1. MCQ – Multiple Choice Questionnaire
PAPER TWO
MCQ – Multiple Choice Questionnaire

2. What do you want from MCQ preparation?
Table as a group (get to know your neighbour)
Person nearest the aisle is spokesperson
Just FOUR items required
Only takes a minute or two

3. TUTORS’ Aims of MCQ preparation
Review format/content of exam
Flavour of questions
Practice (difficult to do under exam conditions)
Identify areas of weakness (go home and check answers)
Some comparison with peer group (need to mark the paper here and now)

4. Plan for short seminar
Overview
Content
Revision
Format

5. Overview MCQ May 2005 1622 candidates
High reliability of the exam (comparable to any equivalent test worldwide)

6. Overview MCQ Mean 74% Standard Deviation 9% Pass mark 67% Merit 81%
79% of candidates passed
23% of candidates given merit

7. Overview MCQ
Just a few extra marks makes a large difference in your ranking compared to your peers

8. Overview MCQ NOW more Single Best Answer questions
Questionnaire – (60% response rate – 90% passed)
Difficult!! (yet nearly 80% passed)
Appropriate questions
Extended matching items most difficult (and Summary Completion)
Time a problem
NOW more Single Best Answer questions

9. Overview MCQ 3 hours and offered in May and October
Tests established and recently discovered KNOWLEDGE of relevance to general practice
(newer questions involve more and more APPLICATION of knowledge)

10. CONTENT

11. Content clinician family physician patient's advocate gatekeeper
resource allocator
handler of information
team member
team leader
partner
colleague
The Gatekeeper

12. Content employer manager business-person learner teacher
reflective practitioner
researcher
agent and shaper of policy
member of a profession
person and individual

13. Content Syllabus 32 pages long
17 pages of general concepts for each defined area
13 pages of appendices - checklist
2 pages of references

14. Content - syllabus Good medical practice and care Generalist skills
The doctor-patient  relationship, communication and consulting skills
Professional, ethical and legal obligations
Population, preventive and societal issues
Information management and technology

15. Content - syllabus Risk management
Monitoring of quality of performance, audit and clinical governance
Continuing Professional Development, learning, teaching and training
Working with colleagues
Organisational administrative and regulatory framework
Financial probity and business management

16. Content (example from syllabus appendix)
Serious communicable diseases
Particularly, but not limited to, infections such as Human Immunodeficiency Virus (HIV), tuberculosis and hepatitis B and C
Means and control of transmission, awareness of diagnosis, investigation, management, consent for testing, issues of confidentiality and the implications to the patient of a positive result
Role of Public Health Services

17. Syllabus – help or hindrance
First direction for revision from College
A little vague in places but a useful starting point
Certainly worth a read to help identify areas of weakness

18. Content Medicine - 65% Admin. & Management - 15%
Research, Epidemiol. Stats - 20%

19. Medicine (65% of marks) all equal - 6% !! Cardiovascular
Dermatology / ENT / ophthalmology
Endocrinology / metabolic
Gastroenterology / nutrition
Infectious diseases / haematology / immunology / allergies / genetics
Musculo-skeletal
Paediatrics
Pharmaco-therapeutics
Psychiatry / neurology
Reproductive / renal
Respiratory
all equal - 6% !!

20. Implications for revision
DERMATOL / ENT / EYES – 6% of exam

21. Research/epidemiol./stats – 20%
Assessing the quality of care
Principles of audit
Understanding and application of the terms used in inferential statistics and evidence-based medicine
Knowledge of statistics and research methodology, sufficient for the critical appraisal of published papers.

22. Content - Revision Clinical areas fairly limitless
Research, epidemiology, administration and management more defined in this exam.

23. Revision Considerable amount of work to be done (sorry)
Need a good general background
Identify areas of weakness
Prioritise these areas
Don’t spend time needlessly
Make use of review articles and publications such as ‘Clinical Evidence’

24. Revision

25. Revision

26. Revision

27. Revision

28. FORMAT

29. MCQ FORMAT – why change? Congruence with education
Mainly PBL
Flaws in multiple T/F format
Rote memory vs problem solving
Benefits of newer formats
?integration of factual knowledge / personal care

30. Format <250 questions Trial questions = different papers
EMQ - extended matching item questions
SBA - single best answers
MBA - multiple best answers
TAQ – table / algorithm completion
SCQ- summary completion questions (???)
Items per question will vary between 3 and 6
Trial questions = different papers

31. Format Pictorial data - charts, photos (on the INCREASE)
NO NEGATIVE MARKING

32. Question Examples SINGLE BEST ANSWER MULTIPLE BEST ANSWER
SUMMARY COMPLETION
EXTENDED MATCHING ITEM
TABLE / ALGORITHM COMPLETION

33. SBA- Single Best Answer, from May ‘98
In the management of croup in a 2y old child, which single treatment has been shown in clinical trials to shorten the course of the condition?
place the child in a steam filled bathroom
administer inhaled budesonide
prescribe amoxycillin 125mg tds for 5/7
administer inhaled salbutamol
prescribe paediatric codeine cough suppressant
administer inhaled tribavirin

34. Multiple Best Answer (MBA)
A statement is followed by a variable number of items a specified number of which are correct

35. Multiple Best Answer (MBA)
A 65-year-old male smoker presents with a gradual onset of breathlessness on moderate exertion, and a cough with clear sputum. Chest examination reveals general reduction breath sounds and the presence of a few rhonchi bilaterally. Spirometry reveals an FEV1 of 50% of predicted. Identify the three most appropriate therapeutic interventions to be considered following the British Thoracic Society COPD guidelines. Give THREE answers.
A Salbutamol inhaler
B Beclomethasone inhaler
C Ipratropium inhaler
D Salmeterol inhaler
E Sodium cromoglycate inhaler
F Oral theophylline
G Oral steroid trial
H Nebulised ipratropium
I Referral for long term oxygen therapy

36. Summary Completion Questions - possible fill in the gap words (given in College instructions)
association
exclusion
sensitivity
bias
precision
success
difficult
safety
validity
error
selection
variables
blinded
questioned
typical
cohort
randomised
undertaken
demonstrated
reliability
unrepresentative

37. Extending Matching Questions
Extending Matching Questions (EMQ) in which a scenario has to be matched to an answer from a list of options. You may feel that there are several possible answers but you must choose only the MOST LIKELY from the option list.

38. THEME: Reduced Vision Option list: Instruction:
(A) Basilar migraine (F) Occlusion of the central retinal vein
(B) Cerebral tumour (G) Optic neuritis
(C) Cranial arteritis (H) Retinal detachment
(D) Macular degeneration (I) Tobacco optic neuropathy
(E) Occlusion of the central retinal artery
Instruction:
For each patient with reduced vision, select the single most likely diagnosis. Each option may be used once, more than once, or not at all.
Items:
1 A 75-year-old man, who is a heavy smoker, with blood pressure of 170/105, complains of floaters in the right eye for many months and flashing lights in bright sunshine. He has now noticed a ‘curtain’ across the vision of his right eye.

39. Table/Algorithm Completion
Format often found in guidelines to advise on management decisions.
You are asked to select the correct answer to complete the table or algorithm box.

40. Medical management of menorrhagia:
Not requiring contraception
Requiring contraception
Combined
oral contraceptive pill
For each of the numbered gaps above, select ONE option from the list below to complete the algorithm,
based on current evidence. Select ONE option only

41. A Copper intra-uterine device
B Cyclical medroxyprogesterone acetate
C Cyclical norethisterone
D Inert intra-uterine device
E Levonorgestrel releasing intra-uterine system
F Mefenamic acid
G Nonoxinol ‘9’
H Tibolone
I Tranexamic acid

42. OPSCAN SHEET

43. OPSCAN SHEET Use only the pencil provided Potential pitfalls
Wrong ID number
Skip a question?

44. MCQ Summary Time is more important
250 questions in 180 mins
43 seconds per question
Answer everything – no negative marking
Practice, practice, practice (go over weak areas)

45. Practice
A composite paper giving examples of multiple choice questions is published from time to time, and is available from the RCGP Sales Office
Does not include many newer questions?
Also,
PEP,
Pastest

46. The End!!!!