Emedica SRA Revision Service Guidance for authors

Transcription

1 Emedica SRA Revision Service Guidance for authors Thank you for your interest in writing questions for the Emedica online revision service. This guide will clarify the type / format of question we are looking for. If you have any further queries, please contact us at info@emedica.co.uk Payments and copyright Payment is 175 per complete batch of commissioned and approved questions. A clinical batch is 25 questions, these can be any combination of SBA and EMQ questions as specified by Emedica An SJT batch is 10 situational judgement questions, these can be any combination of Section 1 and Section 2 questions as specified by Emedica Payment will be made by bank transfer within 10 working days of receipt of a correct invoice after your questions have been accepted. Acceptance of payment transfers ownership of copyright and publication rights to Emedica. We ONLY use original questions for the Emedica online revision service. We DO NOT pay for actual exam questions, and cannot use questions taken from any other source. We will ask you to confirm in writing that all questions you submit are your own work and NOT taken from any other source Samples and Commissions If you are interested in writing clinical questions for our service, please write a sample SBA and sample EMQ set of 3.

2 For SJT questions please write a sample SJT question for section 1 and one for section 2. We will review these and either accept you as an author for our service, or suggest changes that need to be made. Upon acceptance of a sample, we will send you a writer s agreement clarifying transfer of publication rights and will commission you to write full batches covering specific topics. If you would like us to include your sample questions as part of your first paid batch please contact us for a specified sample subject before writing. At the point of commissioning Emedica will specify the subject matter and format of each question and allocate a submission deadline. All submissions should be in an editable Microsoft Word format. Text should be in ARIAL 12 point font and formatted as shown in the example questions in this guidance or as specified at the point of commission. Each batch of questions should be submitted in a single document and any reference numbers provided should be included in the document. Writing guidance, example questions and correct layout for each question type are provided in the next section. If you have any further queries, please us: info@emedica.co.uk

3 Guidelines: Single Best Answer (SBA) Each SBA question should include the following: Heading / title that does not reveal the correct answer A clinical scenario appropriate the level of experience that can be expected of a junior doctor. 5 answer options of the same type (5 possible diagnoses, 5 drugs / management options, 5 complications etc), all options should be realistic differentials given the information in the scenario and where possible, should include the closest differential or commonly made mistakes. Feedback about the correct answer as well as a brief detailing of how or why the incorrect answers are incorrect or how they can be excluded using information from the scenario. Answers should start The correct answer is followed by the letter and full option given in the question. A sample SBA is given in the next section

4 Example SBA Polymorphs A 45 year old female is found to have low haemoglobin (9.0) with high mean cell volume (MCV). There are hypersegmented polymorphs on the blood film. She has a history of ileal resection for Crohn's disease but is now well apart from tiredness. Which ONE of the following is the most likely diagnosis? A. B12 deficiency B. Folate deficiency C. Iron deficiency D. Hypothyroidism E. Alcohol excess The correct answer is A. B12 deficiency B12 binds to intrinsic factor in the stomach and this complex is absorbed in the terminal ileum. Causes of B12 deficiency include diet (vegans), malabsorption from the stomach (pernicious anaemia, post-gastrectomy) and malabsorption from the terminal ileum (ileal resection, Crohn's disease, bacterial overgrowth). It causes a macrocytic anaemia and hypersegmented polymorphs on the blood film as seen in this patient. Folate deficiency also causes a macrocytic anaemia with hypersegmented polymorphs on the blood film. However folate is absorbed in the duodenum and proximal jejunum and therefore an ileal resection is unlikely to cause folate deficiency. Iron deficiency causes a microcytic anaemia. Hypothyroidism and alcohol excess can also cause a macrocytic anaemia but would not cause hypersegmented polymorphs.

5 Guidelines: Extended Matching Questions (EMQ) Each set of 3 questions that make up an EMQ should include the following: The same heading / title The same question The same 8 options of the same type 8 possible diagnoses, 8 drugs / management options, 8 complications etc). All options should be realistic across the three scenarios and where possible should include the closest differential or commonly made mistakes across the three scenarios. Each question within the set should have the following: A different clinical scenario appropriate the level of experience that can be expected of a junior doctor. Feedback about the correct answer as well as a brief detailing of how or why the incorrect answers are incorrect or how they can be excluded using information from the scenario. Answers should start The correct answer is followed by the letter and full option given in the question. A sample EMQ set of 3 is given in the next section

6 Sample EMQ Causes of Hoarseness (1 3) A. Bilateral vocal cord palsy B. Unilateral vocal cord palsy C. Oesophageal carcinoma D. Vocal cord nodule E. Vocal cord granuloma F. Chronic laryngitis G. Oesophageal stricture H. Squamous cell carcinoma of the larynx Causes of Hoarseness (1 of 3) A 51 year old female presents after a recent hemithyroidectomy with hoarse and breathy voice. Select the most likely cause of hoarseness. The correct answer is B. Unilateral vocal cord palsy Given this patient s history of surgery the most likely explanation for her hoarseness is damage to the laryngeal nerve during her hemithyroidectomy. Unilateral damage would result in hoarse and breathy voice. Bilateral damage would cause significant difficulty breathing. Causes of Hoarseness (2 of 3) A 30 year old female singer presents with a 3 week history of a hoarse voice. She denies any pain and has no difficulty swallowing. Select the most likely cause of hoarseness. The correct answer is D. Vocal cord nodule Vocal cord nodules present following vocal misuse and can be common in singers. There is nothing in the scenario to suggest malignancy and as the patient is not in pain a vocal cord granuloma is not suggested.

7 Causes of Hoarseness (2 of 3) A 60 year old male presents with a hoarse voice for the last 2 months. He denies any dysphagia and has a past medical history of GORD for which he takes Omeprazole. Select the most likely cause of hoarseness. The correct answer is F. Chronic laryngitis. The severity of laryngitis varies depending on the degree of inflammation of the larynx. Acute laryngitis tends to start suddenly and will spontaneously resolve. Chronic laryngitis is when symptoms last more than 3 weeks and tends to take longer to develop. Oesophageal stricture is associated with long standing GORD but is unlikely in the absence of dysphagia. Guidelines: (SJT) / Professional Dilemma Questions Section 1 Each question should have A scenario in which it is necessary to exercise judgement or display professionalism and integrity. The scenario should not require ANY clinical knowledge and should be a situation that could realistically be encountered by a junior doctor working at a maximum of FY2 level. 5 answer options consisting of a realistic action that might be taken by the a junior doctor. Each option is to make up an entire response by the junior doctor. Feedback about the preferred ranking of the options as well as a brief detailing of how that ranking is justified. Answers should start The preferred answers are followed by the lettered ranking only the full explanation follows this as shown in the example. A sample Section 1 SJT question is given in the next section

8 Example SJT (Section 1) 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: A. Prescribe the medication as a private prescription, and arrange for her to register with a GP the following week. B. Tell her to register with a GP locally. C. Prescribe the medication on a hospital take home prescription with her details on it. D. Prescribe the medication on a hospital take home prescription with one of your patient's details on it. Collect the medication from the hospital pharmacy. E. Ask one of your work colleagues to write a prescription on a hospital take home script without seeing your wife. The preferred answers are: BACED 1. B. Tell her to register with a GP locally. 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. Your wife could be seen as a temporary resident and register with a local GP. 2. A. Prescribe the medication as a private prescription, and arrange for her to register with a GP the following week. 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. In this case, the prescription is for antibiotics for a chest infection. If the prescription was for controlled drugs, or benzodiazepines, it would be unwise to prescribe for family. This is better than option C as it does not involve you doing anything wrong. 3. C. Prescribe the medication on a hospital take home prescription with her details on it. Take home prescriptions are for patients being seen in the hospital only. You should not abuse your position of responsibility. This is still

9 better than option E as you are not encouraging or involving anyone else in doing something wrong. 4. E. Ask one of your work colleagues to write a prescription on a hospital take home script without seeing your wife. This is worse than option C as you are not only doing something wrong, you are implicating a work colleague in the situation when they are not responsible for the patient or their follow-up. This is unfair to your colleague he has not seen the patient, yet he would be responsible for any adverse events, and may get in trouble for misusing hospital resources. 5. D. Prescribe the medication on a hospital take home prescription with one of your patient's details on it. Collect the medication from the hospital pharmacy. This is fraudulent, and dishonest. This could lead to you losing your job, and potentially your GMC registration. This is the worst option as it has the most potential for harm. Guidelines: (SJT) / Professional Dilemma Questions Section 2 Each question should have A scenario in which it is necessary to exercise judgement or display professionalism and integrity. The scenario should not require ANY clinical knowledge and should be a situation that could realistically be encountered by a junior doctor working at a maximum of FY2 level. 7 answer options consisting of a realistic action that might be taken by the a junior doctor. Each option is to form PART of the correct COMBINED response. The correct answer will require selection of 3 options. Feedback about the correct selections as well as a brief detailing of how that combination is better or more appropriate than any of the alternative combinations. Answers should start The preferred answers are followed by the full correct options and a paragraph providing rationale all options must be discussed in the feedback. A sample Section 2 SJT question is given in the next section

10 Emedica Sample SJT (Section 2) You are an FY2 doctor working in General Medicine. The son of a patient who was recently admitted asks to see you privately on the ward. He expresses his gratitude for the care given to his mother. He offers you an envelope with thirty pounds cash in it. Choose the three most appropriate actions to take in this situation. A. Thank him for his gesture, saying it is very kind of him. B. Tell him that he should keep his money. C. Ask him not to tell anyone about this. D. Suggest that he donate the money to the ward, as everyone helped care for his mother. E. Suggest that he buys chocolates for the ward staff with the money. F. Take the money, and buy chocolates for the ward staff with it. G. Inform the ward staff about his gratitude for the care received. The preferred answers are: A. Thank him for his gesture, saying it is very kind of him. D. Suggest that he donate the money to the ward, as everyone helped care for his mother. G. Inform the ward staff about his gratitude for the care received. By thanking the relative for his gesture (of offering you the cash), you are recognising that he is trying to do something nice. It does NOT mean that you have accepted the money. Suggesting he donate the money to the ward allows everyone to benefit, and the money could be used to help patients as well as staff. Letting all the staff know that the care received was good will improve team and individual morale. Option B could offend or upset the son, who is trying to show his gratitude. Option C is a poor option as it implies you are trying to cover up something wrong. Option E and F do not acknowledge the contribution of others to the son.