NSW Registrar Symposium 2006

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NSW Registrar Symposium 2006

• The RANZCP Written Examination
• Warren Kealy-Bateman
• NSW RANZCP Examinations Secretary

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Sponsor
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Agenda

• Morning
• Opening Remarks
• Written Examinations
• Neuroprotection and Adherence Update
• Lunch
• Afternoon
• OSCEs
• Final remarks and Close

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Aims today

• Overview of the written examination and
  approaches
• Please see Dr Kellers presentation as well
• Sources of information and tour of internet
  resources
• Anecdotal tips
• Surviving the Critical Essay Question

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www.ranzcp.org

• Guide to Written Examinations
• 2 papers- Wednesday and Friday
• 3 hours each
• 1 mark per minute (360 marks total)
• 6 component parts

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Paper I

• Extended Matching Questions
• 54 marks, approximately 48 questions
• Key Features Cases
• 54 marks, approximately 9 questions
• Short Answer Questions
• 72 marks, approximately 18 questions

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Paper II

• Critical Essay Question
• 40 marks, 1 question
• Critical Analysis Problems
• 40 marks, 2 questions
• Modified Essay Questions
• 100 marks, approximately 4 questions

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Paper IExtended Matching Questions

• They begin with a theme, eg psychotropics
• Followed by options that may match that theme
• Two types
• one option to each stem
• gt1 option to each stem

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EMQ example one

• Psychotherapy and History
• For each of the following terms or concepts
  select from the list one person associated with
  its development

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EMQ -Transitional Objects

• A. Alfred Adler L. Karl A Menninger
• B. Michael Balint M. Adolph Meyer
• C. Eric Berne N. Theodore Millon
• D. Robert Cloninger O. Gordon parker
• E. Hans Eysenck P. Frederick S Perls
• F. Anna Freud Q. Carl Rodgers
• G. Kurt Goldstein R. Jean-Paul Satre
• H. Otto Kernberg S. B F Skinner
• I. Melanie Klein T. Harry Stack Sullivan
• J. Heinz Kohut U. Donald Winnicot
• K. Joyce McDougal

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EMQ -Transitional Objects

• A. Alfred Adler L. Karl A Menninger
• B. Michael Balint M. Adolph Meyer
• C. Eric Berne N. Theodore Millon
• D. Robert Cloninger O. Gordon parker
• E. Hans Eysenck P. Frederick S Perls
• F. Anna Freud Q. Carl Rodgers
• G. Kurt Goldstein R. Jean-Paul Satre
• H. Otto Kernberg S. B F Skinner
• I. Melanie Klein T. Harry Stack Sullivan
• J. Heinz Kohut U. Donald Winnicot
• K. Joyce McDougal

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EMQ Mirror Transference

• A. Alfred Adler L. Karl A Menninger
• B. Michael Balint M. Adolph Meyer
• C. Eric Berne N. Theodore Millon
• D. Robert Cloninger O. Gordon parker
• E. Hans Eysenck P. Frederick S Perls
• F. Anna Freud Q. Carl Rodgers
• G. Kurt Goldstein R. Jean-Paul Satre
• H. Otto Kernberg S. B F Skinner
• I. Melanie Klein T. Harry Stack Sullivan
• J. Heinz Kohut U. Donald Winnicot
• K. Joyce McDougal

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EMQ Mirror Transference

• A. Alfred Adler L. Karl A Menninger
• B. Michael Balint M. Adolph Meyer
• C. Eric Berne N. Theodore Millon
• D. Robert Cloninger O. Gordon parker
• E. Hans Eysenck P. Frederick S Perls
• F. Anna Freud Q. Carl Rodgers
• G. Kurt Goldstein R. Jean-Paul Satre
• H. Otto Kernberg S. B F Skinner
• I. Melanie Klein T. Harry Stack Sullivan
• J. Heinz Kohut U. Donald Winnicot
• K. Joyce McDougal

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EMQ - Introversion

• A. Alfred Adler L. Karl A Menninger
• B. Michael Balint M. Adolph Meyer
• C. Eric Berne N. Theodore Millon
• D. Robert Cloninger O. Gordon parker
• E. Hans Eysenck P. Frederick S Perls
• F. Anna Freud Q. Carl Rodgers
• G. Kurt Goldstein R. Jean-Paul Satre
• H. Otto Kernberg S. B F Skinner
• I. Melanie Klein T. Harry Stack Sullivan
• J. Heinz Kohut U. Donald Winnicot
• K. Joyce McDougal

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EMQ - Introversion

• A. Alfred Adler L. Karl A Menninger
• B. Michael Balint M. Adolph Meyer
• C. Eric Berne N. Theodore Millon
• D. Robert Cloninger O. Gordon parker
• E. Hans Eysenck P. Frederick S Perls
• F. Anna Freud Q. Carl Rodgers
• G. Kurt Goldstein R. Jean-Paul Satre
• H. Otto Kernberg S. B F Skinner
• I. Melanie Klein T. Harry Stack Sullivan
• J. Heinz Kohut U. Donald Winnicot
• K. Joyce McDougal

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EMQ example two

• Medical Emergencies
• For each of the following select the most likely
  from the list

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EMQ Hyperreflexia, tachycardia, arrythmias and
tremor

• A. Agranulocytosis
• B. Anti-cholinergic syndrome
• C. Laryngospasm
• D. Lithium toxicity
• E. Myocarditis
• F. Neuroleptic malignant syndrome
• G. Serotonin syndrome
• H. Stevens-Johnson syndrome

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EMQ Hyperreflexia, tachycardia arrythmias and
tremor

• A. Agranulocytosis
• B. Anti-cholinergic syndrome
• C. Laryngospasm
• D. Lithium toxicity
• E. Myocarditis
• F. Neuroleptic malignant syndrome
• G. Serotonin syndrome
• H. Stevens-Johnson syndrome

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EMQ History of dystonia

• A. Agranulocytosis
• B. Anti-cholinergic syndrome
• C. Laryngospasm
• D. Lithium toxicity
• E. Myocarditis
• F. Neuroleptic malignant syndrome
• G. Serotonin syndrome
• H. Stevens-Johnson syndrome

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EMQ History of dystonia

• A. Agranulocytosis
• B. Anti-cholinergic syndrome
• C. Laryngospasm
• D. Lithium toxicity
• E. Myocarditis
• F. Neuroleptic malignant syndrome
• G. Serotonin syndrome
• H. Stevens-Johnson syndrome

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EMQ Exposure to lamotrigine

• A. Agranulocytosis
• B. Anti-cholinergic syndrome
• C. Laryngospasm
• D. Lithium toxicity
• E. Myocarditis
• F. Neuroleptic malignant syndrome
• G. Serotonin syndrome
• H. Stevens-Johnson syndrome

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EMQ Exposure to lamotrigine

• A. Agranulocytosis
• B. Anti-cholinergic syndrome
• C. Laryngospasm
• D. Lithium toxicity
• E. Myocarditis
• F. Neuroleptic malignant syndrome
• G. Serotonin syndrome
• H. Stevens-Johnson syndrome

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EMQ

• Clinical vignettes will also feature in the EMQ

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Paper IKey Feature Cases

• They begin with a brief clinical scenario
• Specific questions that focus on the resolution
  of the clinical scenario
• Eg What are the most important issues to discuss
  with this patient?

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Paper IKey Feature Cases

• Some questions are answered by selecting from a
  list provided
• Others are answered by writing a brief response

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KFC Example

• As a psychiatrist attached to a general hospital
  emergency department you are asked to assess a 14
  year old boy who has been brought in with a
  heroin overdose, and has been resuscitated with
  naloxone. The boy claims the overdose was
  accidental and wants to be discharged
  immediately.

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KFC Example

• This is the second overdose in a month and the ED
  staff are concerned
• The mother wants him kept in hospital to dry out

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KFC Example

• You conduct a psychiatric assessment of this boy.
  What KEY issues would you consider are the most
  essential to cover in your assessment?
• Select up to four issues
• Underneath there are four blank lines

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KFC Example

• 2 marks for assessment of suicidality or suicide
  risk
• Risk assessment is an inadequate answer
• Elements may include
• DSH/suicidal intent/not an accident
• Ongoing suicidal risk

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KFC Example

• What are the KEY medico-legal issues you will
  need to consider when managing this situation?
• Select up to THREE issues

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KFC Example select 3

• A. Confidentiality
• B. Duty to warn
• C. Guardianship
• D. Informed consent
• E. Invol. treatment under the MHA
• F. Mandatory reporting
• G. Medicolegally defensive best practice
• H. Protection of children
• I. The right to refuse treatment
• J. The rights of family/carers

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KFC maximum of 4 marksNeed E and two of A, C
or I

• A. Confidentiality (1 mark)
• B. Duty to warn
• C. Guardianship (1 mark)
• D. Informed consent
• E. Invol. treatment under the MHA (2 marks)
• F. Mandatory reporting
• G. Medicolegally defensive best practice
• H. Protection of children
• I. The right to refuse treatment (1 mark)
• J. The rights of family/carers

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Paper IShort Answer Questions

• Presentation by Dr Adrian Keller

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Paper IICritical Essay Question

• Ill come back to this one later in the
  presentation

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Paper IICritical Analysis Problems

• Here the starting point is different
• For example, a precis of a published paper
• The candidate is then asked questions that
  require him or her to demonstrate an ability to
  analyse and critique this material

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Paper IICritical Analysis Problems

• We considered a formal statistics and critical
  analysis presentation today but felt that would
  be myopic
• Thus instead a I offer a few hints on the
  approach that may be more useful

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Paper IICritical Analysis Problems

• Preparing for this section requires broad and
  specific skills statistically and analytically
• Mock/past papers are really helpful in generating
  the typical types of questions asked. For
  example
• Why choose a cohort study instead of case
  control?
• What is a Type I or Type II error?
• What is the specificity and sensitivity of this
  test?

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Paper IICritical Analysis Problems

• Chapters on statistics in the major texts and in
  psychiatric exam books (eg the one by Gin Malhi)
  can be synthesised so that you cover a wide range
  of material.
• I used my 1993 University of Sydney Medical
  Statistics notes as well!

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Paper IIModified Essay Questions

• Presentation by Dr Adrian Keller

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www.ranzcp.org

• Tour the website

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Written ExaminationsPossible Approaches

• Read a text book cover to cover
• versus
• Just do past examinations

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Written ExaminationsPossible Approaches

• Most successful candidates place great emphasis
  on the completion of past examinations
• Very few candidates boast that they just read a
  text cover to cover but you do hear this
  occasionally
• Candidates that fail often note that they did not
  do any or enough past examinations

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Written ExaminationsPossible Approaches

• Advice on examination approaches can be found at
  anzapt.org
• Read it and work out which approach is for you.

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Written ExaminationsBut Im sitting on the 9th
August and I have barely started

• CRISIS EXAMINATION MANAGEMENT STRATEGY (used
  widely by the initially avoidant)
• Past exams
• Past exams
• Past exams
• The advantage is that the multitude of mock exams
  and the occasional past paper will lead you into
  learning the areas of knowledge that you need
  and also augment your ability to translate this
  into fluent examination answers

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Finding the Past Examinationswww.anzapt.org

• Practice Written Exams 2004
• (winzip file)
• Approach to the Writtens by Ben Duke
• Mock Writtens from NZ late 2004
• www.ranzcp.org has examples
• Now for a tour

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Written ExaminationsBut Im sitting on the 9th
August

• It takes approximately 4-8 (pre-exam) weeks of
  intense study to work through all the mock and
  real papers and develop model answers and fluency
  with the topics
• Particular parts of the paper may require
  examination practice in a group setting, eg CEQ

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Mock Writtens

• At first they can seem so difficult it is really
  discouraging as there are a few very
  challenging papers around
• Be persistent and if there are no model answers
  discuss the best response with friends

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My Sources of Information Desk to help with
answering mock exams (recreated much more neatly)

• Texts
• Examination books
• Clinical Practice Guidelines
• Favourite summary journal articles
• Institute of Psychiatry CDs and notes
• The internet
• Pre-existing knowledge

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My desk resembled this
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Your Desk

• Will be filled with the sources that allow you to
  answer the examination questions
• www.anzapt.org has loads of suggestions for your
  desk

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Be legible

• The Written Sub-committee provides the following
  information
• HANDWRITING whilst every attempt is made to
  decipher candidates responses, if the examiner is
  unable to read the handwriting, they are unable
  to mark the question

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The Essay
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Paper IIThe Critical Essay Question

• The candidate is given a brief statement or
  quotation and asked to critically discuss it in
  the form of an essay style answer

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Paper IIThe Critical Essay Question

• Recall from Dr Kellers presentation that
  discussanalysis, weigh up pros and cons
  (requires you to mount a case, state an opinion,
  and reach a conclusion)
• This contrasts with his definition of
  describelist, outline, write notes on

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CEQ - Overview

• 40 minutes
• Critical evaluation
• Requires much cognitive flexibility that
  demonstrates you can shift between opposing
  viewpoints from a great range of perspectives
• Plan it before launching into an answer
• Pad richly this initial plan

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CEQ

• DOUBLE SPACE IT TO MAKE IT MORE PLEASANT TO READ!
• Dont spend too long (see Ben Dukes Tip 9 Law
  of Diminishing Returns and Tip 7 Time Is Your
  Enemy)

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CEQ RANZCP marking sheet5 dimensions worth
equal marks

• (1) Capacity to produce a logical argument and
  critical reasoning
• (2) Flexibility
• (3) Ability to communicate
• (4) Judgement, experience and maturity, ethical
  awareness
• (5) Breadth ability to set psychiatry in a
  broader context

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CEQ

• Why is this statement important?
• Start with a motherhood statement of your own
  demonstrating some hypothesis of why the College
  members may regard the quote as important or
  thought provoking

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CEQ

• (2) Define the terms
• (3) Note and conservatively comment on the source
  of the quote/statement

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CEQ

• What is the context?
• eg historical
• political
• recent developments/trends
• clinical
• ethical
• theoretical

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CEQ

• (5) The analysis For VS Against
• consider stakeholders perspectives
• Response frameworks include
• Individual/family/community
• Medical Legal
• Social/cultural Economic
• Political Historical
• Philosophical Religious
• Ethical

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CEQ

• (6-1) But what is meant by discuss?
• Pros vs cons
• Advantages and disadvantages
• Strengths and weaknesses
• Limitations of argument
• Controversies

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CEQ

• (6-2) Remember to approach using dialectics, ie
  thesis vs antithesis.
• The reality (most probably) resides between
  these two extremes of argument.

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CEQ

• Express a hope for further elaboration
• Research
• Application
• In the College/outside
• Importance to stakeholders

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CEQ

• Then conclude

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CEQ

• The key is to practice CEQs repeatedly under exam
  conditions
• Then pool your responses with someone who is good
  at these questions this will help you to
  develop a richness/density and complexity in your
  answer

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CEQ

• I found that workshopping answers on a whiteboard
  with 3 others was very helpful after all
  sitting the question under exam conditions

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CEQ

• But what gems can you weave that will distinguish
  your answer from all the others?
• The key is to have a bank of extra knowledge that
  you deliberately take into the exam and somehow
  incorporate into your argument if possible and
  relevant.

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CEQ

• Build up a bank of ideas that relate to
  psychiatry and its place in society but may be
  peripheral to the substance of psychiatry
• For example I enclose the following gems that I
  considered as I was writing my essay

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CEQ Gems

• Know the RANZCP Code of Ethics

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CEQ Gems

• Ethics matters of professional conduct
• Morals social, personal or sexual behaviour
• Laws Common Law (Judges)
• Legislation (Parliament)
• Laws - Criminal Law
• Civil Law (Contracts and Torts of Negligence)

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CEQ Gems

• Laws that you can quote
• Rights of the Terminally Ill Act (NT) 1995
• Declaration of Geneva (World Medical Association)
  1948, 1968, 1983

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CEQ Gems

• Laws that you can quote (cont)
• Declaration of Lisbon (The Rights of the Patient)
  1981
• -choose physician accept or refuse treatment
  confidential die with dignity receive or
  decline spiritual comfort

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CEQ Gems

• The ethical pillars
• Autonomy
• Beneficence
• Non maleficence
• Justice
• Mention if they are in conflict with regard to
  your statement

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CEQ Gems

• Qualities of an ethical doctor
• Veracity (truthfulness)
• Privacy and confidentiality
• Fidelity and trustworthiness/integrity
• Compassion/discernment/judgement

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CEQ Gems

• Religion
• Happy is the man who trusts in the Lord King
  David
• Religion is the opium of the people Karl Marx
• Religion is the universal obsessional neurosis
  Freud
• Religion makes and unmakes prejudice Allport

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CEQ Gems

• Religion (continued)
• And remember that psychotherapy has many origins
  in the discourse between the individual faithful
  and the cleric. Eg terms like pastoral care
  come to mind.

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CEQ Gems

• Know something about philosophy
• Example 1
• Morality as a social contract (Hobbes)
• Vs
• Morality innate (Rousseau)

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CEQ Gems

• Know something about philosophy
• Example 2
• Realism things exist independent of the mind
• Vs
• Idealism the world is fundamentally mental

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CEQ Gems

• Consult your grids but dont make them
  prescriptive (bio/psycho/social/cultural/historica
  l/philosophical/forensic)
• Mention the college statements or guidelines
• And as you practice find your own strengths of
  knowledge that lie outside of psychiatry but are
  related

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• Good Luck!