Preparing for the Geriatric Medicine Specialist Certificate Examination
All specialist trainees starting a training programme from 1st August 2007 have been 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 Specialist Certificate Exam. 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 normally be taken in ST years 5 or 6 though it may be taken earlier 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 centres 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 as well as stand up to external scrutiny from regulatory bodies such as the General Medical Council. As a consequence it may not feel easy.
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 2012 exam (Table 1) 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. Attend the Trainee weekends. They usually include in their programme, a mock exam that will give a flavour of the exam.
4. Review the sample questions on the MRCP(UK) website. From the 6th February 2012 there will be 50 questions. To aid preparation we categorised some of the questions to the blueprint heading, aiming to give an idea of the type of questions one can expect under some blueprint sections.
5. The Geriatrics SAC has set up a network of SCE leads for every deanery. The list of these leads is available on the MRCP(UK) website. The intention of the network is that the local leads can act as a resource for education and advice in the relevant deanery.
6. 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 best of five questions, identifying questions about conditions that can be seen in old age. I think this is an excellent suggestion
7. 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. Many question writers also use Cochrane reviews and the CME Journal in Geriatric Medicine as a basis for their questions and these sources are worth a visit.
There is an inevitable sense of apprehension by prospective candidates in the run up to the exam I hope the above points can be of some assistance in your preparation for the exam. I would like to wish you good luck and hope that none of you would need to read this article again in the future.