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

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

Paediatrics is a clinically demanding specialty

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

The circle to be avoided Only available once a year Sit exam Fail exam Prepare for exam Feel sad

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

But life can be sweeter in the country

Lifestyle

Family commitments

Future job prospects

Staff retention in smaller centres

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

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

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

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

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

Question 21: 3/10

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.

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

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

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

$$$$$$$

Academic time + administrative support + telepaediatrics time =

We teach so your District Health Board pays

The Starship Foundation TelePaediatric Fund

$$$$$$$

How do you stop people hiding behind the technology? If I point the camera at my navel they won’t know who I am

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

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

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

Place left hand here Place right hand here

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

What have we achieved?