Saturday, 9 June 2012

General Advice for Written Papers (MRCPsych Paper A and B)

General Advice for Written Papers (MRCPsych Paper A and B)

We need preparation for the written exams, and we would suggest you think about starting your revision at least three months before each one. Although it’s difficult to balance examination revision with a full-time job, it is possible with wonderful organisation and discipline. Furthermore, many people have other responsibilities, such as children, which makes it much more difficult to fit in. It may have been years since you took your medical school examinations, and getting back into the swing of things can take some time. One technique is to start with half a day on weekends or a couple of evenings each week, then escalate the time as the examination approaches. There will be times when you can’t do any revision, for example, during weeks of night shifts. Although individuals strive to cram as much studying as possible into the weeks leading up to the test, it is equally crucial to relax and enjoy yourself. Rather than making your preparation less time-effective, scheduling some relaxation time will make your revision period more productive.


 

A good first step would be to study the Royal College of Psychiatrists’ examination web pages. There are details of the syllabus, regulations, frequently asked questions, and lots more useful bits and pieces. Google’ MRCPsych examinations’ to find the official College website.

 

Regarding what to revise, make sure you look carefully at the syllabus for each examination on the Royal College website to check the areas you need to cover in your revision. There is no point in covering areas that don’t appear in the examination, and you would better spend your time learning things. Although the proportion of questions in each subject area is worth bearing in mind, it isn’t the only factor. It would likely be better to allocate your time to concentrate on the areas you find most challenging.

 

The biggest change in the written exams has been moving from 3 written papers to 2. There are now 2 written exams, papers A and B, each comprising 200 questions over three hours. The exams contain multiple-choice questions (MCQs) and extended matching items (EMIs), with a rough split of 2/3 MCQs and 1/3 EMIs.


Examination online sites from the Royal College of Psychiatrists are a fantastic place to start. There are syllabus details, restrictions, frequently asked questions, and a slew of other valuable information. The official College website may be found by searching for "MRCPsych exams."

Friday, 11 May 2012

The CASC



CASC is an OSCE-style clinical exam made up of 16 stations in total. There is one circuit of eight stations in the morning and one circuit of eight stations in the afternoon. They have scrapped previously linked stations.  Any clinical topic can come up, and only the most impractical scenarios are off-limits. Commonly tested stations include:
  • Brief history-taking e.g. psychosis, depression
  • Collateral history e.g. in dementia
  • Risk assessment following self-harm information-giving e.g. ECT, medication, psychological therapies
  • Discuss management plans with consultants and other members of staff, e.g. nursing students and ward managers.
  • Physical examination e.g., EPSEs, cardiovascular, neurological


The CASC tests knowledge and communications skills such as history taking, explanation & advice, breaking bad news, and managing challenging consultations.

When you first look into the CASC exam, the pass rate may not fill you with optimism about passing it. However, having a rough idea of what the CASC involves at the start of your training and looking at the requirements in more detail when you are preparing for the papers is a good idea. When studying for the written papers, start thinking about how you would make history for the topics you are preparing and read the relevant leaflets for patients - imagine you are explaining it to a patient or relative. It may even make revising for the written papers less abstract!!

Speak to trainees who have sat the CASC. There is also information available online about past stations. You will need to train your body to recognize what seven minutes feels like - timed practice as early as possible is very important. Mock exams are a good way to prepare for the range of skills you have to show in a short time and also develop the ability to quickly change from one task to another. There are ‘OSCE timers’ apps available that have a one-minute warning bell and an ‘end of examination’ prompt which creates the right amount of anxiety/anticipation to prepare you for the big day.


Practical issues during the exam


You get a short time before each station. There is no defined way to use it this time, but make sure you use it! You may decide to take notes but don’t let this distract you from thinking about the question. You may just want to write the name of the patient and the key task that they have asked you to undertake, and a few areas you’d like to cover. You can also take notes during the first stations of each linked pair details will stick in your mind and they will give you another task with some information for the linked station. Taking notes can be a welcome distraction to the station, and you won’t be as present in the station.

The UK sitting of the CASC takes place at the English Institute of Sport in Sheffield. They hold it in a sizeable room with several circuits going on at once. Noise carries, and this includes the examiners and role-players talking to each other between candidates. Listen, but it might not always be positive comments and may derail you if things have not gone, and you thought. Remember, it’s only the opinions of people who have seen you for a few minutes in an already stressful setting.

There are no rest stations on the circuits, but you potentially have several hours to wait between the morning and afternoon sessions. There is enough time to have an excellent lunch and get focussed on the afternoon (though don’t rely on the cafĂ© in the venue being open) Some people like to talk through the stations they have just sat with friends, others might find this frustrating and unhelpful Remember, there is nothing you can do to change things and you need to focus instead on the afternoon stations. What has gone on, however, may also highlight things you have missed out on which can then be remembered for the second circuit?

During each station, let the role-player set the initial agenda but make sure you steer things in the right direction later on if needed. Summarising is useful to double-check information and re-focus the interview. Listen for cues and address anxieties when they appear. Don’t be afraid to answer questions, even if the answer might not be something the patient might want to hear—this may be the only way to move on. Be careful not to ask double questions—the actor might only answer one part.



Books we found helpful for CASC

‘Pass the CASC’

CASC books are far from perfect. One of the most popular is ‘Pass the CASC’ by Dr. Seshni Moodliar. This has a list of all the stations that have previously come up and is a good way to map out your revision. The content is comprehensive, but some phrases suggested in the book have not served candidates well.

Psychiatry: Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees

Although not written for the MRCPsych exam, "Psychiatry: Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees" by Sarah Stringer is an excellent all-rounder book. It’s a practical guide to working as a psychiatry trainee and covers all commonly encountered situations. Many of these give good advice that would help in passing CASC.

The Maudsley Handbook of Practical Psychiatry 

The Maudsley Handbook of Practical Psychiatry has a section on special interview situations. This has some excellent advice about how to manage challenging situations.

Preparing for CASC:

Have a plan and stick to it. Plan out each day where you work through a list of previous stations together. Find someone you want to spend the day with and practice regularly. Make it fun and schedule in breaks. Be honest with each other when giving feedback. Check that your practice is going in the right direction by asking trainees who have passed the CASC for feedback. Many trainees find that organizing a small group of three to four trainees who are all about to sit CASC and meet regularly to go through stations, practice your approach, and learn from each other can be a great way to prepare. If you are in a more rural location and struggle to meet up, consider regular Skype meet-ups instead.


Friday, 1 January 2010

A 40 years old man attends your outpatient carrying his CT scan brain which is suggestive of space-occupying lesions in the parietal lobe. a) What clinical signs would you look for while examining this patient? b) How would you elicit those signs?

Friday, 8 June 2007

Single-photon Emission Tomography SPET

Single-photon Emission Tomography SPET

Principle

uses single-photon (gamma-ray) emitting isotopes

given IV or inhaled

the resolution is lower than PET

Uses

SPET can give information about:

regional cerebral blood flow

ligand binding

Clinical uses include:

Alzheimer’s disease

When the symptomatology (e.g. hallucinations, epilepsy) occurs when the patient is not near a scanner; we can give a suitable ligand at the material time and the patient scanned afterward

Schizophrenia

reduced rCBF in frontal regions—‘hypofrontality’

Affective disorders

as that in schizophrenia, with reversal after antidepressant therapy

Alzheimer’s disease

decreased rCBF in posterior parietal and temporal regions

Xenon inhalation

Shows the failure of activation of frontal lobes in schizophrenics performing the Wisconsin Card Sorting Test


Tuesday, 28 February 2006

FCPS-2 March 2006 College of Physicians and Surgeons

FCPS-2 March 2006 College of Physicians and Surgeons 

Q.1 A 55 years old feudal - lord presents with over six weeks' history of inability to ” face the world”, disinterest in sex, suicidal thoughts, and weight loss. He relates his current plight to losing a large sum of money and a part of his fortune in gambling:

  1. What will be the differential diagnosis in this case?
  2. What investigations you should undertake?
  3. Draw a comprehensive management plan for this patient

Wednesday, 5 January 2005

History taking, Mental state examination, and making a diagnosis

History taking, Mental state examination, and making a diagnosis

What body language and behavior used are most suitable while taking psychiatric history?

What is an open-ended question?

What question could you ask the patient after they have stopped volunteering their symptoms?

"What other changes have your partner/family/friends noticed in you?"

What is the definition of Command hallucinations?

A voice or person telling them to do things

PMH relevant to ask about in a psychiatric history

  1. Developmental problems 
  2. Head injuries 
  3. Endocrine abnormalities 
  4. Liver damage
  5. Esophageal varices 
  6. Peptic ulcers (can show if alcohol problems) 
  7. Vascular risk factors

What to ask about alcohol/illicit drug use?

  1. Regular or intermittent
  2. Amount (know the units)
  3. Pattern Dependence/withdrawal 
  4. Impact on work, relationships, money, police 
  5. Screening questionnaires e.g. CAGE

What to ask in a forensic history

  1. Offenses including sentences
  2. Recidivism 
  3. Particular attention to violent or sexual crimes

Recidivism meaning

Tendency to re-offend

History taking, Mental state examination, and making a diagnosis

Mental state examination involves...

  1. Appearance Behavior
  2. Mood Affect
  3. Speech 
  4. Thoughts 
  5. Beliefs 
  6. Perceptions 
  7. Suicide/homicide 
  8. Cognitive function 
  9. Insight

What is looked at when assessing appearance?

  1. Height/build
  2. Clothing (appropriate, kempt, bizarre) 
  3. Personal hygiene 
  4. Makeup 
  5. Use of Jewelry

What is looked at when assessing behavior?

  1. Greetings 
  2. Non-verbal cues 
  3. Gesturing 
  4. Abnormal movements (tremor, posturing, etc)
  5. Response to unseen stimuli 
  6. Cooperative, rapport 
  7. Evidence of intoxication, or 
  8. medication side effects

What is looked at to assess mood?

  1. Self-rating scale
  2. Eye contact
  3. Affect 
  4. Psychomotor function (retarded, agitation)

What is looked at when assessing speech?

  1. Spontaneity
  2. Volume (loud, quiet, poverty)
  3. Rate (pressured, slowed)
  4. Rhythm (rhyming and punning)
  5. Tone (monotonous, lilting)
  6. Dysarthria 
  7. Dysphagia (expressive, receptive)

What is an illusion?

When the stimulus is there, but you may interpret something different

What is a hallucination?

There are no stimuli, but they see something these

What domains can abnormal percepts be experienced?

Auditory-Visual Somatic/tactile Olfactory Gustatory

What should be asked about suicidal thoughts?

Ideation Intent Plans (vague, detailed, specific, already in motion) Also the homicidal risk


What is used to assess cognitive function?

Orientation Attention/concentration Short term memory (3 objects, name, and address) Long term memory (personal history) If any concerns perform objective tests e.g. MSQ, MMSE, executive function tests)

History taking, Mental state examination, and making a diagnosis

The most key symptom of depressive disorder

Low mood

History taking, Mental state examination, and making a diagnosis

What indicates more likely to kill yourself?

The more effort you make to kill yourself

History taking, Mental state examination, and making a diagnosis

What does tolerance mean with respect to drinking?

You need to drink more to have the same effect.

History taking, Mental state examination, and making a diagnosis

How long roughly does citalopram take to work? (anti-depressant)

About 2 weeks

History taking, Mental state examination, and making a diagnosis

Hypothyroid is related to what psychiatric disorder?

Depression


Hyperthyroid is related to what psychiatric disorder?

Anxiety

What does the premorbid personality look at?

Are they different now from what they were normally like before?

History taking, Mental state examination, and making a diagnosis

Definition of psychopathology

Concerned with abnormal experience, cognition, and behavior

Definition of Descriptive psychopathology

Describes and categories the abnormal experience as described by the patient

Definition of phenomenology

Refers to the observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patient's experience feels like

Mood definition

Generally held to be the patient's subjective report on their current mood state in terms of how they rate themselves from depressed through euthymic (neutral) to elated

How do you define Affect? 

Affect held to be the emotions conveyed and observed objectively during an interview in terms of- types of affect observed - range and reactivity of affect - Congruity of affect

Low mood and psychotic symptoms together mean what?

Severely depressed

Definition of Delusion

An unshakable idea or belief which is out of keeping with the person's social and cultural background

Broadly 3 classes of perceptual disturbance

Hallucinations Pseudo hallucinations Illusions

Features of hallucinations

Have the full force and clarity of true perception Located in external space No external stimulus Not willed or controlled

What should insight be conceptualized as?

A spectrum - rarely 100% absent or present

3 Questions for the continuum of insight

Do you think you are ill? If you are ill, is it a mental illness? If you are ill and it is a mental illness, do you agree broadly with the current treatment plan?

Symptoms of a depressive episode

Persistent sadness or low mood Loss of interests and pleasure Fatigue or low energy At least one of these, most days, most of the time for at least two weeks (above)disturbed sleep poor concentration or indecisiveness low self-confidence Poor or increased appetite suicidal thoughts or acts agitation or slowing of movements guilt or self-blame

How many symptoms are classed as a mild depressive disorder?

4

How many symptoms are classed as moderate depressive disorder?

5-6 symptoms

How many symptoms are classed as a severe depressive disorder?

seven or more symptoms, with or without psychotic symptoms

What is the SSRI choice in children and adolescents?

Fluoxetine

Wednesday, 1 October 1997

The Experience of the Patients Taking Part in the MRCPsych Examinations

The Experience of the Patients Taking Part in the MRCPsych Examinations 

This is a draft article on the experience of the patients taking part in the MRCPsych examinations that we will soon republish in a clear format, referencing the original source. This is one of the many other articles I am making available here. The purpose is to find all the evidence regarding the RCPsych Exams and make them accessible to help researchers and students prepare for the MRCPsych Examinations. These articles are already available in journals, particularly the BJPsych Bulletin, albeit in the least-accessible format. We are thankful that the Royal College has published previous print-only articles as scanned PDFs under the Creative Commons license. I am trying to review them, enhance them for clarity and readability, and make them available as text. These adaptations are currently NOT creative-common. We will soon discuss and hope to make them available under a similar license so everyone can benefit by sharing them anywhere.

Darina Sloan, Laura Mannion, Gregory Swanwick, and James O'Boyle


Studies have highlighted Candidates' views regarding examinations in psychiatry in recent years. Few studies to date, however, have examined the views of the patients themselves toward the examination procedure. This study examines the knowledge and experience of a patient group taking part in the College membership examinations. Providing patients with written information prior to the examinations significantly improves their knowledge and experience of the exam procedure.

The participation of patients in the MRCPsych examinations is central to the current format of the clinical exam. Although studies have documented the stressful impact of this experience on the candidate (Williams et al., 1995: Marcus, 1996), and the views of the examiners (Mindham, 1995), researchers have paid little attention to the views of the patients themselves. A study by Persaud et al. (1990) examined the experiences and views of 21 patients who had taken part in the MRCPsych examinations. Prior to taking part in the MRCPsych examinations, the patients had received verbal counseling regarding the purpose and format of the examinations. I interviewed all 21 patients after the examination and questioned them regarding the purpose of the exam, their knowledge of the examination procedure, and their personal views of the experience. The results showed that 29% (n=6) of the patient group found their experience to be distressing. Thirty-eight percent (n=8) of patients said that they would not like to take part in the examinations again in the future. Despite the prior tuition regarding the purpose and format of the examinations, 38% (n=8) of patients failed to recall this information subsequently. Nine percent (n=2) of patients in this study were unaware that participation in the examinations was entirely voluntary. All patients were pleased with the amount of payment received, and most of the group had full recollection regarding details of payment.

Most of the patients viewed the candidate positively, although five (23%) reported that the candidate carried out a physical examination and it surprised them. Interestingly, some patients from this group found the fact that doctors could appear to be nervous rather distressing, although this also allowed them to perceive doctors as being more 'human'. Most of this patient group described their exam experience positively. Persaud et al. (1990) conclude that further, we need research in this area. The purpose of our study was first: to examine patients' experiences during the exam and their Knowledge of the exam procedure and second: to investigate if the provision of written explanatory instructions regarding the examination affected their experiences and knowledge.

Discussion



Our findings show that taking part in the MRCPsych examinations may be a stressful event for some patients. Despite prior tuition, patient-participants in our study displayed a considerable lack of knowledge about important aspects of the exam procedure, for example, including a physical examination. The study by Persaud et al. (1990) also found deficiencies in patient knowledge, again despite prior briefings. However, their report of overall positive response in the patient group towards exam participation was in keeping with the positive views expressed by our own population.

Sixty-five percent of our verbally prepared group and 31 % of the group whom we had given written preparation, found the examination distressing, as compared to 29% in the Persaud et al. study. Events that patients found to be distressing were, however, comparable in both patient groups. Receipt of written instructions regarding the exam followed a significant reduction in reported levels of anxiety. All candidates in our study said they would be happy to take part in the exams again if asked and finding contrasts with the eight patients (38%) of the sample from the study that Persaud et al. did, who showed that they would not like to take part in the MRCPsych examinations again. Although the College had informed the patients in our study and those in Persaud et al. study on the payment they would receive, it is of interest that no patient group had a universal recollection of this. Patients in both studies thought that the amount of money they received was adequate. Both studies revealed that they viewed the candidates positively and with a certain amount of sympathy. 

The results highlight an area of inquiry that researchers have neglected. However, our study takes this line of inquiry a step further by investigating the effect of a simple intervention, i.e. the provision of written instructions to take part patients on patients' attitudes and knowledge. It would appear to be important to prepare candidates individually for their participation in the examinations.

Many of the events which caused anxiety and distress in both patient groups appeared to have their basis in insufficient Knowledge. Despite prior tuition in exam format, some patients may still forget certain details. We recommend the provision of written instructions, besides the routine assessment of patients' views and experiences following each set of examinations.

Patients contribute importantly to the successful running of the MRCPsych examinations. We feel that any study which examines their views and experiences following participation in the examinations will be of benefit not only to exam organizers but also to taking part candidates in the future.

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