This style of examination is become a lot more in vogue at the moment; my generation were the first to do this test on leaving med school as part of national ranking for FY1 jobs, but generally most of us are more used to answering questions based on knowledge. I managed to pass this exam about a year ago, many find it a bit bewildering so here are a few tips I have to offer.
Timing is crucial
Like most membership exams it tends to be a bit rushed, one minute a question for 120 minutes. With the format being “best single answer” you don’t have much time to ponder. This is especially difficult with the more ethically tricky questions. You are to be strict and just pick an option and move on.
What is likely to come up.
These were quite reflective of the examples on the RCEM website. They are general either “best response” with some kind of day to day ethical decision or “first response” which tend to require some sort of clinical knowledge (e.g do you go see this quite unwell patient or this very unwell patient first).
Questions included patient orientated ethical issues (self-discharging, declining treatment), colleges behaving badly (smelling of alcohol, bullying, making obviously poor clinical decisions), things around dealing with stress (when to call consultant, how to hand-over difficult cases) and, as mentioned, task prioritisation.
How to prepare?
I didn’t do a who load of preparation, as I didn’t really know what to revise. I couldn’t really identify any particular areas to study, most the ethical dilemmas were things you see day to day working in the ED (for example, a patient self discharging after an overdose, a rude specialist refusing appropriate referral). They did this more than rely on revisable material like the mental health act or guidelines.
I sat down with one of my consultant and worked through the example questions independently and then together. This was useful to try and get an idea of what an experienced A/E consultant would do. However, if you have worked at least a couple of years in a U.K ED most the scenarios should be familiar. There were a couple of very very complex and difficult vignettes that no amount of reading of guidelines could have prepared me for (remember you only have a minute so pick on and move on!)
All going well this is a very passable exam that doesn’t require much study, however on the downside I really don’t know what I would have done if I failed as can’t really sit down and study more. Good luck on judging those situations.