Discussion in 'MRCP Forum' started by Adam1982, Jul 23, 2010.
nopes no news yet
Results should be published today.. I hate waiting
I hate waiting too. Almost went to phone them to ask what's up before I came to my senses.
I passed, but they really did keep us waiting.
Congratulations to all those who passed.
My advice to others is to go on some courses. I personally went on the Cardiff course and Paces Ahead - both UK based. The latter was extremely worthwhile.
study partner for paces oct
I am trying build a group for practicing for paces in october. I am currently in London. Anyone interested please give me a call on 07910287447. Anyone interested in an intense practice for the paces should contact as we have enough time.
What's the pass mark, 138 ?
How can we ask for feedback?
Adam1982, could you give us some detailed tips and advice about how to prepare for the exam and tips for during the exam, keeping all stations in mind? thanks
Certainly, I shall try my best. I did part 2 in April and began to prepare for PACES immediately after I got my part 2 results in May.
I cannot emphasise this enough - go on at least 1 course. This is very important.
For several reasons - you shall see a large volume of patients with common signs ie Turners, Marfans, etc. Secondly, doing the courses with people who are doing the exam at the same time was really motivatonal. I met some very excellent candidates and this drove me to work harder and practice more. Lastly and perhaps most importantly, you have the oppurtunity to be watched and scrutinised by senior colleagues and the other candidates. To get the most out of the courses you should always volunteer. Don't be shy or nervous.
For those of you in the UK. I highly recommend PACES Ahead at St Georges. I've heard Ealing PACES is also very good. I also went on the Cardiff course. It has a mock exam on the last which was very useful.
I'll post another entry soon.
Thanx so much for your input, I shall look forward to you second post.
To begin with, here are the stations which I encountered in my exam.
CVS - AS
CNS - Syringomyelia (I was asked to examine the UL and on inspection I saw a vertical scar on the back his neck. So always look!)
C+E - Telling a wife her husband is no longer suitable for chemo since he is too ill and has widespread mets (lung ca)
Station 5 1. Hypothyroidism and double vision. In the history the patient tells u the diplopia is worse at night so I could only think of myaesthenia gravis. I examined her thyroid system ie pulse and neck and then eye signs. Then examined fatigueability by asking to open and close a fist repeatedly. 2. Easier station. RA with sore eyes.
Resp - COPD and pulmonary fibrosis
Abdo - Renal transplant. Fistula. SVCO.
History - Low Hb, on Warfarin for AVR. H/o dyspepsia.
I shall post again soon. I've got to go just now.
thanks for usefull tips and congrats on Passing the exam
COuld you please guide us how should we prepare for each station ?
Keep things simple. Think of common problems which could come up. Please do nor make up any signs. If you really cannot hear anything just say so.
CVS - most commonly a single valve problem, ie MR or AS. Remember MS is uncommon. Ask for the BP as part of the examination. When presenting be prepared to offer a list of differentials. For eg "There is a systolic murmur loudest at the LSE. It could be AS, VSD. HOCM or MR. However it is most likely to be "X" as supported by these other findings - then list those". Have 2-3 causes for each valvular lesion. If there is sternotomy scar it is either a CABG or a valve replacement. Look at the legs for vein harvesting. If it is a valve listen with just your ear for an audible click. Comment on signs of haemolysis or SBE. If the patient is young think of an ASD or dextrocardia.
Respiratory - it is most likely to be lobectomy/pneumonectomy, pulmonary fibrosis or bronchiectasis. CF is also likely. Spend time thoroughly inspecting the patient, from the end of the bed and the surroundings ie sputum, inhalers or peak flow monitor. Look closely at the front and back. Old surgical scars which have healed well or tattoos from radiotherapy can be difficult to see. Be able to reel off the causes for pulmonary fibrosis and bronchiectasis. Look at the supraclavicular fossa for phrenic nerve crush scars. You might pick up more than diagnosis. Eg COPD/cor pulmonale and OSA.
Thanx so much for your effort and your kindness, Adam1982.
I suggest you keep posting whatever points come to your mind, if you can find the time to do it. Your tips are extremely useful and practical.
CNS - Peripheral neuropathy is common. Don't panic. Work through your exam in a slick manner and then put everything together. Spastic paraparesis is also common. The examiner might ask - "What is the most important question you might want to ask the family?" - the answer is FH as this points to hereditary spastic paraparesis. Otherwise if you think it's MS tell the examiner you would like to examine for cerebellar signs. Be prepared to examine the cerebellar system. A LMN VIIth nerve palsy is also common. Always look behind the ears when examining the CNs for any CPA surgery scars. Other possible scenarios are myaesthenia, myotonic dystrophy or HMSN.
Abdo - The main 3 possibilities are chronic liver disease, splenomegaly or renal replacement. Know the signs of CLD very well. If it is CLD you should be prepared to offer the aetiology. Eg xanthelasma + rooftop scar for PBC. If you elicit a large spleen them examine for lymphadenopathy.
Comm + ethics. This is where I think IMGs often struggle. The possibilities are mainly - breaking bad news, explaining treatment or a procedure, discussing end of life and DNAR decisions. Remember you will not be asked to do anything which you do not already do at work on a daily basis. Tip - before starting quickly jot down the main ethical principles on your instruction sheet. They are justice, autonomy, beneficence and non-malifecence. You should understand what they mean. During your discussion having these written down to glance out could prove useful. It's important to be aware of a few general points, eg DVLA rules (there is a summary document on the website), advanced directives, lasting power of attorney etc. Be sensitive. Avoid jargon. Slow down. Regularly summarise. Show compassion and empathy. If you don't know the answer say I'll ask my consultant and get back to you.
History. This should be straightforward. In case you forget you can write down PC, HPC, PMH etc before you enter so that you have a guide in case you struggle. Also it helps to avoid forgetting important questions such as smoking, alcohol. When you begin don't forget to double check the identity of the patient. Remember to ask about any investigations or treatments which the GP may have already inititated. Please do not forget ICE, ideas, concerns and expectations. You're expected to come to a plan at the end. Explain to the patient the differential, your investigations and any treatment if appropriate. Tailor your history taking to the scenario you are faced with. Travel history is important in a young patient with infective symptoms but there is no need to ask about type of accomodation. Pets is also important as is OTC medications.
what do you think about the pastest course(4 day course)
do you think the ealing course is better or are both on the same level?so you get to see lot of patients(they say we can see 100 in 2 days!) and do they help you a lot with the communication skills in the ealing course?
can you pls give me any idea on the pros and cons on the 2 courses?
i think paces ahead is already booked..
I'm sorry I cannot comment on Pastest courses. I did not attend one mainly because I was put off by the cost. They are very expensive in comparison to others. Honestly speaking, I've not spoken to anyone who has attended a Pastest course.
I had a quick glance at the PacesAhead www - I couldn't see anything to suggest it was full. I would give them a ring. They may have a reserve list. You should be able to secure a place.
Ealing Paces is very good too but if I had to choose - it would be PacesAhead.
are the charges of paces ahead and ealing thesame?
why do u think paces ahead is better?
do examiners of rcp come for any of them?
what are the plus points of paces ahead?thnks a lot..
ya..pastest is very expensive
This was my first attempt. I attended three courses in UK. During the exam, I relaized the time was too short to think. Yoiu need to be ready with all the answers and scenarios. Make quite dumb mistakes; I had the knowledge but at the time I blurted out all the stupid things that came to my mind. Not knowing and failing, you can reconcile with but knowing and making dumb mistakes is hard to live with.
except for one station 5 case which no one could even make a decent differential diagnosis of.
I need advice. Adam1982 and anyone else please help.
PacesAhead + Ealing both were Â£650.
They were both good but PacesAhead had the edge because it was not rushed and was very well organised. The tutors at each station were very enthusiastic. Ben (renal reg) took the abdo station, he was great but rather eccentric.
Dr Rashmi Khaushal (co-author) of Sharma for part 2 took time with all of us especially on the last day with station 5. She was inspiring and really motivated me.
Another course I've heard very good reviews of is the Whittington Hospital course.
I shall post an entry on Station 5 soon.
What kind of clinical experience is essential before we should think about going for PACES. Anyone, please?
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