Introduction to Year 6 Dr Alice Lee AFP in Surgery, North West Thames, London Gold Medal Winner Dr Mohammad A. Fallaha AFP in Surgery, North West Thames
Introduction to Year 6Dr Alice Lee
AFP in Surgery, North West Thames, London Gold Medal Winner
Dr Mohammad A. FallahaAFP in Surgery, North West Thames
Structure
• FPAS• SJT• Exams
• PACES• Writtens• PSA
• Firms• Neurology• Cardiology• MSK• GP
• Elective
• Senior Med• Senior Surg• Acute Care
FPAS Deaneries (2019)
Timeline• 30th September – 11th October 2019– Oriel is
open for application• Third week of October – final EPM score available,
which includes validated EA*• 6th December (for Imperial) – sit SJT• 5th March 2020 – Deanery allocations released• 2nd April 2020 – Final programme allocations
released
• 14th October – January –local AFP recruitment –will discuss later!
• 15th Jan – 12th Feb 2020 – AFP national offers
Med School Performance
/ 43 / 50/ 2
Publications
Additional degrees
Dr M A Fallaha, Intro to Year 6 Talk 2019
= Educational Achievements (EA)
Educational Performance Measure (EPM)
…
SJT
/ 5
*Based on 2019 timeline
SJT
Top Tips• Finishing the paper = success• Sinking time into one question? Move on• Start preparation at the right time (one month is
fine)• The best preparation are the official mock papers
online (there are 2)• Make a list of common topics (e.g. unsafe
colleague) and read up on GMC Best Medical Practice
Friday 6th December 2019
Type 1
Option 2
Option 3
Option 4
Option 5
Type 2
Option 1
Option 2
Option 3
Option 4
Option 5
Option 6
Option 7
Option 8
Option 1
Four stems. “Please rank by:• Appropriateness of actions• Appropriateness of statements• Importance of considerations• Order of actions
Scoring
Dr M A Fallaha, Intro to Year 6 Talk 2019
Type 1 – 4 marks for each correctly placed item = maximum 20 per question, minimum 8
Type 2 – 4 marks for each correct item, maximum 12 per question
Convert using wizardry (+maths) to score between 1 – 50*
*most candidates get between 35 - 44
• 70 questions in 2 hours 20 minutes (2 minutes / question)• = 50% score for FPAS
Exams
PSA: 11th March
Writtens x2: 5th, 7th March
PACES: 19th, 20th, 21st March
*Please note: last year’s exam dates
Writtens
Exam format
• Two SBA papers• 150 Qs (each)• 3 hours long (each)
• Content• Some from ‘national’ bank• Some from ICSM
• Total mixture of content between 2 days• Can partially predict content (if
one exam particularly specialty heavy)
Writtens
Practice
• AS Notes – Med, Surg
• PassMed
• Question books?
• Official mocks (from Faculty)
• NICE Guidelines• What is the first line investigation /
management?
• Past paper bank (including from other medical schools e.g. Kings)• Repeats likely
Advice
• Don’t neglect palliative care, oncology, anaesthetics• https://www.palliativecareguidelines.
scot.nhs.uk/guidelines/
• Pass/fail exam
PSA
Exam format
• 60 Qs, 2 hours• Prescription writing 8 Qs, 10 marks each
• Prescription review 8 Qs, 4 marks each
• Planning management 8 Qs, 2 marks each
• Communicating decisions 6 Qs, 2 marks each
• Adverse drug reactions 8 Qs, 2 marks each
• Monitoring drug therapy 8 Qs, 2 marks each
• Data interpretation 6 Qs, 2 marks each
• Calculation skills 8 Qs, 2 marks each
Pass mark (11th March 2019):
62.5%
PSA
Practice
• Don’t spend >1 month revising
• Pass the PSA. William Brown.
• https://prescribingsafetyassessment.ac.uk• Practice mock• Full length mocks x3• Do them all multiple times• Similar topics every year• Speed is important
• (PassMed)
• National prizes to be wonNICE BNF vs. Medicines Complete*
PACES
Exam format
• One combined exam: Medicine & Surgery
• Real patients
• 9x 10 min stations + 22 min stationMedicine Surgery
• Cardiology exam• Respiratory exam• Neurology exam• Shorts: endocrinology, rheumatology,
dermatology, ophthalmology
• Abdominal exam• Orthopaedics exam• Images & instruments• Shorts: general surgery, vascular, urology,
breast/plastics, ENT
Acute care (10 mins)
History (22 mins)
PACES: General advice
Advice• Practice in groups (like 5th year)• Examine patients & present• Make a list – common topics• Prepare a presentation for each
common condition:• Definition• Causes• Investigations: bedside, bloods,
imaging, special tests• Management
Resources• Alistair Scott – PACES notes• Past PACES reports
• Do not worry/obsess over them
• Courses• Muslim Medics Finals Crash Course• Art of War
• Mocks (Chelsea)• Books
• Cases for PACES• Clinical Medicine for MRCP PACES• Clinical Cases & OSCEs in Surgery
My PACES
Medicine
• Respiratory – Bronchiectasis
• Cardiology – Prosthetic valve?
• Neurology – Parkinson’s
• Shorts • Systemic sclerosis
• NF1
• Thyroid mass
Surgery• Abdomen – renal transplant
• Ortho – bilateral knee OA and TKR
• I&I• LLL collapse
• Large bowel obstruction
• Epidural pack (what?)
• Suture scissors
• Chest drain trocar
• Shorts• Vascular bypass
• Fasciotomy scars
• Liver cyst?
PACES: Medicine advice
Respiratory• Chronic conditions:
• Bronchiectasis• COPD• Pulmonary fibrosis• Lung cancer (uncommon)• Pneumonectomy/lobectomy
• Visit Royal Brompton?
Medical shorts• Endocrinology
• Thyroid masses• Cushing’s syndrome• Acromegaly
• Rheumatology• Rheumatoid hands• Systemic sclerosis
• Dermatology• Psoriasis• Neurofibromatosis
• Ophthalmology• Fundoscopy (DM, HTN, retinitis pigmentosa)
• AS Notes – PACES• Do a proper examination • Practice with friends using
images of clinical signs
PACES: Surgery advice
Abdomen (gastro or renal)• Kidneys:
• Renal failure• Polycystic kidneys• Renal replacement therapy: transplant,
dialysis access• Liver:
• Cirrhosis / hepatomegaly• Bowel:
• Inflammatory bowel disease (+ scars, stomas)
• Colorectal cancer (+ scars, stomas)• Stomas (must learn!)
• Spleen• Splenomegaly
Surgery shorts• General surgery
• Stomas• Scars
• Vascular• Amputation• Varicose veins• Ulcers• Bypass surgery scars
• Urology• Urostomy
• Breast/plastics• Mastectomy• Breast reconstruction (different types!)• Skin grafts…
• ENT• Tracheostomy
• Clinical Cases in OSCES and Surgery
• AS Notes - PACES• Practice with friends using
images of clinical signs
• Renal attachment, haem wards (splenomegaly)
PACES: Acute station
Acute Care Station• Blueprint for station (from Dr Sam):
• Read patient history & exam (max. 3 mins)• Domain 1: summarize history & exam• Domain 2: suggest likely causes• Domain 3: suggest investigations to perform & interpret them, explain treatment• Domain 4: explain management plan to patient
• Revision:• Learn an A→E spiel (you may not get to say it!)• Learn investigations and management for common emergencies (incl. doses?)• Practice explaining in lay terms
• Resources:• Oxford Handbook of Clinical Medicine• Oxford Handbook of Foundation Programme
PACES: Images & instruments
Images (AS PACEs – radiology)• CXR – respiratory pathology (pneumothorax, lobar collapse, pneumonia), air under diaphragm• AXR – bowel obstruction• CT – renal stones, subdural/extradural haemorrhage, subarachnoid haemorrhage…
Instruments (AS Notes - instruments)• Practice your spiel• “This is a ____• I have seen this used during ___ firm…”• Instructions for use• Indications• Complications• Look at CX / HH box, Blackboard, Dr Sam’s lec
PACES: History station
• Direct opening question asking about patient background
• Thank the patients for coming down
• Use pen & paper if it helps you
• Always ICE!
Cardiology
• Try to examine:
Condition
Prosthetic valves – metal, bioprosthetic
- Which valve affected? Which type of prosthetic valve? - Complications of treatment (e.g. bruising from anticoagulation,
infective endocarditis)- Is it working?
Murmurs: aortic stenosis, mitral regurgitation (most common)
- How severe is it? - Evidence of decompensation?
Chronic heart failure - Evidence of cause e.g. ischaemic (cardiac catheterization scars), dilated cardiomyopathy, murmurs
- Evidence of decompensation?
Pacemaker and implantable cardiac devices
- Always palpate- Any complications e.g. infection?
Neurology
• Rehabilitation unit at Hillingdon Hospital = excellent
• Try to examine:
Condition
Parkinson’s disease - Different exam with extra tests (to rule out differentials) – practice this separately
- Adapt your examination
Stroke - Likely to come up- Can you localize the stroke – pattern of motor signs, visual loss,
presence of any cerebellar signs
Peripheral neuropathy - Think about the causes including rare conditions e.g. CMT, Friedrich’s ataxia, DM, alcoholism…
Multiple sclerosis - Confusing signs!- A differential for any upper motor neuron or sensory loss
MSK
• Orthopaedics• Try to examine:
• Osteoarthritis – knee, hip
• Total knee replacement
• Total hip replacement
• Ask an ortho doc to review your examination (talk through it?)
• Adapt your examination: cannot do certain tests on patients with hip replacements or knee replacements
• Rheumatology• Perfect the hand exam!• Try to examine:
• Rheumatoid hands• Systemic sclerosis
• Try to visit Hammersmith hospital – infusion unit, Renal building • Lots of patients with systemic
sclerosis, severe rheumatoid, extra-articular manifestations e.g. lung fibrosis
GP
• Lots of patients with chronic conditions• Practice for the history station
• Opportunity to examine:• Osteoarthritis
• Heart failure
• COPD
• Surgical scars
• Audit
Tips for Firms
Senior Surgery
• GO TO THEATRE – opp. to get quizzed by consultant
• Shadow F1 and SHO on surgery –attend emergencies
• Review patients (ABCDE, fluids, analgesia, bloodwork etc.)
• Strategic library afternoons…
Senior Med
Acute Care
• Ask to do jobs! (#cannulamaster)• Look for DOPS opportunities
early• Befriend the F1s• Clerk every patient (could be
finals patient)
• Be the FIRST to clerk patients• Come up with DDx + working Dx then
present to senior• If offered, do a supervised primary
survey of blue light patients• Sharpen ABG + catheterisation skills
General
• SIGN HUNTING in groups 2-3 max
• If you have a suggestion for your colleague say it
• Balance bookwork with firms (personally suggest 50:50 split)
• Sign up to PassMed / PasTest for practice during firms
• QUIZ EACHOTHER REGULARLY
By the end of the year, be confident examining:
Vascular• Varicose veins• Arterial / venous ulcers
General• Hernias (inguinal, femoral,
other…)• Breast surgery patients• Head and neck lump examination
GI / transplant (HAMMERSMITH!)• Renal transplant• Abdominal scars• Stomas (including types and
associated operations)
Cardio / Resp / Gastro patients• Cardio exam (murmurs, HF etc.)• Gastro exam (hepatic failure, renal failure etc.)• Resp exam (asthma, COPD, CF etc.)
Acutely unwell patient• A->E assessment• Obs + interpretation• Requesting investigations systematically• Interpreting results
Dr M A Fallaha, Intro to Year 6 Talk 2019
ElectiveThings to think about
• Travel• Climate• Part of the world• Post-elective trips
• Funding
• Alone vs. with others
Things you need to do:
Before you go:• Vaccines + OH approval• Elective approval forms (personal
tutor + FEO)• Medical indemnity• Insurance
During• Learn• Keep a diary (+/- logbook)• ?Research• Take photos for the ‘gram
On return:• Elective report• +/- Extended elective report• +/- Sponsor elective report
• Experience• In specialty• In country• Different healthcare
setting
• Single centre vs multi-centre• Paperwork• Budget
Top Tips
• Organise early on (you have finals and other things to be doing!)
• Don’t leave vaccinations to the last minute• You don’t need to go somewhere exotic to have an
incredible time• Use time after to catch up with non-uni friends
Dr M A Fallaha, Intro to Year 6 Talk 2019
Introduction to Year 6
Dr Alice Lee – [email protected]
AFP in Surgery, North West Thames, London Gold Medal Winner
Dr Mohammad A. Fallaha – [email protected]
AFP in Surgery, North West Thames
https://tinyurl.com/howtoyear6