Living in the country and studying in the city: The art of passing exams and remaining sane

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Dr. Cameron Grant FRACP PhD …

Dr. Cameron Grant FRACP PhD
Associate Professor, Paediatrics, University of Auckland
Paediatrician, Starship Children’s Hospital, Auckland

On behalf of Ralph Pinnock, Simon Hayden, Michael Sullivan and Innes Asher
Starship Children’s Hospital, Telepaediatrics and University of Auckland

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  • 1. Living in the country and studying in the city: The art of passing exams and remaining sane Dr. Cameron Grant FRACP PhD Associate Professor, Paediatrics, University of Auckland Paediatrician, Starship Children’s Hospital, Auckland On behalf of Ralph Pinnock, Simon Hayden, Michael Sullivan and Innes Asher Starship Children’s Hospital, Telepaediatrics and University of Auckland
  • 2. Paediatrics is a clinically demanding specialty
  • 3. Until you pass the exams You cannot proceed Completion of medical degree 6 years 2 or more years post registration experience Paediatric registrar Sit and pass FRACP examinations Complete 3 years of advanced paediatric training Paediatrician
  • 4. The circle to be avoided Only available once a year Sit exam Fail exam Prepare for exam Feel sad
  • 5. To avoid the circle, you must pack up your things and move to the big smoke!
    • On average 63% to 73% pass rate across Australia and New Zealand
    • Higher pass rate in bigger centres
  • 6. But life can be sweeter in the country
    • Lifestyle
    • Family commitments
    • Future job prospects
    • Staff retention in smaller centres
  • 7. To overcome these issues we developed a national teaching programme deliverable electronically to hospitals throughout New Zealand
    • The structure of the programme
    • How the students were engaged
    • The teaching success
  • 8. How it all was in the beginning
    • Established by Department of Paediatrics, University of Auckland
      • By paediatricians in Auckland for paediatric trainees in Auckland
    • All Winter, Spring and Summer
      • Each Thursday 3 to 5 pm
      • Exam first week in March
        • Identical exam at multiple centres in Australasia
  • 9. Going national: In preparation for take off please focus your attention
    • Time for topic = # questions on topic in exam
      • 15 topics accounted for > 90% of questions
        • Another 11 topics each < ½% of exam
      • Practice MCQ exams
        • Nothing but questions from old Royal Australasian College of Physicians exams
        • No cheap English or American imitations
    So don’t waste your time on them
  • 10. F R A C P PA R T 1 T R I A L E X A M I N A T I O N August 2007 32 QUESTIONS Department of Paediatrics University of Auckland Format Paper 1 – Medical Sciences: 12 questions; time allowed: 20 minutes Paper 2 – Clinical Applications: 20 questions; time allowed: 36 minutes Compiled by: Cameron Grant Andrea Evans
  • 11. 2 9/10 5 2/10 4 7/10 10 5/10 9 9/10 8 3/10 7 5/10 14 4/10 15 8/10 17 3/10 16 6/10 12 6/10 19 3/10 20 7/10 21 3/10 26 6/10 25 0/10 24 6/10 Feedback of MCQ results 22 5/10 29 7/10 1 6/10 6 8/10 Q 1-12 Medical Sciences 11 8/10 13 6/10 18 7/10 23 5/10 28 4/10 27 4/10 30 8/10 31 4/10 32 8/10 Q 13-32 Clinical Applications 3 5/10 Range 13 – 23 Median 18
  • 12. Question 21: 3/10
  • 13. Question 21 cont: A nine-year-old boy presents with a two-week history of cough, tachypnoea, recession and increasing cyanosis. The chest X-ray and a lung biopsy (stained with methenamine silver nitrate) are shown above. The underlying immune deficiency is most likely to be primarily affecting his: A. B lymphocytes. B. macrophages. C. natural killer cells. D. neutrophils. E. T lymphocytes.
  • 14. Question 26 - Answer
    • Answer = E = T lymphocytes
    • The scenanrio and lab data describe a child with Pneumocystis carinii pneumonia
    • Pneumocystis carinii occurs as an asymptomatic infection in most young children. P. carinii pneumonia occurs in immunosuppressed infants and children as well as debilitated infants.
    • P. carinii pneumonia is the most common pulmonary infection in patients with human immunodeficiency virus (HIV) infection, including infants and young children with perinatally acquired HIV infection.
    • Ref: Rudolph's Pediatrics 21st edition 2003 McGraw-Hill, New York
  • 15. 2 9/10 5 2/10 4 7/10 10 5/10 9 9/10 8 3/10 7 5/10 14 4/10 15 8/10 17 3/10 16 6/10 12 6/10 19 3/10 20 7/10 21 3/10 26 6/10 25 0/10 24 6/10 Feedback of MCQ results 22 5/10 29 7/10 1 6/10 6 8/10 Q 1-12 Medical Sciences 11 8/10 13 6/10 18 7/10 23 5/10 28 4/10 27 4/10 30 8/10 31 4/10 32 8/10 Q 13-32 Clinical Applications 3 5/10 Range 13 – 23 Median 18
  • 16. Hey, can we join in? Us to please Me to! Me to! Me to! Can I play??? Don’t forget us Yo! From ‘naki, we’re in to I want, I want, I want Sign us up now! Telepaediatrics
  • 17. $$$$$$$
    • Academic time + administrative support + telepaediatrics time =
    • We teach so your District Health Board pays
    • The Starship Foundation TelePaediatric Fund
    $$$$$$$
  • 18. How do you stop people hiding behind the technology? If I point the camera at my navel they won’t know who I am
  • 19.  
  • 20. 2 9/10 5 2/10 4 7/10 10 5/10 9 9/10 8 3/10 7 5/10 14 4/10 15 8/10 17 3/10 16 6/10 12 6/10 19 3/10 20 7/10 21 3/10 26 6/10 25 0/10 24 6/10 Feedback of MCQ results 22 5/10 29 7/10 1 6/10 6 8/10 Q 1-12 Medical Sciences 11 8/10 13 6/10 18 7/10 23 5/10 28 4/10 27 4/10 30 8/10 31 4/10 32 8/10 Q 13-32 Clinical Applications 3 5/10 Range 13 – 23 Median 18 Ok Christchurch, its your turn to chose a question
  • 21. Another Week Ends :- All targets met Completely up to date with reading timetable Full and comprehensive notes all done Scoring > 90% in the practice MCQ exams And I am being so nice to everyone at work All pigs fed and ready to fly No plan is perfect, everything takes longer than you think
  • 22. But I am on nights this week and will be asleep on Thursday afternoon
    • Webcasting
    • Allows remote access and unlimited viewing
    • Does not allow downloading
    • Can view again as exam approaches
  • 23. Place left hand here Place right hand here
  • 24. FRACP exam pass rate by year  6 2 = 2.41, p = 0.88 66 to 69%  1 2 = 1.29, p = 0.25 69% vs. 80%  1 2 = 4.28, p = 0.04 60% vs. 82% Teaching improved Teaching available
  • 25. What have we achieved?
    • Developed a national real time video and auditory teaching programme
    • Enabled those training in smaller NZ centres to have an improved likelihood of being successful
  • 26. What does this mean
    • Enables high calibre trainees to complete more of their training in smaller centres
    • Smaller regional centres in NZ benefit
      • Greater staff continuity
      • More experienced, knowledgeable staff
    • Trainees benefit
      • Greater appreciation of possible future role there
      • Enjoyment of lifestyle opportunities
      • Stronger position for subsequent employment
  • 27. What opportunities does it create?
    • 2007 started webcasting to Queensland
    • Interest from South Australia, Victoria, New South Wales and Northern Territory
    Strewth, blue, what about ya mates across the deetch?
  • 28. Acknowledgements
    • All of the teachers
    • Simon Hayden, Murray Silverstone and all the telepaediatrics staff
    • Shelly then Chaitra and now Andrea who keep the whole thing running