was a very different exam. Then we had a dissertation to do, we had expanded case summaries and then we had a sort of S O E type thing in the afternoon. Um But after having done the M R C P and the F R C A, I found the D I C M A very adult exam and I think most people find the thick imma very adult examined by that. I mean, that the examiners actually, particularly there. So we are very respectful of your views and it is a conversation about the subject topic. Now, the or skis are very, very different because they're examining different things. So they had far more prescriptive exams for junior doctors has been both glamorized and demonized. So, you know, this is going to hurt was a book written by Adam Kay in which this lovely young junior doctor call Shruti. Um May, sadly, it takes a life at the end of the, uh, the TV series, but she is so consumed by her exam. She's very, very sort of, she doesn't tell people very much about her exam and it goes to show how exams just dominate our lives as doctors. Um, in fact, some of us feel as if you've spent our lifetimes only sort of jumping through various hoops. Um, but for almost all of you, this is probably going to be the last exam that you take and the sense of relief that you'll have after this is just amends. I don't know if anybody's had the chance. Probably none of you because you're studying for an exam and you're working really hard. But, um, certainly there's a series called Maternal and it's about women in medicine. And again, it does sort of mentioned exams. There's also, um, the fact that the public seem to want, um, doctors to be held to account and want very rigorous standards to be applied by the G M C. And while, for someone who's really struggling with the exam, six times doesn't seem enough because you prepared so much and it might just be exam technique or it might just be bad luck. You can see that actually the public don't have so much sympathy. They think six is perhaps too many attempts for us to pass the exam and they don't perhaps realize the pressures that doctors are under. What does the exam test. So it there is a syllabus for the exam and you'll find that on the thickened website and its actually been developed from this sort of koba trees competency network. Um and it tests your knowledge, test behaviors. It's a submitted assessment because it's done at the end. Um and just a year to go before you become a consultant, often it tests sort of outcomes um and skills as well. The standard that the exams expecting from the trainees is that we're expecting the trainees to be at the level of a pre CCT registrar. So within one year of actually getting their CCT who would be able to formulate a plan of care for a critically ill patient with appropriate consultant back up. So they don't expect you to know everything you'll still have consultant back up, but you should be able to formulate a plan which and you will only need the assurance of a consultant. Passing the fellowship exams is a requirement for progression to stage three of intensive care medicine training program. And the standard is set to reflect this, the eligibility for the exam as all of you know is that you need a primary exam in another specialty. You should either have the FRC A primary or the final, the MRC puk in full and the M R kem, you should at least have the primary s be, you should be registered with the faculty. So if you have an N T N s, if you're in a training program, then you're already registered with the faculty, you should have be a member, you could be on a medical training initiative. So these are overseas doctors that come from a for a sort of designated period of time, you could do it through another route through an affiliate fellows route or an associate members route. But you should have finished your stage one. I see em in its entirety. And if you are dual, you should have also completed your partner specialty requirements. So one of the things for dual trainees is that you have to move through the stages almost together. So you can't be in stage two. I see em, but stage one, anesthesia, you have to be in stage two, both. So you do have to complete both um to be able to do the exam. When should I see that you can only sit at the two. There are two sittings a year. It does include subspecialty questions. So it does include questions from pediatrics, from neuro and cardiac. But one of the things that you have to remember is that you have to sit your victim within 10 years of your primary qualifications. So if you've taken time out to do research, if you're on an academic program and you're actually doing a phd, you do remember that every year that you add on you me, me and we have had a couple of trainees in the UK that have actually just about breached um the 10 year rule and we've needed to actually seek the permission of thicken. And interestingly, the thicken just can't give unilateral permission for trainees to do this. They have to actually seek the permission from GM. See, because the GMCR, the ultimate sort of arbiters of standards in this country, they're a regulatory organization and they can't love one trainee to be exempt from certain rules that have been created for all trainees. And then I love them to get their CCT so often when we do appeal to the thick um and the thick um say they have to take you to the G M C have had consultant call colleagues say that seems a bit sort of over the top, why do they need to do it and they need to do it because actually, ultimately the thick im are sort of facilitating the sort of are setting standards, of course, but they're also facilitating the compliance with those standards. And from your MCQ, you have only about three years to the closing date of application. And again, we have had trainees that have breached this because of various sort of, again, prolongation of training for other reasons for good reasons out of program expiry after program research. So they've started it and then they've actually had a great opportunity to do something else if you do take sort of statutory leave, like maternity leave, er, sick leave, that gets sort of counted. So you will be given a pro rata extension to be able to sit your final thicken. So the MCQ, which is the first bit that you do in stage two um is got single best answers. It was a set of MCQ S but the G M C wanted to be replaced by single best answers. And now all the questions are replaced by single best answers. There are 100 and 30 questions, 80 are short stems in 50 years longer and you're given three hours and you do it in a platform called Test Reach you. Then once you pass your prime MCQ, you apply to sit your S O E in Norske and certainly you supply to do it on the same day and, and most often the office keys are in the morning and the S O S in the afternoon, but it can be the other way around sometimes. And the exam now is face to face and it's in the Royal College of Nice status and in the, in the, in the third floor, I think, but they can change that as well depending on how many candidates they have. And your S O E has got stage, you has eight questions with four sets of to examiners each and you're off ski has got about 13 stations. The thickened MCQ, as I said at the G M C's request, all the M C Q s have been gradually replaced by single best answers. Um and the 50 long stems are usually a clinical scenario where the correct correct response is awarded to mark. So the short stems are awarded one markage and the long stems are awarded to marks and you get three hours to do the exam. The Oscar, he's got 13 stations, seven minutes each with one minute between them. There are 12 live stations and one test stations. So neither the examiners, the candidates will know which one is a test and the test is for the Osk E group to actually try out questions to make to see whether the how candidates performing the question before they actually added to the question bank, all stations should be approached equally. There are four main areas that you're off ski tests. Its data professionalism equipment, resuscitation stations are marked out of 20 and there is a predetermined pass mark. And I will discuss that in my next few slides. There is a specific way that you move between our ski stations and they don't change this so that no candidate feels that they're given an unfair, unfair, uh they're either disadvantaged or given an unfair advantage. And you start off in your Rosky station. There's a bell. You go, you have an information point where you read about what you're going to be questioned on and then you go into your Rosky Station and then you move on. But it happens in a specific order. The S O E, there are four stations. It's 14 minutes each with two minutes in between them. Draw out to examiners at each station. You can get 32 marks in total and the marks that are given for the S O E R zero's fail. One is borderline into his past. The examiners cannot confer about the score ing that they're giving given and actually, um having now done this a few times, there is just no conferring at all. So they independently mark the performance of the candidate. So all these questions that are there in the M C Q s, the or skis and the S O E s are subject to rigorous standards setting because we need to know that they actually reflect the standard that the G M C and the thickened wish. And they also reflect, they are actually also indicative of the performance of a cohort of trade ease. The S P A s are set by the MCQ subgroup of examiners, all examiners are divided into three groups. You might be in the MCQ group, the OS key group or the S O E group, the pass mark for the MCQ for each question is determined by the angle of methods. So every question is subjected to what's called angle where the examiner, each examiner independently estimates the probability or for trainee of a and they call it the minimally competent trainees, a, a trainee who's an year away from CCT getting the right answer. It's then waited because the long stems are two marks and the short ones are one mark and the past mark, the sum of all individual waited questions, they then subtract one standard error of measurement to arrive at the final pass mark, which means a candidate who scored just below the pass mark will pass because it's lowered slightly. It also means a few borderline candidates will go through to the S O E and the or ski. And this has been rigorously scrutinized by both the thicken board, the R C O A board. And it would appear to be a validated sort of method for examinations. The standard setting for our ski. There is an Kaskey group of examiners. Each Noski question has a number of sub questions with a total of 20 marks available for each question and they're 12 questions for exam. Now, the test question does not contribute to the candidate scores. So there'll be 13 stations the angle of process is carried out by the or ski subgroup examiners who again independently apply the process separately to each mark within each question. The angle mark then is the some of the anger of's for each mark within the question. And the pass mark is the sum of all the angles marks for the questions it contains if more difficult questions were to be selected into an exam and that random selection can happen, then the past mark for that exam will be lower because angle will be lower for it. S O E questions are subjected to the anger of process in order to establish the question difficulty. And it helps to decide what questions actually go into the exam. But it doesn't actually, it does not used to establish the pass mark. And they use a statistical method called borderline progression. And each examiner awards a separate score for a candidate's answer to the two questions in that station and then awards an overall global score for their performance. So if you, if there are five stems and a candidate doesn't really get all the isn't able to answer, let's say two bits of that question properly. But globally, the examiner gets the impression that the candidate actually knows the subject. There might be some basic signs or some some minuti a that the candidate is well worst with that actually gives the impression to the examiner that they can manage. Let's say, for example, sepsis. Well, but they might not be able to actually mention all the cytokines and tumor necrosis factor. They can still actually pass the candidate. The total score for a candidate exam is the some of the individual question scores. And then the past mark is determined by the borderline regression of all the scores against the global scores for the candidates. Where do you start? Well, you get into stage two and then the clock starts ticking and most people start thinking about doing them secure in the very first sitting that they can, there are some trainees who have been able to do it um slightly earlier if they're within seven weeks of finishing stage one. But for that, they do need the support of the regional advisor and we don't actually advise you to be too hasty. So give yourself time, get into stage two and do it because the exam does require preparation in time. There are lots of videos on the thickened website which are quite useful to watch. And after every exam, the chairman of the exam boat actually produces a report and they have always been very, very open about discussing the questions the topics that the candidates have had difficulty with in order to instruct future attempts. And also in order to instruct those who are planning to sit the exams about the questions that maybe people are not that confident about. There are also presentations by candidates on the website which are quite useful to watch to look at exam technique. The chairman's report actually discusses the poorly and discuss topics and one of the topics that's often poorly done is the E C G certainly in the or skis, the E C G station um is poorly done but it seems to have improved over the last few sittings. I think the candidates are reading the res and, and pick him again. Uh credit to them for the last two years have been actually publishing more resources on their web page. It wasn't like this in 2018. And so there's access to actually looking at more um sort of the sort of sample questions and things. Um 2018, the candidates struggle with bubble management systems like flexi seals. I mean, we see that, you know, you can't go around a unit in the west of Scotland without the nurses having at least one patient on uh flexi seal system. So it's quite important that, you know, a bit about it short bowel syndromes, you know, we have patients that are sort of present to our sort of, I see us what sort of electrolyte disturbances with other problems with short bowel syndrome. So again, I expect you to do it asset base again, seems to be poorly discussed um sepsis. Very surprisingly, you think that we get a lot of teaching on sepsis, right from the time we, our medical students to the time that we're actually trainees but sometimes I think they fall into the trap of thinking that the overthinking the question and thinking the question is, um, perhaps a trick question. But actually it isn't, certainly, there are no trick questions at all. And with the ask e just answer the question. And even if the answer seems really straightforward and simple and you think, well, I couldn't have got to this stage and, and they're asking me the definition of something if they're asking you that that's what they want and you will get the marks for it. Basic sciences. Again, pharmacology and physiology are poorly done. Critically ill obstetric patient was poorly done in 2020 equipment. Again, seems to be poorly done. So, um we find that certain equipment which are perhaps not used that often are very well described and discussed, but something like CPAP, you know, which we just coming out through the pandemic, we've all used a lot of CPAP seems to be poorly discussed. It might just be that candidates haven't spent the time perhaps with the nurses setting it up or a respiratory nurse specialist. Again, our, our tea is poorly done. Let's see. And again, that becomes a surprise because we have at least I would zero and 10 to 20% of our patient's receive our, our tea and all our units. Um Ethical issues do try and get sort of uh some sort of viral practice on this because often they are actually quite straightforward questions and you just need some advice particularly from consultants in your regions who have an interest in medical law and ethics to sort of help you navigate the issue and also be able to articulate it at an exam. Radio radiology is always poorly done, but that seems to be improving. And I think it's because candidates are spending more time looking at scans. Um you might get an X ray or you might get a single slice ct and most of them, most of these are have pathology. That's pretty straight forward to actually identify the examiners do get the opportunity to look at the artefacts before the exam. So if they feel that they can't, if the artifact isn't up to scratch, then they will actually mention it and it, it, there, there is, there is scope for changing it, but it will change for the entire cohort. Um But all, all those sort of questions are vetted very carefully before. Um there sprung on candidates. Um Pulmonary hypertension, never events again. Um Things like environmental hazards and I see you very poorly discussed. Um I get with applied basic sciences, both physiology and pharmacology. Um It's official rupture, um D K and H H S transfer again, you know, you get signed off for a transfer sort of high load. If certainly if you're doing any other sort of partner specialty, you need to be signed off for it as well. But I think again, people think that these are trick questions. I think that's the answer to simple, but just say it like you would do it because you have done many of these and you will get the marks for it and the topics in the S O in the past exams. Actually, the October 20 to report the chairman's actually given a list of the topics and it, you know, it would be helpful to actually make this and then discuss it amongst peers um and try and answer them. And the more practice that you get in answering these questions or just discussing and describing these topics, the better it is for the exam. There are a number of books for the exam. Um and you probably have access to them, but there are also websites which are useful. The picket website has got a lot of resources that's really useful. But there are on the thicken website. The list of websites that I have actually listed on the slide are from the thick and website and I do find some of them really good. I must say I do find the deranged physiology, the bottom line. Um the sort of pommery ccm. I do find those websites quite useful sometimes to just get a refresher start tradition, early practice with peers and consultants and do not shy away from seeking opportunities with nurses, HPS in your M D T and visiting a rotating senior trainees. We often have trainees in our intensive care units who come from respiratory cardiology, your ID. And so, you know, seek some help from them, actually spend some time with the nurses to see how they set up our, our t spend some time with respiratory nurses to see how they set up CPAP. When the dietician comes on the ward round, ask them how they write a nutrition prescription because that actually will give you the content to an S O E or an off ski. And what I would end with is that you should just be kind to yourself. And you got into medical school, you go through medical school, you got your primary examination, you actually manage and I see you on your own overnight. There is no reason why you should not pass this exam. Good luck and you've got this, you will pass it and I'm happy to take questions at the end. Thank you. Shall I hand you over to Helen? Shall I hand over to Duncan or? Yeah, thank you so much for that Roger. That was fantastic insight into the exam. Yes. And now we've got Duncan talking about his experience as a candidate. Thanks very much Helen. Um, just trying to put my slides up. So, yeah, I'm just trying to chat about, I guess my uh time when I did the exam and a wee bit about what um I thought about it and a wee bit about what the guys that were doing at the same time as me who have just recently done it, thought about it as well and hopefully gives you some insights into it, but I don't think anything's going to be mind blowing. But, yeah, just a bit of a feel for what, what the exams like. So I'll have a chat about what I did during the exam. I know rat has already touched on it, but I think the examiner's reports are really interesting to see what people do badly. And, um, uh, a text are teeny group and these are the kind of things that they asked about was the OSK E E T G radiology stuff. Do you need to know lots of trials? So, try and chat about that a wee bit and then just the sort of resources and courses and stuff that, that I use, there are unaware that exists. So hope, hopefully it's helpful. Um, so this guy's David Goggins don't know if you've ever heard of him, but he's one of these maniacs that tells you to get up at four in the morning and 200 press ups and go for a run. And that's his kind of version of motivation. It's definitely not my version of motivation, but he's got a six pack and I'm mostly made of mashed potato, but something that gets you going, some mental health type thing that makes you think that you're, you're working hard. This, this suits me a bit better. But I think whatever you do, uh, moderation is the key but you need to get your head kind of up for revising, do, do it when it suits you. There's no point in trying to study for an exam. If you, if you're not on the right headspace for it, you know, if you're going to get married next week or something that isn't, there's no point in trying to sit an exam. But, yeah, when you, when you're ready psychologically do it and you've got a good kind of car and stick structure, I think that's important about getting through, getting through an exam for me. A lot of that family support. I'm really lucky to be married to really support a woman, but even she started to lose the faith a little bit when I was starting to be extra exams as she saw it. Um, and she asked a few tricky questions. I wasn't totally sure the answer to it all the time. But yeah, now on the other side of it, I think it's been the right decision to do it and get through it. But yeah, you do need a bit help from friends or family and whatever that help is. But that's your flatmate, your mom or your wife or your boyfriend or whatever. But yeah, the people who kind of cut your dinner for you and get you at the house and whatever is to keep you, keep your head in the game. So, yeah, I've got five tips for total life. Success. I'll guarantee you passing thick, um, complete happiness in life, you'll lose weight, you become more attractive, you become more interesting. You'll definitely rich. And if you're lucky you can retire at three. Um, possibly, but of course, it's not really like that. I just thought I'd talk a wee bit about in general. What I thought was like and what I did. So, I mean, I revised in the same way that I've always revise for exams and that, that's no surprise, is it? I mean, you love all of past loads of exams already. Uh, so you should just do the same thing that you did before. You're gonna have a way that works for you that doesn't necessarily work for anybody else. I don't like to study early in the morning or late at night. I study during the day. Um, and I've got a way of doing it. What I like to do is the written. There's lots and lots of questions. I don't like to sit in front of textbooks particularly. So that's what I did. I did lose of questions for the written exam and if I've got those questions wrong and then that was an area that I probably had to go and read up a bit about and if it was an area that kind of new, okay, then just kept doing questions and those. But I know that doesn't see everybody, the Yassky and the viva or a bit more what I did for the F R C A. So if you haven't done the FRC A, maybe it will be a kind of different style of exam, but definitely getting grilled by people was the way I went about it. And it's getting to that point where you're not embarrassed to not know the answer anymore. That's when you know, you're ready for the exam. It's good to get asked questions by, by people you're worried about being embarrassed in front of, because by the time you go down to London, like, these are like, faces examiners you'll never see again. So, if you can't remember what the odds net trial showed, then, I mean, it doesn't matter, you'll never see that person again. Is a bit more embarrassing too. Uh, look like an idiot in front of, you know, the consultant that's meant to leave you in charge tomorrow night or whatever. Um, so, yeah, I think when you get to a point where you feel just totally bored, used to being grilled by people for the viable, then that's definitely where you want to get to. The other thing you hear a lot on certainly west of Scotland. We've got lots of non anesthetic. I see em, trainees. Is, is it just like the F R C A or do you have an advantage because you've done the FRC A? I don't think so, but I've done the FRC A. So maybe I would always say that I thought it was quite different. Exam is definitely not sciences. The FRC A, it's much more clinical and yeah, I don't think there was a massive advantage in doing the FRC A, maybe a tiny one, but I had nothing that isn't easily overcome by like tiny bit revision. It definitely wouldn't recommend doing FRC A questions revision. For example, I wouldn't buy any efforts a books. I just think the exams they're not, not related in the same way that there must be a bit of overlap with them RCP with, with the E D exams. But I would, I don't think I would recommend studying for those exams specifically to do your thinking. Um, he usually did get asked a wee bit about evidence based medicine but it was always at the end of an S O E question, it never felt like this was going to be the deal breaker to passing or feeling. So I think it looks good if you knew the evidence behind why you from people or steroids or, you know, I'll be in or those kind of bigger topics. But if you don't know some small study or, you know, if you can't remember, I don't think that's going to pass ophelia that we might opinion. But yeah, and I thought the all ski was the one that was the least kind of clear cut sometimes and, and maybe rather would describe this. I think that was unfair. Uh I did the Oscar online and I think that was, that wasn't that obvious sometimes what the difference in the all ski and the S O E was and maybe in real life think that would be a bit easier. Um, I did like the best example of that. I think I was 60 seconds into the resuscitation station before I realized it wasn't a communication station which probably in real life to be a mannequin or a defect or something to give you a bit of a tip. Um I think the question is something like you're the I C registrar on the unit for the night. And the anesthetic trainee wants to speak to you about a Labour Award patient he's having difficulty with. And I spent the first minute asking lots of open in questions and tell them what they were doing was really good to just sort of blank stares from the examiner. And then I realized they were actually asking me about how you were able to get uh, surgery patient. So, yeah, I think they asked, he feels a bit less clear that you can, if you study really hard, you'll definitely pass the su and you'll definitely pass the, the MCQ. There's no doubt about that, but I think you probably could have a bad day and they ask him more so than the other ones. Yeah. And it's possibly reflected in the marks that have been the case over the last few years. I think also the people probably revise less for the Oscar E. I think people are pretty good at doing the, the written stuff and then they spend those of time revising the S O E and maybe they do less revision for the Oscars. So that, I mean, that could definitely account for that as well. Rather definitely touched on this. And I just thought it was interesting to just mention again, like some of the topics you'd expect people to do really well and you would expect people to know about sepsis and ventilation and you know, transfer medicine and that kind of stuff. Some of this stuff about pharmacology and science might be less well done. But yeah, a lot of topics you think pretty fair game for an icy exam and people that these are the top things that the examiner reports said people are so badly. So, yeah, again, you often hear that the exam wasn't fair because they get asked about how many microns a filter is or whatever, but it isn't, isn't seem to be like that when they look through the reports that you're getting asked about things that happen intensive care, people with COPD with septic shock on ventilators that all seems pretty fair, fair game to get asked about. Um So yeah, if you, you kind of need to know the court topics, well, these are a few funny comments from the examiner report, but I thought it was worth mentioning as well. Uh So, you know, I think you should probably dress up for your exam. I think that would be obvious but there's people turning up in genes and T shirt apparently. Um, again, they're mentioning about being specific. I think that's definitely right. I think they're example is saying hostile card money is a better on that than saying infection. I mean that, yeah, so I think it is an exam and it's quite formal. So just these specific and clear as you possibly can be, the resources on the thick and website are really good. I actually, to be honest, when I was writing this talk that they may be the first time I'd really seen those, there was definitely something when I was doing my exam, but it wasn't as detailed as this. So if you just type in thickened exam, um you'll, you'll get to this resource and it's got loads of stuff on it. Um Obviously it's got a syllabus, but particularly got lots of example questions and it's good examples of good passes and poor passes and things like that. And there's so there's lots of good Oscar questions on it and lots of good S O E questions on it. It's definitely worth doing those. Uh Imagine there's not that bigger question bank and some of them might get, get repeated. One of the other questions people ask was about the EKG and chest X ray questions because they have been answered badly in the past. It seems like from the examiner's report, they were getting answered better and then thought, okay, that's because there's quite clear cut guidance and what you should do on the thick um resource web site. So there's a 30 minute video and radiology for FICA Malsky. They just got on their website and that was part of a training course I went on was, was that video. So you're, you're kind of getting that for, for free on their website. I'm not read through it, but this is copied and pasted from the thick and website about what you should do for an HCG structure. So like they're, they're giving you how they want answered structured. So I'm just definitely do that. All of this is just copied and pasted off the, the thicken website. It's stuff you would know. But in an exam, I guess you, you panic and do stupid things. So you have definitely practice, you're definitely gonna gas an ETD in your Rosky. So you just have this pad exactly the same for, for x rays. I'll go through it. But on the thicken website, this is why they want you to answer a chest X ray question and you're, you're undoubtedly going to get some radiology. Some of the radiology can be pretty out there. You can get asked about MRI S and CTS and angiography and things like that. But I think that the answers will be much more straightforward. You know, you're not, it's not radiology exam. But if you get asked about a chest X ray and then when you on or rds, they're probably going to want you to have quite a detailed answer. So, yeah, this is their example of how you answer chest extra questions. So I've just learned that. Mhm. There's been uh those are different uh different books. These are the books I used, none of them I thought were stand out. Possibly the Masterclass one I thought was the best one. I've text again. The guys that have done it around the same time as me and they all used slightly different books. So doesn't really feel like there's, these are the five books to get around things like that. So, um, I think these have to pick a few and see what you think and ask, ask around. These are the ones I used, I thought they were okay. Nothing was perfect. Um, but for me personally, I don't really like to use books. But, um, yeah, like online things and these are the online stuff that I spent most of the time looking at life in the fast lane. I've always looked at, I think is a really good website and it's pretty reliable. Um, Aussie, any website, the bottom line has all the research stuff and it has a kind of re summary. So if you're like wanting to know what the evidence for steroids is in septic shock. The bottom line is a really nice summary of the evidence and a little phrase and I just kind of learned to one for sepsis in steroids for ARDS, whatever, whatever kind of core topic. I think I had a little list of 10 things or something that I knew a couple of bits of evidence for Wikipedia is always reliable and there is stuff on the learning for healthcare. I didn't think it was that good, but it's there again. If you're running out of resources, it's definitely worth using it. And then of course, you need some downtime as well. I use BMJ on examination. I think, I think it was good. But other people have said they didn't like it. It's currently 30% off. So it's pretty cheap at the moment. Um If that's unused to you for the, for the written, definitely, it's just a big bank of questions. It depends on how you study for me. I like this at the computer forever reason. And I thought that was easy to do. Be MG on examination at work. So, yeah, that's a little cooler, concerned for 30% off of my emails this week. And these are the courses I went on. So the west of Scotland's really lucky and they do uh become Markovsky S O E type thing. Um So I think it's, and I think there's one coming up really soon. But I'm not sure the date is exactly. Um, but it's, it's been put on by Barbed o'neill Brain for the last few years and it gets a good review. It's basically just formalizing what you're already doing. You know, you're studying. Um, I also went on the formal victim exam prep course, um, which is run three Victims through the college. It was online when I was doing it and I thought it was, again, it was pretty good. Um, it was a kind of day of lectures which probably wasn't for me. But then there was a day of being Viibryd, um, which I thought was really good and it was just a whole day of being vibe by examiners from victims. So it felt like the stand was what you were going to get and it probably was. So, um, yeah, I think that's in London now. So that might be different. It was really convenient for me to go on it because it was just online. But, um, yeah, I think practice, practice these things in the more formal setting the better. So, yeah, I would recommend both those, both those courses, whatever you're doing it for you. I don't know, keep that in your mind. I just wanted to be done from exams. Have my life back. And, uh, I had a wee girl when I was studying for my thinking, which I didn't have when I was studying from F R C A. So, uh, there was a different pressure and, uh, definitely felt like, um, it was starting to become more selfish. Maybe that's not fair but it's not the right word, but I needed to pass it to keep my, keep my family life happy. So, uh, I worked pretty hard to get it done and to, to, to get through it and now I don't have any exams and I spent a lot more time, uh, not doing exams and play with a little girl. But, yeah, that's pretty vague. But I think you all know how to pass exams and, uh, just have to keep doing, you know what they do and just go for it. And that's my talk if that's any good to anybody. Thanks so much Duncan. Um, that was really helpful. Um, I've got a good list now from both of you. What to do next. Um, there's a question here from Chris lady that says, um, how questions relate to various legal and ethical and legal matters that might have different, different frameworks. So, should we be familiar with some English law or just stick to what's happening in Scotland? You don't need to be familiar with English law because the examiners will ask you for those questions will ask you if you're from Scotland, Wales or England on northern Ireland. And then we'll ask you the questions, the questions have been modified to actually reflect the reason that you might be from. Um, and certainly for the questions for the Scottish candidates have all been sort of vetted and looked at by Monica Beattie who was the leader are a AM and it's also a sort of ethical expert. So you don't need to know about English Law. So just, just your own practice. It is quite a good exam because it does reflect what a jobbing person who's going to be a consultant in a year would face. So, um you know, the questions have been modified. Thank you. That's good to know. So definitely need to um read up on more of the Scottish law, but it's good to know where to focus your revision. Um I had a question um so Duncan and alluded to it as well, the October 2021 Noski, um for which uh the kind of report into that and some of the FRC exams came out today. Um Do you have any thoughts about kind of how things might go forward or some of the actions that have been taken with regards to that? Osk E? Yeah. So it came as a huge surprise to the, to the examiners when the past rate for the or ski was much lower than previous years because it does sort of follow a pattern most years. Um And so, uh and because of the sort of understandably the unhappiness and on these amongst candidates and amongst actually non examiner consultants in various units because they actually approached the victim and were upset because they felt that these candidates were actually jobbing doctors who they were very happy to leave their units with and they couldn't understand how they had in past. So a vigorous review was done both an internal and external review and the report was embargoed until today, but it's now been released and there have been a few recommendations. But for the or ski, one of the recommendations is to have to sort of standard setting mechanisms. Apart from the angle, there has to be another standard setting mechanisms. So if the results are out of keeping with what we would normally expect, then we have another second standard setting mechanism to compare it with. But there are lots of other recommendations. The victim have also written to all the candidates who unfortunately didn't pass in that attempt. Um But the report has concluded that actually the pass rate for that and they will have upheld the pass rate for that exam. But, you know, going forward, they will, I don't think there'll be huge changes, but certainly a scrutiny is always useful because it makes us reflect on various elements of the way the exam is conducted. Thank you so much. Um Yes, it's all quite topical with that all coming out today. So, and it's reassuring to know it's all kind of been looked at very recently. Um It doesn't look like we've got any more questions. Um But as someone sitting the exam in. I actually wanna calculate how many weeks. Um, that was really, really helpful and you both kind of chatted through everything and brought some of the stuff that's on the website, which can be quite dry to life. So, thank you very much. Um, I'll let you both go and get on with the evenings now and, um, I just wanted to mention the next talk. Um, it's gonna be the 23rd of March and that's Dr Rob Heart from the Queen Elizabeth. Um, it's going to be talking to us then and all the information and sign up sheets will be out soon and hopefully see a few of you at the conference in much. Thank you so much. Thanks. Thanks. Bye. Goodnight.