Guide to prepare for Postgraduate Examinations

 

Introduction 

Postgraduate examinations are necessarily set at a high standard and the preparation required in order to pass any part of the examinations must not be underestimated. 

This guide is written to help you fine-tune the techniques that already work for you and introduce new ones that may be useful for you in the future. 

There are two fundamental differences in undertaking a postgraduate examination rather than one at undergraduate level.  

  1. You will be studying in addition to working. 

  2. At postgraduate level, the standard rises substantially 

Therefore, it is essential that you address your studies with a seriousness that matches the nature of the undertaking.   

 

Is this the right time to do this exam? 

You should be able to dedicate a minimum of 4 months, preferably 6 months of intensive studying. You need to ‘pace’ yourself so your peak and optimal performance culminates around the examination period. 

It is therefore not a good time to be moving house, getting married, having a baby etc. 

Failing that, you will need a very robust social infrastructure to support you. 

 

How to study: 

Self -Directed Learning (SDL)- get your syllabus. Read, listen, attend the teaching delivered locally and regionally. Do you know your best learning style? - (Learning style questionnaires can be found on the internet). Textbooks, journals, royal college e –learning modules, past papers, current editorials and review articles. Up- to -date developments etc 

Group work- Lectures and tutorials, also provide a perfect forum to meet up with your peers who are preparing for the same examination. Why not set up a peer study group- support and challenge each other! 

Examination orientated courses may be important to gauge the general level of knowledge required.  

When taking part in a learning activity 

  • Before the session- think about what you already know about the topic and what you want to find out.  This will help you engage with the session and retain information.   

  • Do any preparation work you have been asked to do. 

  • Take an active role as possible within the session e.g. asking questions, jotting down key points.   

  • Build in time after each session to actively recall what you have learnt, perhaps using a mind map or notes.  

  • Revisit this learning (e.g. at the end of the day and end of the week) 

  • Build in time to do follow up work from the activity, including adding detail or following up anything you didn’t fully understand 

  • Reward yourself 

 

Study Strategy:

The key is to develop a routine. A routine which suits you and your family but to which you must ruthlessly adhere. Frequent and short periods of time are the name of the game. 

 Practice for any OSCE and viva parts of the examinations. The stress and anxiety generated when observed by your colleagues during a group mock viva/OSCE sessions is invaluable as it simulates the ‘hostile’ condition when you are faced with the real examiners.  

 

How do I learn best? 

There are several key points to think about: 

  • Memory skills 

  • Time management skills 

  • Reading skills 

  • Note-taking skills 

  • Study habits 

  • Revision skills 

  • Specific exam preparation 

 

Memory skills 

  • Maintaining attention and concentration is difficult beyond 20 minutes so design your routines round little blocks of time. 

  • Limit the amount of information you acquire in each session to a maximum of 7 chunks. 

  • Organise your knowledge so you work within a pattern - a clinical condition would for example include demographics, causes, presentation, history, signs from examination, investigation and management plan; whereas a basic science question would include pharmacodynamics and pharmacokinetic stems. 

  • Understanding of the knowledge – this can be greatly enhanced by group learning i.e. explaining to your peers a certain pathological condition such as the aetiology & mechanism of myocardial infarction. 

  • Make connections and links to what you already know. For example, you may have learnt about fibrosing alveolitis but cross referencing it with other causes of alveolitis would strengthen your understanding of the conditions. 

  • Set ‘SMART’ objectives on what else you need to know having fully appreciated what you already learnt (Specific, Measurable, Achievable, Realistic, Timely). 

  • Essential active recall. It is known that if you revise a piece of information several times in a short period, the retention of the knowledge is less than if you space the revisions in a longer interval – ‘spacing effect’ – hence 4-6 months of preparation time. 

  • Use meaningful patterns e.g. trying to learn the following series of words: dog, boat, spoon, hat, car, cat, cow, knife, coat . Organise the words e.g.  animals, utensils etc. 

  • Think of concepts as a way of organising your knowledge 

  •  Understand what you are reading or learning- teaching others on the subject can help, or using problem- based learning.  

  • Link what you learn to the real world/clinical cases

  • For more information on memory, see Appendix 2

 

Time management

Remember to make use of time off after night shifts and weekends. Plus, unexpected time available during your normal working day. 

 

Reading skills- SQ3R 

S=Survey- skim the material paying attention to headings, topic sentences, maps, charts, graphs, words you do not understand 

Q=Question- make your own questions about the reading based on the information you have surveyed.  

R=Read- read the material to answer your survey questions. Avoid getting sucked into the text itself. Much of what you read is padding.  

R=Recite- answer your questions without looking back on the reading. Use the method of recitation which best suits your particular learning style. The more senses you use the more likely you are to remember what you read - Seeing, saying, hearing, writing. 

R=Recall- look away from the reading material and focus on the major ideas and concepts. Review the reading material frequently i.e. every 30 minutes, at the end of the block of learning, at the end of the day and at the end of a week or fortnight. Periodically review the sheet, some students make flash cards which can be very effective 

 

Note taking skills

Use the method that works best for you. Visual- mind maps work well. Summarise what you have learnt- key ideas or concepts  

 

Study habits

You work more effectively if you are consistent in the way you work. Being consistent means the brain does not have to work out what you are up to. Consistency applies to how you work as well as when you work.  

Make a space in your room for work – that should not be the bed, as your brain will be confused whether you should be sleeping or working.  

Many students find the library is an ideal place to work, and find it anchors them into work mode.  

Remember that success is achieved through a few simple behaviours that are repeated daily. 

You may wish to use the study skills questionnaire (with or without your educational supervisor) to gain additional insight into your learning style (Appendix 1).

 

Revision Skills

Planning 

  • Study at the same time every day (As much as possible, it will make it easier to habitually follow the schedule and to maintain an active approach to study. 

  • Make use of the free time (10-20 min blocks) during the “normal working day”.  

  • Plan study periods to follow scheduled activities.  

  • Space study periods. 60-90 of study at a time works best.  

  • Relaxation periods of five minutes should be scheduled every 20 minutes.  

  • Plan for weekly reviews of new learning. At least one hour each week (distinct from study time) should be scheduled. The weekend is a good time for review. 

  • Leave some unscheduled time for flexibility. This is important!  

  • Allot time for planned recreation.  

  • Prepare your work space  

  • Prepare your rewards 

When studying/revising 

  • Start with a 5 -minute think- get motivated, ‘empty your bucket’  

  • 5 minutes thinking- what do you already know about the subject 

  • Map out what you need to know on top of that, create SMART questions (Specific, Measurable, Achievable, Realistic, Timely) 

  • Find the answer to the questions you have created. Avoid getting sucked into reading the text, use SQ3R (see earlier) as a way of helping you read more effectively. Do this for 20 minutes. 

  • 5 -minute break, exercise a bit, stretch, and have a glass of water. 

  • Active recall what you have learnt without notes- check to see if you are right, if not do a spot of revision 

  • Repeat the cycle 

  • You can do this cycle three or four times.  

  • Reward yourself. 

  •  Spacing Effect'- if you revise a piece of information a number of times with an ever-increasing interval this is meant to be better. E.g. One strategy for active recall is to do this after 30 minutes, at the end of each study period, at the end of a block of learning, at the end of the day, and at the end of a specialty module. 

 

Appendix 2 image 5 timing 

 

Specific exam preparation

Practice doing the different styles of exam in exam conditions.  

 

Self- Care during revision times 

During this period of intense demand on your discipline and stamina, you must have a strategy to regularly relieve the tension. This could be exercise or any pleasurable activities which you enjoy – the important message is to make it part of your routine. This ‘downtime’ is enormously important to recharge your battery. 

Stress management - It is very important to recognise symptoms of stress and depression (Iversen et al 09). The idea is not to manage this yourself but to recognise them in yourself and the peers working with you should you come across them. Some of these symptoms are: lack of interest, trouble sleeping, and problems concentrating on things e.g. reading paper or watching TV. 

‘Empty the Bucket’- empty your mind of other information not relevant to the exam before you start, so there is lots of processing space for the exam.  Also, treat each OSCE station/viva/written question as the only one that matters, forget the one before. 

Fake it until you make it- imagine you have already passed the exam. Imagine yourself leaving the exam happy or getting a pass. 

 

Some exam Q&A’s: 

  • Should I work late the night before? Working late before the exam only results in an overloaded and tired brain that cannot cope with a demanding exam. Sleep really is more productive than last minute cramming 

  • Should I read the answers and questions at the same time?No. Sometimes seeing a particular answer convinces your brain to read the question in a way that fits the answer. Always read the question first and think what the answer might be before looking at the answers. Remember some answers may be there to trick you. 

  • I tend to read the questions in a hurry, is that okay? All parts of the question are relevant. Read it carefully. You might find it helpful to underline words or jot down key points. 

  • I am nervous about doing that first skim through and prefer to go through slowly one question at a time. Is that okay?There is a risk if you go through the paper slowly one question at a time of running out of time so a whole section of the paper (usually the last part) is not answered.  Remember, this section may include 2 or 3 questions you could easily answer and missing these could significantly affect your score.  If you are someone who tends to be short of time, it is particularly important to do a first trawl through the paper. 

  • I sometimes feel that if I wrestle long enough with the hard questions, I am bound to find the right answer. It is not a good idea to spend valuable time and brain energy on questions you know nothing about and are very unlikely to be able to answer.  Follow the advice above, identify these questions and move quickly on, saving your time for questions you have more chance of getting right. 

  • I tend to be a perfectionist and feel very uncomfortable guessing. Only answering questions where you are absolutely sure of the answer will almost certainly lower your score.  You need to be prepared to go with your hunches and make educated guesses.  Being a good doctor/dentist/pharmacist includes feeling comfortable with a degree of uncertainty.  And in the real world you can always put systems in place to make sure the patient is followed up so you’ll know if they aren’t getting better! 

 

 

  

I failed- what now?

                 There is no such thing as failure- only feedback

 

See Appendix 3. for additional things to think about.

 

Appendices

  1. Appendix 1: Study skill questionnaire
  2. Appendix 2: Preparation for independent study
  3. Appendix 3: I failed- what now?

 

Reference

Iversen A, Rushforth B, Forrest K

The complete novice: How to handle stress and look after your mental health

BMJ 9 May 2009 volume 338 

 

 

Appendix 1

 AreaScreening QuestionsWhat we recommend
1 General
  • What do you see as the issues?
  • Try and be honest and specific
Time spent on Self-Directed Learning (SDL)
  • How many hours do you spend on SDL (outside of programmed teaching) each week?  If necessary go through week day by day
  • This will vary but a minimum of 10+ hours/week of effective study. 4-6 months exam preparation
  • Not excessive – ensure work/fun/relaxation balance
Quality of Time
  • When you plan to study does anything tend to get in the way of you starting work?
  • How long do you study for without a break?  What is the longest you have studied for at a time?
  • What time of day do you tend to study?
  • How often do you have breaks?
  • Do you use a diary and what for?
  • Where do you study?
  • Consider use of diary for planning SDL
  • Short “switch off” break after every 20 minutes
  • Not working all night etc.
  • Wind down breaks before bed
  • Work/relaxation/fun balance
  • Deal with obstacles e.g. Facebook, whatsapp, telephone calls, friends, noise
  • Use of rewards – when I’ve learnt this I will...
  • Consider study skills training
Planning Study Time
  • Do you use a diary and what for?
  • How do you decide what to learn in each session?
  • How much time do you spend on each aspect of the syllabus? 
  • Use of diary to plan SDL time and content
  • Use of SMART objectives or similar
  • Evaluate learning (see below) so know when to stop
  • Consider study skills training
Evaluating Learning
  • How do you know when to stop studying?
  • How do you know when you have learnt something?
  • How do you know when you have learnt enough?
  • Clear SMART objectives
  • Revisit and check pre-break learning after break
  • Assessment tools
  • Gut feeling
  • Use of peers, tutors, feedback etc.
  • Consider study skills training
Question Answering Strategy
  • What do you actually do when you do the exam paper?
  • Do you answer each question in turn or run through the paper quickly first?
  • What makes you decide to answer a question?  Would you answer a question if you could narrow the answers to 2, 3 or 4 options?
  • Do you finish in plenty of time?
  • Do you ever miss questions because of lack of time?
  • Do you read the question first or question and answer together?
  • Quick pass through whole paper
  • Answer those you immediately know. Mark those you definitely don’t know, leave rest unmarked
  • Take a short break and have a drink/stretch!
  • Go back through unmarked questions in turn
  • Consider answering questions where you can narrow down to 2 or 3 options
  • Always read the question and try and answer it before looking at the answers
  • Don’t revisit your answers 
Personal Issues
  • What do you do in your spare time?
  • Do you belong to any clubs or organisations and how much time does this take up?
  • Do you feel you have enough support?  Who do you/would you go to if you need support?
  • Any other issues or difficulties?
  • Do you have to work to support yourself and if so, how often?
  • Do you know who your AES or CT are?
  • Do you have a GP?
  • Would you like a mentor?
  • Advise re counselling service
  • Looking at fun/work balance 
Health
  • How do you sleep?
  • How often do you take exercise?
  • Do you often find it difficult to unwind?
  • Do you eat a healthy diet?
  • Are there any other issues that are bothering you?
  • Do you know who your AES or CT are?
  • Do you have a GP?
  • Advise re counselling service
  • Advice re looking after self and consider setting goals around this
 (Modified with permission from student support materials prepared by the Peninsula College of Medicine & Dentistry)

 

Please use this blank form to review the questions with your College Tutor.

 

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Appendix 2

Much of the learning throughout the career of a doctor comprises of self-directed independent learning which underpins the foundation of Continuing Professional Development. The adoption of effective strategies to assist in this is of paramount importance to our busy clinical working life.

Independent learning can be defined as “that learning in which the learner, in conjunction with relevant others, can make the decisions necessary to meet the learners own learning needs”. (Kesten, 1987 p 3). You may find this contrasts with the way you worked at school or previously, where you are likely to have been given hand-outs or notes which if you learnt completely would give you good marks. Here you will be expected to think about what you need to know and then research this for yourself. This is much closer to the way in which qualified doctors learn and keep up to date.

It is worth learning how you can best learn for yourself. There are several key points to think about:

  • Memory skills ,
  • Time management skills,
  • Reading skills
  • Note-taking skills,
  • Study habits,
  • Revision skills
  • Specific exam preparation

Or to put it another way

Appendix 2 image 1 independent learning

Areas for study

You will need to build in time for preparation and follow up for all the areas of the curriculum.   As you progress through your specialty training, you will need to schedule time to revisit “old” learning which you may have covered already previously.

Memory skills

Many of the ideas of how to learn effectively are based on our current understanding of how memory works.

Memory is probably divided into three main parts. Research suggests that these are located in different parts of the brain.

Appendix 2 image 2 memory

Current theories suggest that working memory is located in the pre-frontal cortex, whereas the medial temporal cortex binds experiences together helping make connections and thus helping to form new memories. How long term memories are stored in the brain is less clear – this is likely to be widespread through the cerebral cortex.

Seven things are important:

  1. You must maintain attention and concentration. You cannot realistically do this for more than 20 minutes at a time;
  2. Organising what you learn into meaningful patterns will help. So for example if you are trying to learn the following series of words: dog, boat, spoon, hat, car, cat, cow, knife, coat – you are more likely to remember the list if you organise the words, for example some are animals, some utensils etc.. You will be encouraged to think of concepts as a way of organising your knowledge;
  3. understanding what you are reading or learning – this is often helped by working with others, and problem based learning, PBL helps as it encourages you to explain to others what you have learnt;
  4. Making connections with what you already know helps you form links which aid recall of your learning – in PBL you will often be asked what you already know about a subject. This also encourages you to focus on new learning rather than going over what you already know;
  5. Having thought about what you know, think then about what new things you need to know. Frame these as questions – SMART questions are the best:

i    Specific
ii   Measurable
iii  Achievable
iv  Realistic and Relevant
v   Timed

  1. Limit the amount of information you cover in each session. Working memory is limited in the amount of information it can handle – the maximum is about seven chunks;
  2. Active recall is essential; we quickly forget what we have studied (see Ebbinghaus curve). Active recall means putting your books and notes away and writing down what you know from memory, then going back and checking if some of what you learnt needs reinforcing. 

Appendix 2 image 3 forgetting

What has been found is that if you revise a piece of information a number of times in a short period of time, your retention of that material is less than if you space out the revisions of that material with an ever increasing interval. This is known as the 'Spacing Effect'.

One strategy for active recall is to do this after 30 minutes, at the end of each study period, at the end of a block of learning, at the end of the day, and at the end of a specialty module. 

Appendix 2 image 4 relearning

 

Understanding how to make the most of your memory suggests some ways of effectively managing your time: 

  • Study at the same time every day. As much as possible, you should schedule certain hours which are used for studying almost every day in a habitual, systematic way. Having regular hours at least five days a week will make it easier to habitually follow the schedule and to maintain an active approach to study.
  • Make use of the free time (10-20 min blocks) during the “normal theatre day”. The hours between scheduled activities are perhaps your most valuable study time yet, ironically, the most frequently misused.
  • Plan study periods to follow scheduled activities. This should be done whenever possible. The next best procedure is to schedule the period for study immediately before a theatre list in the morning (you’d have to be an early riser).
  • Space study periods. Sixty to ninety minutes of study at a time works best. Relaxation periods of five minutes should be scheduled every 20 minutes. It is more efficient to study hard for a definite period of time, and then stop for a few minutes, than attempt to study on indefinitely.
  • Plan for weekly reviews of new learning. At least one hour each week (distinct from study time) should be scheduled. The weekend is a good time for review.
  • Leave some unscheduled time for flexibility. This is important! Lack of flexibility is the major reason why schedules fail. We tend to over-schedule themselves. A diary helps a lot.
  • Allot time for planned recreation. When you plan your schedule, you should begin by listing the activities that come at fixed hours and cannot be changed. Next, schedule your flexible time commitments – these hours can be interchanged with other hours if you find your schedule must be changed during the week. Plan recreational activities last.

(From “time scheduling” Virginia Tech student guide)

In practice this means,

1. When studying:

  • Start with a five minute think about how you want to be, get motivated, find reasons why you want to do the work, think of how you will reward yourself as you go along. Plan how long you are going to work. Prepare your work space, and gather texts around you.
  • Then spend five minutes thinking about what you already know about the subject, a mind-map can help. If you want to know more about mind maps buy one of Tony Buzan’s books, or see and hear him on YouTube here
  • Having thought about what you know, map out what you need to know on top of that, you could add it to the mind map. Good questions are the key to good learning, and, a reminder, these questions should be SMART.
  • Now read to answer the questions you have created. Avoid getting sucked into reading the text, use SQ3R (see later) as a way of helping you read more effectively. Do this for 20 minutes.
  • Now have a five minute break, exercise a bit, stretch, and have a glass of water.
  • Start studying again by actively recalling what you have learnt. Again a mind map is an ideal way of doing this – or make linear notes if you prefer. Remember this is active, it is not about reading notes you took. Check to see if you are right, if not do a spot of revision
  • Repeat the cycle
  • You can do this cycle three or four times. Shorter periods are better than longer ones. By dividing your work time into thirty minute blocks, you can make more effective use of short periods of time that you have previously thought were too short for learning,
  • Reward yourself.

2. When taking part in a learning activity

  • Make time before the session to think about what you already know about the topic and what you want to find out.  This will help you engage with the session and retain information.  Make sure you also do any preparation work you have been asked to do.
  • Take an active role as possible within the session e.g. asking questions, jotting down key points.  
  • Build in time after each session to actively recall what you have learnt, perhaps using a mind map or notes.  Then check back on your notes from the session if needed.   Remember to revisit this learning (e.g. at the end of the day and end of the week)
  • Build in time to do follow up work from the activity, including adding detail or following up anything you didn’t fully understand
  • Reward yourself

Appendix 2 image 5 timing

 

Reading skills (SQ3R)

  • S=Survey

Skim the material paying attention to:

Headings

Topic Sentences

Maps, charts, graphs

Words you do not understand

  • Q=Question

Make your own questions about the reading based on the information you have surveyed.  Include your own questions you generated in stage one of your learning plan above.

  • R=Read

Read the material to answer your survey questions. Avoid getting sucked into the text itself. Much of what you read is padding. Always keep in mind finding answers to your survey questions.

  • R=Recite

Answer your questions without looking back on the reading. Use the method of recitation which best suits your particular learning style but remember, the more senses you use the more likely you are to remember what you read - i.e. TRIPLE STRENGTH LEARNING: Seeing, saying, hearing- and QUADRUPLE STRENGTH LEARNING: Seeing , saying , hearing, writing.

  • R=Recall

Look away from the reading material and focus on the major ideas and concepts. Review the reading material frequently i.e. every 30 minutes, at the end of the block of learning, at the end of the day and at the end of a week or fortnight. Periodically review the sheet, some students make flash cards which can be very effective

Note taking skills

The best way for you to take notes is to use the method that works best for you. If you are visual, mind maps work well, and there is some evidence that this works well for everyone. What does matter is that you make time to think about and make sense of what you have read and then make notes that summarise what you have learnt rather than it being an almost complete transcript of the chapter. Jot down key ideas or concepts as you go along, though avoid writing everything down.

Study habits

You work more effectively if you are consistent in the way you work. Being consistent means the brain does not have to work out what you are up to. Consistency applies to how you work as well as when you work. Make a space in your room for work – that should not be the bed, as your brain will be confused whether you should be sleeping or working. Many students find the library is an ideal place to work, and find it anchors them into work mode. Remember that success is achieved through a few simple behaviours that are repeated daily.

Revision skills and specific exam preparation

You will find that if you continually revisit your work, you will need to revise much less. Ideally you will only need to look at the mind maps or conceptual summaries you have written, possibly fleshing out some of the detail.

You cannot specifically revise for the whole syllabus in details, though there are things you can do before the exam that are helpful. You may find it useful to refresh your memory by looking at the summaries you have made as you have been studying. You can also practice the technique of answering the style of question that comes up in the examination by looking at the past papers.

There are various ways of looking at how you learn. Honey and Mumford described learning styles – Activist, Reflector, Theorist and Pragmatist – and the learning cycle

http://www.peterhoney.com/  

Other experts suggest we have different sensory preferences when we learn; we may be visual or auditory for example. You can find out what you are at:

http://www.vark-learn.com/english/index.asp  

Memletics have a comprehensive on-line questionnaire which you may find helpful and for a small fee you can obtain a detailed breakdown of your preferred styles. You can find this at:

www.memletics.com

You can find an index of learning styles questionnaire, which also looks at whether you are a global or sequential learner, at:

http://www.engr.ncsu.edu/learningstyles/ilsweb.html

Completing the cycle

Remember, learning is about more than just remembering information.  It is also about making sense of what you have learnt and planning how you will use this in the future.  Linking what you learn to the real world will also help you retain it – and recall it when you need it.  This means you will need to work in all parts of the learning cycle, even though you may have preferences for one particular style. Also, learning styles indicate your preferred way of learning but do not mean you cannot learn in other ways.

Reference

Keston, C (1997) Independent Learning: A Common Essential Learning: A Study Completed for the Saskatchewan Department of Education Core Curriculum Investigation Project - accessed 27 June 2007

 

(Modified with permission from student support materials prepared by the Peninsula College of Medicine & Dentistry)

 

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Appendix 3 

I failed- what now?

 

There is no such thing as failure- only feedback

 

General

  • What is your approach to adult learning?
  • Do you have all the necessary study skills?
  • Are you managing your time sensibly?  How much time are you spending on personal study outside the scheduled training – is it sufficient and effective?  Do you plan your study time realistically particularly just before the examination?
  • Are there personal and social issues which are affecting your ability to learn?

Knowledge base

There is no way in which you can ‘cram’ for any part of the Medical Postgraduate examination.  It is a test of sustained learning.  

  • Revisiting the curriculum and syllabus published by the Colleges and making sure that the breadth and depth are equally tackled
  • Checking that you have fully explored all the self study material and learning resources from courses, tutorials & e-learning available to you
  • Revisiting basic and clinical science materials to ensure a thorough understanding of core scientific principles and concepts underlying medical practice 
  • Reflect on the feedback from your peers and senior colleagues over the preparation period and identifying areas of weakness for further study. This includes refinement of examination technique.
  • Reviewing your logbook and identifying areas which you have not covered sufficiently and address this with the help of your college tutor.
  • Practicing communication skills – video yourself with a colleague in a practice session with clear objective and debriefing procedure

Personal Circumstances

Sometimes your performance will have been affected due to personal circumstances which are largely out of your control - such as illness, finance or family issues. These circumstances may well affect your performance in the examination.

 

 

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