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Hi, everyone. Welcome to the Northern Ireland Foundation. Trainee societies. Um, third Webinar. Um, tonight we're joined by Mr Adnan Hammond and Mr Sujit gonna Kumar both stu on neurosurgeons in the Royal Hospital. Um, we're going to talk about the top tips for the MSR exam, which obviously everyone's aware that has recently been announced, for course surgical training before, And I got started into the talk, was keen to do a pool. Um, so if I just pop on the polls into the group chat and if everyone, um, just answers So the first one. So what level of training are yacht? And so third f owns the third F to us and the remainder then F three year, we'll post f two. Um, just the next question. Then, um, are you applying the specialty training this year? I assume most people are. And that's why I've joined to have half a replying this year and half are not applying. And then, um, what specialty you're you're applying to. So the 85% course surgical. Um, it's probably because we're a surgical society, obviously. Um and then just one more point. Um, So have you sat the MSRA before. So no one then has sat the m s Sorry before. That's fine. Thanks very much for engaging with that. So really, tonight we just want to give you an overview of what the MSRA exam is and sort of generally what it involves, Um, some tips on how to prepare and then a sort of question answer session at the end with albumin. Sukit. So the MSR I suppose everyone is aware already it's the multi-specialty recruitment assessment. It's a computer based assessment, and it really assess his competency to enter postgraduate medical training. Amateurs by now a whole heap of medical specialties and, um, surgical specialties as well. Um, you can see the sort of range of specialties that use it. Obviously, um, everyone's aware that it's new to court surgical training applications this year, both locally in Northern Ireland and nationally. Um, although do be aware that if you're going to apply for any other specialties alongside sick or surgical training and then choose different and weighted differently in each of the application process is, um so when is it actually sat? So the applications closed tomorrow and afternoon, and that stage then your long listed based it on having actually like a medical degree in and completing a WHO recognized sort of foundation program. Everyone who's successfully long listed and will be invited through through Oriole to register to sit the test. The test is, um, is ran through patient view. The same people that do SJ tea and MRCS exams in the driving test, etcetera, and you'll be invited in sometime in December. Don't think it's actually been released at the official date, and but it goes to your email address. That then is attached to your oral application, so keep an eye out for it. So when you're invited, then you'll you'll be able to to book your exam date. Um, the test window is between the fifth of January and the 17th of January. And to be aware that the different specialties release at different times and and the different you know, there's a different date that you can potentially book. And obviously then if say, if we're all a plan to court surgical training, then and of course, surgical training releases their dates sometime after other specialties there might actually be reduced availability to to book and clearly, if you feel the register and set the MSR, then you MSRA. Then your application will be withdrawn. So where where can you actually sit it? Um, as I said, it's a piercing view. Test centers, and they're UK wide. And but I assume that everyone is keen to sit it in Northern Ireland. As I said, it's the same same format in the same place that you set your driving test, etcetera. The exam itself is free to register, and it's free to sit. But clearly it's not free to to pay and for all the resources that you need to prepare for it. Um, I'm aware that you can apply for remote testing and an exceptional circumstances if that's regard. I was keen to chat about the rationale for the introduction of MSRA for a course surgical training given way that we are a surgical society. And there was two, um, talks around by Health education, England and the committee doing Committee for Surgical Training and a little while ago. And those talks are available on YouTube. If you're interested in watching reckon now long, but you can skip through um so really last year and what the application that looked like you were shortlisted based on portfolio points, and at that stage you were invited for interview and then final offers were based on your portfolio points plus your interview score. But that's changing them this year. 2023 start date your you really shortlisted based on your MSRA score. And we know for knowing that. And they're gonna combine that with the application portfolio. So it'll be a MSRA score plus, um, application slash portfolio points at that stage, and then you'll be invited to interview and offered will be based on your portfolio score, plus an interview. Plus the M s. All right. So why did they? What did they want to bring in in the MSRA for a short listing for court surgical training and will really besides last year, there's been a year on year increase in applications. I think there's 2293 nationally and to verify portfolio points. It's exceptionally resource intense, and they calculated about 100 and 80 consultant days nationally, um, 23 and and verify all those portfolios. And they said that they couldn't deliver a course surgical recruitment, using that portfolio system. It wasn't possible to deliver that. So they needed a different and more efficient way too short list. Um, so how did they validate the M s? Sorry for? For course, surgical training. They put forward this hypothesis is the MSRA test non inferior to the current portfolio assessment for short listing applications. And based on previous applications over the last few years, they had a de facto pilot, and they realized that approximately one third of people who apply for course surgical training actually already had sat the MSRA because they were playing for other specialties at the same time as you can see year on year, approximately a third. And the number was increasing year on year. And so then they used to test the significance. They established the difference between those invited to interview or not based on the MSR a score. So, um, data from last year and you can see that those who were invited to interview had a higher mean score on the MSR they MSRA than those who were not invited. Um, so so, um, this basically just shows the same thing. But but on a graph where those who were not invited to interview, um had a mean, lower meaning score on their MSR on the red tick than than than the green ticks. Who really they felt that that the MSRA could be used for short listing instead of instead of portfolio points. And so what is the actual exam and look like There's two parts. There's a professional dilemmas paper and a clinical problem solving paper, The Professional Dilemmas Paper and comprises of 50 scenarios. 42 questions are actually scored with the pilot questions. Um, so you have 95 minutes to complete the 1st 50 questions, and there is an optional five minute break in between the two parts second clinic clinical problem solving paper, 97 questions and to complete in 75 minutes. So if you think back to medical school, I think it was any questions. In two hours, the Times cut down considerably. Um, so the the first part of professional dilemmas paper was really equivalent to and very similar to the sgot and that we all sat to get into foundation training. Um, it assesses your understanding of situations and challenges, your response to situations, and they say that it requires judgment regarding priorities and how you approach working. And they say that it it draws on general knowledge and understanding of the healthcare system rather than a specific knowledge of, of, say, the specialty involved in the question. It's really looking at your professional attributes and behaviors when interacting with patient's and colleagues and the similar to the sgot. Again, it broadly lines up with G. M C guidelines of give medical practice and the sort of key areas that they like to focus on or based on integrity, coping with pressure and empathy and sensitivity. And there's two main types of questions. They typically come up in the professional dilemmas part ranking questions where you rank in order the following actions. Um, in response to this particular situation most appropriate least appropriate or multiple choice questions where you choose from, say, seven or eight options. The most three most appropriate actions take in a situation. And so I thought I would get sort of a similar kind of question that could potentially come up as an example of a ranking question. Um, it's really an elderly patient and pre assessment clinic for active Hemi colectomy for cancer, she confides. in you that the situation is all too much for her to cope with. And she says you just want to go ahead with surgery. I just want to be left alone to die peacefully. She tells that she feels pressured by her family to go through the surgery. Um, so I think the technique that I use and did use for for S J T and have been using when practicing for them I'm sorry I am coming up is think about the single best answer out of the options. Um, choose it and remove it. And then out of the remaining four options, pick the next single best answer and then remove it and move on. So really, the the answers then and so the most appropriate would be a to explore views and get in. Sit inside. As to why she does not want to go ahead with the surgery. D is the next best answer, and it shows that you're actively listening and you're getting the consultant involved. He is somewhat appropriate, um, involving the nurses there well placed to to listen to your concerns. But it's more appropriate for you. The doctor. The time to explore the concerns. Um, I don't think it's really appropriate. And for Option C just to go ahead and cancel the operation. Um, although it's better than be, which is just ignorant and dismissing the patient. And this is the the other example of multiple choice questions. Basically, and think about the three, um, answers, which in combination would give the most appropriate response to the situation. And it's really helpful to think about multiple actions in the same situation which will solve the problem. And so it's a group of medical students comfort clinical skills, teaching em their final exams are approaching, and you haven't have a very patient, pleasant patient and who consents to being examined. Um, it's a lower limb neurological exam, and the student examines the patient nervous and only remembers to test light, touch appropriate reception. His exact examination technique is also per and then he brings his low, but the low back at the end of the session for signature. So, really, what are the three options available that provide the best response when working together? So really, the question is testing your ability to give honest and constructive feedback, and they don't want you to sign the log book Option D is quite good because it gives them time to read up on the examination and then repeat it at a later time. He is also good because it allows for reflection and they always love reflection. Each again is a good option because it's useful for the student just out of interest. G may appear like a decent option initially, Um, but actually, the signature in the log book is for port forming in the examination rather than just talking through it. And then the second part of the paper is clinical problem solving. And so, really, this is more similar to finals questions, and we're more used to, I think, and it assesses your ability to apply clinical knowledge and make everyday clinical decisions. And they say that it seemed at the level of sort of have an F to train a year, an F one training at the end of their F one year, and it's really broad and can cover any aspect of medicine and surgery. Um, from my practice so far in questions, it seems quite GP heavy, and so they look at a lot of dermatology questions Ophthalmology. Pediatrics in women's health. Um, so really clinical problem solving? Um, part of the paper assesses your core competencies into identifying or investigating properly diagnosing important. A very common conditions. Emergency scenarios such as the ls, uh, algorithm. Prescribing appropriately and recognizing side effects and complications and, uh, deciding on appropriate management. Um, strategies. Um, they say that it maps to the foundation curriculum generic knowledge and really is similar quite similar to medical finals. And it's quite GP heavy in terms of content. So what's the reform that does that look like, well, single best answer and similar again to finals questions and the single best response with amongst five potential answers. And they're also sometimes she's extended matching questions, Um, which is selecting the correct answer from a list of 10 potential answers and given a similar topic or theme. So this is one that I stole from past medicine. Am I? Sorry. Um, it's a single best answer. So it's a just an example of question 71 year old woman diagnosed with Polymyalgia Rhuematica and she started on prednisolone. And what was the most appropriate approach to bone protection? Um, in this scenario, because he's on long term steroids. You started lending it, um, and your calcium and vitamin D Europe eats. That's the correct answer at the bottom. And then again, um, this is an extended marching question. So on the theme of vertigo, I'll give you three separate scenarios, um, and ask you for for the correct answer, the 62 year old man. Three month history of dizziness, many rules who were in bed. Um, episodes last for about 20 seconds. Um, I hope I can get that right. Um, I think it's BPV BPPV and 2nd 1 51 year old female with a three week history of recurrent toxic vertical right here. Tinnitus and then sensation of fullness in her right ear. Um, on testing, there's noted to be right sided hearing loss affecting low frequencies. So I think that's many our disease. And then the last one 33 year old with Kerasal symptoms presents with a one day history of vertigo and nausea. Um, no hearing loss. I think it's a vestibular neuronitis. Um So how how is the actual exam marked? And what about results? Um, a simple one mark awarded for each correct answer. Um, which means that there's multiple marks available for each question. The professional dilemmas part of the paper. There's no negative marking, so you should answer all questions. Even if you don't know the answer, it's probably worthwhile to guess or, um, and then and then flag the question, and then you can review it at the time at the end, if you have time. But you should really aim to answer all questions because there's no negative marking. Um, And then what about results? Um, results are then posted on on the Oriole system against your application short listing score, and that's looking like it'll be late January of next year. Then, for course, surgical training here. Just who's the big question is how do you actually prepare them? The health Education England and the Joint Committee for Surgical Train and say that you don't need to prepare. But clearly, if one person prepares for the exam, they're going to be at an advantage to the rest, so it really forces everyone to prepare, um as much as they can. Obviously, it's easy to start early, Um, and that's the best advice to give. But we're kind of forced for course, surgical training because it was announced so late that we haven't had the luxury of having months in advance to prepare and from reading online and then challenge of people who have done it before. And I think the most common way people prepare is using question banks. Um, there are some available, and I don't think any of them are actually free. Um, over on the right. Um, I try to compile a list of the most common, um, question banks. The people use E Medica seems to get quite good feedback, but it's the most expensive, Um, one month subscriptions, like 49 lbs, I myself have been using past medicine. There's 2750 questions for about 25 lbs past test as well. Um, MCQ banking and Medi body are also advertised. I'm just gonna launch another pool. And if anyone else has started preparing and be interesting just to know what what question banks or other that you've been using? So what resources resources are you using to prepare? So it's interesting. Every 100% are using past medicine. Um, it's probably is is the most. It's the cheapest, and it's probably one that everyone is most familiar with them with With finals. Um, there are crash courses available. Um, I know that E Medica run a Kraemer course. It's 450 lbs. Um, and it's on this weekend. If anyone is really interested, it's really quite expensive. Um, and there are revision books available. Um, there's situational judgment books available on Amazon. Um, and there's a pocket MSR A, which covers the clinical side. I think it it looks at a lot of the guidelines and and summarizes in point. I say it's only 10 lbs in Amazon. If if you wanted something to look at the clinical side, there are four sample questions on the health education England MSRA Page, which is probably worthwhile looking at just to look at the sort of example questions that they use. Although there's only four, um, again, there's there's a Pearson Vue have a page online looking at other the exam format. There's a mock test that they set a mock test, but it doesn't actually have any, um, clinical or professional dilemma questions. It's just a mock, um, mock paper to get used to the exam format. Um, but there's there's no actual practice questions on it. It's It's questions like what color is the sky is green, blue or blue or red? And but it's useful enough, Just maybe in the last week or so before the exam, too, to log on and familiarize yourself with, with the layout of the exam just out of interest and just the final and pull question, I'm just wondering, was anyone would anyone consider, um, going on to a course like the medical course, for example? So a small minority, 22% they're gonna have booked her and tendon booking on a course, Their main you're 77% and wouldn't probably comes down to the cost. So I think at this stage I've covered basically everything. Everything. I wanted to cover regards to the layout of the exam and what it involves. Um, and we'll move on to him to speak to him, maybe are done first. And if you would like to call on his experience within the exam and thanks for joining us. And, uh, Norris. Hi. My name's Adam, uh, near surgery ST one based at the Royal Victoria Hospital in Belfast. Um, I sat the MSRA last year. Um, so in terms of kind of my experience, I'll try and split it into the two parts of the exam. Um, so I'll start with the clinical problem solving section. Um so as car has already said, um, there's a lot of sort of focus on on G P issues, so there's a lot of sort of general medicine. Psych Ochsenbine impedes Um, there's some ophthalmology, some e n t. There's not really a lot of sort of general surgery, um, or any kind of any of the other kind of surgical specialties. Um, it's, as Carr has already said. It's the questions are, um, sort of pitched at a level that's pretty close to medical finals. Um, so it's stuff that that you guys would have already covered. It's just sort of re familiarizing yourself yourself with that, Um and really, I I pretty much exclusively used past medicine. Um, it's actually really good kind of resource for that. That part of the exam, um, you have access to a lot of questions. If you sort of go through the question bank as a whole, um, you have covered most things, Um, and actually, the content and and even the format of of the questions were very similar to To to the actual exam. Um, so I think that that that sort of resource actually works really well for for that part of the exam. Um, I didn't use any other resources. I didn't sort of go on on any courses or anything. Um, so I I think, yeah, sort of sticking to past medicine, trying to get through it, um, would would suffice for for the clinical problem solving section, Um, in terms of the professional dilemmas part of the exam. Um, again, I I did use past medicine. There's a There's a limited number of questions. It's, um, nowhere near the sort of number of questions available. Um, for the other section, Um, and I didn't find them particularly similar to the to the real exam. Um, I did have a look at the sort of I reread essentially the foundation program, Um, s J t practice papers. I think there are two of them. Um, and I think actually, the questions certainly in terms of the format and, um, and the kind of rationale that they used for for answering the questions um, we're a lot more similar to the sort of stuff that that we got, uh, in the MSRA itself. Um, there again, they're not exactly the same, but it's I think it's certainly closer. Um, I I didn't really use any any other resources. Um, there may be some better resources out there in terms of sort of question banks. Um, but it usually you can sort of you can sort of work out what the best answer is. Certainly in terms of the ranking questions, Um, often you can kind of work out what the worst answer is. And it's just sort of trying to rank the question, the the answers in the middle. Um, but if you've got the sort of top answer and and and the worst answer, you've already got quite a lot of points anyway, So, um, you don't I think you don't need to worry about it too much. Um, just in terms of kind of I think general tips for for the MSRA. Just just, um, kind of before and and just just try and relax as much as possible. Try to get a good night's sleep and don't kind of rush through it. I know there's quite a lot of questions, but, um, just try and read the questions carefully. Try and read the answers carefully. Um, I actually found I had quite a lot of time kind of at the end to to reread the question potentially and, um, sort of go through them again. So try and not rush through it. Just just be careful. Um, and I'm sure you're gonna be fine. Thank you. And then can I just ask you How long did did you prepare for the exam? What? When did you start? Uh, so I think I started in October. I think the exam was in January. Um, it's about three months, I think. Thanks, Alan. Um, and then suited, if if you'd like to just talk about your experiences with the exam we appreciated. Great. Uh, my name is surgery. I'm also one of the ST ones in neurosurgery. Thank you very much for having me and also, pretty much, you know, completely agree with what you've been saying, Kyle. And sort of the stuff that Ireland's touch on as well, sort of very important points. Um, I did the exam sort of the year before last, Probably a little bit out of date, but, you know, I don't think the exams changed hugely. Um, with the first part. Yeah, I agree. It's probably more like medical finals, and it's kind of important that because it is like medical finals that you sort of things like, you know, the vaccination schedule impedes and all these things that actually have not touched on for years. And if you've not done a Pete's job, if you've not done know MG job, you probably you know it's not stuff that you sort of keep at the top of your top of mine. At least I didn't. So it's just important to make sure you sort of brush up on these little things, which, you know they might. They might throw a question, which is sort of ask me directly, You know, what age does this vaccine? What what age do you give these vaccines? So it's just small things like that just to brush up on those things. Um, and in terms of the, um, the the S J T esque part of it again, pass med like as as Ireland said, I think Pass Med probably isn't. It's. It's useful to start sort of doing the questions to get an idea of things that you might get asked. But I think sometimes the reasoning I found was perhaps not always the best on past med. So it is worth always, you know, checking the sort of, uh, G M c good medical practice or the official s J T papers just to see if if the if the reasoning doesn't quite look right, maybe it isn't right. And sometimes I don't think Pass Med always get it right. So I think for the first part for this sort of, um, finals esque part of the exam, I think past meds very good for the S J t. As as I said, I would say, probably just treat it with a bit of caution, especially where if you if you think you've done something right and Passman actually tell you it's not quite quite right. Just make sure that actually their reasoning does stand up to other sources. Um, I think one other thing that is quite useful, and I think, especially if you're sort of an F two or doing a job where you don't you know you have a rotor that you're working cause obviously, with finals your your your only sort of job there is you're revising for exams, whereas with the MSRA, you're trying to fit around fit, revision around, sort of work social life, you know, it is it is over Christmas. Um, and so especially if you're in your job, If you've got a zero week, I know it's not ideal, but if you're gonna use up a bit of annual leave, sort of trying to time it so that if once you've once you put your exam whether you can you can or whether you can pick your exam sort of at the end of a zero week. So you've had that week want to be away from the hospital to get some rest and also just a little bit of time to cram some stuff, especially because a lot of the stuff is not stuff that you're going to need to remember day to day, but you're going to need for the exam. So just sort of when planning to sit the exam, even if you have to sit a bit earlier or a bit later, just try to sort of plan it around, maybe annual leave, zero days and other commitments because you don't want to sort of have to sit the exam on A you know, a Monday morning after you've done, you know, a whole weekend weekend have long days, and you've been working for the previous week. You're just gonna be knackered. So I think it is something worth considering actually spending a bit of time sort of planning around, even if you do have to make a swap with a few people, like, I think it is worth it. Sending the exam sort of refreshed and as an NSAID having good night's sleep. And it's quite difficult to do that if you've just been on a sort of, you know, days and you're still thinking about what's going on and work. So just think. Just the thing to be mindful of. And obviously, if you're low coming this year, it's probably a bit easier to have that sort of control. Um, in terms of resources, I'd say I pass med. That's predominant what I use. I think I signed up to the Medica sort of two weeks, three weeks for the exams because I've done the past med questions and was like, Oh, I should probably do something. Um and I did. I think, you know, it's useful to to sort of flick through questions more because I think you just sort of get into a bit of pattern recognition. If you start seeing things, um, just sort of reinforces bits, especially if there's a lot of the exam is sort of nice guidelines space. So it's often just that reinforcing bits, um, of those guidelines. So, yeah, I think more questions, probably the better. I didn't really do any sort of reading or get any book, so I didn't get out. Get out of my finals notes to read through just because you've got a lot to cover and quite a limited amount of time, and I find doing questions the most useful way of learning. But again, you think you have to play to your strengths. And if you have a different way of learning stuff, go with you know you. You know you've done medical school exams for for for 56 years. So, you know, go with the way that you like to revise in the way you like to work. Um, I think that's really it. I'd say in terms, of course, is like, I don't know different people in different ways. But considering you know, the sort of prices that have been quoted, they're seeing quite pricey for what you're getting in. Probably worth subscribing to an extra bank and trying to do a few more questions than paying for quite a pricey course. But, you know, I think that's really it. And you'll be fine. Just it's also a lot of it is just luck of whether you're on a busy job when you're not on a busy job, and you know all these things to bear in mind but and also the fact that, yes, it's an important part of the application process. But it's not the the only part. So there are other areas that you know, still are considered, Um, and can you not to get too stressed about it? Thanks. Think that's all, Um so can I just ask you, How did you find it on the day? Like, did you find that you're rushed for time? Or did you have a lot of time after the end? Or I think so. I I think I probably didn't feel rushed, but I'm someone who usually just spends a bit more time with my questions, and I still, you know, ended up, you know, didn't have didn't have to rush through it. But I didn't really have too much time at the end. But I normally sort of try to pace myself that I get to the end, and I'm sort of near the near the end of the exam. So whereas I guess you can either sort of race through it and go back and look at stuffs like start to look at things, I tend to try to look at things as I go through, and I tend to use try to use, like, way points. So I know that, you know, within, you know, 30 minutes I should be halfway through. And if I'm not, I should speed up. Or if I'm beating well past it, I'm like, Okay, that's fine. Perfect. 20. Um, if anyone has any questions for our nurse, you get, um, feel free to pop it into the chap, and they can try their best answer. Does anyone have any questions? That's that's okay. If you don't That's okay then, um, we can just finish the session. Thanks very much, everyone. For for coming along and joining, I hope it was worthwhile. And I hope you learnt at least something and that you didn't know before. And I wish you all the best, um, for, um, for sitting the exam in January. And I would appreciate if you could fill in, fill in the feedback. And when you do so, then you'll get your certificate for for attending the session. And again, thanks very much to Adnan and search it for for coming along and help it out.