More MRCS Exam stuff!

Sorry but it has been brought to my attention that I forgot to post the two clinical skills stations which
I received. They were both single examiner and 9 minutes in length.

1) The scenario was someone was involved in an RTA and you needed to put in a cannula and write up fluids. Things to remember are confirm patient ID, correctly insert cannula and write up drug chart. After this it becomes an ATLS viva where thy quiz you on management of trauma. Its not a difficult station if you stay calm.
2) The second station was to excise a benign appearing lesion as your consultant was going to do it but he had to run to theatre. You have to pick the blade and suture you need to use and mount the scalpel (I found this the trickiest bit as my hands were shaking). Remember to check consent form, infiltrate with local and give advise as to when to remove stitches, how long to leave dressing and when histology will be back. Also give follow up details.

Hope this helps!

MRCS Stations - Efficiency Of Time Critical

With the next sitting of MRCS rapidly approaching, I thought that I would post what stations I got in the exam in May to help give you an idea of what the exam was like. Obviously, you need to prepare for the probability that anything can come up but this may help give you a flavour of what to expect.


So the exam is done at the Royal College of Surgeons HQ in London if you're sitting at the English College. The exam is split over two floors with chaperones escorting you between stations. There was also a 20 minute break half way through the exam with tea and biscuits which I must admit was very welcome!


On the day, you register and put your things in a locker (do not forget to put away your mobile otherwise its an instant fail!). You are then split into two groups and do a circuit of 9 stations then a break followed by the second circuit. Here were my stations:

Rest station

Head and neck: asked to examine a neck. On exam patient had enlarged left lobe of thyroid. I examined her neck and then I said I would like to examine the rest of her thyroid system. So I looked for proximal myopathy, exophthalmos, lid lag, AF, myxoedema etc… when I was done I said that she was euthyroid but with an enlarged left lobe. I was asked for differential diagnoses, investigations and management plans. Then I was asked to talk about different cancers of thyroid (so I did the whole epidemiology, pathology, investigations and management of each…). Good station, I finished early and had a nice chat with examiner and patient.

Investigations station: I got a CXR which showed NG in bronchus as well as the patients notes and asked to comment (basically SHO did NG tube then left at 17:30 without handing over for anyone to check. Patient then NG fed erroneously and ends up in ITU with respiratory distress). The examiner was an anaesthetist who was very quick with questions so you had to answer quickly. Asked what management of patient was (obviously remove and replace tube immediately). Second was a CT abdo slice of px and blood results. Diagnosis was acute cholecystitis and gallstones in gall bladder. Asked about management. Simple station but it was rushed and you have to think fast.

Examination of Resp system: patient needed elective inguinal hernia repair. I immediately looked around room and spotted inhalers. He had hypo-expanded chest and expiratory wheeze. I diagnosed COPD and was asked how this affects his management. So I mentioned getting pulmonary function tests, optimisation of his COPD treatment, informing HDU as although it is normally a day case procedure he may have difficulties, let surgeon and anaesthetist know. I also mentioned consider use of regional anaesthesia.

HISTORY 1: Back pain in a gardener. Toe is numb. Pain radiates to right leg and increased urinary frequency. She was constipated but was using dihydrocodeine for back pain. My differential was L5/S1 herniation of disc or sciatica. I said I needed to thoroughly examine and exclude cauda equine (MRI if necessary). I said if suspect cauda equine admit immediately, otherwise MRI as outpatient, analgesia, physio and discuss scans with spinal surgeon in case needs decompression if disc prolapse.

HISTORY 2: basically woman with panic attacks. Asked to give a string of differentials so I said asthma, heart failure, vasovagal syncope, angina… For management I said investigate by doing bloods, CXR, echo, PFT and inform anaesthetist, surgeon as well as relatives as she may need support prior to surgery.

Abdo Exam: Asked to examine abdo of patient with abdo pain but patient kept refusing to let me see her abdo so I examined her by piece meal. I also forgot to look at obs chart first so examiner got upset at that (even though he had it hidden in his hand). Handed a piece of paper with urine analysis. There was bilirubin in her urine though she was not jaundiced. Pain was epigastric. I said cholecystitis, pancreatitis, gastritis as differentials and ran ourt of time. Everyone else said they had a tough time with the patient and examiner as neither were helpful. Examiner didn’t ask clear questions.

HISTORY 3: primary school teacher with change in bowel habit, LIF pain and mucous PR. She is adopted and does not know her biological family. So I gave IBD, hereditary bowel ca and said if she was old I may hink diverticulitis but she was only 30!. I would investigate with flex then colonoscopy if needed, barium enema/CT depending on scope results.

  

EXAM Ortho: hip exam of someone with pain in left hip, has scar on right hip, reduced flexion of left hip, fixed flexion deformity on right and small leg length discrepancy (I asked to measure his leg length so examiner got a tape measure out of his pocket). Tested trendelneberg which was normal. I gave differential of OA and then he asked what else so I said RA reluctantly. I said I wanted to do an xray of his hips. Asked about management so I said analgesia, physio, hip replacement if indicated but he wanted to know what else (think he wanted me to say bisphosphonates and calcichew which slipped my mind despite orthogeris).

TELEPHONE: 10 minutes to read patient notes investigations etc in one room then asked call the trauma consultant). Scenario is RTA of 23 year old male. ?free fluid in left paracolic gutter and absent pulses. ?compartment syndrome/critical leg ischaemia and possible head injury. Asked what I would do and said CT head and abdo if stable. Asked how to investigate leg. I said I would also consent patient for laparotomy, fasciotomy and possible leg amputation.  Then ran out of time.

REST

Anatomy 1: examiner pointed at bladder, vas deferens, seminal vesicles etc… asked about blood supply and posterior relations of bladder. Also types of bladder cancer (yay shistosomiasis!)

  

Anatomy 2: surface anatomy of ankle. Asked to point out peroneus longus, brevis and tertius. Where do they originate and insert? What happens to foot if tibialis anterior and posterior contract together? Where is EHL and EDL (Surface marking). What are the roots fof the knee and ankle reflexes. Demonstrate knee and ankle jerk. Demonstrate foot pulses. If patient had crush injury what is he at risk of? Sensory distribution of deep peroneal, saphenous, sural and S1?

Anatomy 3: Abdomen. Asked to find ascending colon on cadaver. Where is appendix, caecum and ileum. Demonstrate internal and external oblique. Nerve supply to external oblique. What makes the conjoint tendon and the nerve supply? Which nerve gets damaged in inguinal hernia repair and how does it present? Asked to name all the positions that the appendix can lie in. why does pain refer to RIF? 

CRITICAL CARE 1: 2 examiners, both anesthetists. Given vignette of patient who had TURP and is now confused, hypotensive and hyponatraemic. I said Trans uretheral resection of prostate syndrome likely diagnosis but differentials maybe sepsis, hypovolaemic shock and explained why it was not these things. Asked why TURPS occurs, so I said due to the osmotic actions of glycine the asked what glycine is. I said an amino acid. Then asked why confusion?  So I said that glycine breaks down into ammonia and causes confusion.  Asked what other conditions this occurs in and I said hepatic encephalopathy. Asked management so i said in ITU/HDU and went through how to carefully manage his acute issues.

PATHOLOGY: vignette of someone with gastric ca. asked about epidemiology, pathophysiology, investigations and management. Shown another vignette of patient at 6 months post op now with swollen abdomen so I said ascites likely die to peritoneal mets. Asked how to investigate and overall management in light of all this.

COMM SKILLS: given ten minutes to read patients notes and investigations. Then to explain to patient with obstruction and perforation why he needs surgery. Also explained stoma formation, complications, how long he needs it for…

CRITICAL CARE 2: 2 examiners and 20 minute station. Vignette on someone who had accident, swollen leg, renal impairment etc… discussed that problems due to crush syndrome and resulting rhabdomyolysis. Talked about acute management of his rhabdomyolysis.      

1)  All in all a fair exam in that examiners do give you a chance to prove yourself but you effectively only have 6 minutes to examine/take history and present findings in order to be able to answer as many questions as possible to score points. Most people have the knowledge but you need to compose yourself and be professional at all times! I hope this helps a little in preparing for the exams and I wish you all the best of luck.

Books etc to prepare for MRCS OSCE

When preparing for my OSCES I asked my friend Essie who had already sat and passed her exams for advice on which books to revise with. Although I didn't use al the books she recommended due to time limitations, here are the books I did use:

1. Instant Anatomy: great little book for brushing up on blood vessels, nerves etc... to be used as memory aid rather than for learning from scratch. The free podcasts from the website are also really good.
2. Netter's anatomy atlas. Excellent for learning anatomy from scratch.
3. Get Through MRCS: Anatomy Vivas by Simon Overstall. This book is amazing. 96 pages of anatomy vivas and model answers which really help with structuring answers for exam. It was the one book I couldn't have done on demand.  
4. Master Pass: MRCS Picture Questions Book 2 by Tang and Praveen. This book covered Trauma and Orthopaedics, Transplant, Vascular, Paediatric and Breast surgery. It has amazing pictures and excellent explanations. Can be used as a learning aid.
5. MRCS clinical question book by Catherine Parchment Smith. This book was good for structuring your clinical examinations and useful for anticipating questions around each topic. I dipped into it occasionally but did not use it very much as I was happy with my clinical examinations. Good for targeting weak areas or checking your examinations are in good shape.
6. Rafftery's MRCS book. I used this book for Part A and the pathology section for Part B.

In addition to books I also bought 2 apps on my iphone. Netter's flash cards were useful but I did not learn much from them and it was an expensive app (£20). Rohen's anatomy app is excellent (£15) as it uses dissections and really handy for exam practice as you get dissections in 2 of the anatomy stations.

I also bought the OSCE Cases online course from Pastest as it was on offer for £69. Although they need to do alot of work on the format and increase the content, I thought that Prof Ellis' anatomy lectures were amazing and the OSCE tutorials on the different examinations were excellent. I would not pay more than £69 for the course as it is but if they improve it (Alot of improvements need doing) then it may rival more expensive courses. 

Internet wise, the following free website was absolutely amazing. It allows you to create your own anatomy quiz and uses dissections. The link is http://ect.downstate.edu/courseware/haonline/quiz/practice/u7/quiztop7.htm . Definitely worth trying out. I also discovered Acland's atlas of human anatomy which is a video atlas. You can download/view on University of Warwick's website and youtube. I thought it was very useful as a break from books.

As for critical care, I used the notes I made from the RCS Course that I went on instead of a book. However, if you don't go on the course, these two books cover everything you will need (we got given them free for the course):

1. Surgical Critical Care Vivas by Kanani
2. Applied Surgical Physiology Vivas by Kanani and Elliot

Anyway, I may have gone a little OTT with learning resources but I managed to use all of the above materioals in one way or another to target my weaknesses and it seems to have worked. The trick is to not use everything at once but to start with one or two books and add other learning materials as needed because your weak spots will become evident. Closer to the exam you can start whittling down the books you need.  

MRCS OSCE RESULTS OUT TODAY

So after 4 hours of pressing refresh screen and trying to take my mind off MRCS results by reading some biochem revision book (yes I did say that), I found out that I passed MRCS Part B and thus am now Miss Ibrahim. I can't describe how amazing it feels for all that hard work to pay off and thought I'd share some of the good news with you guys.

So after I'm done elebrating, I'll upload more info about the stations I got.

Amel

Change is coming to IWTBAS

Great news y'all. We have launched the website finally! Although it is still far from finished there are a few pages to keep you occupied for the time being.

Amel

MRCS Courses

Enjoying watching the soccer this weekend but thought I'd give you the low down on the course I went on.

I found it super difficult to pck a course as very little info is available and because they are so expensive I felt more apprehensive about making a bad choice. AFter much debate and searching, I wittled it down to 3 course:
1) The St Thomas' 7 day course costing £1200. So ths course was highly recommended by my Reg because he said they got you to practise stations on real patients. However, as it is very popular, I couldn't get a place on he course.

2) The PASTEST MRCS revision course. Costs £799 and you also get the online revision course for free. This course is run over a weekend so its only 2 days. I didn't go as I wanted something longer. A riend went and said it was excellent. Apparently you get grilled all day as the course is mostly in OSCE format and you go around in circuits. He felt it was very useful.

3) The Royal College of Surgeons' Applied sciences for the MRCS course. This is a 5 day course at the Royal College in London and costs £1000. I went on this course and thought it was fantastic. They explained what the format of the exam would be like, taught anatomy on cadavers in small groups and gave lectures on pathology and critical care. There were also lectures and an opportunity to practise comm skills stations. I think the highlights of the course were the lectures on critical care (very comprehensive) and the anatomy demonstrations. You also get critical care viva and a physiology viva books for free. The two problems with the course is that it didn't cover clinical examination or neuroanatomy.

I don't think you need a course to pass the exam but the royal college course really helped me prepare as I was most concerned with anatomy and critical care. Much of the stuff covered on the course came up in one way or another on the course. Hope you found this useful and if you have any experiences of the other courses please share with us.

Amel

Post MRCS Part B

So I finally sat the OSCE on thursday and it was a very passable exam although I think I screwed up 2-3 of the stations and thus may lead to my failing the exam. However, results aren't till the end of June so I can still try and be mindlessly optimistic.

Anyway, for all those considering sitting the exam this winter (which will very likely include my self), I shall endeavour to give you as many tips and advise as necessary using my experiences. Over the next few weeks, I shall blog about the format of the exam, the level of detail questioning required as well as books, courses and other revision aids.

Firstly, the exam involves 18 stations in addition to two 10 minute rest stations whereby you sit by yourself in a cubicle and one twenty minute rest station separating the exam in two and during which everyone who has sat the same stations gathers and has tea. Of the 18 stations these are divided as follows:

1) Anatomy and pathology:
1x speciality anatomy station
2x generic anatomy stations
1x generic pathology station

2) Communication skills:
2x history on speciality topics
1x generic history
1x explain something to patient/relative (also has a 9 minute prep station whereby you read the notes)
1x communicate with a colleague over the phone (also has a prep station whereby you have 9 minutes to read notes and prepare)

3)Clinical skills and patient safety:
3x speciality topics- physical exam
1x generic system- physical exam
2x procedure e.g gloving/cannulation/blood cultures/excision of lesion

4)Critical care and physiology
1x manned station with imaging/results for interpretation
1x 2 manned station with a scenario and viva on critical care
1x manned station and viva on physiology and critical care

Ok so that's me done for now but watch this space for further info in the coming days and weeks.

Amel