Diploma in Geriatric Medicine Part 2

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I've recently passed the Diploma in Geriatric Medicine (DGM). Various medics go in for the DGM, but from psychiatry it tends to be of particular interest to old age trainees. When I was revising, there wasn't much information out there for part 1 and there was nothing about part 2 (apart from what's on the RCP website). I thought it may be helpful for me to write about my experience of part 2 in case anyone is interested and so they're a little more informed about the part 2 exam.


The part 2 exam consists of four stations. My stations were:

Station 1: Take a history from a patient with shortness of breath and atypical chest pains. He had lots of comorbidities including ank spond, IHD and polypharmacy plus a history os asbestos exposure. The history taking was pretty standard. Then after taking a history I had to answer some questions from the 2 examiners about differential diagnoses, and how one might investigate lung fibrosis or cancer. There was nothing outrageously hard  or massively in depth in this station. But background reading would be a good idea and an idea of how to investigate lung pathology.


Station 2: Comprehensive Geriatric Assessment: I was given a clinical history with a lot of information in it. I had to summarise it for the examiners, discuss my priority list. The examiners asked questions and it was along the lines of a dialogue with them. The history was of a lady with complex causes of her falls, on some BP meds and an in depth MDT assessment. I was questioned about BP management and stopping BP medications including which antihypertensives to stop first. I was then also quizzed about the Mental Capacity Act as she wanted to go home which was deemed to be an unwise decision. On the whole this felt the most challenging station as it was a bit more of a grilling, but the examiners were nice and not too hard going. The MCA questions were straight forward as a psychiatry ST.


Station 3: Communication skills: There was a female actor who has a history of chronic leukaemia and was a Jehovah's witness. She wanted to discuss future care planning and particularly not wanting to have blood transfusions in the future in the event that she lost capacity. It was around discussing LPOA and Advanced Directives. Afterwards the two examiners asked questions about MCA, LPOA and Advanced Directives. Again there topics were very familiar territory so this was an easy station for a psychiatrist.


Station 4: Physical examination: Potentially daunting to someone who had to rummage around their wardrobe for their stethoscope which had last seen the light of day 5 years ago! There were two parts, first was to do an upper limb neuro exam on a gentleman with tremor. He very clearly had Parkinsonism. After the exam, the examiners asked me to present my findings and asked for the diagnosis. The second station was a bit random, it was 'examine this lades arm swelling'. The right shoulder was swollen and difficult to move. Once the lady was exposed properly, it was clear she had had a right mastectomy with axilla lymph node clearance. The shoulder swelling was lymphoedema. I didn't really know what exam to do in this (I did a mish mash of breast exam, lymph node exam, and musculoskeletal) but I managed to get through it. Apparently the swelling was more pronounced due to the position of her bra strap. Random!



So that was the exam. I found everyone at the exam centre friendly. The examiners were fair, friendly and they smiled. Some background reading from Geriatric Medicine at a Glance and the Oxford Handbook of Geriatric Medicine were all that I used. I also hooked up with a Geriatrician for a few special interest days to see CGA in practice in a general hospital which was helpful. 


Hope this helps anybody who is desperately trawling the internet trying to find some useful information about part 2 of the DGM!

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On 7/29/2016 at 14:12, dave1986 said:

So that was the exam. I found everyone at the exam centre friendly. The examiners were fair, friendly and they smiled.

Unlike anything you might come across in the Psych CASC. 

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