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I don't then I can. Hello. Um Are you, are you ready for me to share my presentation? Uh I, we shall we go first? We and then is it ok for you to go afterwards? Yeah, that's fine. No problem. Yeah, great. I think we should start now. Yeah, great. All right. So OK. Am I OK? To just go ahead and make a start? Yeah. Yeah, introduction before we, we get you to start straight away. I think that's fair. Um So, hey, everyone, welcome. Thank you, everyone for signing up to our W PMN event. Um The Radiology Unlocked, uh Success Guide and this is our second episode. So this is the M Sra Tips and Tricks uh which will be conducted by two very, very lovely doctors who know all about the M SRA. So the first one is uh Doctor Basal Goal who is an ST three clinical background in um clinical radiology. He bef before starting radiology, he was involved in internal medicine. Um And now he is decided to make the switch to internal radiology. So he's gonna talk to you about that and also about the M SRA um our second guest our second speaker is Doctor Omar Hassan. He's an ST one radiologist in East Midlands and he has some interest in education, health, tech and entrepreneurship. Um He graduated from Leicester and completed some F one and f two years um and locum in emergency medicine as well. So, yeah, these are our two speakers. Uh Vishal will speak first and then we'll go to Omar uh take it away Vishal. Brilliant. Thank you so much. Thank you for the introduction. Um I'm just gonna start uh by presenting my screen. So if you guys can just confirm that you can see it and then oops, we should be able to make a go. Um Yeah. Have you been able to see the screen? Yeah. Are we able to, are we able to see the screen? Yeah, I've got, yeah, you can see. OK, perfect. So I'll just stop sharing my face because we see that right. So um greeting everyone. Um uh my name is Vishal. Um and um I've been given the opportunity to talk to you guys um about some tips and tricks um for the M sra um I do realize that um we're in November now, so we're not too far away. So I'm trying to keep um the talk to a bit more um tailored towards a, a mid to tail end of your preparation, but I'll still include some stuff in case you just starting out. Um I think anyone if you ever spoken to anyone who's taking the M SRA or any of you have taken it before. Um, it's a pretty bad exam and there's a lot of ptsd associated with it. So, um, there's no shying from that if you're feeling that way. Um, you're absolutely right. And it's a universal experience. So everybody feels that way about the M SRA. Um, and, um, people still get through every year and, and so can you, so just a little bit about me. Uh So I'm an international medical graduate. I uh graduated from India in 2017. Um did my f one year which is called internship in India for a year, took a gap year, took some exams, some clinic uh attachments, six months as a clinical fellow in Ed. And then I did fr to stand alone for a year. Um My initial um aim was to be a medic. So I did I MT for two years. Um And then I um decided to see the doc as it were and switched to um radiology. So I uh started radiology in 2022. Um And I just started my ST three in um in August. So just before we start, I think it's always nice to remind yourselves why you're putting yourself through um the prep of M sra many of you, everybody's got a different reason as to why they want to do it for some people. It's a, you know, a lifetime uh, you know, a lifelong passion, um, for others. Um, it could be something they were, they were doing before, especially as IM DS, they might have been doing it in their home country. Um, for me it was, uh, a place a, a job that had all the things I wanted. Um, but didn't have the things I didn't want, um, from medicine. So, um, you know, stressful on calls, um, you know, nonstop bleeps and, and, and all of those things. Um and basically in my aunty one year, uh I actually had a friend who was super keen on radiology. He kept hopping to me about how great it is. So I decided to do a taste a week and um I actually um met a consultant who was uh looked like me, he was bald, he had a beard, he was brown and he was really into his um anime, which I am. Um And I kind of went well, these are my people. So, you know, this is what I wanna do and that's sort of when I started preparing until then, it wasn't something I wanted to do at all. Um Certain things to remember, like things that I was never, I was a very average medical student. Um I did not have a lot of experience clearing exams. I had failed my MCP one twice at that point and I was prepping for the third attempt which, you know, thank God I passed um, and I was certainly not a workaholic. I used to, you know, whatever little time I had. I love traveling. Um, lots of hobbies. Um, uh, I've got a cat. This is my cat, Mimi, her name is, um, and I love coffee. I love simulation racing. I love gaming, all of those things. So, what's life like as a radiology trainee? Um, sometimes it may be good there, sometimes it may be shaped. So, um you know, so I kind of do it like a good one. So, um the physics it that you'll, you know, have to learn as an ST one can be quite daunting. Um I still to this day don't quite understand the ins and outs of MRI don't think most radiologists do. There'll be like always one person in the department who actually understands it and then everyone else just knows the practical aspects and that's all you need. Um And then, um ultrasound is another thing that takes a while to truly make sense. Um But then the, the plus point is that, you know, the way more medicine is these days, you kind of just use the donut of truth to answer a lot of questions, just throw them through the scanner and you have an answer as to why they're having the problems that they're having the other side to that is sometimes in a scan, you can't tell what it is and that's when you use the dreaded line please correlate clinically where there's a bunch of differentials that could explain the given appearance and because most clinical histories don't go beyond pain, um you're kind of just left with no option but to say, all right, this could be an infection, this could be ischemia. You need to correlate clinically as to what it is because those patients who present very differently. Um Another thing that sometimes can um be a little bit of a negative is that we're kind of the unsung heroes uh in the sense that a lot of the times you make the diagnosis, but the only people who knew that you've done that are other staff members. Like if you, for example, diagnose a patient's cancer that was very, very difficult to find and asked the patient five years later who was the doctor that diagnosed your cancer? They probably don't know your name. Um So that is definitely something that, you know, might get to you. But on the flip side, um you don't have to interact and, and all the nonsense that comes with that interaction is not your problem. Um A nice example is, is COVID and you know, most radiologists were fine during COVID, I walked on the walls during COVID, I got COVID like twice and I was really ill with it because I was dealing with patients all the time and none of the radiology trainees or radiologists have to do that. Um Another really good positive thing is teaching. Um you will usually get a good amount of legitimate teaching. Most many will have an academy block where it's basically like back to UNI you get paid to go to UNI, which is very nice. Um Whereas in I nt we used to have teaching days, but out of the 10 I NTS that were there only two could ever attend because the other eight would either be on call or post on call. So it was quite, quite ready. Um So on to the M sra, no doubt, it's a bit of a David and Goliath story for all of you. Um that it is a, a challenging exam and it can sometimes seem like with all the things that you read that, you know, with the cutoffs going up and the challenges and the, the, the competition ratios that it's a really difficult thing. Um But basically what I'm trying to tell you is that it's not like that every year people get in, every year, people will tell you that. Oh, it's too difficult. That's been the story since before I started and it's gonna be the story for forever. You, you can't listen to those people if you're going to make this goal a reality. Um So you could have the most amazing portfolio, you could have 100s of prizes audits, you know, publications P hds, whatever have you. But if you do not clear the M SRA, you do not get a spot, you have to make the cut off if you want to make, if you wanna make your dream come true. We know that this year that uh it's not gonna be part of your interview score, but all the same um getting through the cut off is extremely important because if not, then nothing else like all the prep in the world can't save you from that. Um So some basic technical considerations which I'm sure all of you already know that it's free. So you will have all um registered, you will be doing the applications. Now when the application deadline is done, you're going to have uh an invite once you're uh long listed, usually happens. Uh uh in, in mid December, we'll go over the syllabus um in a bit. And the thing I would advise you is choose your date wise wisely and it's first come first served. So book as soon as you get the invite, keep an eye out, like have an idea that, ok, we we're gonna get the invite soon um and make sure you book it. So you get it at the best time for you. So you don't wanna be around on calls night. So you wanna have some days before to kind of get your sleep cycle in order not be stressed out from work. Have some time to do that last minute that before the exam try and take your leave, even if it's annual leave it will be well worth it if you use it for this. Um So obviously you've got two sections of the paper as I'm sure you all know, there's the um professional dilemmas paper, which is kind of like the S GT bit, um which is about 95 minutes with 50 questions. Half of them are ranking and half of them are multiple choice questions where um it's three actions that you have to take together. And then the other half are like, they'll give you five options and be like rank this in order of what you should most do and what you should least do. Um And then the other one is the clinical problem solving paper, which is a lot more like the exams you've taken up to this point. There are 97 questions in that half of them are kind of extended matching questions where you'll be given a bunch of options and a bunch of questions will pertain to those set of options and you can have to match. Um And then the others, other half will be SBA where a bunch of options and then you just have to choose one. So the professional dilemmas um this can be a bit of a tricky um topic for you. And a lot of times people just go like, oh, I just can't figure out what the SGTS are all about. You gotta remember. No S GT question will ever ask you about a technical medical theoretical question, they're all gonna be about ethics or uh you know, clinical judgment or prioritization. Um They look at your core competencies, so your profession, uh professional integrity, how you cope with pressure, empathy sensitivity. And it's basically testing what an ideal GMC, good medical practice sho would do in any given situation. So whenever you answer it, don't think what did I do in real life or what did I see being done in real life, kind of just say in an ideal world, in a utopian world where everything was great. We had all the resources all the time in the world. What would the ideal GMC? Good medical practice doctor do? Should you worry about how difficult the exam is? Um Absolutely not because this exam difficulty is relative, right? If it's difficult for you, it's difficult for everybody else. That is not what the exam is testing, it's a competitive exam and all you have to do is be in the top 600 to 700 positions. Your trip will determine that the difficulty of the exam has no role to play in that. It's a game of how much you can walk more than the other people who are taking that exam. And obviously, you know, there are factors that are out of your control. Like luck how you feel on the day, all of that stuff, but that was never in your control. So that's something you should never be worried about. Um, and then the scores are normalized. Um So I'll explain what that is. Um, so you, the difficulty of the test is relevant. As a matter of fact, I would say a more difficult test is a bit better for everybody because in a more difficult test, you know, there's a less likelihood of making silly mistakes like reading the question wrong because if it's a difficult question, most people who got it wrong anyways. Um Whereas if it's an easier exam, there's a chance that everybody will get a lot of the answers, right? And it won't necessarily increase your score because it's a normalized score. So what's a normalized score? It kind of uses your performance, compares it to the average performance of your group. Um And then it kind of says, right, how you compared to that? So ignore the standardized score range on the left because this is kind of applied to each paper. Um And then thi this is kind of the math they use, but it's basically a big algorithm that does it. So um that's how the score I II, it's not just how many write like, you know, one mark for correcting zero marks wrong. It isn't like that. So this is a really nice um quote that um I um I think is very relevant strategy without tactics is the slowest route to victory and tactics without strategy is the noise before defeat. So that means um if you start working without a plan, it's gonna take you ages, it's gonna take you eight months to do what you could have done in four months. And if you keep planning without actually doing anything, you're just gonna be doing a lot of useless things and not gonna achieve your goal. So, um, being an I MG, um, you have some advantages and disadvantages. Um, so I don't know what the cohort of people, um who are attending this talk, uh where they are, what they're doing at this point in time. If you're not yet in the UK, you may not be in a full time job or you may be able to take some time out of your job to be able to revise this full time. Um If you are working, that may not be uh a possibility. Um You would have taken a lot of exams before if you've taken plan and all of these things, you've, you've got that adaptability. Um That is more than normal, especially if you've already come here, you've started working. Um So you have that advantage and never forget that that's something that sets you apart. Um For some of you, English may not be a first language. So that makes some of the S GT questions a little difficult, but that can be overcome with practice. Um Naturally S JT S are purely based on a UK clinical setting. So when you're practicing questions, you may come across terms or phrases that don't make sense. Um And really through practice, you're able to kind of understand what, which terms are important and which are not really relevant to choosing the right answer. Um Anxiety, worry, it's completely normal, it's completely normal to ask yourself. Am I up to the task? Is this even possible? What am I doing? All of those things you're gonna have ups and downs and a stress-free preparation is pure fantasy. It doesn't exist. And the point is you, you do wanna get down on it just because of that because everybody is going through that. You're not alone in that. So how to start? Um I think it's safe to say that with a month and a half to two months for the exam, you should have already started and you should be well into your prep now. Um So yeah, start early. Um I like to break it down by specialty because that allows me to then go through each bit one at a time. Um And essentially like I said, with the quote to reach your destination, you have to know two things where you are and where you're going. So do yourself a favor after this talk. Um After today, the next three, you know, 3 to 6 hours you get whenever that is do a mock exam, I don't care where you are in your prep. It does not matter. No, but he's gonna see the results of your mock except for yourself, but do a mock exam that will give you a very good idea of on this day, this week where you stand and that will show you how much, what's the gap you need to bridge before you reach um where you need to go. So do a walk on the, do a walk and benchmark yourself. I think that's the cornerstone of any good preparation. The materials that um I used were past medicine. Um Past Test and M CQ Bank. Um E Medica is also a very popular resource and it's been cited by a lot of people as it very good, but it's a slightly more expensive resource. Um Not a lot of books I would suggest to read for theory, a past medicine is really good in terms of um giving you um things to read. Um And I think if you combine that with the questions from the other resources, you, you'll be fine. Um The only book I can suggest is the Oxford Assessment Progress Situational Judgment test book. You can find this on Amazon. Um It's quite a good book. I wouldn't put it at the forefront. I'd say if you have some time and if you want some variety and STD questions, then this is a good book with good explanations as to how to go through um those questions and, and what's the logic behind the answers? Um So be, yeah, like I said, be smart about your prep, don't go back and try and do all of medical school again. That's not gonna help you. Um, efficiency is key. Um regardless of whether you're in a full time job or not at this point, because you've got a month and a half left. So you really got to uh be efficient with your time. Um You wanna build a strategy that's personalized to you. Like at this point, you know, all of us have taken loads of exams to get to this stage in life. We know quite well where we, where we are strong, where we're weak, how much we need to sleep when we work the best. Um And sort of how much we are able to do in a day. And if we need to do more than that, where do we make cuts? Xy and Z um it's a marathon, not a sprint. So take time to rest and recover, try to be healthy, sleep well, eat well. Um And I if you're somebody who likes to prep with a group of friends, um find a group of friends who um have the same um gumption as you and don't, don't get stuck with people who are not interested in uh really interested in, in doing this because it will just make you feel like you're missing out. Um when it comes to like core clinical revision, I love to use this app called Microsoft one note. So this is a screenshot from it. And this is kind of how I prepped my, um, for any example, all the exams are taken really. Um, I kind of make these subheadings of subjects and then within the subjects I just make page after page of, of information. Um, and I kind of just put, um, the relevant bits that I find. So if I've read a question on bronchiolitis, I'm gonna make a note on it. And if later down the line, I find something new, I go back to the same note I added so that by the end, I can go through these notes and I've basically covered everything that I've, you know, gone through in my questions. Um You can use screenshots. Um I have a tablet so I write as you can see, I kind of just write into it and it's a really good app. Uh It just comes with your Microsoft office suite. So if you have Word Excel, all of that, you have access to this app, but there are many other apps that you can use. The idea is you wanna make it as easy for yourself to go back and revise as possible. So you can do the most with the time that you have. So the the syllabus is kind of broken down into surgical and medical um and then pediatrics, um and, and reproductive medicine. So a lot of it is medicine. So your core gi cardiovascular infectious disease, uh respiratory um renal, um, all, all of that stuff, pharmacology. Uh, you'll have a bit of psych, you'll have some surgical subjects. So, sort of, uh, gen search ent, um, ophthalmology, um, M, uh, orthopedics and M SK. Um, and, uh, you'll have, uh, pediatrics and OBGYN. So, yeah, I think the other thing is if you, if you find yourself in a spot where the question is, do I want to do more material? Now, I have a limited amount of time left very little. I can either go back and review what I've already done or I can go through new material. The usual answer is go back and review what you've done because all the notes, all the prep in the world is not gonna help you. If you've not been able to go back and look through it a few times, you have to kind of go over it again and again, for it to become solidified in your mind. Most people myself included are not able to retain everything properly. After just one read, you have to kind of go back again and again and again and review your notes and your, um uh your material. What whatever you're studying from S GTs. S GTs are a weird one. They, to me, they didn't make a lot of sense and the kind of way I dealt with them was I would do, um, enough questions um until I was able to look at a question and and tell myself. Right. Ok. I'm able to kind of reduce what they're asking here. And then, right, this is a question on, um, confidentiality, let's say. And then they are asking me about this particular aspect of confidentiality. I know this is what's supposed to be done in the ideal situation. Then I look at the options and I go. Right. Ok. So this is how I'm going to order it based on that fact. Um And you know, the first and the last option are usually pretty straightforward. It's usually the middle options that sometimes you get right. Sometimes you don't, you get wrong. And the only way out of that is you keep practicing until your heart rate goes up and up and it will go up like there's no two ways about it. Um So I've kind of made a bell graph here of um you know, a, a beginner, a novice and an expert. And usually if you're gonna revise just very little material twice, that's not good enough if you're gonna revise lots of material, but only once, that's not good enough. The best way is to do a decent amount of material, revise it more than once and then have a solid theoretical backing. So, you know why you've answered the questions the way you have. So here's a sample question and what I'd like you to do and what I'd like some help with guys is if you guys can, uh when you see the options, just type it away in the chat. Um It's just something I'm not gonna be able to see them because my screen just shows a presentation. But I think it's a useful way to kind of put an option down and then see if you're right or wrong. I only put a couple of sample questions here. Um But so the first one is you've got a 72 year old man who comes to the A&E with chest pain and shortness of breath. Um While taking a history, he becomes more unwell hypotensive and unresponsive. The ECG monitor shows the following rhythm and you've got this rhythm strip here and what's the next most appropriate step in management? So let's give it to say 20 seconds for you guys to think. Let's make it 30 seconds. Are we getting any answers through and check? We're getting mostly, yeah, mostly Bs there and I mhm B and I so far. Yeah. Brilliant. So we're at 30 seconds. Now, here's the next thing that I want you to do. And the reason I'm putting you through this exercise is this is the way I think you should be solving each question, whatever answer you've chosen, write down. Now, you don't have to write this in the chat, just write down why you thought that was the answer and then go through each other option and write down what you think the question should have been. If that should have been the answer. So what would, if B and I are the most common, then what would be the condition you give adenosine for? What would be the condition you give adrenaline for? Where would you give amiodarone? Where would you give max myself? That kind of stuff? Just a quick note. Like, so we'll give that, let's say another minute. Let's give it a minute and a half and just write down what you would, what would be the question for each one of these options? OK. So we'll wait another maybe 30 seconds, right? So the majority of you were, right? So the answer was DC shock and the rhythm that you're seeing here is, is ventricular fibrillation. It's polymorphic, ventricular fibrillation. Uh but it's, it's not polymorphic, it's just ventricular fibrillation, sorry, this is not compatible with life and this is a shockable rhythm. So now the the other option that was the most common was start CPR and there's a reason that's not the answer. So we go back to the question and if you look at the question, now the question is he, so he two, he's come with chest pain. So just underlying the bone stuff. So he's 32. He's come with chest pain, shortness of breath and he becomes more and hypotensive and then he becomes unresponsive. Now, this is the key clincher, he's on an ECG monitor, right? So, uh if a person has got chest pain, shortness of breath hypertensive unresponsive and he's on an ECG monitor, he's probably on a defib and that's where the option is there. Um So the question may say he's on a defib, it may not. But then at that point, you have to assume unfortunately, the questions in the MSR tend to be really vague. Like I remember still one of the questions that was in my MSRA was a person has come um into A&E after a fall down the stairs. What's the most appropriate imaging? And there were other options were like a CT head, an X ray of the spine. This that and then there was one which was a CT trauma and to be fair like it, it, it, it, it could have been any of them. II don't think it was falling down the stairs. It was just a fall and II selected pa scan just because you have to assume the worst and move on. So sometimes questions may not necessarily have all the information, but that's kind of what the question is telling you. It said ECG monitors. So you know that it's immediate uh DC shock and then you start CPR um in real life, you're probably first gonna like try and rouse this person. Look at the monitor, pull the buzzer, start CPR until people come in. Then you're gonna give the shock. Or if you know, if you know how to operate the machine, you're gonna give a shock and then you're gonna start CPR and obviously people will come. So the point I was trying to emphasize with this example is the way you wanna learn from questions isn't just to go. Oh It was DC shock. I was right. Let's move on. That's not how you use a question banks full advantage. You gonna go through each option and you're gonna think when is it gonna be the right answer? How could they question me on this? It takes a little time at first, but you learn a lot from one question. So as you go along, film, start to repeat quite quickly and it really puts you in the right mindset for the exam. So let's just go through each of the options. So when would you give adenosine if it was supraventricular tachycardia or an SVT that we can see on this ECG here. Um When we do the options CD and F with adrenaline, amiodarone and CPR is going to be um um the A S protocol. So it kind of depends on the question where you would be um in, in the, in, in the pathway. So in our pathway, we, we had a monitor on, we had already assessed the rhythm and if it was shockable, it was a shock and then CPR, which is why that was the answer. Um magnesium. So magnesium sulfate, um you're gonna give um in torsade de points and that als also should make you think, right? What are the signs of hypomagnesemia, which is a prolonged pr interval, a prolonged QT interval, you'll get atrial and ventricular ectopy. A predisposition to polymorphic ventricular tachycardia. The specific type of which in hypomagnesemia is to the point of TDP. And um that's when you give magnesium, sodium bicarbonate is uh used to mitigate cardiotoxicity secondary to TCA poisoning. That's the main thing. So, if you've got a history of TCA overdose like amitriptyline or nortriptyline and an evidence of cardiac compromise, that's when you're going to load up the sodium bup. Don't worry about the dosing. They're not gonna ask you about that when you're going to give to, obviously, this is a, a thrombolytic agent. So you're gonna give it uh in, in primary embolism. So you're gonna have a patient with chest pain, shortness of breath, maybe hemoptysis, you're gonna have some risk factors like travel, oral contraceptive pills. If clotting disorders may be factor five laden cancer, they could have a history of DVT, which could be explicitly stated as a DVT or it could just be leg swelling or pain in the calf. Um uh They might give you an ECG with right axis deviation, sinus tachycardia S one Q three T three. And you'll have evidence of hemodynamic uh instability, but uh they wouldn't have already arrested because if they have arrested, then you go back to your als algorithm in your first CPR when you're gonna get calcium. So specifically, it's gonna be calcium gluconate. So that's usually given in um hyperkalemia, severe hyperkalemia. And what it does is it stabilizes the cardiac membrane. Um for all things, ecg I think this website life in the Fast Lane, which is also from where I've taken all the images um is really useful. Um So they explain hypokalemia and hyperkalemia a very nice way they say in hypokalemia, someone's pushing down just before the T wave uh pushing down on the T wave and in hyperkalemia, someone's pulling up the T wave. So you're gonna got T wave inversion that causes ST depression and a prominent T wave in hyperkalemia. It will give you att wave or a tall tented T wave. You, you're gonna have flattening of the uh T wave because you're kind of pulling the QR S um apart and then this gives you a white QR S. So w what do you need to know about hyperkalemia? Obviously, in the electrolyte imbalances. This is an important one. So um you need to address precipitating factors. For example, acute renal failure, you need to stop the aggravating drugs like ace inhibitors. Um You wanna stabilize cardiac membrane, I VG gluconate, then you wanna give short term shift of potassium from extracellular to intracellular fluids. So, insulin dextrose infusions, salbutamol um nebulizations. Long term, you wanna remove potassium from the body with calcium resonium loop diuretics, dialysis. Um And if you've got a potassium of over six in a patient with CKD. Remember you always have to stop ace inhibitors because they're a very high risk of developing hyperkalemia again. So another little tip I think is work on your weaknesses. Do not ignore your weaknesses. So if you've taken this question and at any point, something's got you out. Whether it was the initial answer, whether it was when you went to answer the other options, what questions would you have gotten if you were like, oh, actually, I don't know where sodium bicarbonate is actually used. Um, never think to yourself. I'm a little weak here, but I'll cover it up with being better in another topic because questions are randomized. You don't know if your paper will have more than one question on a topic that you're weak. Um, you want to actively be aware of your weaknesses and whenever you're revising those topics, you have to revise them really hard for me personally on G in pediatrics were really big weaknesses of mine because I've been doing gen med for two years at that point. Um, and you, so I'll just repeat, repeat, repeat. I kept reading them again and again because I don't know what to do if a kid shows up with a rash on some day or something like that. I had to just go over it again and again and again until I remembered it and I promptly forgot it afterwards. I don't know at this point, but it's important for the exam with SG at, it's a little different. Um It's very important to be calm when prepping for the S GT. It's an incredibly frustrating experience. Um Don't take any of it personally. Um A lot of people will do poorly in the S GT the whole time and then in the exam they'll do OK, just because they just kept going in and despite making mistakes, each mistake was hammering some information into your head and that helped them not repeat the mistake again. So professional dilemmas or the ST paper is essentially a set of questions where either you arrange what you should do or you choose three options. Um And like I said, they're gonna ask you what an ideal perfect good medical practice doctor will do in any given situation. Don't take the answers personally. Um And there's always a theme to a question and if you can start recognizing these themes, um it starts to make a lot of sense and you will see a few common themes emerge again and again and again. And that will tell you this is something I really need to read up on because they asked this a lot of times like consent was a good example. Um uh confidentiality is another example. Um you know, uh uh a colleague, you know, some something that a colleague has done, that's unethical is a good example, so on and so forth. So let's do a, a sample question for S GT as well. Um So this is a question. Um You're an F two and you're treating a 72 year old man detained in the psychiatric unit on the section two of the Mental Health Act for Assessment and treatment of schizophrenia. Whilst in hospital, he has a fall and fractures his right hip. The orthopedic registrar advised that he needs an operation, he refuses to have an operation and he doesn't give any reason. Um The registrar is unsure. So he's a typo there, whether he has capacity to make this decision. So, a 72 year old man section two under MHA he's admitted for treatment in schizophrenia, he's fallen, he's broken his right hip. They've offered surgery, he's refused and he's not explained why he just said, I don't want to have it. So the reg just kinda come up to you and he's like, I don't know what to do. This guy says he doesn't want the hip replacement. I asked him, you're not telling me the question is, what are you gonna do? So, these are the five options and I'm gonna give you a solid. Um So let's give it a minute and a half, um, to answer it. Um, and then we'll go over the, the correct answer and if you want, put it in the chart so that you can kind of compare or write it down either way is absolutely fine. So another 10 seconds. So, um, the correct answer was um EA BDC. So uh I've got uh so the, the first one is ex so before we go over the explanation, let's go back to the question, right. So it's an old patient who is admitted under section two of the Mental Health Act, uh which is basically uh your uh admitting the patient to treat the mental health illness, um which can be against their will. Um And um they had a fracture, they've had a fall and they're refusing to have an operation. That's all the information you've given and that they have not explained why to the registrar, right? Um So the way to approach any S TT questions is now to ask yourself, right? What are the testing here? So what they're testing her is um capacity and consent, right? So the next thing you wanna do is, right, what's the ideal GMC? Good medical practice you are going to do? So, what does the GMC tell us the GMC tells us that we should not assume that somebody lacks capacity unless they give us a reasonable reason to assume that if we then assume they may not lack a mental capacity, then we have to assess and see if they have mental capacity. If they do not have mental capacity, then we need to act in their best interests. So that's kind of the framework of the question. So then, right, so what's the most ideal answer? So if you read through the options the most ideal answer is e we're not gonna assume the capacity. We're first gonna ask, why don't you want the operation if they give us a legitimate reason? Like, maybe they're, you know, afraid of the pain or they have had a relative who's had this operation and, and has had lifelong life changing or life ending consequences. That's a reasonable, that's a very reasonable reason to refuse treatment. And maybe they don't know what happens if you don't treat a broken and they're like, oh, maybe it'll heal on itself, uh heal by itself. So um that will be the most appropriate answer. You explor reasons. We're not wanting an operation to assess the capacity based on this, decide on treatment accordingly just because they've got schizophrenia doesn't mean that they lack capacity. And that's the first thing this question is testing, right? So never assume capacity. That's number one second point. So now we're gonna look at what's the worst option because those easiest. So assuming they're having capacity, not having capacity of both wrong, but assuming that they lack capacity is worse because then you're like, oh yeah, you're crazy. You don't have the capacity. I'm gonna do what I think is right for you. That's the worst thing you could do. So he lacks capacity becomes one of the worst options. We got two options here, right? Operate under section two or operate in his best interests, which is worse if you know anything about section two. Section two of the Mental Health Act allows you to admit to treat for a mental health condition. It does not work for a broken hip. So that question is factually wrong and that option, sorry is factually wrong. So, C becomes the worst option, right? You're assuming that he doesn't have capacity because of the mental illness and you're treating it incorrectly. The the next worst option then obviously becomes operate in best interest. So now we've got E at the top and we've got C and D um uh uh at the bottom. So that leaves us with A and B. So either you assess mental capacity and decide treatment based on this or you assume he has capacity and respect his wishes. So we know we know that assuming capacity is again incorrect, assessing mental capacity is right, that you should assess it, but you've missed a step where you shouldn't assume that the capacity isn't there and you need to assess it. So then we know that B comes below A. So now we have E ABCD, uh uh sorry, EA BDC. And that's the answer. So that's kind of how you want to approach N SGT question. And as you kind of do more and more of these questions, you'll get quicker at doing this and then you'll know why you've ran something you've not just kind of gone. Oh, this seems right. That seems right. And that the frustration will be less as to like, why did I get this wrong? I don't understand this thing. Doesn't make any sense. Shut the book, forget about it. Go out, have a walk, whatever, make a coffee, you're a bit more calm, you're a bit more calculated, you know what you're doing. So this is the, a sample question of the other type of questions. So, um, we'll take a, uh, we'll read those questions to your GP, you've got a 14 year old girl who comes to you, um, requesting treatment for a possible sexually transmitted infection. She's been with a 14 year old boyfriend for a year. He's recently admitted to having intercourse with another girl from school and she's worried she might be at risk. Her boyfriend is also a patient at your practice and this is the kind of question where it's asking you to choose the three most appropriate actions to take in this situation. So, a explain that you cannot treat the ST I without parental consent. B assess her symptoms and concerns about a possible infection. Arrange screening c refer her boyfriend to the police as she is under the age of consent to have sex. D refer her to child protection as she is under the age to have consent to have sex. E explore her understanding and maturity to assess if she's competent to make a decision about her medical care. F explain that you need to discuss this with her mother because she's under the age of 16 G, let her know that the there are free condoms available from the family planning clinic at the surgery or look at the all the boyfriend's medical notes for any recent entries, which may be significant. So let's give us a minute to answer that question and then we'll come through to the answer. So, right. So let's analyze this question. So what is this question? Testing? So this question is testing a few things and the multiple choice questions will tend to test more than one concept usually. So they're testing about um something called g competence here, right? So it's, it's an underage child and you are making a decision about her medical treatment. She's come to you in confidence without telling an an adult. Um So or rather you don't know if an adult is involved, they clearly not brought them with them. Um The second thing we need to know about is um is it OK that these two teenagers are um having sex? Um And then the third thing that they're testing you is uh how much leeway do you have to access the boyfriend's medical notes? So, what are the things we need to know about this? So, what we need to do um is, is, is gil competence, right? Which means that if she understands the condition, she understands the risks and benefits of treatment, then she is able to consent to treatment um uh based on Gillis rules So is there any option that allows us to do that? Yes, there is. So there's e so e definitely becomes one of our answers, right? Then one of the options is, is b where you assess the symptoms, concerns about possible infection arranged screening all of those sound reasonable. So most certainly. Yes. And then what's our last option? So explain that you can't treat an sti without parental consent. That's definitely wrong, right? You don't need parental consent to treat it, especially if the patient is getting it competence. Um You may involve the parent if the patient refuses treatment because then that's that, you know, that doesn't fall under the purview of g competence. Refer her boyfriend to the police under the age of consent to have sex. Not true. There's a clause in the GMC that says that if they are of similar age and they're having consensual sex, it's not a crime. Um Refer her to child protection again. No, same reason if you've already decided is the correct answer. Explain that you need to discuss this with her mother as she is under the age of 16. This option has nothing to do with sf incompetence. So no, let her know that condoms are available from the family planning clinic. Yeah, that's something that you could do. So let's put that. So we've got three options. Let's look at the last one. Look at all the boyfriend's medical notes for any recent which might be significant, you'll be breaking consent if you do this and this is not a AAA possible sti is not a reason you're allowed to break consent. So the answer is be and G makes sense. So this question is checking about Gil competence. So you're seeing if they have the maturity to make their own decisions regarding a particular investigation. So he was assessing Gil competence. B was assessing symptoms and G was general advice. Um Why would you need, why are the other answers wrong? So we've, we've discussed this. Um Yeah, so that was the question. So I hope this gives you an idea of how you want to answer a um a best like a best three actions question is you want to go through each option. You want to understand what it's testing, you want to see if you recall that knowledge and then you want to answer accordingly. And that when, then when you get an answer wrong, you'll be able to go through the options and be like, oh yeah, OK, I got this wrong or if it's like, that's not what I remember, then you can go back to the resources and maybe the question that you're doing is wrong. That does happen sometimes. But then you can confidently say the question is wrong. I right. And if you have a doubt, then obviously you wanna approach somebody uh with some guidance to try and figure out what the answer is or if you can't find anything, just assume this is a weird question. It's probably not gonna make its way to the exam because there's so much confusion around it. It's not gonna be a good question. So, benchmark, benchmark, benchmark really important. Um And it's always the worst thing you do a mock, you start calculating the results and you're like, oh shit, it gets better as you reach closer to the exam. But certainly at this stage, you kind of feel like bingo in the main, right? Um Something I'd advise is when you do a mock set exam conditions, switch off the phone, close the door, all of that. Um Don't be tempted to get up. Uh Even if you finish the paper la like I'd say in an exam setting, you ideally go back and revise your questions, do that kind of just train yourself in sitting the exam. So the exam just feels like another mock. Um They take a lot of time to do. So it'll take three hours to do the paper, it'll take lots of time to look through the questions, go over the information, it takes a whole day. So plan accordingly. Don't tell yourself I'm gonna do a mock and then I'm gonna do 100 questions on, you know, this Saturday, it's not gonna happen. You're setting yourself up for failure that way, ok? Um And a good exam taker is only good, not because I'm a natural, good exam. Taker. No, it's because you've taken many exams badly at home in a well controlled environment. Understood where you specifically tend to make mistakes and are mindful of that when you take the exam, which makes you a better exam taker on the day of the exam. Remember that all the prep that you needed to do is done panicking in the last minute, freaking out in the last minute is not gonna help you. The way I like to think about it is that your results are already decided before you walked into the exam. So all you need to do is give yourself the best chance to manifest. That result show up early. So you're not stressed out about time. Keep your head nice and clear, be well fed, be well hydrated, make sure you slept well the night before and do not. And I repeat, do not prove on the exam when it's done. That's something to live by when the exam is done. Go have fun. Forget about the exam. So don't be this guy when you step out of the exam. How did the exam go? I don't know. It's an exam. We'll find out on results day. That's all you need to think. Again, you wanna be surgically precise or sniper precise during the exam, be calm. Each question is a new chance. Forget about the previous questions. Focus on the one that you're doing a nice trick is they'll, they usually give you a glossary of abbreviations in terms. Um So if you find something in a question you don't know, don't just freak out. They go, I don't know anything about this question. It might be something that you'll find in the glossary. Um If the question doesn't make sense, reread the question and train yourself to read the question carefully. Um And lastly, there's no negative marking. So under no circumstances leave an answer blank. If you find an exam, you run out of time, pick random answers. Make sure you put something in for each because you stand a better chance than leaving it blank. Post exam. Relax, pat yourself on the back, forget about the results. Like the way I say is the results is not today means problem. It's tomorrow means problem. So today we can check um I like to have a plan already. So if, if you wanna do something fun tonight, just think about what you're gonna do post exam, make a nice solid executable plan like whatever it could be. If you wanna plan a trip, I'm gonna start planning a trip to go here. If you're gonna give yourself a treat, book the reservation to wherever you want to go. If you're going for something with a significant other, just have that set. So that, you know, let's say Wednesday is my exam Thursday. I'm doing this or Wednesday evening, I'm doing this. It really helped me be motivated when I'm uh when I was preparing so kind of a panic come panic me, if you will, um, panic, you come during the exam after the exam before results and panic after the results, either if the results were not good or if the results were good. And now you've got an interview, um, and that's like kind of the way you wanna try and be. So that's the end of my presentation. Um, I hope I didn't bore you guys. And um, if you've got any questions, I'd be more than happy to um answer them. Oh, sorry, my camera fell down. Ok. I any questions, I don't see any questions. I'm going to child uh link for Mox. So I think it's changed now, but I'm pretty sure e mea still has mocks um in them. Um Past medicine definitely has moocs. Past test has Mox um M CQ Bank and I don't think M CQ Bank had Mo um And then another thing that I did during my prep was um there were Facebook groups and whatsapp groups. They're a bit of a mixed bag. All right, like by all means, join them. Um Sometimes, you know, they can be good. Um, try to ignore them unless you need them. There'll be people discussing questions every day and it can make you a little anxious. So I don't check it regularly. I only check it when I want something from the group. Um or if I have something to contribute like I found an interesting question or something, but oftentimes people will have links to mock or um just, just resources that they could share either free or uh paid um that, that you can do closer to the time. But those three question lines definitely have marks. Great. We have another question. How long did you give yourself to prepare for the test? So I think it varies for um each set of people. Um I had just taken MCP part two at the time. So my MCP part two was in October and then I had some family visiting um during November. So I only started around this time, mid November, but you have to understand that I had already done all of medicine. So I had to mainly focus on the nonmedical and the S TT. Um So if you count my MCP two prep, then, you know, you'd be talking six months before that. But in an ideal situation, I think if you're, let's say an F two who's uh or you just finished your internship, your house observ whatever in your home country and you're, you're, you're going for this exam a solid 4 to 6 months. Um I would say is, is, is adequate time, but obviously, as the time narrows um you up your prep um accordingly to, to compensate for that. Um And I would say be consistent with your revision because spacing out repetition of things is scientifically proven to improve retention. So if you have a week, I would rather you put one hour each day for seven days, then put seven hours on one day, you usually will tend to be more productive. OK? It doesn't seem like we have more questions for now. Um So thank you, Rachel. It was really helpful. I wish like I had the session before I prepared for M sra last year. It would have like saved a lot of my time because I was so chaotic. Didn't know what results is to do or what to do for it. Yeah. Yeah. II hope, I hope it helps. Um And, and it kind of helps to structure things for everyone. No worries. Yeah. So we have speaking next. So when I choose, I was already last year, uh my clinical and S JT part was like totally different. I have like 70 or more difference in my mark. So I thought we thought that having more focus on S JT would be helpful. So Omar has kindly uh volunteered to provide some insights about S JT Omar. Are you there? Yeah, present. Um Hi guys. Nice to meet you all. Uh So let me just load up my presentation number. OK. Can you see my room? Yeah, we can see. I don't know if people in the chat can see as well. Yeah. Um If you're changing slight, we cannot see it. Uh No, I'm just trying to so many tabs open. Um fine. I think you might be able to see any change signs now. Great, cool. Ok, so yeah, nice to meet you guys. Um uh And thank you, you know, for that, for that presentation. It was really good. Um I enjoyed the meme. Um, my memes are not as good unfortunately, but I have been tasked kind of with talking to you about the S JT. Um which in my perspective, at least is probably the more difficult part of the exam. Um So we'll go into that. Uh But yeah, I'm a radiology trainee. Um I own my ST one as uh that I mentioned. So, um you know, I've kind of been through this relatively recently. Um And hopefully I can maybe give you guys some advice a little bit on or maybe some ways to kind of go about doing it. So if you want to get a basic understanding for the MSI, uh although which I've covered that very nicely, maybe a little bit about what the S GT specifically, why it's so difficult and maybe what we can do about it and then maybe cover a little bit of exam technique. Um I'm gonna try and keep this short and sweet, partially because I've been teaching essentially from from midday to day and my brain is slightly melting in my head. Um The other part of it is it's actually quite difficult to teach the S GT. Uh and we'll talk a little bit about that. Um So you guys are probably all aware, aware, but obviously the application date soon. Um they, at least when I made these slides, they had yet to kind of confirm the, the specific window, but they did say at least that they had a, uh, had uh windows in January and February, I think they've been more specific now, but you can always check the, um the application website and they'll kind of be more specific. But we're talking roughly kind of January is when you probably end up sitting the M sra. So as I said, now is probably a good time to start revising if you haven't already. Um Cool. So again, if I covered this, I'm not gonna spend too long on it, but you have a standardized score that's separated into different bands. So, of course, you know, it's not one of those things where you can kind of get 100% and, you know, win the S JT and just get put straight on the consultant road. So it doesn't necessarily work like that. Um You just have to beat everyone else, basically, you have to be better than everyone else, all of the, all of your colleagues um to kind of expand out that, that uh band three cos that's where the time most people tend to be expanding it out. You kind of get here. Now, realistically, these days, you probably the, the cut off on my year. I think was 248, I think for the uh MS sorry. Um So it's probably not going to move much. If it does move, it might move, you know, higher basically. So you, you want to be in that kind of above 250 range to, to have a, a realistic chance, obviously, the higher you are, the better um you'll get better preferences, you're more likely to, you know, get where or to get AAA training post where you want to be um cool an SAT can be the difference maker. So for me personally, um my clinical was only a little bit above average. It was kind of nothing super special, but my SAT score was pretty good. And that's kind of what allowed me to get into, into training program. Um The clinical, you're all medics, you're all doctors, you've all done medical school, you're probably all working as doctors. You know, we know how to study for medical exams because, you know, we're scientists at heart. There's a right, there's a wrong answer. There's pathophysiology that you can think through that you're used to thinking through for years. So it kind, it's kind of um it's somewhat easy for you to, to do that revision, you know what you need to revise, how you need to revise it. But with the SAT, it's a lot more difficult. It is especially the case if you're kind of not from the UK. I like to think of the SAT as a bit of a culture test. It's a test of British culture or more accurately, it's a test of professionalism, which is how you should act as a doctor, how you should act as a professional person. But what does that mean? It's a bit subjective, right. That can be different whether you're living in the UK or Pakistan or India or Sudan or anywhere around the world. Professionalism might mean something slightly different there. And that's where the challenge comes with the SS JT. Um, so you are a little bit disadvantaged. Unfortunately, if you didn't, if you haven't worked here for very long, if you didn't study here or even if you weren't born here, you can be a little bit disadvantaged. There's different communication styles, et cetera, et cetera. Uh, we'll come on to how we might kind of come to get to the bottom of that. The pressure dilemmas for the S JT generally covers kind of three core competencies, professional integrity, coping with pressure, empathy and sensitivity. Um, so these are the kind of things that, you know, that, that they're gonna cover, we'll talk about again how we might understand those things. Um, but, you know, somewhat self evidently, professional integrity is about, you know, um, how you are as a doctor in terms of, you know, do you turn up on time? Do you know what to do in kind of difficult situations? Do you need to, you know, respecting others, professional boundaries, social media rules, uh these kind of things, all coping with pressure, again, somewhat self evident, it can be a very pressured job. They want to know that you can handle pressure, not just kind of in a kind of acute situation whereby, you know, you have to give someone a DC shock or, or, or something like that, but also how do you manage and cope with, you know, balancing your work and life and being able to kind of less the distance as it were as a doctor. Empathy and sensitivity. Obviously, that's something that, that, you know, we're kind of very keen on in the UK, you know, how do you empathize with patients? Are you, do you actively listen, do you respect them, their individuality, et cetera, et cetera? So these are kind of three very broad themes and you might think, ok, well, how do I learn what I need to know to kind of, to, to kind of prove that I can do these things as well and that's where this document comes in. So good medical practice as you all are probably aware, did you see publication that they kind of, you know, that they put out that basically sets out it's the Bible of professionalism, let's put it that way. It's the Bible of medical professionalism or the, or the Torah or whatever and stuff like that. Um But it is the holy book that you are going to be, uh, memorizing and reciting from when it comes to professionalism for better or for worse. The GMT are basically basically in charge of what is and isn't professional and they document good medical practice is, it is basically their way of telling you that. Right. So it would be a bit daft not to read that because it's literally what it means to be professional is written in there. Ok. So you need to read it and you need to read all time because it's gonna set the core foundation of what isn't and isn't, isn't, isn't acceptable what they want from you, what they expect from you, what you must do as they call it, what you should do. Ok? So make sure that you read that document, they, it's not actually that long if you haven't kind of looked at it 30 pages or so, um you can read it in kind of, you know, one sitting really and you can read it a few times and that's what I'm kind of encouraging you to do, right? It's split into kind of four broad categories, knowledge, skills and development. Um So this kind of also includes as well as obviously kind of, you know, what, what it might say on the 10, it includes kind of things like you have to be committed to keeping your knowledge up to date, to engaging in things like Q IP uh and audits and these kind of things. So it tells you what the expectations are there. And if something is in there that they say you must do this or you should do this, what that probably tells you is as a professional, as a professional doctor. These are things that I value or at least we should value and for the purpose of the SAT we do value, right? So this is the stuff that we do value as medical professionals. And so if a question comes up on it in the exam, you can understand, OK, this is a valuable thing that for example AQ IP or an audit, right? And you don't completely dismiss him and some of these things as you know, useless waste of time because the GMT have told you that you should care all patients partnership, communication. So again, this is respecting dignity, things like information, government consent, confidentiality. Again, obviously, it breaks it down into more into like um you know, more than just these simple words, but it will tell you the different rules that they expect you to abide by with regards to these topics. OK. Colleagues, culture, safety, teamwork, you know uh how to act with colleagues, teaching to get involved in that respecting colleagues, taking care of your own wellbeing, all that kind of thing, trust and professionalism, fly, um honesty, integrity, non-discrimination, public trust, social media rules, all this kind of thing. So you can see that this is going to be a very high yield exercise, I feel. So make sure you read good medical practice. I'd read it a few times, you know, maybe once a week, uh, just like Bible study. Um, so, so it goes into your head and so you understand the basics. Ok. Um, obviously as I mentioned before, it has, it has sentences in there. You should do this and you must do this. So, things that are musts are generally kind of hard rules, things that you should are things that you should pay attention to. But you know, if they come into conflict with something else, then maybe, you know, maybe it's not so not as important. Um That's the kind of the another. So priorities is another kind of big part of the SAT now. Unfortunately, we don't have enough time today in this session to talk about this or at least to kind of go through it in depth. But the SAT or at least it's not really called the S JT anymore. But, you know, it's a anachronism and we still call it that based on medical school days. But, you know, situational judgment test or professional dilemmas, right? The point is judgment in a dilemma. The point is they're gonna put you in a difficult situation. They're not gonna ask you straightforward questions like I don't know, um you're about to operate on a patient and the patient says he doesn't want the operation. Do you a operate, do you b not operate that's very clear. Right. But what it's going to do is to put you in a slightly difficult situation where there's doubt or there's, you know, some sort of mystery or something and make you decide what to do. What's your priority in this situation? What should you be focusing on? Right. And there are different things. So there are, you know, there's patient safety, you could focus on that and make that your primary, you know, objective. Um There are things like legal standards. Um I think Michel mentioned a situation about the Mental Capacity Act uh or something like that or the Mental Health Act. I think it was. Um So that's kind of like a legal thing you kind of must abide by. There are things like resource management. So how do I kind of effectively use resources like good medical practice tells me to what does that actually mean? There are things like um you know, professional development of yourself to go into teaching and things like this, there's teamwork. So there's all these different things and what the SAT will do is it will kind of put one against another, it'll fight two things and it's kind of asking you to read between the lines, understand what the question is asking you, what are you, what are the priorities that are kind of um being compared here? And which one takes priority, right? And which of these answers is gonna solve this issue or prioritize the thing that we're talking about in the best way, that's kind of what it's asking you to do. So the skill is trying to like, understand the question and, and try to figure out what it's asking you to do or asking you to kind of compare, figuring out what your priority is and then which of those figuring out which of the answers is kind of best addressing that situation. That's kind of it in a nut nutshell. Um We'll come onto this a little bit later again, but if you can get good at those three things, identifying what the question is talking about where the priorities are and how to kind of address things in the best way possible as defined by the GMC and by the kind of general medical culture, then you'll do pretty well with this exam. Just a brief note on escalation pathways. These are things that you should be aware of as well. Um You know, nurses and doctors have, we're not do doctors aren't in charge of nurses if that makes sense. Um We're two separate roles or two separate kind of line management systems. So if they have an issue with a nurse or another kind of a professional group, it's not necessarily the case that like you're the boss or something like this anyways, um will come by the way, d if anyone's, in fact, I've got the chat and if anyone has any questions, you're welcome to uh put it in the chat. So talk a little bit about exam technique. Um timing. So timing is very important in the sat, especially uh you have 95 minutes to answer about 50 questions. It's around about a minute 54 per question or if we kind of run round it down a little bit about a minute 30. And I kind of encourage people, especially towards the end of their practice to get used to going at that pace, like it's all well and good kind of and, and it's encouraging, it's encouraged even in the beginning to maybe take your time, try and understand the rationales. Um you know, so take your time a little bit more, right? But when you get towards the end, your answers have to come in one minute 30. So your analysis of the question reading, analyzing, you know, picking the best options that has to come in about a minute 30. Ok. So towards the end, make sure you're doing that. So if you're doing mock exams time yourself, because you need to kind of get an idea of what kind of pace you need to be working at. When you review the paper, you can take as much time as you want to kind of absorb the information. But when you do the questions focus on getting it done quickly and this will, this is important for kind of the following reasons. This is how it scored the SG at, um, if you've not seen this before, obviously, um, if I go on here, if you put one, if you put, let's say you don't know the answer is ABCD, E if you put a in slot one, you get four mark. If you put B in slot two, you get four marks C in slot three and so on and so forth. So your maximum score you can get for a question is 20. And we're talking about the rank five questions. You can see that like if you answer, let's say you get two and three or, or B and C the wrong way round. So you've put B and three and um C and two, then you're swapping the, you rather than getting a four for that question, you're gonna get free for that particular bit and rather than getting four for the third one, you're gonna get free for that. So your answer then is 43344. So you're gonna get 18 points, ok? If you get the first one and the last one correct, you're pretty much guaranteed. Something along the lines of like uh 14 points or so what? So you can make mistakes in the SAT or in a particular question and not kind of be penalized way too hard, right? But the only time you can get zero on a question is if you don't answer the question, that's why timing is so critical for the S GT there's no negative marking here. There's no, like if you get him really wrong, they don't say, oh, this guy's clearly an idiot, just kick him off. Right. That's not our work. You don't get any negative marking, but you can get zero if you don't answer the question. So answer the question right. It's catastrophic for you. Basically, if you don't answer the question, you have to do well in like 10 other questions to make up those kind of marks. All right. So time yourself, if you find that like after a minute of, you know, reading and kind of analyzing the question is kind of not super, it's very if, if you feel like it's gonna take you ages to basically think through it, there's a flag button, right? Use the flag. Um for those of you who've sat the the sat for the MSR broadly, you'll know you'll know about the flag button, but you can highlight the question basically. And then when you come to the review stage, right, at the end of the exam, before you submit it, you can go back and see all the questions that you've highlighted. So I'd say look, do a question. If after a minute or even a minute and a half, you're not sorry, apologies. If after a minute you're not getting anywhere, put an answer that you think is roughly correct. Highlight it come back. Worst case scenario, you got it completely wrong. You get a minimum score of eight, but at least you didn't get a zero. Yeah, that's gonna set you back. So use the, use the flag. That's good. 32, I think, I wish I mentioned this as well. But it's this idea that if you can do the first step of kind of identifying or the first two steps identifying what the question is saying, like what it's asking you about and then you can kind of prioritize uh the, the, the kind of you understand where the conflict is and what your priority is. Then you've got a very good chance of getting, you know, a relatively good mark quite easily by just separating them out into good answers, bad answers. So let's take an example whereby, um, I don't know, it's a patient safety issue versus consent or something. In fact, we've got some questions coming up. Uh So we'll, we'll actually, we'll do it in practice. So we'll take this as a prac practice exam or a practice case. You guys can put it in the chat if you like, uh put your answers in the chat. Um I'll just read out for you whilst taking a history from a new patient. She tells you that she was sexually abused by her father as a child, but has since come to terms with this. She later mentions that her father is looking after her eight year old daughter while she is in the hospital. You explained that you will have to inform social services of the possible risks to her daughter. She says that she would not leave her daughter at risk and insists that the information she has given you remains confidential. So your options are to offer her offer to telephone her father to check her daughter's ok. Discuss what you should do with the nurse in charge of uh, discuss what you should do with the nurse in charge of the ward. Discuss what you should do with your clinical supervisor. Explain that it's your duty to discuss this, which I social services. That's why doctor may be at risk. They agree to keep the information confidential but suggests that she try and find alternatives. So you guys feel free to have a go, I'll give you a, a little bit of time. It. Ok. Ok. Ok. Good, good, good, good, good, good. Put your answers in the chat if you can. Ok? And you must be already stumped. Maybe the time is too short. It's a bit of a difficult one. Yeah, that's fine. Don't worry about like the exact answers. Um, I don't, didn't time you to see exactly how long I gave you. But remember if you're ever stuck in the exam, just put an answer flag it come back, right? Sa thank you. Uh, by the way, this is kind of time to practice. So don't worry if you kind of get things wrong, don't feel bad. This is the point of the practice situation as VAR said, if you work hard now, then it becomes easier in your exam. Um So, you know, don't feel any sort of way about, uh, getting things wrong, et cetera. Ok. So a few, a few answers that, so let's go and see what they've said and why. So this is kind of the, the, the, the answers that were given officially, right? So CDB EA, so they've said you should discuss what you us you would do or should do with your clinical supervisor. Then you should explain. Or the next best option is to explain that your duty, explain that it is your duty to discuss social or social services as the adults may be at risk, discuss what you should do with the nurse in charge of the ward, agree to keep the information confidential, um, or offer to telephone her father to check. So, going back to kind of what I was saying, what is this question about? Well, there's two kind of conflicting things here, right? The patient says that she wants us to keep the informa information confidential and you know, we should respect patient confidentiality, shouldn't we? Right. So, so we don't tell anyone. Oh, but um, the daughter is at risk here because she's been left at home with a known pedophile. We do kind of have a, a legal duty to, to protect that child. So what's the, what's the priority here? Is it better to kind of do the legal duty and ignore the patient's kind of confidentiality or is actually, is it confidentiality? That's the priority here when you do enough of these questions, right. You will figure out that it's basically your legal standards, your legal duties. I mean, this is a somewhat obvious case, but a legal duty always comes abo above confidentiality. If you think about situations whereby we break confidentiality. It's things like this, isn't it? It's things like where someone's gonna come to harm. It's things something like your patient has had a stroke and can't has, you know, complete hemianopia. But these, you know, adamant on driving his truck home, uh there's a patient with meningitis going around licking patients or licking other people and you know, you need to, to tell public health authorities about him. Yeah, these are the kind of situations where we break confidentiality and why do we break them? Because actually there's a law that says we can break confidentiality in this, in this situation. So if we were to understand that the, the legal duty here outweighs the, the confidentiality issue for the, for the mother, then we can see that. Ok. CD and B, they're addressing the issue. They're actually basically saying that, look, we're going to break confidential out here and then it's just the bar which is the best way to do it. That's the difference between CD and B. But we know that we can categorize dose three at the top and the other two at the bottom because these three address the problem. These two don't address the problem. E and A while E is just wrong cos we're just gonna be like, yeah, cool. Leave the child with a pile. We're not gonna say anything and a might make things worse because it might just alert the father to, you know, that we're onto it basically. Right. Um So yeah, so that's what I mean by using the 32 rule, trying to understand what the question asking you and what your priorities are in terms of then trying to differentiate between CD and B. There's a few things here that might, um might, what's the word I'm looking for, you know, might basically prioritize one of them over the others. I've highlighted the words, you explain that you'll have to inform social services and then she said she would never leave her daughter at, at risk and insists that the information remains confidential. C and D one is discussing what you should do with your clinical supervisor. One is just telling the patient again. No, I'm gonna tell social services anyway. Why is C better in this case? Cos D is kind of a more direct answer. Well, the reason is because it says you've explained to this patient already that you're gonna have to inform social services and she insists is the word used, insists meaning I don't care what you have to do. This is what I want to happen, right? That, that it remains confidential. So you can see how they would say that OK. D is just gonna be confrontational cos it's just gonna be like I'm telling them, no, you're not telling them, I'm telling them. No, you're not telling them. I'm telling them. No, you're not telling them. I can ignore that and just go straight to see which is good. Cool. I'm just gonna talk to my consultant because I've told you what I'm gonna do. You're not happy about it. Remember you're always an F two in these scenarios, right? So I'm gonna go speak to my senior doctor. That's why it's the higher answer B is better than E and A because at least you're still trying to address the issue, but it's not as good because you're talking to the nurse in charge of the ward. Whereas actually this might be better placed coming from your consultant or from a medical decision. Cool. I hope that makes a level of sense guys. Um If anyone has any particular questions about it, do put them in a chat and I will stop and answer them. Um Otherwise I'm gonna give you another one. Cool. So let's try this one. So your fy one colleague, Amira has been working alongside you during a busy night shift. You've been, you've both been on call for the last seven hours without a break or a meal. Uh Amira has complained that she's feeling dizzy throughout the shift and she tells you she needs to go like she needs to go lie down. But suddenly she faints in the middle of the ward. She regains consciousness two hours later, two hours later, two minutes later. Um but I'm setting a timer. So you guys kinda have an idea of how long you have. Thank you, answers a discuss with Amira whether she will be able to take, undertake her remaining tasks. B ask the nurse to help you transfer Amira onto an A little bed C alert. Your specialty, reg of the of the incident D speak to the patient on the ward. Reassure them that they will be seen too soon. E give a mi a blanket and a cup of water. So feel free to answer it in the chat guys. Good. Thank you. You think? Ok, so that's time. So that's roughly about how long you might have in the exam to kind of read and answer that. Ok. Um Got a couple of answers. So that's good. Um Yeah. Ok. A little bit of variety, but that's fine. I like it. We've got mostly BS and ES towards the front, which is good and most of us are agreeing that Ds and A s are generally towards the end. Cool. So the answer is roughly correct, you're going kind of, you know, close. All right, don't worry if you got like one or two mixed up, that's fine. You can still get a quick, like a, you know, a score of 18 or 16 just if you get them roughly in the right order. So what's this question kind of like? What's the tension in your head if you kind of, you know, do some mindfulness and focus on the, on the, on the feelings going through your heart. When you're reading this question, it's like, oh poor Amira, we need to help her out but oh no, we're professional doctors and we need to make sure that the job gets done, right. Those are the kind of that's the conflicts going through your head. It's I need to take care of my colleague and I need to take care of these patients. And OK, how do I prioritize it? Do I just like, do we just kind of drag a mirror? I don't know off the ward and then just like, I don't know, put another sho in because the job is important and the America can live or die. It's fine as long as the patients get looked after or do we say screw the patients? Um We're all going home now cos Ami Ami is unwell somewhere in the middle. But I'd say the priority as you guys are rightly recognized is actually we look after our our colleague. So again, what you learn from this particular question is OK, looking after your colleagues is more important than managing the resources and making sure the w work gets done. Now, bear in mind that this question doesn't tell you that there's a patient who's, you know, uh using 10 and is very unstable and all that kind of thing. If it did say that the considerations might be a little bit different, you're busy but no one's gonna suffer. There's no patient harm that's coming as a result of the situation with the mayor being unwell and you're not having as much resources to do the work so you can see that. Ok, cool. The, the top answers are B and E. So asking a, a nurse to help you transfer onto a bed or giving her a blanket and a cup of water. I mean, maybe the reason there is cos being on a bed is more comfortable than just putting her on the floor with a cup of water and a blanket. But you know, beggars can't be choosers. Um C is to your specialty training of the incident D and A are kind of the worst answers. D is not so bad, but it's not the priority here. So it shouldn't be at the top, right? The patients. Yes. Ok. Patients are important. We're all there for the patients but they're not suffering as far as we can tell. Don't worry about it. Amir is a priority. A is just a little bit coldhearted, isn't it? Um Discussing a as soon as she wakes up, you're just standing over her face like, hey, you forgot to take bloods on bed three, right? That's not what we're looking for in a doctor. We want someone who's empathetic and all that kind of good stuff, as we mentioned earlier. Yeah. So those are a couple of examples. We can go through some extra tips. I apologize because you know, this is, it takes a little while and this is hard to kind of grasp in one sitting. You really need to take time to absorb this information and to kind of regularly start putting it into practice. But a few tips is as we mentioned, try and identify the underlying principles or the principles asking you to weigh up. Read the question carefully. What does the question tell you? So remember in this situation when we said that the pa the question tells you that you've already explained it to the, to the daughter and she's already insisted that you don't tell. So read that there's other, there's questions where they put in little details that make a difference. Remember, these stems are only like two or three sentences they don't put in there, they don't put things in their willy nilly, they're not gonna tell you about something that's completely irrelevant to the question. If they put it in there, pay attention to it because it's probably it might make a difference. OK. So I mean, another example that comes to mind that we did earlier um with some, some guys is uh a question where the consultant goes off the ward to go do something else and then you've got a decision to make and one of the options was, oh, do I tell the consultant? So I call the consultant, do I bring the consultant back to the ward to answer my question or do I just speak to the reg? And while normally it's a good thing to speak to the consultant if they've made the decision because of the, the, the because the question stem had said that the, the consultants wandered off, right? You don't wanna call them back because they're busy. So you speak to the reg instead, it's these small details that can make a difference. Third point is read the question carefully. What does it not tell you? Right. So in this question, we might assume that, oh, you know, patient safety is the priority and so we need to, you know, d is good because we need to reassure the patients, right? But the question doesn't really say anything about. So trying to call me, um It does, the question doesn't say anything about not patients being at risk, basically, apologies, just texting my dad that I'll call him back. Otherwise I'll get battered um full address the problem for you and ideally yourself. So sometimes often times there will be at least two or three answers, that kind of address the issue. So how do you pick the best one broadly speaking, you wanna address the problem as best as you can. So address the problem fully and try and address it yourself right. There are some situations where that doesn't apply to. Um, it's kind of maybe a bit too much to go into right now, but try and familiarize, familiarize yourself of when it's not appropriate for you to be the one who solves the issue. You'll do that just through kind of constant repetition and doing lots and lots of questions. You realize the specific situations where, oh OK, fine. I'm the F two. In this situation. I don't do this. But for the most part, you try and address the issue yourself, you don't necessarily say, oh, I'll give it to the nurse to sort out or to the doctor or to, you know, the reg to sort out et cetera. Um Five don't be heavy handed. So you don't necessarily need to escalate things straight to the top of the ladder. Much like the pain ladder. You start with paracetamol and Ibuprofen and weak opioids and strong opioids. Generally speaking, you're gonna start with escalating to your reg, to your consultant, to your educational supervisor, to the CEO to, I don't know the GMC um to the health secretary. So going stages there are again as with everything, there's caveats to each rule. So there's some situations where, where you might want to um you know, escalate quicker and you can sure you can think about some of them, it might be situations where, you know, there's immediate risk to patients et cetera. Um The other thing is um as I mentioned earlier, escalate within kind of the line manager pathway if that makes sense. So if you have an issue with the nurse, there's kind of no point telling your consultant. I mean, no, not no point, but it's less good than telling the charge nurse or the sister in charge, right? Those are gonna be the line manager for that nurse as opposed to your consultant. So just sometimes bear that in mind. Six, seek more information if it's a one off problem and don't bother if there's already a pattern. So some questions will, will tell you like, oh, I don't know this, your colleague has turned up late to work. Um What do you do? Do you tell your consultant? Do you go and ask other colleagues if he often turns up late for work, blah, blah, blah, blah. There are some situations where you want to go and ask other colleagues and to check if there's a regular occurrence and that's fine when the question tells you, it's a one off if the question tells you that this person always does this thing, but they're always, I don't know, late. He has a habit of turning up late, the consultants drunk every day, right? In those situations, you actually don't wanna go and talk to other people because that's kind of like spreading the issue larger than it needs to be for no real benefit because you've already established, established a pattern of behavior. All right. So I hope that makes sense. These are just some rules that you guys can, I don't know, make a note of, take a picture of and, and you'll see it. Hopefully, as you practice that these rules apply, obviously, you'll be coming up with some rules yourself as well. So don't forget to do that. So have some rules and then, you know, as you meet kind of new rationales and new rules, you might add to it, et cetera. Cool. Lastly, we'll go through a couple of these best of three questions. So these are the ones where it's like, oh, there's um you know, a stem and there's eight options and you have to pick three of those eight options to uh give a complete answer, you know, or a holistic answer shall we say? So they say that these are three things that are combined that make a good answer if that makes sense. So again, read the scenario carefully, understand what the issue is. Often a few of the answers will address the same kind of element if that makes sense. So when they do that, there's no point, kind of picking um multiple answers that address the same thing if that makes sense and you'll see what I mean when we go through practice questions, um prioritize picking any of that on involve good medical practice guidelines or ethical standards. So if there is something that you need to do legally in a situation, then that's probably gonna be one of the answers, right? Or if the GMC says, says you must do X in this situation, then again, that's probably gonna be one of the good answers. So here's an example. Um I'm gonna set a timer again and then I'm gonna read it out. So a 45 year old alcoholic is admitted in the afternoon of delirium tremens. After stopping drinking two days previously, during the night, you'll call to see him as he becomes very aggressive and is demanding to be allowed home as you arrive on the ward, he punches one of the nurses, he's confused, shouting and threatening other patients. Do you a prescribe extra sedation with the patient? B ask the nursing staff to call hospital security C attempt to talk to the patients, try and calm him down. D reassure the other patients in the ward that they're safe. E ask the nursing staff to help you restrain him. F ask the nursing staff to call the police g inform the patient that his behavior is inappropriate and will not be tolerated. H ensure that the nurse who was punched is not badly injured, Karen. I'll come back to your question and if that's ok, I'm gonna let everyone answer this one. Ok. Can I share the question on the screen? Is it not on the screen because that was timed, by the way? Um, Regina is, is my question, is the question not on the screen? I assume you guys can see the presentation, right? Oh, yes, we can. Ok. Yeah. Good. Yeah, some people can Regina. I don't know if, if it's maybe, I don't know, maybe try to refresh the page that might bring up the presentation again. Perhaps. Cool. Anyways. Um, did anyone have any answers? And I wanna put them in the, in the chat? No, I don, I know you guys saying you can't see the question that I'm asking the sat question. Good. OK. Regina can now Mohamed, maybe you should try and refresh your screen as well. Does don't have any answers? No. OK. That's fine. We'll jump into it. So this was the answer. Ok. Thank you, sir. Beh Good. I mean, not perfect but good. Um So let's go through a few things. So the answer is BBC H, right? So asking the nurse to call hospital security, that's a good answer. Attempt to try and talk to the patient to talk to him, to calm him down. That's a good answer. Apparently. Ensure that the per the nurse who was punched is not badly injured. That's a good answer. So why b so I'm just gonna draw your attention to the idea of the fact, oops that B asking the nurse to call hospital security is very similar to asking the nurse to call the police, right? Which you could argue is also a little bit similar to ask the nurse to help you restrain the patient. So these three answers are trying to stop the, basically, you know, stop the patient from fighting any more nurses. Um And what can you see how it would be superfluous to kind of pick B and F? There's no point calling the police and calling the hospital on current hospital security. Those are kind of addressing the same elements of the question. So you can pick the most appropriate of those ones. Sometimes in these questions, you can kind of group answers like that A and C, um, are also somewhat similar one A is prescribed sedation. C is trying to talk to him to calm him down. Again. They're kind of addressing the issue here. They're trying to prevent him or to, you know, reduce his anxiety or, you know, agitation level shall we say? Um, so again, you, I mean, in, in practice, you could do both and you probably would do both to be honest. But for an S JT question, what's the best answer is? Ok, cool. Well, we'll, the first thing we'll try and do is attempt to talk to him to calm him down. We don't have to go straight to kind of chemical sedation. We try and talk to the patient, which is why C is better than A H um, is obviously about kind of just making sure that the nurse is well looked after again, we mentioned that it is a priority to kind of look after our colleagues as well. So that would kind of make a nice complete answer. Um E generally speaking, we don't restrain patients as doctors and nurses unless there's something very, very severe going on. So I don't know, patients trying to jump out the window or something like this. Um so it's generally not as good an answer. That's what security are there for. Basically they're there, they're there to restrain patients. Um, d is not a bad answer. It's a good answer but it's not the priority answer if that makes sense. So it's fine to reassure other patients, but we don't know that he's attacking other patients or being aggressive to them to be fair. He's seemingly taking it out on the nurses. G is pointless because he is confused. That's the question, right? Trying to have a rational discussion and, you know, tell him off is probably not gonna help much trying to talk him down isn't the same as, I don't know, explaining rationally would debate why his behavior is inappropriate. That's just trying to say, oh, yeah, what's, what's going on? Are you ok? Or, or, you know, all that kind of stuff? Um, cool. So, I hope that kind of answered that question. Um, before we go on to the next one, I'll just go back to current's question. So he says there are subtle lines in queue in queue. Um Oh in the question, give you an indication of where to rank. I don't know if you were referring to a specific question. But it sounds like you're saying if, if the colleague is taking home a patient list because they mention there's no confident Ament. Would you first try and see if you can obtain a confident Ament before I spoke to your consultant? I mean, I've not seen the question but I'd say that generally does sound like a good idea. Um If you can solve the issue, the issue is ok, patients er taking or the colleagues taking confidential waste home. If you can bring a confidential waste bin and tell him here's the waste bin. Start using that. That's probably a good thing. So yeah, it might be towards the higher end of it obviously depends on the specifics of each question. Um Asthma, how is C different to G, I'm guessing you're talking about these ones, right? So that, that's kind of what I was saying C is to try and, and talk to the patient to try and calm him down. The difference between that and G is G is kind of a G is telling the patient that his behavior is inappropriate and will not be tolerated. That's basically being quite firm, quite harsh, this patient, right? And granted his behavior is not tolerated, it's not a good thing. But remember he is confused. He's got delirium t tremors. He's very agitated to fight fire with fire in this situation. To basically, you know, you shout at him, he shouts back at you. You shout at him that's gonna escalate the situation. So if anything, it might make things worse, do you see what I mean? Presumably, the reason he's punching the nurses is because the nurses have basically been telling him you can't leave. So the challenge in this situation is gonna make him worse where c the approaches you're still talking verbally, but the approach is you're trying to calm him down, you're trying to kind of distract him perhaps or maybe address other needs. I don't know. Are you in pain? Is that why you want to leave? Do you want some painkillers? You know, are you very agitated? Do you want some more? Liri blah, blah, blah, blah, that's the difference between C and G. So I hope that made some sense. Uh Cool. We'll do. I think we've got maybe one more of these. Uh So again, I'm gonna set a timer. You're the foundation f two doctor in surgery and you're looking after carry or carry. A 25 year old patient was operated on by your registrar yesterday. You've just taken postoperative blood from Carrie. When the theater nurse bleeps bleeps you, she asks you to add a HIV test to the requests as your surgical registrar sustained the needles to injury while performing Carrie's operation. So do you a have the HIV requested her blood samples? B ask Carrie for permission to check her HIV status. C ask the nurse in charge to speak to Kerri about the needle stick injury. D ask your registrar to contact occupational health. E look up to look up the hospital records to see if there have been previous HIV tests performed in Kerri f. Complete a significant event form. G ask her if she has any risk factors for HIV H discuss the situation with your medical defense organization. So I'll let you guys take a second and try and answer, maybe put your answers in the chat. OK? So that's time. So again, we're roughly trying to simulate the idea of how long you might have in the exam, kind of emphasizes the point you gonna practice at pace. Um Cool any answers? Mm Maybe not. No one's feeling that confident. That's OK. So this is the answer that they've given you B GD. Um So if you didn't know this, like with tests that are kind of like uh virus serology type stuff. So HIV hepatitis um you know, and kind of ST is these kind of things. It's not the kind of uh test that you just take Willy nilly. These are tests that kind of patients have to be specifically consented for, you know, we don't tend to send people for the usual stuff F PCU S and EZ FT S but these ones you do because the implication is broader than just that patient. It might also have an impact on their family and blah, blah, blah, all that kind of stuff, right. So that's why basically adding it to the, to the request is uh is a bad idea. So A B is fine checking permission to asking permission to check her status. C is pointless because it's not really the nurse's responsibility to do this. D is an acceptable answer. Ee is pointless because it's kind of not gonna make a difference. Basically, even if she's had HIV before or hasn't had HIV before, it doesn't really make a difference because you're still gonna want that blood test. If it's not your responsibility to complete a significant event form, you're another one who stick a needle in your hand. G is fine. H is kind of pointless. I don't know why you'd wanna do that. Ok. Uh Does anyone ask a question about that one or does that all kind of, is that all self exposure to some extent? Yeah. Cool. Self-explanatory. I'll take it co so nearly there. Don't worry you can all rest very soon. So how I might recommend to revise, um, is do as many questions as you can get. I think as Michelle said, you do, you can get. So there's two kind of schools of thought. Some people will say, look, don't worry, don't study too much for this because you know, you're never gonna get it correct. And sometimes you can go confuse yourself. I'd say you probably can. If you get, like, if you do a lot of these questions, you can get a better idea for, for a better feel for when you do one thing versus when you do another thing. There is the cos this is a subjective test. This isn't like the clinical part of the, the exam where, you know, there's a right answer. What's this? E CG? There's a right and there's a wrong answer. It's VF it's not, I don't know VT or P EA, right? That's just right or wrong with the SAT questions. It's about judgment. Even consultants will disagree. Even the people who write the questions disagree. That's why they have to almost do like a, an MDT type discussion to, to get to an agreed answer. So, yes, you are gonna get kind of rationales that conflict with each other a little bit, unfortunately. But if you do enough of them, you should get a kind of a good average for how to think when it comes to these things, these er questions. So I would recommend do as many questions as you can. The last point was there's a few practice papers that are like, officially sanctioned. I think there's only like two, maybe three. I would save them towards the end basically. So maybe use them go through them a few times towards the end of uh, of your revision process. Um And in the middle of that, I said, you know, reflect when you get wrong, reflect on it and say, OK, well, why did the answer put it this way as opposed to this way? Right? Is there a rule that you can take away from this or was it just sometimes it was just luck, you just had a slightly different judgment. But if there's a general a rule that you can apply to other questions and try and take that away, consider revising in groups. I know some people don't particularly like that. Some people do. I think it's nice. Um especially for those difficult questions. So maybe you don't have to rise in groups all the time, but maybe even if you just meet with some friends once a week to discuss kind of difficult questions, some kind of SJ T MDT, you know, that would be good. Um It would help you kind of get an idea for what other people think. All right, potential resources. So, I mean, you guys all know about like passed M CQ bank E Medicare. Um I used passed, I probably, if I was, if I had to do the exam again, I probably wouldn't use passed. But that's just me personally, you use whatever you feel is comfortable. I've heard, you know, there's lots of other ones as well. Mind the bleed, by the way, I just put that in there because it has like um, discount codes on there. So if you're going to buy pass Med or M CQ bank or your Medicare, go on mind in the bleep and you can get like 15% off. All helps, um, papers. So, things to read. So there's the UK FP O papers which are the ones that I talked about and those are the kind of officially sanctioned ones I think there's only two of them or three of them. So, you know, but those are important to go through cos they're probably the most accurate resource, right? Good medical practice. The, the document that we mentioned earlier, very important. That's your Bible, reread it a few times. OK. Books. So I've heard lots of good things about this particular book. Um The Oxford kind of S JT book. I didn't actually use it myself, but, you know, it's, it's something that can be recommended a lot. So if you're the kind of person that likes books, go for it courses, so this is where um I have a conflict of interest. So I do run a course. Um Unfortunately, you guys can't join it this time, cos we've already filled the, the slot. So, so I'm not actually selling anything right now, but there are various courses available um online. I'm sure you can find S GT courses and things like this. Obviously, my, my company is called Me Academy, but, you know, use whatever you like um courses if you learn from that kind of thing. Go for it if you really kind of need help, especially perhaps if you've struggled, I'd always say, like take, take the SAT or the M sra at least once by yourself as and see how you do and you might find that actually you do quite well. So brilliant. You don't need anyone help from anyone else. But if you have struggled once or twice and you kind of want the extra help, consider doing a course. Um Lastly because you guys are radiology kind of applicants, I assume um just a few general kind of pointers on the radiology application, be generous with your portfolio points like this doesn't mean lie before any of you report me to the RCR, right. Don't lie on your portfolio, but don't also be too harsh with yourself. Like if something is a national um teaching project or something like that, um Call it a national teaching project, don't kind of play it down to be a bit humble like this is the time to kind of be as generous to yourself as you can and they will mark you down if they want to if they disagree with you and they think no, you're probably stretching the truth here. They'll mark you down. It's fine, right? But be be um generous with yourself, give yourself as many points as you can have a real good, think about what you've done in the past and you know, can you basically use that to your advantage? Uh, Sheikh Ahmed asks, what question would you recommend the post? Um, or the most? I imagine you mean? Um, so Ici can't speak for my experience cos I've only ever really used, passed what I would say. So I, so I, and pass meed wasn't bad. Like, clearly I did. Ok. So it wasn't that bad. But I think if I was to retry it, I'd look at the others. I can't say which one I would do because I've never actually done the others. So I can't say e Medica is really good. I've not tried it, but I, yeah, I would use something else, I think personally, but you can find lots of recommendations from your mates, from these guys on here from Reddit, I imagine. Um Yeah, the Oxford book, if you like books, I recommend uh anyway, going back to this, a wide space question, wide space questions. So this is new because we didn't have it in our yet. But um a few people have asked me um ask me about kind of, you know, advice on this and kind of how to do it. So I think it's one, it's designed for you to kind of give a bit of a description of what you did. So if you did, I don't know a taste a week, you can say, oh, I did a uh one week taste a week in a tertiary hospital or I went and spent three days in AD GH and did some fluoroscopy and interventional radiology and blah, blah, blah. That's fine. Do a little bit of description but try and keep that very concise. Don't use chat GPT guys. Right? Part of the reason I say that is because I don't know, but they might have like an A I detector. So it might be one of those things where they detect that you've used A I and then they, you know, cause a problem, either they, whether they mark you down or kick you out or something like that, right? Number two is Chat GPT is very verbose and superfluous and just it, it talks a lot of bollocks to be frank like it'll be like, 00, I don't know. I can't make it up myself but it's just not concise enough. You need to be very concise with these things. Cos you've only got 100 words be as concise as you can, you can use Chat GPT to give you a structure but then write it yourself. This is my personal opinion and try and relate. So once you've described, try and relate why this experience makes you a good radiologist, right? So you can say, oh, you know, for example, I went on taking a week and that showed me the, the kind of uh the extent that we liaise with other um specialities like surgeons, et cetera, et cetera or um how you know, we have, we have to have such a breadth of medical knowledge because we are diagnosing, you know, a wide variety of, of conditions based on imaging. So, neurosurgical and surgical and medical and blah, blah, blah, blah, I try and reflect on what what it is that you saw that you think would make you a good radiologist and put it in there if you can. Lastly, lastly the interview, the interview is now 60% of your final score, which is a little bit up for us. Cos I think that was 50% for us. The interviews a game. Um Unfortunately, like in an ideal world and it's kind of what I wanted it to be like, oh, they get to know you. Oh yeah, you really, what are you interested in? I'm like, oh, you like a I That's so interesting. Tell me about A I but what they don't care about that stuff, man, what they want you to do is hit. Do you remember when you used to do like osk finals or OSK in med school where it's like, you know, you're doing a cardiology exam and it's like, oh um Osler's notes, Janeway's lesions uh doing this spot that spot, blah, blah, blah. That's kind of what interview like is like. Unfortunately, you have to kind of hit certain targets, certain buzzwords, you have to convince them that you've done XY and Z to meet the person's specification. So it's a massive topic and maybe, you know, at some point in the future I might decide to do a, an interview prep, you know, kind of webinar or something. Um But yeah, it's, it's, it, it's, it's a bit of a game. So just kind of revise for it in similar way as you might revise for an exam as in you write best case answer. So you memorize them and then you regurgitate them in your interview. Um We can, again, I can go into more depth about the interview but maybe now is not the time. Cool. So hopefully we've got a little bit of understanding of the M sra talks about the SAT, what we can do about making it easier. We covered some exam techniques. So I'm hoping that was helpful for you guys. Um If anyone has any questions, I'm more than happy to take them and chat. Maybe can I share my screen? Yeah, maybe if I stop sharing, you can share. Uh um Just mhm Why is it not sharing the other one? Yeah, because if you could can see. Mhm I'm just gonna, while you're sorting yourself out, then I'm just gonna address I mean question. So I know England versus Scotland can be different. A W I, Scotland is coming out in England and G is also available. What one do we go with? That is a great question actually. Um I've never actually considered that. Yeah, maybe Scotland is different to some extent. II imagine so the common law system in the UK, II imagine is probably very similar in kind of the healthcare space that said, I honestly, II don't wanna give you wrong information. I'm not certain I'd have to maybe look into it a little bit. Perhaps when I, one of my colleagues, Dana or uh Vel or one of you guys are aware of this kind of difference, but it's not something I've come across before which, which probably means it's not too big a deal. I don't think it would matter because the exam is standard for all in United Kingdom. Yeah, I think in terms of prep, just prep with the English law. If, if you find a discrepancy, go with the majority because if there's a discrepancy raise which II haven't heard of to this day. But I, if, if you were in doubt, go with, go with the English law rather than the Scottish one. Yeah. Um Yeah. Any more questions about MS or applications or the exam in general. This is a great time to ask questions. I don't, we don't like questions about like if you wanna ask about portfolios or you wanna ask about uh interviews and not that I'm sure we won't mind even for Yeah, exams exam day, I think um cause I took the exam last year and if I thought like one of the difficult things about it is time management because I felt I was just running answering questions a very good time to get back to my flap questions. So I don't know if you guys would provide that advice about that as well. Um Yeah, I think the best way to prepare yourself for time management. Obviously, everyone looks at how much time you have and how much time you have a question. But in the exam, it's not practical to look at the clock after every question and be like, oh, did I, you know, was I a minute and a half for this question? And how far I am. So the best thing to do is to train your mental clock. So when you do mocks and that's sort of why I stress do a mock under exam conditions. Um, after a few mocks that if suppose, you know, the issue is that you, you're running out of time or that you're going too quickly, whatever issue you have will show itself in mocks and do enough of them. And then an internal, you know, you'll have some sort of sense that I think I'm going a bit slow and then you check the clock and be like, oh, yeah, maybe I need to speed up a bit or I'm spending too long on this question. Um, I think that's probably the best way to go about it is, is do timed mocks, um, while prepping and that'll, that'll really help you with, with time management. We all know that you know, let's say you set aside 20 minutes to check your answers and, or go back and look at difficult questions and the rest of the time you have to do 95 questions, then you say the time divided by 95 this is how much time I have per question, but it varies because some questions, you do quicker, some you'll do slower. You won't spend the exact amount of time per question. So if you do that math, every time in your mark, then there'll be a sense of familiarity when you actually take the exam and it won't seem as um as stressful on the day. Oh, so that's helpful. Uh So, uh when we can, we expect the mass already booking invite, uh I don't remember but it's usually not too long after the um application closes down. Yeah. So it'll probably be around mid December, like maybe second week of December roundabout that time, second to third week because they'll, yeah, I think the applications are closing on the 24th this month, right? 21st. Yeah, 21st. So then maybe expected a bit earlier. So they'll need a week or two to sort through all the people who don't meet the essential criteria. And then once they have that list, um barring any technical difficulties from BA in view, which there won't be because BA in view does a bunch of other exams, all your license, you know, driving license test and these are tests all happen there, so they have already booked out the slot. So the invites will go out at the moment. Long listing is completed. So I would say in the third week following your application is when it's most likely to come out, like just add on to the whole timing thing. Um I agree with Michelle you, you're not gonna be able to time every question in the exam. So that's not, that's not what we're telling you to do. We're not saying go in there and time yourself with a stopwatch, but it's the idea of you'll get an idea, as I said, of your mental time slot. So that ok, if you're used to doing it at the right pace, then you'll have an idea if you're going slow or quick. The other thing that you can do is actually, you generally will have a clock in the room somewhere. So you can almost split your exam into say, quarters or halves. So you can kind of get an idea for like a call. Uh Roughly speaking where, um I've got 95 minutes, half of that will be, you know, roughly about 45. So you can say like a call by the time I'm on question 25 I should be about 45 minutes in and then you can reflect, you can look at the, the clock and see, am I miles behind or I need to speed up or actually am I making good pace in which case? Good for you? The key thing is don't leave any questions empty. So even if it's the last minute, just go through and put a random answer in there, it's better than getting zero also. I mean, know the five minute break does not eat into your exam time. It's separate. Yeah. OK. Do you have more questions? All right. I just want to uh probably right, which we host the session also for about uh interview, but that would be after the probably the M sri results and people got shortlisted. So look forward for that. And thanks a lot Michel and er for your session today and your help. It was really informative and really like, I wish I had it before I would have, it would have fixed like a lot of uh things I found difficult during. I was right. Thank you. Thank you very much. Thank you, sir. Pleasure is all ours. Thank you. Thanks guys. All right. Thank you, everyone for attending. Yeah. All the best guys. All the best. That's luck.