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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, August 15, 2016

MRCEM part C: 9 unsolicited advices!

1.    Practice is the mantra!
For part C, the formula is simpler than B. The more you practice stations, more the chances of passing the exam with ease.

2.    Find someone or be found by someone (who has cleared part C) who can monitor your practice sessions and give corrective feedbacks each time.
Plan the practice sessions well in advance so that you don’t mix it up with part B preparation and mess up both.

3.    Be the Bond, James Bond!
Develop a unique opening line for introduction in every station. NEVER fumble in introduction or conclusion! Also, clean hands save lives!

4.    Form a group for the practice
Decide what a group is, what a crowd is and what a mob is! Be careful!
Stress on things that you don’t do often – Psychiatric assessments, systematic joint examinations, etc.
Some unforgettable fun moments during the practice sessions are guaranteed!

5.    YouTube is your best friend – Like always!
This is extremely useful. This channel called ‘geekymedics’ on YouTube is a goldmine.  These videos are very well structured and almost cover everything that you need to perform in an OSCE. 

The following links might be very useful for different sections of part C

1.Geeky medics (All examination and procedural skills): https://www.youtube.com/user/geekymedics123
3.Ottawa knee rule – Application demo with explanation: https://www.youtube.com/watch?v=sPMmIptAs-w
4.Ottawa ankle rule – Application demo and explanation https://www.youtube.com/watch?v=Dqq09sR0vuc
6.Latest ACLS update has a very good video about breaking bad news
7.Psychiatric history taking by University of Nottingham: https://www.youtube.com/watch?v=4YhpWZCdiZc (these videos are longer than 7 mins. So you need to create a tailored down version of yourself once you see these videos)

6.    What books?
Though the main focus should be on practice some books help you to get an idea about the checklist. Though these are not standard checklists and may vary from the actual checklists in the exam, having an overall idea is not bad, isn’t it?
‘125/110 OSCEs’ and ‘Mastering emergency medicine’ can be very helpful in this regard.

7.    Reaching a specific diagnosis might not be always very important but being logical, empathetic and structured in your approach is. So if you are Donald Trump, you will never pass the exam (Oops!). Always explain the plan to the patient and ask if they have any further questions or concerns!  Another very important aspect is always maintaining a non-confrontational attitude towards the patient! Patient has 5 global marks with him. Be nice and he’ll be nice to you!

8.    Read the pie chart: Before you enter every station, know where the focus is! There’s no point taking history for 6 minutes when the history is only 25% of the pie chart and the rest is examination!

9.    Difficult stations!
Difficult stations are usually difficult for everyone. You need to pass just 14 out of 18 stations. So, do the basics very well, do not lose confidence and think what you would do in the ED if you encounter a patient like that, conclude well, thank the patient!

The most crucial aspect in passing MRCEM is time!

-       Manage time during your preparation – Prepare a study schedule for the entire month covering all the topics – For B and C.
-       Time your sessions while practicing for part C. Each station lasting up to 6-7 mins(use a stopwatch)
-       Maintain strict timing in all the mock sessions of part B.
-       Reduce the time you take for answering each question!
-       Always be aware of the time you spend on each question in the exam
-       Writing using a pencil consumes more time compared to pen – So practice writing with a pencil! Also, pencils can break!
-       Be very cautious of time in stations which expects you to do multiple things at once – Ex: Teaching, examining, taking history and explaining the plan to patient.


Dr. Apoorva Chandra, MRCEM
Twitter: @apoorvamagic  

Resident, Emergency Medicine         
Apollo Health City, Hyderabad