The Palliative Medicine Specialty Certificate Examination (SCE)

Dr Clare Marlow Consultant in Palliative Medicine

Previous Palliative Medicine SCE Exam Board Secretary (2011-2016)

Dr Hazel Coop Specialty Registrar in Palliative Medicine

Passed the Palliative Medicine SCE (2016)

Overview

• Background

• Delivery

• Examination format

• Hazel’s SCE Experience – Preparation

– What to expect on the day

• Practice questions

• Summary

SCE Background

• SCEs conceived in 2005 as national knowledge-based assessments in all major medical specialities.

• Piloted (4 specialties) in 2006.

• Palliative Medicine: 1st diet in 2011.

SCE Purpose

• To ensure that certified specialists have sufficient knowledge to practise competently and safely as consultants.

• To complement workplace-based assessments.

• To provide a rigorous national assessment.

What the SCE assesses: • Knowledge base.

• Advanced clinical problem-solving skills.

• Selection and prioritisation of investigations.

• Ability to make a diagnosis and reason between differential diagnoses.

• Acute and chronic management of conditions.

• Recognition and management of complications of a primary diagnosis.

• Recognition and management of complications of medical therapies.

• Knowledge of evidence-based medicine and nationally / specialty-approved management guidelines.

The SCE is a summative assessment of scientific and clinical knowledge, as well as problem-solving ability.

Eligibility requirements

• There are no entry requirements for the SCE in Palliative Medicine, although trainees in UK training posts would normally take the SCE in their penultimate year of higher specialty training.

• Physicians in UK training must pass the appropriate SCE, in addition to successfully completing an approved specialty training programme, in order to gain admission to the GMC Specialist Register.

Examination format

• The SCE is a computer-based, multiple choice test divided into two papers.

• Candidates are allowed three hours to answer each paper.

• 100 items per paper.

Best of Five (BOF) question

• Stem

– A clinical scenario.

• Lead-in

– A question, which must be specific and unambiguous.

• Answer options

– 5 plausible options; 1 clear best answer.

– Must fall in the same domain.

SCE pass mark review

• One change in recent examinations has been resetting the pass mark standard for the SCEs, using the UK cohort as the reference point.

• 70% of UK trainees will pass.

• Majority of UK trainees will pass first time.

• Most trainees find the exam difficult.

SCE preparation

• Become familiar with specialty curriculum.

• Know the exam blueprint, noting distribution of questions.

• Remember:

• The knowledge necessary to pass the SCE cannot be acquired from clinical practice alone.

• Clinical experience has to be complemented by private study.

Hazel’s SCE experience

MRCP

When did I start thinking about the SCE exam?

Where to start?

1. Look on the MRCP website when the exam is!

2. Register for the exam.

3. Have a look at the palliative medicine SCE questions on MRCP website.

4. Look at courses – St Gemmas.

5. Find out who else is doing it in your area.

Resources available

medinfo@kyowakirin.com NICE/SIGN guidelines Cochrane reviews PCF Revision cards Information for peers who have taken it in the past Use Previous MRCP questions to get used to ‘best of five’ answers

• Presentation / usual course of conditions.

• Investigations.

• Management options.

• Pharmacology.

• Therapeutics.

• Evidence base.

• Guidelines.

• Theories.

• Legal aspects.

• Remember an exam for whole United Kingdom

What I found useful?

• Attended extra palliative medicine clinics/ ward round.

• Encourage consultant to ask lots of questions about management/pharmacology.

Things to think about when booking your exam

Day of the exam

• Arrive early.

• Have your ID documents (2 forms of ID).

• Bring some water (but you can’t take it in with you).

• Think about lunch!

• You will be knackered!

Sample questions

A 58-year-old man with newly diagnosed prostate cancer presented with a 1-

week history of fatigue and difficulty passing urine.

On examination, his pulse was 88 beats per minute and his blood pressure was

136/78 mmHg. His respiratory rate was 25 breaths per minute and his oxygen

saturation was 94% (94–98) breathing air. On chest auscultation, fine crackles

were heard bilaterally.

Investigations:

serum sodium 134 mmol/L (137–144)

serum potassium 6.7 mmol/L (3.5–4.9)

serum urea 19.1 mmol/L (2.5–7.0)

serum creatinine 298 µmol/L (60–110)

What is the most appropriate initial management?

A calcium gluconate

B glucose/insulin infusion

C intravenous antibiotics

D intravenous fluids

E salbutamol nebuliser

A 60-year-old woman was brought to hospital having lost consciousness

following a subarachnoid haemorrhage. A nasogastric tube was inserted

for enteral feeding.

What is the most appropriate method for confirming the position of the

tube before each feed?

A chest X-ray

B external tube markings

C litmus paper test

D pH paper test

E 'whoosh' test (listening for bubbling sounds after air entry)

A 44-year-old woman presented with right upper quadrant and lower back

pain. She had cancer of the breast with lung, liver and bone metastases. She

declined chemotherapy, radiotherapy and conventional analgesics. She

asked about acupuncture for pain control.

According to the Cochrane review, ‘Acupuncture for cancer-related pain in

adults’ (2015), what is the best level of evidence informing the use of

acupuncture in cancer-related pain?

A case study

B cohort study

C expert opinion

D meta-analysis

E randomised controlled trial

A 68-year-old woman with metastatic endometrial cancer and type 2

diabetes mellitus was advised to take duloxetine for peripheral neuropathy.

What best describes the mechanism of action of duloxetine?

A α1-adrenoceptor antagonist

B α2-adrenoceptor antagonist

C noradrenaline and serotonin re-uptake inhibitor

D selective noradrenaline re-uptake inhibitor

E serotonin re-uptake inhibitor

A 78-year-old woman with advanced colonic cancer was admitted to a hospice.

She died with her family around her the following day. A doctor was called.

According to Academy of Medical Royal Colleges’ guidance, what clinical sign

must be present for death to be confirmed?

A absence of a central pulse during 3 min of palpation

B absent corneal reflexes after 3 min of observation

C no breath sounds during 5 min of auscultation

D no motor response to supraorbital pressure after 3 min of observation

E no pupillary light reflexes after 5 min of observation

A 65-year-old woman was admitted with type 1 respiratory failure that required ventilation. She had a history of a rapid clinical deterioration over the previous 3 weeks with loss of appetite and weight, breathlessness on minimal exertion and increasing weakness. She was found to have a small cell lung cancer with Lambert–Eaton myasthenic syndrome. Despite treatment with corticosteroids and plasmapheresis she remained ventilator- dependent. Communicating via an alphabet board, she refused chemotherapy and requested withdrawal of ventilation. In determining her capacity to make a decision regarding treatment withdrawal, what is the most appropriate next step? A assess her ability to communicate the decision B assess her ability to understand and retain relevant information C obtain a psychiatric opinion D obtain a second opinion E undertake a mini-mental state examination

Summary

No one likes examinations…

• Knowledge-based assessment.

• Every question subject to:

– Peer review.

– Editorial scrutiny.

– Detailed quality assurance.

• Trainees advised to sit during ST5.

Palliative Medicine SCE 2016

“Passing the SCE provides objective evidence that you have the necessary knowledge and understanding of evidence-based practice to take on the responsibilities of a consultant in your chosen specialty.

The SCE is intended to help demonstrate your suitability for this role”.

“The reading and learning required when preparing to sit it also requires you to revise and update your knowledge of topics and conditions that may not be part of your everyday practice”.

www.mrcpuk.org/SCE

• Sample questions (77)

• Exam blueprint.

• Exam fees (2018):

- UK: £665

- Overseas: £833

• The Specialty Certificate Examination (SCE) in Palliative Medicine is delivered once a year.

Exam date

UK

registration

period

Pearson VUE

UK centre

booking

window

International

registration

period

Results

release

14 November

2018

25 July - 17

October 2018

22 August -

18 October

2018

25 July - 22

August 2018

4 weeks after

exam date

Any questions?