PAPER TWOPAPER TWO

MCQ – Multiple Choice MCQ – Multiple Choice QuestionnaireQuestionnaire

What do you want from MCQ What do you want from MCQ preparation?preparation?

Table as a group (get to know your Table as a group (get to know your neighbour)neighbour)

Person nearest the aisle is spokespersonPerson nearest the aisle is spokesperson Just FOUR items requiredJust FOUR items required Only takes a minute or twoOnly takes a minute or two

TUTORS’ Aims of MCQ TUTORS’ Aims of MCQ preparationpreparation

Review format/content of examReview format/content of exam Flavour of questionsFlavour of questions Practice (difficult to do under exam Practice (difficult to do under exam

conditions)conditions) Identify areas of weakness (go home and Identify areas of weakness (go home and

check answers)check answers) Some comparison with peer group (need Some comparison with peer group (need

to mark the paper here and now)to mark the paper here and now)

Plan for short seminarPlan for short seminar

OverviewOverviewContentContentRevisionRevisionFormatFormat

Overview MCQOverview MCQ

May 2005May 2005 1622 candidates1622 candidates High reliability of the exam (comparable to High reliability of the exam (comparable to

any equivalent test worldwide)any equivalent test worldwide)

Overview MCQOverview MCQ

MeanMean 74%74% Standard DeviationStandard Deviation 9%9% Pass markPass mark 67%67% MeritMerit 81%81%

79% of candidates passed79% of candidates passed 23% of candidates given merit23% of candidates given merit

Overview MCQOverview MCQ

Just a few extra marks makes a large Just a few extra marks makes a large difference in your ranking compared to difference in your ranking compared to your peersyour peers

Overview MCQOverview MCQ

Questionnaire – (60% response rate – 90% Questionnaire – (60% response rate – 90% passed)passed)

Difficult!! (yet nearly 80% passed)Difficult!! (yet nearly 80% passed) Appropriate questionsAppropriate questions Extended matching items most difficult (and Extended matching items most difficult (and

Summary Completion)Summary Completion) Time a problemTime a problem

NOW more Single Best Answer questionsNOW more Single Best Answer questions

Overview MCQOverview MCQ

3 hours and offered in May and October3 hours and offered in May and October

Tests established and recently discovered Tests established and recently discovered KNOWLEDGE of relevance to general KNOWLEDGE of relevance to general practicepractice

(newer questions involve more and more (newer questions involve more and more APPLICATION of knowledge)APPLICATION of knowledge)

CONTENTCONTENT

ContentContent

clinicianclinician family physicianfamily physician patient's advocatepatient's advocate gatekeepergatekeeper resource allocatorresource allocator handler of informationhandler of information team memberteam member team leaderteam leader partnerpartner colleaguecolleague

The Gatekeeper

ContentContent employeremployer managermanager business-personbusiness-person learnerlearner teacherteacher reflective practitionerreflective practitioner researcherresearcher agent and shaper of policyagent and shaper of policy member of a professionmember of a profession person and individualperson and individual

ContentContent

Syllabus 32 pages longSyllabus 32 pages long

17 pages of general concepts for each 17 pages of general concepts for each defined areadefined area

13 pages of appendices - checklist13 pages of appendices - checklist

2 pages of references2 pages of references

Content - syllabusContent - syllabus

1.1. Good medical practice and careGood medical practice and care

2.2. Generalist skillsGeneralist skills

3.3. The doctor-patient  relationship, The doctor-patient  relationship, communication and consulting skillscommunication and consulting skills

4.4. Professional, ethical and legal obligationsProfessional, ethical and legal obligations

5.5. Population, preventive and societal issuesPopulation, preventive and societal issues

6.6. Information management and technologyInformation management and technology

Content - syllabusContent - syllabus

7.7. Risk managementRisk management

8.8. Monitoring of quality of performance, audit and Monitoring of quality of performance, audit and clinical governanceclinical governance

9.9. Continuing Professional Development, Continuing Professional Development, learning, teaching and traininglearning, teaching and training

10.10. Working with colleaguesWorking with colleagues

11.11. Organisational administrative and regulatory Organisational administrative and regulatory frameworkframework

12.12. Financial probity and business managementFinancial probity and business management

Content (example from syllabus Content (example from syllabus appendix)appendix)

Serious communicable diseasesSerious communicable diseases

Particularly, but not limited to, infections such as Particularly, but not limited to, infections such as Human Immunodeficiency Virus (HIV), tuberculosis Human Immunodeficiency Virus (HIV), tuberculosis and hepatitis B and C and hepatitis B and C

Means and control of transmission, awareness of Means and control of transmission, awareness of diagnosis, investigation, management, consent for diagnosis, investigation, management, consent for testing, issues of confidentiality and the implications testing, issues of confidentiality and the implications to the patient of a positive resultto the patient of a positive result

Role of Public Health ServicesRole of Public Health Services

Syllabus – help or hindranceSyllabus – help or hindrance

First direction for revision from CollegeFirst direction for revision from College

A little vague in places but a useful starting A little vague in places but a useful starting pointpoint

Certainly worth a read to help identify Certainly worth a read to help identify areas of weaknessareas of weakness

ContentContent

Medicine - 65%Medicine - 65%

Admin. & Management - 15%Admin. & Management - 15%

Research, Epidemiol. Stats - 20%Research, Epidemiol. Stats - 20%

Medicine (65% of marks)Medicine (65% of marks)

CardiovascularCardiovascular Dermatology / ENT / ophthalmologyDermatology / ENT / ophthalmology Endocrinology / metabolicEndocrinology / metabolic Gastroenterology / nutritionGastroenterology / nutrition Infectious diseases / haematology / Infectious diseases / haematology /

immunology / allergies / genetics immunology / allergies / genetics Musculo-skeletalMusculo-skeletal PaediatricsPaediatrics Pharmaco-therapeuticsPharmaco-therapeutics Psychiatry / neurologyPsychiatry / neurology Reproductive / renalReproductive / renal RespiratoryRespiratory

all equal all equal - 6% !!- 6% !!

Implications for revisionImplications for revision

DERMATOL / ENT / EYES – 6% of examDERMATOL / ENT / EYES – 6% of exam

Research/epidemiol./stats – Research/epidemiol./stats – 20%20%

Assessing the quality of careAssessing the quality of care Principles of auditPrinciples of audit Understanding and application of the terms Understanding and application of the terms

used in inferential statistics and evidence-used in inferential statistics and evidence-based medicinebased medicine

Knowledge of statistics and research Knowledge of statistics and research methodology, sufficient for the critical appraisal methodology, sufficient for the critical appraisal of published papers.of published papers.

Content - RevisionContent - Revision

Clinical areas fairly limitlessClinical areas fairly limitless Research, epidemiology, administration Research, epidemiology, administration

and management more defined in this and management more defined in this exam.exam.

RevisionRevision Considerable amount of work to be Considerable amount of work to be

done (sorry)done (sorry) Need a good general backgroundNeed a good general background Identify areas of weaknessIdentify areas of weakness Prioritise these areasPrioritise these areas Don’t spend time needlesslyDon’t spend time needlessly

Make use of review articles and Make use of review articles and publications such as ‘Clinical Evidence’publications such as ‘Clinical Evidence’

RevisionRevision

RevisionRevision

RevisionRevision

RevisionRevision

FORMATFORMAT

MCQ FORMAT – why change?MCQ FORMAT – why change?

Congruence with educationCongruence with educationMainly PBLMainly PBL

Flaws in multiple T/F formatFlaws in multiple T/F formatRote memory vs problem solvingRote memory vs problem solving

Benefits of newer formatsBenefits of newer formats?integration of factual knowledge / personal ?integration of factual knowledge / personal carecare

FormatFormat

<250 questions<250 questions EMQ - extended matching item questionsEMQ - extended matching item questions SBA - single best answersSBA - single best answers MBA - multiple best answersMBA - multiple best answers TAQ – table / algorithm completionTAQ – table / algorithm completion SCQ- summary completion questions (???)SCQ- summary completion questions (???)

Items per question will vary between 3 and 6Items per question will vary between 3 and 6

Trial questionsTrial questions = different papers = different papers

FormatFormat

Pictorial data - charts, photos (on the Pictorial data - charts, photos (on the INCREASE)INCREASE)

NONO NEGATIVE MARKING NEGATIVE MARKING

Question ExamplesQuestion Examples

SINGLE BEST ANSWERSINGLE BEST ANSWER

MULTIPLE BEST ANSWERMULTIPLE BEST ANSWER

SUMMARY COMPLETIONSUMMARY COMPLETION

EXTENDED MATCHING ITEMEXTENDED MATCHING ITEM

TABLE / ALGORITHM COMPLETIONTABLE / ALGORITHM COMPLETION

SBA- SBA- Single Best Answer, from May ‘98Single Best Answer, from May ‘98

In the management of croup in a 2y old child, In the management of croup in a 2y old child, which single treatment has been shown in which single treatment has been shown in clinical trials to shorten the course of the clinical trials to shorten the course of the condition?condition?

X place the child in a steam filled bathroomplace the child in a steam filled bathroom administer inhaled budesonideadminister inhaled budesonideX prescribe amoxycillin 125mg tds for 5/7prescribe amoxycillin 125mg tds for 5/7X administer inhaled salbutamoladminister inhaled salbutamolX prescribe paediatric codeine cough suppressantprescribe paediatric codeine cough suppressantX administer inhaled tribavirinadminister inhaled tribavirin

Multiple Best Answer (MBA)Multiple Best Answer (MBA)

A statement is followed by a variable A statement is followed by a variable number of items a number of items a specified numberspecified number of of which are correctwhich are correct

Multiple Best Answer (MBA)Multiple Best Answer (MBA)A 65-year-old male smoker presents with a gradual onset of A 65-year-old male smoker presents with a gradual onset of

breathlessness on moderate exertion, and a cough with clear sputum. breathlessness on moderate exertion, and a cough with clear sputum. Chest examination reveals general reduction breath sounds and the Chest examination reveals general reduction breath sounds and the presence of a few rhonchi bilaterally. Spirometry reveals an FEVpresence of a few rhonchi bilaterally. Spirometry reveals an FEV11 of of

50% of predicted. Identify the 50% of predicted. Identify the threethree most appropriate therapeutic most appropriate therapeutic interventions to be considered following the British Thoracic Society interventions to be considered following the British Thoracic Society COPD guidelines. Give COPD guidelines. Give THREETHREE answers. answers.

AA Salbutamol inhalerSalbutamol inhaler

BB Beclomethasone inhalerBeclomethasone inhaler

CC Ipratropium inhalerIpratropium inhaler

DD Salmeterol inhalerSalmeterol inhaler

EE Sodium cromoglycate inhalerSodium cromoglycate inhaler

FF Oral theophyllineOral theophylline

GG Oral steroid trialOral steroid trial

HH Nebulised ipratropiumNebulised ipratropium

II Referral for long term oxygen therapyReferral for long term oxygen therapy

Summary Completion Questions - possible fill in Summary Completion Questions - possible fill in the gap words (given in College instructions)the gap words (given in College instructions)

associationassociation exclusionexclusion sensitivitysensitivity biasbias precisionprecision successsuccess difficultdifficult safetysafety validityvalidity errorerror selectionselection variablesvariables

blindedquestionedtypicalcohortrandomisedundertakendemonstratedreliabilityunrepresentative

Extending Matching QuestionsExtending Matching Questions

Extending Matching QuestionsExtending Matching Questions (EMQ) (EMQ) in in which a scenario has to be matched to an which a scenario has to be matched to an answer from a list of options. You may feel that answer from a list of options. You may feel that there are several possible answers but you there are several possible answers but you must choose only the must choose only the MOST LIKELYMOST LIKELY from the from the option list.option list.

THEME: Reduced VisionTHEME: Reduced Vision

Option list:Option list:(A) Basilar migraine(A) Basilar migraine (F) Occlusion of the central retinal vein(F) Occlusion of the central retinal vein(B) Cerebral tumour(B) Cerebral tumour (G) Optic neuritis(G) Optic neuritis(C) Cranial arteritis(C) Cranial arteritis (H) Retinal detachment(H) Retinal detachment(D) Macular degeneration(D) Macular degeneration (I) Tobacco optic neuropathy(I) Tobacco optic neuropathy(E) Occlusion of the central retinal artery(E) Occlusion of the central retinal artery

Instruction:Instruction:For each patient with reduced vision, select the single most likely For each patient with reduced vision, select the single most likely

diagnosis. Each option may be used once, more than once, or diagnosis. Each option may be used once, more than once, or not at all.not at all.

Items:Items:11 A 75-year-old man, who is a heavy smoker, with blood pressure A 75-year-old man, who is a heavy smoker, with blood pressure

of 170/105, complains of floaters in the right eye for many of 170/105, complains of floaters in the right eye for many months and flashing lights in bright sunshine. He has now months and flashing lights in bright sunshine. He has now noticed a ‘curtain’ across the vision of his right eye.noticed a ‘curtain’ across the vision of his right eye.

Table/Algorithm CompletionTable/Algorithm Completion

Format often found in guidelines to advise on Format often found in guidelines to advise on management decisions. management decisions.

You are asked to select the correct answer to You are asked to select the correct answer to complete the table or algorithm box.complete the table or algorithm box.

Not requiring contraception

Requiring contraception

1 ------- 2 -------

Combinedoral contraceptive pill

3 ---------

For each of the numbered gaps above, select ONE option from the list below to complete the algorithm,based on current evidence. Select ONE option only

Medical management of menorrhagia:

AA Copper intra-uterine deviceCopper intra-uterine device BB Cyclical medroxyprogesterone acetateCyclical medroxyprogesterone acetate CC Cyclical norethisteroneCyclical norethisterone DD Inert intra-uterine deviceInert intra-uterine device EE Levonorgestrel releasing intra-uterine systemLevonorgestrel releasing intra-uterine system FF Mefenamic acidMefenamic acid GG Nonoxinol ‘9’Nonoxinol ‘9’ HH TiboloneTibolone II Tranexamic acidTranexamic acid

OPSCAN SHEETOPSCAN SHEET

OPSCAN SHEETOPSCAN SHEET

Use only the pencil providedUse only the pencil provided Potential pitfallsPotential pitfalls

Wrong ID numberWrong ID number Skip a question?Skip a question?

MCQ SummaryMCQ Summary Time is more importantTime is more important

250 questions in 180 mins250 questions in 180 mins 43 seconds per question43 seconds per question

Answer everything – no negative markingAnswer everything – no negative marking Practice, practice, practice (go over weak Practice, practice, practice (go over weak

areas)areas)

PracticePractice

A composite paper giving examples of multiple A composite paper giving examples of multiple choice questions is published from time to time, choice questions is published from time to time, and is available from the RCGP Sales Officeand is available from the RCGP Sales Office

Does not include many newer questions?Does not include many newer questions? Also, Also,

PEP, PEP, PastestPastest

The End!!!!The End!!!!