introduction to year 6 - imperial meded

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


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

https://www.palliativecareguidelines.scot.nhs.uk/guidelines/

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*

https://prescribingsafetyassessment.ac.uk/

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


Elective

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


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

introduction to year 6 - imperial meded

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