Specialty Certificate Examination

Lucy Abbott and Yasmin Kaur Thanks to Fiona Rossiter and Laura Daunt for some of the slides

BGS trainees weekend 07/02/16

Overview

• Preparing for the exam • Exam format & questions • Pass mark and rate • Problems • Practice questions

The exam itself

• Usually held the first Wednesday of March (2nd March 2016) – Apply online through MRCPUK (11th Nov 2015 – 3rd Feb 2016) – Then book Pearson View Centre (9th Dec 2015 – 4th Feb 2016) – £861

• 2 papers, each 3 hours • 100 questions for each paper (best of 5) • This is just under 2 minutes per question • Lunch is only 1 hour- take some food with you! • Results 4 weeks after exam

Questions

• Written by the SCE committee • There is some overlap in topics with MRCP II • Questions are selected from a bank (of around 1600) and

conform to the curriculum blueprint: • https://www.mrcpuk.org/sites/default/files/documents/sce-

geriatric-medicine-blueprint_1.pdf

Questions - blueprint Topic Number questions Acute illness 29

Anaemia/Haematology 1 Dermatology 4 Cardiovascular medicine 1 Endocrine medicine 2 Gastroenterology 3 Infection 4 Musculoskeletal medicine 2 Neurology 4 Renal medicine including fluid/electric imbalance 2 Respiratory medicine 4 Sensory impairment 2

Basic Science and Gerontology 6 Chronic Disease and disability 33

Anaemia/Haematology 1 Dermatology 4 Cardiovascular medicine 1 Endocrine medicine 3 Gastroenterology 3 Infection 4 Musculoskeletal medicine 4 Neurology 4 Renal medicine including fluid/electric imbalance 3 Respiratory medicine 4 Sensory impairment 2

Questions - blueprint Topic Number questions

Cognitive Impairment 20

Dementia 8

Delirium 12

Continence 10

Falls and Poor mobility 16

Geriatric assessment 8

Factors affecting health status 5

Measurement of health status 3

Surgical liaison 3

Intermediate and long term care 9

Nutrition 4

Rehabilitation and transfers of care 14

Subspeciality 48

Palliative care 10

Old age psychiatry 7

Orthogeriatrics and osteoporosis 10

Stroke care 15

Tissue viability 6

Total 200

Questions

• Question writers have to base their question on something concrete: – NICE/SIGN guidelines – DVLA restrictions – Cochrane reviews – CME journal – “Blue book”

• Consult the curriculum – JRCPTB website

Possible resources

Other resources

• BGS website guidelines • BGS trainees weekend

– Variety of core geriatric topics – Practice SCE exam

• Trainees section of BGS website – 5 mock exams • MRCP website - practice questions (also palliative care,

neurology, acute medicine)

Passing the SCE

How useful were the resources?

Setting

• Pearson Vue Test Centres (where you took your driving theory test) • Multiple locations across the UK • Downside is putting up with teenagers taking their theory test • Computer based, with the ability to skip and highlight questions

– Computer tutorial beforehand, and online: http://www.pearsonvue.com/athena/athena.asp

• You are not allowed to leave before the end • Food and drink are not allowed • Need permission to leave the room • Don’t forget your ID!

Results

• 2013 pass mark was 56.8%, 2014: 59.6% • Overall pass rate 2013: 78.6%, 81% for UK doctors

– 2014: 77% passed, 81% for UK doctors

• They want you to pass this exam!

Pass rate at multiple attempts (2013)

Attempt Pass Fail Total

1 94 23 117

2 6 1 7

3 3 2 5

4 0 2 2

Total 103 28 131

Results in specific domains

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Geriatric Medicine Topic Performance - UK Graduates

2011 UKG 2012 UKG 2013 UKG

Problems

• Multiple problems with the delivery of the exam in 2012; no reports of similar issues in 2013/2014/2015 – If you do experience a problem, report it after the exam and it can be

taken into account

• We do have to share the centres- the alternative to this is to pay more and travel further for exclusive access

• Cost- not increasing but still substantial; the exam is still not turning a profit

Conclusions

• Use guidelines and regulations in your revision • Subject breakdown of the exam can be found at mrcpuk.org • Know the curriculum • The exam is fair and is designed for the majority of people to

pass • Problems with exam centres appear to have improved

Any questions?

Example question 1

A 75 year old male with a background history of hypertension and IHD is admitted with falls. On direct questioning, he describes slowing of movements over the past 12/12 and freezing episodes, his gait is slow and hesitant. In terms of confirming his diagnosis, what is the most relevant step/investigation? a) CT Brain b) DAT Scan c) medication review d) referral to physiotherapy e) referral to Parkinson’s Clinic for assessment

Example question 2

An 80 year old male is admitted following falling in the snow, he is complaining of pain in his sacral and right groin region. It is particularly worsened on standing. What is the most appropriate investigation to exclude a sacral insufficiency fracture? a) MRI pelvis b) Bone Scan c) CT Pelvis d) X –ray pelvis e) Clinical assessment

Example question 3 A 94 year old lady with advanced dementia is admitted from home where she has been cared for in bed by her aging husband. Physical examination reveals an elderly lady who appears malnourished with significant sarcopenia. She has a large sacral pressure ulcer. The sore covers an area 15cm by 10cm, the skin has broken down and the ulcer is deep, you can see exposed tendons and bone. The ulcer described would be classed as: a) Grade 1 b) Grade 2 c) Grade 3 d) Grade 4 e) Grade 5

Example question 4 A 76 year old lady is reviewed in the incontinence clinic complaining of a five year history of urinary frequency, urgency and occasional urinary incontinence. She is now having to wear pads 24 hrs a day and is limiting her social interaction due to anxiety regarding ability to access toilet facilities and concerns regarding body odour. Which of the following symptoms is suggestive of stress incontinence? a) I pass urine more than 7 times a day b) My urine flow stops and starts c) I leak small amount of urine d) I have a fullness in my bladder area e) I have an urgent need to pass urine

Example question 5 You review an 81 year old lady in clinic. She gives a history of 3 months of lower back pain for which she has taken Paracetamol and prn NSAID. She is otherwise well and asymptomatic. FBC/UE and Calcium normal. Serum protein electrophoresis reveals Ig G 15.2, Ig A 2.5, IgM 1.0, IgG kappa paraprotein 4.3g/L. Lumbar Xray – mild degenerative changes. What is the most likely diagnosis? a) amyloid b) low grade lymphoma c) monoclonal gammopathy of undetermined significance d) myeloma e) solitary plasma cytoma

Example question 6

Which of the following is most correct? a) The Frailty index is easily usable in clinical medicine b) A Frailty index score of 0.7 is usually incompatible with life c) Frailty is twice as prevalent in men as in women d) Disability and frailty are synonymous e) Co-morbidity and frailty are synonymous