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slartibartfast

Pass the part 1.. gurandamnteed guide

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did a lil guide for passing the part 2 that went down ok with the peeps there so I thought I might as well do another for the part 1..

when i was starting the part 1.. i had absolutely no idea where to begin.. there was a lot of advice bandied about.. a lot of it im sorry to say was really bad.. and kinda demoralising..

they said read the syllabus and work from there.. i had a look at the syllabus.. and saw a 104 page document staring at me.. i had a looksee at the psychology syllabus and was heartened to note that it was only a page.. however when i compared individual subheadings from the page with the psychology text.. i found it corresponded to the whole fricking book!!

of course i didnt look at the syllabus again..

i got other 'helpful' advice..

read oxford textbook, buckley bird harrison, puri and hall for main textbooks (i ignored the kaplan sadock, core psychiatry, CTP tips right off the bat..)

read gross, hilgard atkinson, munafo for psychology

Read bateman brown pedder, core psychiatrys psychotherapy section for psychotherapy

Read Stahl, Andersons basic psychopharmacology, katona for pharmacology

Read SIMS, and fish for psychopathology

and i had no idea where to start.. what was expected of me.. what to do.. what to leave out..

then like a gift from the gods.. an examination course came my way.. and once i went for it.. i realised that the exam was passable.. with every passing hour at the course my confidence grew.. and i knew that i only had to do one thing to pass the exam.. and thats work a lil hard.. not too hard.. just a lil bit..

Heres how i went about it.. or rather how id recommend going about it..

the easy going dudes guide to passing the exam.. again.. this isnt for the 6 month dudes.. its for the 2-3 month wham bam thank you ma'am shoot n scoot dudes..

NOTE: if you do all the past question papers.. some of which have been so kindly answered by Kamran in the forum.. theres a very very good chance you can pass with two weeks work if you read the manchester course notes too..

HOWEVER: questions though similar can be twisted just that little bit and if you know the answer and not the theory / principle behind it.. youre dead in the water..

im not going to make this a pass the exam just for the sake of passing it kinda guide though.. we are training to be psychiatrists / specialists and have that lil bit of an obligation to ourselves doing a reasonably good job acquiring knowledge when we have a rare chance when we're forced to read / study..

anways here it is..

Past question papers past papers past papers.. can say it enough.. at least 85-95% of the questions are repeated.. i had done all the past papers pretty thoroughly and when i was sat in front of the ISQ sheet.. my hands started trembling because of how easy it was..

but of course the exam is easy.. you might not really feel that way now.. but the minimum pass mark for the exam is 75-82%.. which means everyone who passes (i.e. at least half the candidates) are answering 8 out of every 10 questions.. that a pretty high hit rate by any standards..

Theory - Step by step guide

4 Months before the exam

1. Manchester course

Read the manchester course notes.. first.. they are by far the best book out there.. much better than any textbook..

this will help you get a firm knowledge base on which to build on..

2. Read SIMS and / or FISH.. a sound psychopathological grounding is the foundation to being a good reliable diagnostician

3. Read Hilgard Atkinson and Munafo for psychology

Hilgard is a beautiful read.. Nicely written text and a brilliant loo-side read.. munafo is a small book with subheading that correspond to individual subheadings of the psychology syllabus..

4. Read Andersons Psychopharmacology

simply written text with diagrams explaing a lot of difficult concepts of a very difficult topic

Thats enough for a chill easy going month.. of getting set for the exam.. 2 hours a day is good enough.. three is excellent.. you'll have an excellent basis for a long term grounding in basic psychiatry..

manchester course is a tight run through of all the important topics for the exam.. SIMS / Fish.. as stated above for a good sound psychopathological grounding.. Hilgard Atkinson because its such a kickass read.. just the sorta book you oughta have by the loo.. Andersons psychopharmacology.. again.. is a simplified version of a very difficult topic..

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3 months to the exam

the best way to revise.. field tested.. is to sit with the past question papers and with several textbooks in front of you.. and GOOGLE.. google is god as far as mrcpsych exams are concerned..

the textbooks id recommend are Puri Hall, Buckley Bird, Kaplan, CTP, Oxford, Sims, Fish, Hilgard Atkinson, Gross..

that might seem like a lotta textbooks.. but you might need to look around for information.. and reading the same topics in different textbooks would be helpful in long term memory storage and makes understanding difficult topics easier.. and also get that oh so important right brain activation in.. helps you get an intuitive feel of the subject IMHO..

group study is highly recommended especially for the part 1..

4-5 guys sat around a table discussing answers everyday and explaining difficult concepts to each other is one of the nicest ways to study for an exam..

I would NOT recommend looking through the previous superego solved papers.. as thats not really helpful.. at this stage you'd like to be looking for the answers on your own and getting a good feel for whats required in the exam..

id really recommend highlighting the answers in the exam as you go through..

there are a few college favourites that keep cropping you.. i.e. developmental theories in psychology, reinforcement, drug interaction especially cytochrome p450 and inducers and inhibhitors

more later

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8-) just 2 mnths remaining and yet to start with some serious studies. thanks for the advice. is really going to bolster my confidence and put some inertia into me. :)

thanks again

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thanks fer the kind words guys

3 months to the exam contd.

I would NOT recommend looking through the previous superego solved papers.. as thats not really helpful.. at this stage you'd like to be looking for the answers on your own and getting a good feel for whats required in the exam..  

id really recommend highlighting the answers in the exam as you go through..

there are a few college favourites that keep cropping you.. i.e. developmental theories in psychology piaget piaget piaget, reinforcement, drug interaction especially cytochrome p450 and inducers and inhibhitors..

so hopefully by the end of the month you will have all the important topics marked with a flourescent marker..

thats it.. all you have to do for the whole month is sit with six or seven text books in front of you and google on your comp..

id really recommend cutting and pasting important topics off google onto word documents.. sorted into individual topics..

so by the end of the month you shouldve answered ALL past question papers and read around the most important topics..

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Two months to go

1. do a revision of the stuff you did in month one..

2. do questions from other courses..

in the meantime please read the ICD-10 for the important topics.. as these will come in useful for the OSCE.. sure you can read it after the theory.. but a second reading at that time will be excellent and you wont regret having read it before

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one month to go..

do all the past question papers again and read around all the answers

also do questions from other courses for the second time now..

you should be looking to solving around 200-300 a day..

highlight any unanswered questions or questions you dont know the answer to.. and post them on superego and youll have your answers in a few hours tops..

do a course.. sure its close to 500 quid.. but no one who does a good course regrets having spent the money..

if you do what ive suggested you will be able to answer almost every ISQ at the course..

brilliant as a confidence builder..

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10 days to go

dont read any textbooks now.. unless youre reading around topics..

this is what you should be having by now..

1. xeroxes of as many ISQ's and EMI's as you have been able to get your hands on.. these ISQ's should be solved.. with the answers and a brief explanation of each one beside the ISQ.. if theres no space do it on the blank facing page side..

2. xeroxes of the above questions but without answers so you can start solving them

3. highlighted important sections in the relevant textbooks..

4. brief cut n pasted notes off google on important hard to find topics and organised into topics

5. cheat sheets for important topics that you just have to study by rote for e.g. EEG's, sleep rhythms, etc etc.. as many cheat sheets on topics as you need.. dont go overboard though and get overwhelmed.. you'll have a good idea what topics by now..

just go on a question solving blitz.. around 500-1000 a day.. any question you get wrong.. highlight it for later..

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five days to go

on this day.. do ONLY questions you got wrong.. and have highlighted over the previous few days..

T-4, T-3, T-2

one final manchester course read.. you should be able to do it in a day by now.. but id suggest spreading it over 3 days..

intersperse that reading with a rapid runthrough of all the other course questions you have been able to get your hands on..

taking leave for the last 3 days is reccomended..

day before the exam

you should be in the city where the exam is by now..

do ALL past question papers.. this should take the whole morning.. highlight the ones you get wrong and do those in the evening for half hour or so..

all the rest of the time chill out.. have a beer or two.. watch a movie.. laugh with friends..

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D-day

get yourself into a smiling hypomanic mood.. and KILL the exam..

when youre writing the exam it will seem really really easy.. but beware.. read every question carefully.. the dirty sods will try and trip you up with the semantics any chance they get.. ok.. doesnt happen too often.. but read the question carefully.. once twice thrice..

after youve finished.. come back and go over your answers again..

it will be chickenshit.. really easy stuff when youre answering it.. and it is.. the part 1 theory is the most difficult part (in terms of manhours needed to pass) of any mrcpsych exam in my opinion.. but everyone else has worked hard..

you must understand that every single person who passed answers eight out of ten questions.. thats a pretty high hit rate by any standards.

however..

FAILING IS NOT AN OPTION

PEOPLE WHO FAIL THE PART 1 THEORY SIMPLY HAVENT PUT THE REQUISITE AMOUNT OF WORK IN..

i dont mean to offend people who've failed.. but failing any other mrcpsych exam can be down to luck.. but not the part 1 theory..

there is no luck involved.. its the only one of the mrcpsych exams with minimum luck.. its all about graft..

if youve paid.. you can play..

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Additional tips

1. strong scoring areas.. psychology.. psychopathology.. most people score close to 100% in these areas.. a lotta people also score 100% in psychopharmacology..

the difference between the people who pass and fail comes in areas like neuropsych and again psychopharmacology..

i give a talk every year on passing the mrcpsych exam.. and i usually recommend working till you are consistently answering at least 80-85% of the ISQ's and 65% EMIs..

however with all the competition thats happening now.. if you follow the suggestions ive given you should be aiming for 90-95% by the time youre 3-4 weeks away..

DO EMIs.. cant stress this enough.. do ALL past EMI's.. if the stems look thin or with lil information on the superego questions.. read around the stems.. theres far too much importance attached to EMIs in terms of marks.. all the more reason to be really tight with these..

2. do an ISQ intensive revision course.. skip the ones that have you sat for five days discussing theory

3. Points to note while answering ISQ[ch8217]s/ EMI[ch8217]s

Always [ch8211] 100% and often false

Never [ch8211] 0% and often false

Invariably- 98-99% of time

Majority - more than 50%

Usually - more than 50%

Common [ch8211] more than 50%

Often 30-50%

Frequently [ch8211] more than 10%

Rare [ch8211] less than 5%

Unusual [ch8211] less than 5%

Uncommon [ch8211] less than 5%

` Infrequent [ch8211] less than 5%

Occasional [ch8211] less than 5%

May [ch8211] is often true, if in doubt try may not

Recognised feature [ch8211] one that has been reported at least once, hence often true

In association with [ch8211] more common than chance association

Characteristic feature [ch8211] of diagnostic significance. &nbsp:lol:iagnosis doubtful if absent

Typical feature [ch8211] characteristic feature

Pathognomic feature [ch8211] occurs only in that particular d disease and in no other

Specific feature [ch8211] a pathognomonic feature

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Additional tips contd

at the exam

Reach early

Transport

Stay good hotel, book well in advance.

Do EMI first. 30-45 minutes.

Read question carefully, more so Q[ch8217]s you're confident about. See how it[ch8217]s framed.

Regularly check transcribed answers onto correct line.

Answer generally accepted version. No special knowledge.

Avoid post mortem post exam

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OSCE/Clinicals

12 compulsory stations

1 minute to read instructions

Each station - 6 mins. + 1 min. conclusion

Total: 96 minutes

C in at least 9 / 12 stations

E in any one can possibly result in a fail

Types of stations

History taking

Examination skills

Practical skills / use of equipment

Emergency management

Communication skills

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OSCE mindset

this isnt a test of knowledge.. that has already been tested in the theory..

if you arent sure of anything.. or even if you know a lil about it but want to play it safe.. say you'll speak to your reg or consultant and get back..

its a test of communication.. rapport.. sensitively eliciting psychopathology.. risk

theres usually one reason why people fail.. ignoring the patients agenda..

its not helpful to go on a whirlygig trying to cram all edwards gross criteria in in an alcohol history.. and ignoring the patients cues.. move with the patient.. guide him/her gently..

work according to the patients agenda.. the patients usually have one or two questions they want to ask.. make sure you allow them the space and the oppurtunity to ask them that early on..

sure.. you might be thinking.. how can i do all this in seven minutes.. well.. take it from me.. seven minutes is a LOT of time.. more than enough for almost any task actually..

the first minute or two.. chill out.. smile empathically and ask open ended questions.. later on.. closed questions..

make sure you ask the open ended questions first.. the actors will give you a shedload of information and it makes the rest of your task much much easier..

stick to the task asked of you.. and do the actual task and not anything else..

try to get a feel for whats being asked.. what sort of station it is.. history taking.. communication etc etc..

the initial two minutes are crucial.. but take them easy.. chilled out open ended questions.. get as much information as possible in those two minutes.. nod helpfully.. mutter uh uhs and ah ahs..

i did a mock osce once that i failed.. it was.. do a risk assessment of a lady post OD in a&E.. shes been assessed by medics.. and they told you that she has had an od in the context of relationship breakdown and had xyz tablets.. and this this and that is also happening in her life..

so since i knew all that information i went in and did a risk assessment.. it felt really awkward..

i later found out that the guys who did well in that station had asked her to recount what brought her into hospital.. and once they had that information from her they could move so much more easily through the history.. and also got the rapport going..

for e.g. patient with gangrene refusing operation

wrong: surgeons told me you have gangene.. and you dont want the operation.. why is that.. sure.. you save 2-3 minutes and delve straight into the matter.. but how about a

better way: surgeons seem concerned... could you tell me more about whats been happening.. theres more space for information to ping off and get rapport with..

if you get an angry patient.. dont react.. try to be that really really nice helpful doctor.. remember the patients reactions can only ping off your reactions.. if you give them something to react to or with they will.. so be nice and empathic..

rapport rapport rapport..

sensitive communication..

sensitively elicit information..

practise in groups.. dont practise with overly critical friends.. those guys who go on and on over that obscure point you missed.. the completist dudes.. practise with the.. as a patient i felt uncomfortable when you asked me if i wanted to harm myself right off the bat guys..

practise with the guys who place emphasis on rapport and communication.. not the 7 minutes is very little time.. make sure all the t's are crossed.. i's are dotted guys..

groups of three.. patient.. candidate.. examiner..

and importantly.. dont forget risk.. risk in all its forms.. if you miss risk.. theres a good chance youve failed.. pregnant lady.. ask about risk to child.. etc etc

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Studying for the OSCE

groups of three.. patient.. candidate.. examiner..

stick to time alloted and dont extend beyond it..

i was extending beyond when i was practising.. and when the exam came.. thats what i did in almost every station.. which gave me around half a minute or less to read the next OSCE..

make sure the examiner dude tells you when theres a minute left and start finishing then..

introduce yourself first.. im dr. x, an sho

set the scene.. ive been asked to speak to you about xyz.. or it looks like youre concerned about whats been happening with your son whos just been admitted..

get consent move on..

DO NOT GIVE FALSE REASSURANCE

DONT CON.. if you dont know the answer... say you dont and that youre unsure and will ask your spr or consultant..

practise OSCE's off the trickcyclist templates.. and read the attached notes to the old osce's..

albert michael is a shite book for the OSCE's.. dont spend too much time on it.. sure its good for knowing what questions to ask at times.. but dont do anything other than skim through it..

do ALL trickcyslist OSCEs.. and mark yourself.. identify weaknesses.. and work from there..

trickcyclist is ALL you need to do to pass.. with a lil added reading for e.g. capacity consent etc..

practise with real life patients anytime you get the chance..

PRESENT STATE EXAMINATION IS GOD

the examiners have all read the PSE and will know you know it too when you use the questions off it..

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specific examination techniques

1. mirror the patients body language

2. learn techniques to interrupt difficult/rambling patients.. i dont mean to be awkward/funny but what youre saying is interesting but is it okay if we get back to that later..

3. Linking questions.. try not to change topics suddenly.. learn to transition smoothly.. youve told me youre feeling low.. when people feel low they sometimes feel life isnt worth living.. have you felt that way.. make a list of link questions you can use

4. emergency question.. questions to use when youre stuck for anything to ask.. can you tell me more about that? So you[ch8217]ve been feeling X recently can you tell me more about that? Is there anything else that[ch8217]s been worrying you? How has that affected you?

5. closing techniques: youve had a lot to take in, if you have any questions id be happy to answer them, ill be back later, ill get some reading materials, ill get a video that explains what we have talked about etc etc..

6. if you finish early.. summarise and probe.. begin summarising in the last minute

7. Do not forget to ask the patient if they have any questions.. helps if you also tell them to interrupt you at any time if they have any questions

8. backtracking.. this is sometimes necessary and can also be used if stuck for questions to ask.. you spoke about xyz earlier.. can you tell me a little more about that..

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at the exam

hypomanic mood again.. smile with all the other candidates.. if youre alone.. move to a group of guys that look like theyre having a good time.. or you could do your good deed for the day and cheer up that nervous looking cutie..

Reach early most osce places are in out of the way towns like sheffield.. which is a fricking maze in itself.. familiarise yourelf with the route the day before.. if its a taxi youre calling.. remind them a half hour earlier..

Find out previous days OSCE[ch8217]s.. they add four osce's every day.. so right off the bat you know at least eight possible osce's.. ill repeat myself.. eight of your osce's will be repeats from the previous day or two..

Familiarise yourself with route

Read instructions carefully

answer specific question and not anything else..

Identify type of station

Identify what[ch8217]s required

Give examiner candidate number

Introduce yourself

Set the scene

Open ended questions in beginning

Ignore examiner

thank patient.. summarise in last minute.. use closing techniques.. and make sure you leave on time so you can utilise your full minute to read the next osce..

this will be the fastest 96 minutes of your life.. you start and finish what seems an instant later..

voila tout folks.. if you guys have any specific queries.. id be happy to answer them..

goodluck and godspeed

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Dear S***B***F*****

You are doing a brilliant job of sharing your knowledge with others on this site.

Maybe you should join many sensible others and write your own book!!!!!!!!!!!

Honestly

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moving this up as i thought some of u guys might find it useful.. esp for osce's..

Thanks alot for your advice.

Just 2 questions:

1- what would you do when a patient wouldn't answer your question?

or repeatedly says 'I don't know'

Specifically, husband of a woman admitted last night for ?puerperal psychosis.

2- In a station for depression Vs abnormal grief reaction; how do you approach this?

In this case I believe the woman was depressed, husband was cremated, no pining, no mummification etc

[highlight]Once again thanks[/highlight]

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moving this up as i thought some of u guys might find it useful.. esp for osce's..

Thanks alot for your advice.

Just 2 questions:

1- what would you do when a patient wouldn't answer your question?

   or repeatedly says 'I don't know'

   Specifically, husband of a woman admitted last night for ?puerperal psychosis.

2- In a station for depression Vs abnormal grief reaction; how do you approach this?

   In this case I believe the woman was depressed, husband was cremated, no pining, no mummification etc

[highlight]Once again thanks[/highlight]

apologies for the delay..

1. wait for patient to answer

if you still get i dont knows.. wait for a sec or two. then change questions.

i had that experience with my first OSCE one tight lipped anorexic with no's and i dont knows to open ended questions..

having said that though.. its a rare experience.. and most patients/actors are pretty helpful..

smile and make them feel comfortable..

mirror body position and get rapport..

low soft empathetic doctor voice works like a charm..

2. trickcyclist has a good osce sheet re: abnormal grief vs. depression.. have a look see..

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some patients are deliberately meant to be difficult in OSCEs, as the station might be more about assessing the your ability to handle the situation/ keep calm under pressure/ estab. rapport/ reassure px, etc etc. If the situation persists despite your best efforts,I think it calls for oozing empathy, talking about getting collateral info (with the px's consent) and offering to give px some time and to come back later.

I also remember the unco-op px with anorexia OSCE station.

Justme

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That was an excellent feedback Slart.

Need to kick off from now.

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