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Hi, everyone. Um Thanks for joining tonight for our talk on just some top tips for the M SRA, which will be coming up for people that are applying to multiple in or have a blood and they said it in January. So we've got Doctor Kyle here with us. He is a one in surgery currently working in the city. So he is kindly offered to do this talk for us tonight. Thank you very much. Um, so yes, I just wanted to talk for like the next sort of 30 40 minutes um on the M SRA exam. Um, before I start, I wanted to just do a little poll to see sort of where everyone's at in terms of our at attendees tonight. So could everyone, um, please reply. Ok, so it's quite mixed with a couple of medical students. Um Majority of those are foundation trainees or just finished foundation training. So, are you applying to specialty training this year? So more people are not applying. Interesting. Um I think out of out of my year group. So I was f two last year. I think only a handful of people actually applied the specialty training Um, so I suppose if, even if you aren't applying this year, what would your chosen specialty be? I presume it will be predominantly core surgery given it's the surgical society. But of course you can apply to more than one, specialty. Fair enough. Most would be sic surgical. Um, and has anyone actually sat the MSR before? I assume most people haven't? Yeah, most people haven't, nearly 90% of the people haven't. Thank you. Um So what is the M sri? So I assume most people have heard of it. And if you are applying this year, you've probably already started preparing for it. It's the Multispecialty recruitment assessment. It's basically a computer based exam. Um And it aims to assess competency to enter postgraduate medical training. Um Initially was introduced for GP trainees. Um That really has been adopted by a lot of other specialties. Um And really nearly every specialty now uses it. Um Obviously, it was new to core surgical training applications last year. Um And do be aware that if you are applying to more than one specialty, which a lot of people do, it's used differently by every specialty. Um So it's worthwhile checking how, how it is specifically used when you're applying. Um So when is it sat? Um and what does the timeline look like? So when you apply through oral, the online system, you will be long listed for your specialty. Essentially your long list thing is, can I think can you speak English or have proof that you can speak English to work in the UK? Um And do you have a medical degree or have completed foundation training or equivalent to be able to apply to specialty training? So essentially everyone meets that criteria. Once you apply, then you'll be invited to register via um patient view. So you'll be sent an email via oral and to book your, your exam, the test when due for this year. So that should be the fourth of January 2024. Um So between the fourth and the 16th of January, um depending on what specialties you're applying to where you're applying to as well and the location that you're currently in different dates um are available within that time period, but everyone sits within that time period. Certainly when I sat out last year, um I was on nights for the first week and then could only then apply for the for dates within the second week and there was only one date that actually worked. So even though it says there's a two week time period, um sometimes there's only actually one or two exam times that actually will suit. Um, when I booked it, it was only one date in Ballymena that I could actually sit up, um, do try and book as early as possible, um to try and get the center or as close to as possible, um, where you want to sit clearly. If you fail to register to sit the exam, then your application is withdrawn. So, um, you can sit it anywhere UK wide. Obviously, if you're based in northern Ireland, you'll, you'll likely sit it as close to where you live, same places where you do the driving test, U KCT and MRC S. If anyone has set those, it's free and registered to sit. Um, so there's no additional cost. Um, and I know there are, there is remote testing is available, but it's only in exceptional circumstances. Um I wanted to just chat briefly um about the rationale for bringing an M SRA for core surgical training. Um Up until the 2002, 2022 application, um The M SRA was not used um and they used a portfolio. So that was your portfolio points to shortlist you. If you scored enough portfolio points, then you got them by the 10th interview and then your offer was based on your portfolio points plus your score. But then for the first time, last year, they brought in the M SRA for core surgical training. Um And essentially what they did was they used the M SRA for short listing. Um And then your offer that is based on your interview score. Um Really why they did it um was because there was a year on year increase in applications. Um So, UK national applications for core surgical training, there was over 2000 applications. If every one of those people submits a portfolio, the portfolio needs verified um by a consultant and that is resource intense. It takes about 100 and 80 consultant days to process these portfolios. So they said it wasn't effective, it wasn't efficient and they couldn't deliver um core surgical recruitment using that portfolio method. So they had a more efficient way to do so. Um so how did they validate the M SRA for core surgical training? Well, they put forward a hypothesis and they said is the M Sra test noninferior to the current portfolio assessment for shortlisting applicants. Um And what they did when they, when they, when they looked at it, they realized that about a third of people who applied a core surgical training also also apply to other specialties that use the M SRA. So about a third of people applying to course surgical training were already sitting the M SRA and then they use a test of significance to establish difference between those who were invited to interview based on their portfolio score um or not based on the M sri score if you look at the second column downs and the mean score. So the main score of people who were invited to interview based on our portfolio, they got an average score of 514 and those who were not invited to interview an average score of 474. And they said that was statistically significant to those who were invited to interview, scored higher on the M SRA and it really shows it in the same sort of way. So the red columns are those who were not invited to interview and the green column, the green bars are those who are interview successful and they are always roughly indicate about the average score of those two groups. So the average score of people who are not successful in getting to interview were lower than those who were a an interview. Um and then looking at the competition ratios for last year, so I appreciate the slides quite small. Um But I've highlighted in red. So they said there was 51 places available, but there was actually 46 jobs in Northern Ireland last year. So you have 564 people applying and only 100 and 42 people were actually interviewed. Um And that is the method as to how they to pick those, those that group of people who they interview from the core group of people who apply all based on the M SRA score. Um It's not that scary. That makes it look absolutely terrifying. Um But it's really not essentially if you do well at MSR, you'll be invited to interview. And if you get an interview, all you have to do is avoid the bottom 5% and you'll get an offer um in the competition ratios that were released for the 2022 intake. They also um told you the lowest ranked offer. So where it says number appoint, so there's 100 and 33 people appoint. It tells you 46 of those people were accepted. But the last person, the 46th person might actually placed 100 and 33 in total in, in that interview score. And all of the people above them that rejected the offer might have actually applied to other specialties and they might have applied to course surgical training nationally. So essentially, if you get to interview, there's a very, very, very high chance you will get an offer. Um So what does the M sra look like? So it's basically an exam which is broken down into two parts professional dilemmas and the clinical problem solving professional dilemmas is essentially the SG at and clinical problem solving is like your medical school finals. So it's the medical questions, two parts, you can take an optional five minute break in between, you can keep going. Um So an exam that lasts 100 and 70 minutes with two parts, the professional dilemmas part. So that's basically the S GT um for foundation training. And what it does is it assesses your understanding of situations and your response to challenging situations requires judgment regarding priorities and your approach to working. And what it aims to do is draw on your general knowledge and understanding of healthcare systems rather than any specific knowledge, it looks to focus on professional attributes and behaviors when interacting with other patients in college. Colleagues broadly lines up with the GMC guidelines, a good medical practice and really is three overarching themes of integrity, coping with pressure and sensitivity. What form up then is the professional dilemma questions take? So it's similar to the S GT that I hope everyone has that um because it will make it much easier to do so in the professional dynamics, part of the paper basically ask you to rank in order the following options in the situation to most, to least appropriate or there's multiple choice questions which there's three of the most appropriate actions to take in any situation. So when I was sitting in the ST ti got a book online that had um little scenarios and I use this again um to prepare for, for the M sra. So really, it's talking about an elderly patient and preassessment for the left hemicolectomy bowel cancer. Um She confides in the situ. Um, she confides in you that the situation is all too much for her to cope. And she says that she doesn't want to go ahead with the surgery and just wants to be left alone to die peacefully. She tells you she feels pressured by her family to go through with the surgery. Um So how do you, how do you tackle this? Well, the best way that I sort of came up with thinking about it was think about the single best answer is the only action that you take. So if you can really do one thing out of the five options, what would it be? So, pick that option and then remove it and then out of the next best option. So the remaining four, what is the single best answer that you could choose? Remove it and then repeat. So in, in this question, um if you look through so aeration that she expressed these thoughts to anyone else and explore her feelings. So a is quite a good answer. It explores reviews and allows you to gain more insight. If you remove a, then what is the best of the remaining answers? So D would be the next best. Um It proves that you're actively listening and are involved with the consultant in the decision if you remove that again. So you left the EB and C. The next best answer then is E nurses are well placed to address, but they're more appropriate for the doctor to explore the concerns. Um If you were to choose, be sorry, is the single best answer? Choose that you don't have the expertise and it's not your responsibility to do so. And then B is ignoring and dismissing the patients. So it's clearly not a good option. The other type of questions that you can get um are they multiple choice questions? So these are the three answers in combination which gives the most appropriate response. And the best way to think about it is multiple actions in the same situation which will then solve the problem. So this is basically a medical student who is looking for you to sign off a and examination that they have done. And so what are the three best options of the below which provide the solution to the problem? Um So it would be de and h so you can ask them to come back later and before the examination again. So that allows them time to go back home, learn the examination and come back and perform it properly. He encourages him to reflect on the examination and it also shows that you're refusing to sign the examination because he has been unable to complete it. Um H is also not a bad option because it offers him material to read up on. And it also proves that you don't sign the, the examination. So those three answers in combination give the best solution. The second part of the paper then is the clinical problem solving. And these are essentially the medical questions that you get asked. It really assesses your ability to apply clinical knowledge and make everyday clinical decisions. And what they say is it's aimed at the level of a trainee in their after a year and it covers all areas of medicine. But clearly, there's some areas that feature more heavily than others. And what I found was dermatology, ophthalmology, peds and G and women's health featured quite heavily clearly because the exam was brought in as a GP exam initially. And the guy actually got asked any surgery questions in the whole exam. So what it does this part assesses your core competencies of investigation, diagnosing actions in an emergency, prescribing and general management of clinical um syndromes. Um What it does is it maps to the foundation curriculum, generic knowledge. It's very similar to medical finals and I think it's actually probably easier than medical finals. Um and it's clearly very gp heavy. What format does this part of the paper take? So it's a single best sponsor that everyone is familiar with. There are apparently some extended matching questions um in a lot of the practice papers that you can get your hands on, but the these never actually come up in my paper. It was all a single best answer. So this is one I took from um oh, I forgot the, the name um the past Med of M sra um it's past me. M sri think. Um So it's basically a 70 year old woman diagnosed with um PMR. She started on predniSONE. What is the most appropriate um bone protection? Actually, I have no idea what the answer is anymore. I think it's probably the last one I don't know. And then the extended matching questions. Um So this is one that's looking at vertigo. So 62 year old man with a three month history of dizziness when he rolls over in bed, episodes last for about 20 seconds. Must be g um 5151 neuro femur through your history of recurrent toxic vertical right ear tinnitus and sensation of fullness. Um I think it's man's disease and then the 33 year old with coryzal symptoms. Um I think that is vestibular neuronitis, but as you can see between the two questions, um, osteoporosis and vertigo, that's quite sort of gp orientated rather than any sort of specialty specific. And how is it marked? So it's one mark um for each correct answer, um, there's multiple marks for question, the professional dilemmas depending on the order which you answer the questions, there's no negative marking, she should answer everything and then your results are posted on a, um against your app application shortlist scores. And that happened uh the end of January last year um for co surgical training. So I suppose how you, how do you prepare? So clearly giving yourself the most time is beneficial. So, start as early as possible. Um Use question banks. There are some courses and other books available. Um, I didn't go any courses. Um, but there, there is one of the mini medic or er course, which I've heard is quite good. Period is very, very expensive. You can also get um, some reversion books as well. Um, the pocket MSR eight is quite good. It only covers the clinical side of things, but it's only 10 lbs on Amazon. So it's probably worthwhile. There are four sample questions um on the health education England M sri page, which is worth the look at to see the sort of level of the questions and how they're, how they're arranged. Um in terms of the question banks then on the right side, um I think past past medicine is probably the most popular. Everyone I think used it last year. Um It was only 25 lbs and you get nearly 3000 questions. If you have time, it's probably worthwhile to use more than one source of question bank and to sort of cover all bases. Um But clearly getting through 3000 questions when you're working as well is pretty challenging. Um So it sort of concludes the, the bulk of the talk. Um Does anyone have any questions um that they wanted to ask you for you to put them into the group chat? Um Thank you. I had a question just about what, like what do you think the most useful resource that you used was um past medicine was definitely the sort of main thing that I used. Um Yeah, so I used pass medicine, went through all the questions, completed all the questions. And then I used the S JT book from final year um to, to practice sort of the S GT questions. I didn't think the S JT or professional dilemma questions were actually that great um on, on past medicine. Fair enough. And I know that in January there's also the MRC S part I sitting. So it's kind of, do you think it would be a bit too much? Probably to study for the M SRA and MRC S at the same time or? Yeah, like M RT SS, probably the most difficult exam I've done to date. Um, if you're, it's difficult because you want to set MRC s and pass MRC S to help with your application um and to help undergo surgical training, but you need to do well, obviously in the MSR to even get an interview. So it's hard, it's hard to say and brief focus on the MSR. OK. Um And then I think Danielle, did you look at any of your final notes or finals notes that you've made for? You don't, you don't have time um to go through everything. Um It would take four or five months to go through all of your finals notes. Um And when you're working, it's impossible. I think to, to go through all that, I think your revision has to be just focused with doing question banks um which will hopefully, hopefully sort of ask the common topics that come up. Um And you can learn it in a sort of focused way. And another thing just in terms of breaking up the revision into the clinical part versus the SAT type part, do you think there's, you should spend equal times on both or, um, if I was to do it again, I would probably focus more on the s tt part. Um, I think it's the part which is more difficult and I say that because I find the clinical side was actually easier. So it was knowledge that you basically already had. Um, you think that when you cover all of the clinical stuff that would take, you know, forever to go through all your clinical knowledge. But I found that it was easier than expected. Um, so I'd probably focus on the S TT part more. Um, the, your t book, um, two seconds. I'll try to find it. It was the one situational judgment test. I'll put it into the child. And do you think the questions were, like, were very similar to the S JT exam? Yeah, they probably were, they probably were. Yeah. So I'm just taping this into the shelf. Yeah. They, they probably were. Um, I think, yeah, I think if you have a solid sort of approach to the questions where you try and sort things in house or locally before you escalate beyond, um, actions which do harm, always go last and doing nothing is better than doing harm and having sort of set rules like that can be quite helpful to try and structure your answer because some of them, I'll be honest, there's three answers which it's very difficult to pick between but if you can see one that does harm then, you know, immediately that goes to the bottom. So you're only dealing with the best of four. so having approaches like that was quite helpful. Mhm. And that's all the questions I heard. If there's any new for, um, Aisling if you're doing well on past medicine, do you think it sa good m sri score probably. Um, I can't remember what I was, what scores I was getting on past medicine. Um But yeah, um yeah, I mean, if you're doing as many questions as possible and you're getting a fairly good score, then it probably stands you in good stead. Um Did you find the exam was paper time? I'm trying to think back now. Um I think I completed it and had enough time to go through every question again, quickly to make sure that I was happy with it. So in terms of time, I think it was ok. Um It wasn't terribly pushed for time. Um But typically when I, when I do multiple choice questions like that, I'm usually quite quick going through the first time. Um So the high yield topics, as I mentioned earlier, they're um dermatology, ophthalmology and gyne women's health, I think feature quite heavily. Um And then of the sort of general medicine, the typical sort of general medical, common cardiology, diabetes and those kinds of things are, are um things that come up time and time again. In terms of unexpected topics. There was nothing I don't think that came up that I hadn't heard of or didn't know about. Um, everything was fairly, very common knowledge, um, common situations, common conditions. Um, there wasn't anything unexpected I didn't think, but thank you very much for the day off and back that was end at the end and ok, thank you.