The smarter way of preparation : MRCEM Part C

Exams are approaching and I thought September would be a good time to talk about the preparations for Membership of College of Emergency Medicine (MRCEM) Part A, B and C.  So, the next three posts are about MRCEM Exam preparation. I am going to share the way how I prepared for these exams. There may be other better ways to brace up for these exams, this is just one of them.

We are going to start with Part C today followed by part B and then part A.

MRCEM Part C

The exam gives 18 stations (16 patient encounters + 2 Rest stations), each one lasting for about 7-8 minutes. You are given about a minute to read the question and then proceed. You are required to pass 14/18 stations and each station is recorded as either Pass or Fail.

Prep Material for part C (This is what I used)

• 110 OSCE Station MRCEM Part C
• Chet Trivedy - Mastering EM

Stations

• History taking
• Resuscitation 
• Communication Skills
• Teaching
• Examination (Orthopeds + Other systems)
• Psychiatry
• Procedure stations

Time required for preparation: At least 2-3 months hardcore preparation in addition to your two-year of EM experience.

This exam will not only test your theoretical knowledge, but also your resus skills and communication skills. So what you have learned over years is going to help. Candidates who are not working in an acute care set up (ED/ Critical Care) often find these OSCEs difficult despite having a strong background knowledge because the exam heavily relies on testing you communication skills and etiquette.

How to get started

Go through Chet Trivedy Mastering EM once and have a solid background EM knowledge before you start doing the stations. The other book (110 OSCEs) just gives the questions with instructions for the actors.

Youtube has some great stuff for preparation:

1. Mcleods Examination videos (Basics of examination)
2. OSCE guides by "Geeky Medics" videos (immensely helpful, highly recommended)
3. Psychiatric Interviews for teaching by Nottingham University (lengthy videos, tailor them as per your requirements)

Again, this is just some of the stuff that we used and it worked well for us.

Watch each one of these videos at least once before you start your practise sessions and repeatedly as you are practising the stations. It is best to have a group of maximum three persons to study for this exam. Here, three is company and four is a crowd.

Role Play:

1. Patient (Read the instructions for the actor, from the textbooks and act)
2. Exam Candidate
3. Examiner (Observes, marks the checklist, gives immediate feedback)

Start doing stations 2-3 months before the exam with your colleagues or while you are on a shift. 

Work as the patient, exam candidate and the examiner. Rotate, take turns and do the stations. I recommend to set up time limit of about 6:30 minutes while you are preparing. Set up the timer and get a sense of how fast or how slow you need to be to finish by 7 minutes. It gets really awkward in the exam if you are super fast and finish much before 7 minutes.

Have a simulation software (not mandatory) on one of your devices (tablet/phone) that can be operated with bluetooth and change vitals in response to the treatment while doing the resuscitation stations. Auditory and Visual Stimuli add realism and can take your prep to the next level though these are not a must for the preparation. We used it and it worked really well for our group. These are available on Apple Store for <1000 INR.

Make it as real as possible. Have your PPE, have bedside knee hammer, tuning fork and other equipment to make it look and feel real. While you are preparing, keep that in your mind that none of these checklist in the above mentioned resources are PERFECT. 110 OSCEs checklists is more of  an etiquette kind of checklist and Mastering EM checklist is hardcore theory knowledge/ reasoning type of checklist. If you have ample time make your own checklists combining big points from both these resources and create your own checklist. To begin, as you practise, look at the checklists after you do each station and find out if you are missing anything.

After each one of you have gone through all the stations twice/thrice, then 2 weeks before the exam, run a set of 18 stations (2:30 hrs per candidate, So total 07:30 hrs) continuously as you are expected to do on the day of exam with an elaborated feedback after the eighteenth station. This can be exhausting and may consume a full day but it is worth doing at least once (better twice) before you turn up for the exam. This gives you a sense of what are going to feel like on the day of exam. Do this for all the three group members. Make sure you take a written feedback from your group members and see what you need to work on (Intro, Examination, Body Language, Winding up - The four crucial areas that can improve your global score).

If the feedback thing is not working for you, another method that you can try out is by video recording yourself as you so the stations. In my opinion, the best way to learn and correct yourself is by watching yourself committing the errors. Record (Video) and watch yourself - the way you enter, move, talk, express, your non verbal cues, body language. Everything matters and influences you global score on the exam. This is the most powerful technique to improve your skills.

Another way to work on your skills and body language is to have one of your non-medical colleagues around while you are preparing and ask them for the feedback. They can also work as actors and provide a genuine feedback about your performance and what you need to work on. This can really transform your performance.

In addition to all this, there are various workshops organised on these exams. Look at who is on the faculty list and choose any one of such workshops. They are of tremendous help if you prepare yourself well and take their mock exams seriously. And this can also be utter waste of money if you attend these workshops without any sort of preparation. So keep yourself prepared well before time and then go ahead….

On the day of exam

• Reach before the expected time
• Don't think about the station that you have screwed up. If a station was difficult or unexpected, then it must have been difficult for all the candidates. Get rid of these thoughts and move on..
• With every station, questions almost always gives you a pie chart (see 110 OSCEs) mentioning what exactly you are expected to do. For instance. It may mention something like 75% communication skills and 25% examination. So, on this one don't waste too much time on examination. Examine briefly and more importantly talk to the patient, get out the information what is required (concerns, questions) and communicate well.
• One key question that can save you esp in History stations "Is there anything else that I need to know from you?"

Many thanks to Nikhil Goyal and Naveen Sundaram for contributing towards this post. 

I hope this stuff was useful. If you have anymore questions, please e-mail me at drlakshay_em@yahoo.com. I would be more than happy to help.

Best Wishes
Lakshay Chanana