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While competence is measured using workbased assessments such as mini CEXs and DOPSthe knowledge component of the curriculum istested using the SCE. This is now a necessaryrequirement for the award of a Certificate ofCompletion of Training (CCT). Successfulcandidates are awarded a certificate. Those whosubsequently complete all the assessments ofcompetenceand fulfil therequirementsfor a CCT, orwhoseapplications fora Certificate ofEligibility tothe SpecialistRegister (CESR) prove successful, may apply to theJoint Royal Colleges of Physicians’ Training Board(JRCPTB) for permission to use the post-nominal,MRCP(UK) Geriatric Medicine.

The exam consists of two papers of 100single-best-answer (one-from-five) questions, andthe official advice is that it should be takennormally in ST years 5 or 6 though it may be takenin years 4 or 5 (for single CCT trainees or thoseprogressing well with achieved competencies).Delivery of the exam is computer-based and ismanaged by Pearson VUE, a commercial provider,that has access to examination facilities throughoutthe UK and abroad, where SCE candidates may sitthe two papers. Three hours are allowed for eachpaper, with an interval between. The examination issat in all centres and time zones simultaneously andstrict security is observed within the centres by

invigilators. In some small centres availability ofplaces is limited and it is important to apply early tosecure a place.

The 2010 Geriatric Medicine SpecialistCertificate Examination was held on 24th March2010. This represented the first big test with 160candidates sitting the exam. The mean score was63.4% (S.D. = 5.8), with a range of 44.5% – 78.0%.For this diet of the examination it was decided thatthe criterion referenced pass-mark would be used,and this was set at 58% (116/200). This resulted inan overall pass rate of 83.1% (133/160) The passrate for UK trainees was also 83.1% (128/154)which compares favourably with pass rates in otherspecialities, particularly Diabetes andEndocrinology and Gastroenterology where thepass rate was only just over 60%

The exam is not intended to be abottleneck for trainees in their career path. As aspeciality we want to see a large majority of traineespass first time. However, the purpose of the exam

is to identify the smallnumber of traineeswhose knowledge isnot up to the levelrequired for aconsultant. The SCEneeds to be credible asa test of theknowledge required in

the geriatric medicine curriculum and it has tostand up to external scrutiny from regulatorybodies such as the General Medical Council. As aconsequence it may not feel easy.

Not Easy and feels like MRCP(UK)A recent survey of trainees showed that 67

per cent of trainees found the exam more difficultthan expected. Several indicated that many expectedthe knowledge tested by the exam questions toreflect everyday clinical practice and that severalyears of clinical experience should have secured abody of knowledge adequate to ensure success. It isargued that knowledge of clinical science and rarerclinical problems had already been demonstrated inMRCP(UK) and all the other (workplace-based)assessments of competence now focus upon thepractical aspects of specialist medicine. This point

The next Specialist Certificate

Examination in Geriatric Medicine

(SCE) is fast approaching. All

specialist trainees starting a training

programme from 1 August 2007 are

required to have assessments as part of

their training programme.

Passing the Geriatric MedicineSpecialist Certificate Examination

Table 1: Date of 2011 exam with dates for application

SCE Overseas/UK

Opening date

for

applications

Overseas

Closing Date

for

applications

UK closing

date for

applications

Exam date

Geriatric

Medicine

9 December

2010

14 January

2011

4 February

2011

9 March 2011

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needs clarification. The specialty curriculum drawnup in 2007 and updated in 2010 sets out theknowledge, skills and attitudes expected foracquiring a CCT, and for safe and competentpractice as a specialist

(www.jrcptb.org.uk/specialties/ST3-SpR/

Pages/Geriatric.aspx). This follows on from thecurriculum in General (Internal) Medicine andbuilds on core medical training. The knowledge-base required in the Geriatric Medicine curriculum,

and indeed most of curricula ofother specialities, requires ademonstration that a trainee hasretained knowledge of theprinciples underpinning clinicalpractice in the discipline as well asbuilding on the knowledgeacquired in earlier years. This isknowledge that geriatricians useevery day to carry out their duties.The breadth of knowledge for ageriatrician is extensive and coversvarious other specialities. and thisis reflected in the blueprint of theexam (see table opposite). EachSCE Examining Board is chargedwith setting an exam that tests thisscope and depth of knowledge setout in the relevant curriculum.

This means assessingknowledge of the natural historyand pathogenesis of relevantdisorders, and the basic scientificprinciples and evidence baseunderpinning current clinicalpractice, in addition to knowledgeof how to diagnose and manageeveryday clinical problems. Theexams must also include anappropriate number of questionson less common conditionsaffecting old age.

In addition the exam isset according to the same rulebook and style as the MRCP(UK).In particular, the format is best of5 questions. This means that thereis one best answer but the rest ofthe answers are plausible. Beforebeing included in the exam, everyquestion would have beenreviewed and discussed on threeseparate occasions (Question-writing peer-review meeting,Examining Board meeting andStandard Setting Group meeting)by 18-22 geriatricians. Themembers participating in thevarious groups are in the big part‘jobbing’ geriatricians and a small

Topic Number of

questions

• Basic science and gerontology

• Geriatric assessment

Factors affecting health status

Measurement of health status

• Acute illness

Cardiovascular medicine

Respiratory medicine

Gastroenterology

Endocrine medicine

Renal medicine including fluid/electric imbalance

Neurology

Sensory impairment

Dermatology

Musculoskeletal medicine

Anaemia/Haematology

Infection

• Chronic disease and disability

Cardiovascular medicine

Respiratory medicine

Gastroenterology

Endocrine medicine

Renal medicine including fluid/electric imbalance

Neurology

Sensory impairment

Dermatology

Musculoskeletal medicine

Anaemia/Haematology

Infection

• Rehabilitation and multidisciplinary teamworking

• Planning transfers of care, including discharge

• Intermediate care and community practice

• Long term (continuing care)

• Falls

• Cognitive Impairment (Delirium and Dementia)

Delirium

Dementia

• Continence

• Poor mobility

• Nutrition

• Tissue viability

• Homeostasis

• Subspecialty topics

Palliative care

Orthogeriatrics and osteoporosis

Old age psychiatry

Stroke care

TOTAL NUMBER OF QUESTIONS

Questions in each category are distributed across both papers

10 - 14

3 - 5

1 - 3

3 - 5

3 - 5

3 - 5

1 - 3

1 - 3

5 - 7

1 - 3

1 - 2

3 - 5

1 - 3

4 - 8

3 - 5

5 - 7

3 - 5

3 - 5

3 - 5

3 - 5

1 - 3

1 - 2

3 - 5

1 - 3

4 - 8

6 - 10

2 - 6

2 - 6

1 - 3

8 - 12

4 - 8

8 - 12

8 - 12

2 - 6

4 - 8

1 - 3

6 - 10

6 - 10

4 - 8

12 - 16

200

number of academics. Every attempt is made atthese meetings to achieve a consensus regarding thereadability and clarity of each question, thecorrectness of the answer key, and the relativeincorrectness of the alternative options (thedistractors). Without consensus, a question wouldnot be approved for use. The exam thereforewould inevitably feel to many like MRCP (UK).

Passing the Exam1. Become familiar with the specialtycurriculum. The knowledge necessary to passthe SCE cannot be acquired from clinicalpractice alone. At every stage of one’scontinuing professional development (andthis applies to consultants as well astrainees), clinical experience has to becomplemented by private study. 2. Know the blueprint of the 2011exam (see table above). Note thedistribution of questions and planstudy time accordingly. There will bequestions on the diagnosis andmanagement of acute and chronic general medicalconditions affecting old people as well as questionson specific diseases such as dementia and stroke.Rehabilitation (general, stroke and orthogeriatric)will also be tested and this would require someknowledge of aids and appliances and basicprincipals of rehabilitation. 3. The big difficulty in the preparation forthe exam is the relative dearth of sample questionsavailable to practice. To date there are only 10questions on the website. It is the intention of thecollege to increase these in the near future. It hasnot been possible to make questions available so faras it would mean depleting the questions in thebank that are available for use in the exam. Thiswould have an impact on the cost of the examwhich, I am sure all agree, is too expensive as it is.As the question bank size increases this will berectified although this is unlikely to be done in timefor the 2011 exam. As mentioned above the examdoes feel to many like MRCP (UK). A traineecolleague suggested that prospective candidatesmight get a good feel of the exam by revisitingMRCP(UK) books with the best of five questionsformat, identifying questions about conditions thatcan be seen in old age. I think this is an excellentsuggestion. 4. The curriculum has a recommendedreading list. This is rather cumbersome and it is notpossible to read all that is in it. It would beadvisable to read a text of appropriate length thatwould cover most areas in the curriculum and use

reference books selectively. The college iscommitted to set answers that would be consistentwith NICE and SIGN guidelines for appropriatequestions.

ConclusionTo date it has not been possible to providefeedback about performance to unsuccessfulcandidates However, one major recent activity wasthe completion of the coding of banked questions,so that the knowledge sought by each question cannow be related to the relevant section of thespecialty’s curriculum. It is anticipated that thecollege will be able to provide feedback tocandidates sitting the exam in 2011. While this goessome way to help with subsequent attempts, theaim is to ensure that as many trainees as possiblepass their SCE first time so this information wouldbe relevant to a minority only.

There is an inevitable sense of apprehension byprospective candidates in the run up to the exambut one needs to be reassured that as a speciality wedo not want to create a bottleneck in the careerprogression of trainees and we hope for repeatperformances as in previous exams with the bigmajority of trainees passing first time.

Michael Vassallo

Clinical Lead for SCE in Geriatric Medicine

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SCE - Your Views

Following last year’s sitting of theSpecialist Certificate ExaminationGeriatric Medicine, we askedtrainees to complete ananonymous survey to help guide

both the future SCE exams and othertrainees.

The survey was completed by 59 of the 160 who

took the exam. What was striking was that in

response to the question ‘The SCE was

easier/as/harder than expected’ 67per cent felt the

exam was harder than they expected, with only 6

per cent feeling it was easier.

Below are quotes from some of the openquestions. I hope you will find them helpful:

We asked trainees to give examples of topics

that were “not what you had expected or felt

prepared for”.

• ‘Dementia subtype recognition’

• ‘Questions re life expectancy at birth’

• ‘Most of the questions I recall were based on

clinical scenarios, akin to MRCP part 2.

• ‘Precise percentages of ABCD2 score outcomes

and percentages and detailed numbers of

gerontology and science of ageing.’

The following are quotes in response to asking

for topics “ you were well prepared for”:

• Falls and bone protection, questions on

incontinence

• Various scenarios about different types of memory

loss and most likely diagnosis

• Collapsed elderly patient who presents

bradycardic, hypotensive and hypothermic.

• What is the CHADs score / ABCD2 score etc

We also asked people for specific comments about

the exam. I gleaned from this section, as well as

from talking to trainees, that on the whole, people

felt underprepared. It is inevitable that any new

exam is a bit of a walk into the unknown, especially

when one compares it to the MRCP where there is

a wealth of information out there to help one

prepare.

I trust that the results of this survey, together with

Mike’s article above, will help prospective exam

candidates to appreciate that there is a certain

amount of book work needed and that having

undertaken the preparation, will feel a bit better

about doing the exam. The recurring theme was

that the exam felt a bit like MRCP 2 questions, and

bearing in mind it is an RCP exam this is not

surprising. One may benefit from scanning through

some part 2 question books, just to get used to the

style of questions.

On the positive side, trainees felt that it was a good

opportunity to focus their learning of geriatrics and

many people welcomed that. It also means one is

compelled to study the parts of the curriculum that

are maybe not taught well locally, thus broadening

one’s knowledge.

From the survey, I think it is fair to say there is still a

certain degree of disgruntlement about having to do

this. This particular battle is lost and the exam is

here to stay, so we must prepare candidates as

best we can with as much information as we can

provide. I am slightly wary however, of an MRCP

style revision industry building, benefitting only

course organisers and book publishers financially,

and hitting trainees’ pockets (again). The issue of

the cost of the exam in future sittings will be

watched closely by the Trainees Committee. I would

certainly vigorously oppose any significant increase

to the fee. The justification for the high fee was

based on initial setting up costs, and the College

suggests it will ‘break even’ in a few years. At this

point, we need to push for a fee reduction.

I do hope that this survey and further information

given by the SCE organisers this year will begin to

make taking the exam feel less stressful.

Thomas JacksonChairman, Trainees’ Group