So it turns out the Force was with me after all

[mr friendly guy]

Basically last week the culmination of cramming minutiae came to a head. I sat part one (written exam) of the Royal Australasian College of Physicians. This privilege cost me almost 2 grand to sit. To top it all off, the College couldn't even be bothered to provide you with stationary.

Any way, most candidates I talked to found the exam hard to say the least. Its not about how a good a doctor you are on the wards, its about knowing minutiae and using skills you are never, ever going to need in real life.

The problem was, sometimes you can reason out / know enough so that you can narrow it down to 2 possibilities. Which still leaves you a 50% chance of getting it right. So theoretically you could do really well in these situations, or you could be totally off.

Some of the questions are like what is the chances of this person inheriting this disease based on this family tree. Only problem was I didn't know the mode of inheritance, which makes calculating it hard. Not to mention it was a disease I have never seen before (although I am aware of it vaguely). Fortunately I guessed the inheritance was autosomal recessive and it turns out it was correct, so I am confident my answer was the right one.

170 questions later, some educated guesses and trusting my feelings, I left having no idea how well I did. The results came out today. It turns out I passed.

And it feels good.

[Samuel]

Don't doctors have access to medical encyclopedias precisely so that don't have to remember all the minutia?

Also, congradulations!

[Phantasee]

Way to go! Was it mostly multiple choice types?

I love multiple choice. Barely study the material, and you'll have enough of a grasp to either reason out the answers, or figure out the right one by process of elimination. Assuming you don't just recognize the correct answer (they are on the page, after all).

[Ryan Thunder]

Don't doctors have access to medical encyclopedias precisely so that don't have to remember all the minutia?

It's like that with most professions. Tests are just there to make the professors feel good by measuring your ability to recall arbitrarily chosen information in an arbitrarily set period of time.

Assignments are a much more effective way to measure knowledge because they're much more like what you'll encounter at a real job. Yeah, sure, so some morons will cheat, waste their money and land themselves jobs they can't do and get fired. So what? You can't assume we're all guilty by default anyways.

[mr friendly guy]

Don't doctors have access to medical encyclopedias precisely so that don't have to remember all the minutia?

Also, congradulations!

In my experience physicians will know minutia in their field of expertise and know a little bit about others since they have to sit the basic exam. However, we are expected to know things which seem highly specialised or in fields we rarely touch, eg

a) statistics / epidemiology (ie we have to be able to calculate things by hand), and yes I realise it helps to understand concepts in statistics as drug companies manipulate present the information in a favourable light, however to calculate things by hand.

b) pharmacology (ie which enzyme will metabolise this group of drugs; I mean who actually uses this information in real life)

c) mutations (ie which mutation is associated with good / poor outcomes in this disease, or know how it came about)

d) family trees - ie given this family tree what is the mode of inheritance? Sounds simple enough except some modes of inheritance aren't the stock standard you would learn in high school, and certainly I don't remember learning about imprinting in medical school.
Oh the imprinting mode of inheritance is difficult to see if you don't have some rules. Examples of imprinting diseases would be Prader willi syndrome, which IIRC Broomstick mentioned it several times in other threads.

e) questions which take the form what will you do next ? - where in real life you would do all of those, but you have to pick the best one.

f) this specific immune cell secretes which cytokines. WTF?

I also love this question, if you are allergic to peanuts, what food are you also likely to be allergic to? Intuitively people would pick the option which is another nut, and there is certainly cross reactivity between nuts. Now I don't know if I answered it correctly, but a peanut isn't really a nut. Thats right, its a legume. So I picked something else. Tricky bastards.

Way to go! Was it mostly multiple choice types?

I love multiple choice. Barely study the material, and you'll have enough of a grasp to either reason out the answers, or figure out the right one by process of elimination. Assuming you don't just recognize the correct answer (they are on the page, after all).

The written is all multiple choice. Part two the clinical (if I choose to sit it this year) is examining patients in front of other doctors and requires you to be able to come up with a diagnosis on the spot and run through what tests you need to do etc. Of course that would set me back $3720 AUD. Oh joy.

[weemadando]

The problem was, sometimes you can reason out / know enough so that you can narrow it down to 2 possibilities. Which still leaves you a 50% chance of getting it right. So theoretically you could do really well in these situations, or you could be totally off.

I hear that it's totally not lupus. So that should make life easier.

But congratulations on your achievement.

[The Spartan]

b) pharmacology (ie which enzyme will metabolise this group of drugs; I mean who actually uses this information in real life)

I honestly don't know so this question is from ignorance, but wouldn't that be a useful thing to know when prescribing drugs to a patient that is taking multiple medications? What I'm thinking is that if a patient requires two different drugs that use the same enzyme(s) wouldn't they interfere with one another to a degree?

[Lusankya]

IIRC, MIMS (the drug handbook) says which drugs interfere with each other. You don't have to know about the enzyme, just follow what MIMS says.

That's just what the doctors I know say, though.

[The Spartan]

Presuming you're remembering correctly then, that means that only people that would really need to know that are drug researchers.

[PainRack]

I honestly don't know so this question is from ignorance, but wouldn't that be a useful thing to know when prescribing drugs to a patient that is taking multiple medications? What I'm thinking is that if a patient requires two different drugs that use the same enzyme(s) wouldn't they interfere with one another to a degree?

Drug literature has stuff like drug interactions written out in them.
Otherwise, its more memorising which drugs have the same side effects, so you don't prescribe two drugs with the same problem and monitoring creatine levels every now and then with other tests that you might want to do.

[aerius]

I love multiple choice. Barely study the material, and you'll have enough of a grasp to either reason out the answers, or figure out the right one by process of elimination. Assuming you don't just recognize the correct answer (they are on the page, after all).

You would've loved the exams given out by my Physics prof in university. 30-40 questions, open book, multiple choice, oh, and worth 100% of your mark. No pressure.

Except the prof was pretty sneaky, over the years he'd figured out all the common mistakes which students could make while doing the calculations, stuff like using the wrong formula or constant, unit conversion mistakes, etc. Then he'd put the incorrect answers from making those mistakes down as the other choices, so on the exam, you could make one of several mistakes and come up with an answer which matches one that's on the answer sheet, and you'd think it's right, but it's not. He was one of my best profs.

[mr friendly guy]

b) pharmacology (ie which enzyme will metabolise this group of drugs; I mean who actually uses this information in real life)

I honestly don't know so this question is from ignorance, but wouldn't that be a useful thing to know when prescribing drugs to a patient that is taking multiple medications? What I'm thinking is that if a patient requires two different drugs that use the same enzyme(s) wouldn't they interfere with one another to a degree?

True, but knowing the specific enzyme isn't really necessary. Moreover unless you are a genius you are not going to be able to memorise a lot of drug interactions. Generally if you are worried about an interaction, consult MIMS or the Australian medicine guidelines.

Knowing macrolide antibiotics interact with the common anti coagulant warfarin to boost its effects is something I see and make use of that knowledge when prescribing antibiotics, knowing it works by the enzyme cytochrome 3A4 is just minutiae. Knowing some people cannot metabolise codeine ie so they don't get adequate pain relief with that drug (hence use a different drug) is one thing, knowing its due to problems with the enzyme cytochrome 2D6 makes you look smart in front of the students, but from a clinical point of view, it doesn't help you that much.

EDIT - to be fair, some people think in the future once we know more about enzyme interactions, we will be able to do a simple blood test and figure out which drugs to avoid in patients by measuring the enzyme. So perhaps the college has that type of thinking in mind. Of the top of my head, the only example I can think of where we do this is with a certain immune suppressive drug for transplant patients.

[Broomstick]

Oh the imprinting mode of inheritance is difficult to see if you don't have some rules. Examples of imprinting diseases would be Prader willi syndrome, which IIRC Broomstick mentioned it several times in other threads.

A few times. If you inherit the damaged gene from your father you have Prader-Willi Syndrom. If you inherit it from your mother you have Angelman Syndrome.

I also love this question, if you are allergic to peanuts, what food are you also likely to be allergic to? Intuitively people would pick the option which is another nut, and there is certainly cross reactivity between nuts. Now I don't know if I answered it correctly, but a peanut isn't really a nut. Thats right, its a legume. So I picked something else. Tricky bastards.

I would have picked "other legumes" myself, but then, having food allergies, I need to know these things in a way others do not.

Anyhow congrats!

[Broomstick]

b) pharmacology (ie which enzyme will metabolise this group of drugs; I mean who actually uses this information in real life)

I honestly don't know so this question is from ignorance, but wouldn't that be a useful thing to know when prescribing drugs to a patient that is taking multiple medications? What I'm thinking is that if a patient requires two different drugs that use the same enzyme(s) wouldn't they interfere with one another to a degree?

I'd think that's more in the area of a pharmacist, though obviously doctors know where to go to get this information. One reason to have all your prescriptions filled at the same pharmacy is so the pharmacist has access to everything you're taking and can watch for drug interactions of all sorts, including the one you mention.

Knowing macrolide antibiotics interact with the common anti coagulant warfarin to boost its effects is something I see and make use of that knowledge when prescribing antibiotics, knowing it works by the enzyme cytochrome 3A4 is just minutiae. Knowing some people cannot metabolise codeine ie so they don't get adequate pain relief with that drug (hence use a different drug) is one thing, knowing its due to problems with the enzyme cytochrome 2D6 makes you look smart in front of the students, but from a clinical point of view, it doesn't help you that much.

It would be more helpful if there was a quick, easy test for those mutations - if you could, for example, prick a patient's finger and smear a drop of blood on a device that checks for those oddities you might find out before you prescribe something that a patient will have an atypical reaction, but we don't have that technology (yet). There are people working on such things, but they aren't here right now.

[Akkleptos]

Congratulations!!!
The force is strong in you

Also, regarding:

b) pharmacology (ie which enzyme will metabolise this group of drugs; I mean who actually uses this information in real life)

I honestly don't know so this question is from ignorance, but wouldn't that be a useful thing to know when prescribing drugs to a patient that is taking multiple medications? What I'm thinking is that if a patient requires two different drugs that use the same enzyme(s) wouldn't they interfere with one another to a degree?

I'd think that's more in the area of a pharmacist, though obviously doctors know where to go to get this information. One reason to have all your prescriptions filled at the same pharmacy is so the pharmacist has access to everything you're taking and can watch for drug interactions of all sorts, including the one you mention.

That would be just where your trusty ol' Dictionary of Pharmaceutical Specialties would come handy. It shows what the medication contains, interactions with other drugs, indications, counterindication, use during pregancy and breastfeeding period, the different commercial names of a drug. Quite useful, indeed.

Sorry, I looked up the English language edition -there has to be one- but apparently it must go by a very different name, because I couldn't find it

The Merk Manual is also a must.

[Tahlan]

Basically last week the culmination of cramming minutiae came to a head. I sat part one (written exam) of the Royal Australasian College of Physicians....Any way, most candidates I talked to found the exam hard to say the least....So theoretically you could do really well in these situations, or you could be totally off.

170 questions later, some educated guesses and trusting my feelings, I left having no idea how well I did. The results came out today. It turns out I passed....And it feels good.

First off, congratulations!

Regarding your question, I think the nature of the beast is that one never really knows how they did. My experience was the Texas Bar Exam, 2 1/2 days of hell...it was the toughest thing I ever did, meaning the culmination of my academic career. It was with both trepidation and excitement that I opened that letter that would determine my future, whether I had passed or not, because I honestly had no idea how well I did. Like I said, I think it's the nature of the beast.

[mr friendly guy]

It looks like the hospital is already organising practice sessions for candidates to sit part 2, ie the clinical. I have barely enough time to catch my breath since my current duties are so busy. Oh well, after July past or fail, I am taking a well deserved break.

To all those who congratulated me, thanks.

[The Grim Squeaker]

Congragulations! Now go invent a cure for botox slippage

[Fingolfin_Noldor]

It seems most professions have some kind of test designed explicitly to weed people out. I personally have a grudge for the GRE exams in the US. I hate remembering things, and the GRE Physics test sometimes throw out things which are pretty counter intuitive, or the derivation for the said problem can take a couple of pages. Bloody hell.

[Melchior]

ike what is the chances of this person inheriting this disease based on this family tree. Only problem was I didn't know the mode of inheritance, which makes calculating it hard. Not to mention it was a disease I have never seen before (although I am aware of it vaguely). Fortunately I guessed the inheritance was autosomal recessive and it turns out it was correct, so I am confident my answer was the right one.

Happened to me in my first genetics exam (of a total of three): it was a written, multiple-choice test, but the questions required having memorized the specifics of obscure inheritable diseases (we believed that we would be asked about them in the second exam, at the time, since they were not even remotely touched upon in class). I barely passed.
Here the professional abilitation exam isn't regarded as very difficult, only getting the actual MD is.