British Geriatrics Society

for better health in old age

Passing the Geriatric Medicine Specialist Certificate Examination

Download in pdf format: Includes blueprint of questions in 2010

The next Specialist Certificate Examination in Geriatric Medicine (SCE) is fast approaching. All specialist trainees starting a training programme from 1 August 2007 are required to have assessments as part of their training programme.

While competence is measured using work based assessments such as mini CEXs and DOPS the knowledge component of the curriculum is tested using the SCE. This is now a necessary requirement for the award of a Certificate of Completion of Training (CCT). Successful candidates are awarded a certificate. Those who subsequently complete all the assessments of competence and fulfil the requirements for a CCT, or whose applications for a Certificate of Eligibility to the Specialist Register (CESR) prove successful, may apply to the Joint Royal Colleges of Physicians’ Training Board (JRCPTB) for permission to use the post-nominal, MRCP(UK) Geriatric Medicine.

The exam consists of two papers of 100 single-best-answer (one-from-five) questions, and the official advice is that it should be taken normally in ST years 5 or 6 though it may be taken in years 4 or 5 (for single CCT trainees or those progressing well with achieved competencies).

Delivery of the exam is computer-based and is managed by Pearson VUE, a commercial provider, that has access to examination facilities throughout the UK and abroad, where SCE candidates may sit the two papers. Three hours are allowed for each paper, with an interval between. The examination is sat in all centres and time zones simultaneously and strict security is observed within the centres by invigilators. In some small centres availability of places is limited and it is important to apply early to secure a place.

The exam is not intended to be a bottleneck for trainees in their career path. As a speciality we want to see a large majority of trainees pass first time. However, the purpose of the exam is to identify the small number of trainees whose knowledge is not up to the level required for a consultant. The SCE needs to be credible as a test of the knowledge required in the geriatric medicine curriculum and it has to stand up to external scrutiny from regulatory bodies such as the General Medical Council. As a consequence it may not feel easy.

Not Easy and feels like MRCP(UK)

The 2010 survey of trainees showed that 67 per cent of trainees found the exam more difficult than expected. Several indicated that many expected the knowledge tested by the exam questions to reflect everyday clinical practice and that several years of clinical experience should have secured a body of knowledge adequate to ensure success. It is argued that knowledge of clinical science and rarer clinical problems had already been demonstrated in MRCP(UK) and all the other (workplace-based) assessments of competence now focus upon the practical aspects of specialist medicine. This point needs clarification. The specialty curriculum drawn

up in 2007 and updated in 2010 sets out the knowledge, skills and attitudes expected for acquiring a CCT, and for safe and competent practice as a specialist (www.jrcptb.org.uk/specialties/ST3-SpR/ Pages/Geriatric.aspx). This follows on from the curriculum in General (Internal) Medicine and builds on core medical training. The knowledgebase required in the Geriatric Medicine curriculum, and indeed most of curricula of other specialities, requires a demonstration that a trainee has retained knowledge of the principles underpinning clinical practice in the discipline as well as building on the knowledge acquired in earlier years. This is knowledge that geriatricians use every day to carry out their duties.

The breadth of knowledge for a geriatrician is extensive and covers various other specialities. and this is reflected in the blueprint of the exam . Each SCE Examining Board is charged with setting an exam that tests this scope and depth of knowledge set out in the relevant curriculum. This means assessing knowledge of the natural history and pathogenesis of relevant disorders, and the basic scientific principles and evidence base underpinning current clinical practice, in addition to knowledge of how to diagnose and manage everyday clinical problems. The exams must also include an appropriate number of questions on less common conditions affecting old age. In addition the exam is set according to the same rule book and style as the MRCP(UK). In particular, the format is best of 5 questions. This means that there is one best answer but the rest of the answers are plausible. Before being included in the exam, every question would have been reviewed and discussed on three separate occasions (Questionwriting peer-review meeting, Examining Board meeting and Standard Setting Group meeting) by 18-22 geriatricians. The members participating in the various groups are in the big part ‘jobbing’ geriatricians and a small number of academics. Every attempt is made at these meetings to achieve a consensus regarding the readability and clarity of each question, the correctness of the answer key, and the relative incorrectness of the alternative options (the distractors). Without consensus, a question would not be approved for use. The exam therefore would inevitably feel to many like MRCP (UK).

Passing the Exam

1. Become familiar with the specialty curriculum. The knowledge necessary to pass the SCE cannot be acquired from clinical practice alone. At every stage of one’s continuing professional development (and this applies to consultants as well as trainees), clinical experience has to be complemented by private study.

2. Know the blueprint of the 2011 exam. Note the distribution of questions and plan study time accordingly. There will be questions on the diagnosis and management of acute and chronic general medical conditions affecting old people as well as questions on specific diseases such as dementia and stroke.

Rehabilitation (general, stroke and orthogeriatric) will also be tested and this would require some knowledge of aids and appliances and basic principals of rehabilitation.

3. The big difficulty in the preparation for the exam is the relative dearth of sample questions available to practice. To date there are only 10 questions on the website. It is the intention of the college to increase these in the near future. It has not been possible to make questions available so far as it would mean depleting the questions in the bank that are available for use in the exam. This would have an impact on the cost of the exam which, I am sure all agree, is too expensive as it is. As the question bank size increases this will be rectified although this is unlikely to be done in time for the 2011 exam. As mentioned above the exam does feel to many like MRCP (UK). A trainee colleague suggested that prospective candidates might get a good feel of the exam by revisiting MRCP(UK) books with the best of five questions format, identifying questions about conditions that can be seen in old age. I think this is an excellent suggestion.

4. The curriculum has a recommended reading list. This is rather cumbersome and it is not possible to read all that is in it. It would be advisable to read a text of appropriate length that would cover most areas in the curriculum and use reference books selectively. The college is committed to set answers that would be consistent with NICE and SIGN guidelines for appropriate questions.

Conclusion

To date it has not been possible to provide feedback about performance to unsuccessful candidates However, one major recent activity was the completion of the coding of banked questions, so that the knowledge sought by each question can now be related to the relevant section of the specialty’s curriculum. It is anticipated that the college will be able to provide feedback to candidates sitting the exam in 2011. While this goes some way to help with subsequent attempts, the aim is to ensure that as many trainees as possible pass their SCE first time so this information would be relevant to a minority only.

There is an inevitable sense of apprehension by prospective candidates in the run up to the exam but one needs to be reassured that as a speciality we do not want to create a bottleneck in the career progression of trainees and we hope for repeat performances as in previous exams with the big majority of trainees passing first time.

Michael Vassallo
Clinical Lead for SCE in Geriatric Medicine
published in the December 2010 issue of the BGS newsletter


 

 

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