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GP ST Entry Stage 2 Assessment
Study Guide 2013
7th Edition
The right of Mahibur Rahman to be identified as author of this work has been
asserted by him in accordance with the copyright, designs and patents act
1988.
General Practice is the most popular of all the specialties, with more than a
quarter of all candidates ranking it as their top choice, and more than half
likely to apply for it as one of their choices.
Shortlisting for entry into GP Specialty Training (GP ST) is decided solely by
the scores candidates achieve in the Stage 2 assessments.
In 2012, around 6000 doctors sat the Stage 2 exam, and it is anticipated that
the competition will be similar or even higher in 2013.
It is essential that you are familiar with the structure and content of both
papers (clinical problem solving and professional dilemma) that will determine
your overall ranking.
I hope that you will find this guide useful in your preparation for the
assessment, and I wish you every success in your chosen career.
www.emedica.co.uk
Introduction ......................................................................................................6
Core criteria assessed by the SJT from National Person Specification ..16
Summary .......................................................................................................38
This date is not negotiable, and if you are unable to attend, then you
CANNOT be shortlisted for GP ST. The only exception to this is for doctors
unable to sit an examination on a Saturday for religious reasons alternative
arrangements will be made by the National GP Recruitment Office.
The exam will be done entirely on computer, and will consist of two sections
or papers lasting a total of 3 hours 5 minutes, and you will be ranked
according to your score. The highest ranked doctors in each deanery will be
shortlisted in 2012, 1.5 doctors were shortlisted for every job available in
each deanery.
This study guide will cover the two different papers the background, what
they are testing, what to read, sample questions for each section of each
paper, and advice on further reading and ways to prepare.
Section 1 covers the make up of the papers, with tips on how to prepare.
Section 2 has example questions for the Clinical Problem Solving paper.
Section 3 has example questions for the Professional Dilemma paper.
If there are any jobs outstanding after round 1, then there may be a second
round commencing in late April or early May 2013.
The two papers in the Stage 2 assessment are a Clinical Problem Solving
paper, and a Professional Dilemma paper.
Both papers are equally weighted, and you need to reach a minimum
standard in BOTH papers to be considered for shortlisting.
There are around 100 - 110 questions in the Clinical Problem Solving Paper.
Medical Surgical
General Medicine General Surgery
Cardiovascular Orthopaedics and Trauma
Respiratory Obstetrics / Gynaecology
Renal medicine Urology
Endocrinology / Metabolic Ophthalmology
Gastroenterology / Nutrition ENT
Infectious disease
Haematology
Pharmacology / Therapeutics
Rheumatology
Dermatology
Neurology
Psychiatry
Paediatrics
Genetics
Immunology / Allergies
There are two main types of questions Extended Matching questions, and
Single Best answers.
You can use each answer once, more than once or not at all.
A B C D E F G H
A B C D E F G H
A B C D E F G H
A B C D E F G H
The correct answer is F: Urgent MRI Scan. In cases where there is any
suspicion of cord compression, urgent MRI is the investigation of
choice, and these patients should be referred to the neurosurgeons or
orthopaedic surgeons. A Computed tomography (CT) scan is not
commonly used except where MRI is not available.
A B C D E F G H
A B C D E F G H
This type of question offers a scenario and five possible answers. You have
to select the SINGLE most appropriate response. This type of question made
up the remainder of the questions in the 2012 exam.
A 35 year old man has a severe allergic reaction while in hospital. He has no
history of past allergic reactions. Which ONE of the following commonly
causes a reaction WITHOUT prior exposure or sensitization?
a. Peanuts
b. Hymenoptera stings
c. IV Penicillin
d. IV Contrast media
e. Latex
Other question types which have been used in the past, and may be used
again include algorithm questions, questions where you have to fill in the
blanks from a paragraph with the most suitable word, data interpretation
questions, and multiple best answer questions. It is likely that these questions
will only make up a small part of the paper (usually less than 10%).
This section covers a broad rage of subjects across both medical and surgical
specialties. As the level is set at PRHO / F1 level, it is better to cover a broad
range of subjects briefly than to bog yourself down with any one specialty at
Membership level.
Oxford Handbook of Clinical Medicine you should all be familiar with this,
so reading it quickly will be good revision.
Another way to revise is to practise questions. Use the True / False questions
and explanations in the online revision service to quickly revise the different
subject areas and assess which areas you need to work on most. After doing
your reading, you can then use the Extended Matching questions and Single
Best Answer questions to practise questions at the same level and in the
same format as the real exam.
We recommend you do not attempt the Mock Exams until you are near the
end of your revision. The mock exam will allow you to gauge your readiness
for the exam by providing a timed exam in the same format as the real exam.
SJTs have been used for decades by employers, usually as part of multiple
recruitment assessments. They date back to the 1940s, and have evolved to
become a popular tool in various industries. They are used by the Canadian
Civil Service, the Federal Bureau of Investigations (FBI), the Department of
Works and Pensions, the NHS Graduate Management Training Scheme
amongst others.
They are used to assess soft skills, and non-academic, practical intelligence.
They have been adopted by many organisations because they are seen to be
better predictors of actual job performance and offer a way to test candidates
more broadly than knowledge based exams. They are machine markable so
are much easier to administer and mark, and more cost effective than essay
based assessments. This is one of the key reasons they have been adopted
for GP ST entry selection the short timescales between the assessment
date and shortlisting make it impractical to mark thousands of essays.
The SJT / Professional Dilemma paper will test you against some of the
criteria in the National Person Specification for GP ST entry:
It also tests your capacity to apply the guidelines in the GMCs Good Medical
Practice.
There are two sections to this paper. Both present you with a scenario that a
junior doctor might face. The scenario could be related to an ethical dilemma,
a difficult patient, teamwork, or involve prioritising demands on your time.
You have just started a job as a medical F2 in a new hospital. Your wife has a
chest infection, and is not yet registered with a GP and has asked you to
prescribe antibiotics.
Rank the following options 1-5, 1 being the most effective / best option, 5
being the least effective / worst option:
Your wife could be seen as a temporary resident and register with a local GP.
The GMC Good Medical Practice guidance states that Wherever possible,
you should avoid providing medical care to anyone with whom you have a
close personal relationship.
The GMC guidance does allow for you to prescribe for those close to you if
absolutely necessary, or in an emergency, but your wife still needs to register
with a GP for her future care. This is not an emergency, but this is option is
better than C, D, or E.
Take home prescriptions are for patients being seen in the hospital only. You
should not abuse your position of responsibility.
This is unfair to your colleague he has not seen the patient, yet he would be
responsible for any adverse events.
This is fraudulent, and dishonest. This could lead to you losing your job, and
potentially your GMC registration.
This section offers scenarios similar to Section 1, but with more possible
options. There may be 7 or 8 options for each scenario, and you must choose
the 2 or 3 options which combined make the most appropriate response. This
is very different to Section 1 as you are not being asked to assign ranks to all
the options, nor are you being asked to just select 2 or 3 options that seem
sensible. The options you choose have to be looked at together to make up
the most appropriate overall response.
A. Ask her daughter to sign the consent form and state that she is the
daughter.
B. Inform your consultant she has dementia and ask him to complete
the consent form.
C. Encourage the patient to sign the form as the procedure is in her
best interests.
D. Exclude any acute causes that could be worsening her confusion.
E. Discharge the patient as she will be unable to have surgery without
consent.
F. Cancel the patients operation.
G. Ring the theatre to rearrange the list so this lady is lower down on
the list.
Underline the three options that make the most appropriate combined
response. (Answers are on the next page)
The best way to prepare for this paper is to make sure you are familiar with all
of the competencies in the National Person Specification for GP ST entry.
This will help you understand the attributes being tested. Another useful
publication to read is the General Medical Councils Good Medical Practice.
This provides the material and concepts that are assessed in many of the
questions (there is some overlap with the National Person Specification).
Use the SJT section of the online revision service to practise answering
Professional Dilemma questions.
One of the key things to remember in the exam is to keep an eye on the clock
many doctors were unable to finish this paper in the allotted time last year.
You have to answer around 60 questions in 110 minutes this is less than 2
minutes a question to read the scenario, assess the options, decide on an
answer and check the relevant boxes on screen!
Endocrine emergencies:
A Diabetic ketoacidosis (DKA) F Hypophosphataemia
B Hypoglycaemic coma G Thyrotoxic crisis
C Addisonian crisis H Phaeochromocytoma
D Acute hypocalcaemia
E Acute hypercalcaemia
For each of the following scenarios, select the SINGLE most likely
diagnosis. You can use each option ONCE, more than once, or NOT at
all.
A B C D E F G H
A B C D E F G H
3. A 35 year-old woman presents with headache that has persisted for three
days. She has recently had an endoscopy to investigate her dyspepsia. She
has been vomiting, become very sweaty and is having palpitations. She
describes feelings of intense fear and anxiety. On examination she has a
pulse of 120 beats per minute, BP is 180/108 mm Hg, she has a tremor and a
temperature of 38.4C. You also notice several brown cutaneous macules over
her body.
A B C D E F G H
A Ramipril F Isotretinoin
B Prednisolone G Dermovate
C Methotrexate H Oxytetracycline
D Celecoxib
E Simvastatin
For each of the following patients, select the drug most likely to be causing
the side effects mentioned.
You may use each option ONCE, MORE than ONCE, or not at all.
A B C D E F G H
5. A 55 year-old man with known heart disease presents with severe muscle
pains. He reports feeling "weak". Creatine kinase (CK) is 1,000 U/L.
A B C D E F G H
A B C D E F G H
A. Carbamazepine
B. Orange juice
C. Azathioprine
D. Cranberry juice
E. Nystatin
a. Campylobacter
b. Escherichia coli
c. Clostridium difficile
d. Salmonella
e. Shigella species
a. Isphagula husk
b. Senna
c. Lactulose
d. Movicol
e. Co-danthramer
a. Routine endoscopy
b. 13C urea breath testing
c. Admission to hospital.
d. Triple therapy (amoxicillin + clarithromycin + lansoprazole) for one week
e. Urgent endoscopy
6. A 60 year old man complains of a gradual loss of his central vision. Which
ONE of the following is the leading cause of visual loss in patients over 65 in
the Western world?
a. Glaucoma
b. Diabetic eye disease
c. Cataract
d. Age related macular degeneration (AMD)
e. Retinal detachment
Endocrine emergencies:
For each of the following scenarios, select the SINGLE most likely
diagnosis. You can use each option ONCE, more than once, or NOT at
all.
A B C D E F G H
A B C D E F G H
3. A 35 year-old woman presents with headache that has persisted for three
days. She has recently had an endoscopy to investigate her dyspepsia. She
has been vomiting, become very sweaty and is having palpitations. She
describes feelings of intense fear and anxiety. On examination she has a
pulse of 120 beats per minute, BP is 180/108 mm Hg, she has a tremor and a
temperature of 38.4C. You also notice several brown cutaneous macules over
her body.
A B C D E F G H
A Ramipril F Isotretinoin
B Prednisolone G Dermovate
C Methotrexate H Oxytetracycline
D Celecoxib
E Simvastatin
For each of the following patients, select the drug most likely to be causing
the side effects mentioned.
You may use each option ONCE, MORE than ONCE, or not at all.
A B C D E F G H
5. A 55 year-old man with known heart disease presents with severe muscle
pains. He reports feeling "weak". Creatine kinase (CK) is 1,000 U/L.
A B C D E F G H
A B C D E F G H
A. Carbamazepine
B. Orange juice
C. Azathioprine
D. Cranberry juice
E. Nystatin
a. Campylobacter
b. Escherichia coli
c. Clostridium difficile
d. Salmonella
e. Shigella species
a. Isphagula husk
b. Senna
c. Lactulose
d. Movicol
e. Co-danthramer
a. Routine endoscopy
b. 13C urea breath testing
c. Admission to hospital.
d. Triple therapy (amoxicillin + clarithromycin + lansoprazole) for one week
e. Urgent endoscopy
The correct answer is B: 13C urea breath testing. The NICE guidance on
management of dyspepsia recommends empirical treatment with a
proton pump inhibitor (PPI) or testing for H. pylori as options for initial
management in patients with no alarm signs. Routine endoscopy is not
recommended for these patients. Triple therapy is only recommended
once H. pylori has been confirmed.
6. A 60 year old man complains of a gradual loss of his central vision. Which
ONE of the following is the leading cause of visual loss in patients over 65 in
the Western world?
a. Glaucoma
b. Diabetic eye disease
c. Cataract
d. Age related macular degeneration (AMD)
e. Retinal detachment
You have just started an F2 job in Otolaryngology (ENT). You are asked by
one of the staff nurses to consent a patient for Stage II cholesteatoma surgery.
You are not sure how this operation is performed or of all the risks involved.
The patient is about to be wheeled off the ward to theatre as they are next on
the list.
Rank the following options 1-5 (1 being the best, and 5 being the worst)
Should you:
A. Explain what you can and consent the patient quickly before they leave
the ward.
B. Contact the registrar to explain the situation. Ask him to consent the
patient.
C. Leave the consent form unsigned and continue with the rest of the
ward jobs.
D. Ask to go to theatre to watch the operation at a later date.
E. Tell the patient to sign the form as he cant have his operation without it.
1. B. The patient needs to be consented. For the patient to make up his mind
and give informed consent, he needs to know the risks and benefits, and what
will happen. The registrar will be able to provide this information, and even if
this delays the list a little, this is the best option.
2. D. It would be useful to see the operation in due course. This episode has
shown a learning need, and this would allow you to learn about the procedure
and ask about the risks and side effects.
3. C. Not very constructive. If you are not happy to consent the patient you
need to contact the surgeon/registrar to inform them of the situation. However,
the operation wont be able to proceed without consent, so the patient will
either be cancelled or consented by the surgeon.
4. A. You need to provide the patient with adequate information about the
procedure in order to be able to consent them. If the patient is not aware of
the risks and benefits, he cannot make an informed decision.
5. E. Consent is only valid if it is informed. The patient may find this
threatening. They are in a vulnerable position and may feel unable to refuse.
Rank the following 1-5, 1 being the MOST effective / best option, 5 being the
LEAST effective / worst option:
1. E - You are making your colleague aware that his actions are wrong, and
allowing him a chance to explain himself / make amends.
4. C - this does not address the situation at all. As his action affects you and
all of your colleagues, it IS your responsibility to do something about it.
5. D - This is unethical - not only are you condoning his behaviour, you are
asking for a bribe as well.
Remember that this is a competitive exam, so the higher your overall score,
the greater your chance of being shortlisted. Now that you know what to
expect, please do make sure that you dedicate enough time to prepare
effectively.
I wish you all the best in your preparation, and every success in securing a
place on a GP ST programme.
Medical Director
Emedica
www.emedica.co.uk