Cp3 guide june 2015

Congratulations on getting through CP2 and welcome to final year! We’ve put together this guide to hopefully answer some of the questions you might have and share the things we wish we’d known! If you have any questions or things you’d like to know more about, please do get in touch and email them to studentvoicechair@gmail.com.

Many thanks to previous CP3 students for their contributions!

CP3 GUIDE June 2015

GP

Acute Care

MDD

•The GP attachment is 4 weeks long and you spend it sitting in on GP clinics and seeing your own patients.

•You are expected to do a clinical governance project (usually an audit) during this attachment.

• You also have teaching sessions to practice challening communication skills with actor patients .

•This is a 4 week attachment and is good for practicing clinical skills and getting lots of MACCs done. It's run differently at each site but tends to include time in A&E, ITU or HDU and with anaesthetists in theatre and might also include time with the critical care outreach team.

• You have to write up a couple of case reports during the attachment to discuss with your supervisor at the end.

•MDD is an 8 week attachment and covers orthopaedics and rheumatology.

•There are MACCS on each of the joint examinations and these are organised for you at most sites.

• Some sites have themed weeks e.g. upper limb, hand, whereas other sites combine everything.

•This is another 8 week attachement.

Medicine

Surgery

Finals

•It's a good opportunity to pratice your examination skills and clerking patients .

•Surgery is also an 8 week attachment.

•You're not expected to spend lots of time in theatre (unless you want to!) but it's a good attachment to do some practical procedures and practice clerking and assessing patients.

•For our year, finals were in early February and took place over two weeks with the OSCEs in the first week and the two online knowledge papers in the second week.

•After finals there are a couple of weeks before starting either elective or MAST. During this time you have a careers week which includes a career taster day, careers fair and workshops and an F1 prep week with lectures about being Transition to an F1. practice

MAST

•MAST is a 6 week placement where you shadow a current F1. Depending on where you're placed it may be split into two separate attachments or you might do the whole 6 weeks on the same ward. The aim of MAST is to get more familar with the F1 job so you'll be doing things like ordering and chasing investigations, helping with the ward jobs and clerking new patients. It's a great chance to quiz the F1s on their experience and get tips on how to survive as an F1!

•This is a chance to spend 6 weeks doing something you're interested in and visit somewhere new!

Elective

Understanding FPAS FPAS is the system used to apply for your deanery and F1 jobs. Below is the timeline of key dates for the FPAS application process. There’s a lot more information about FPAS and a useful applicant’s handbook on their website: http://www.foundationprogramme.nhs.uk/pages/home.

You can also find out more about each of the foundation schools here: http://foundationschools.info/.

Your FPAS score is based on two areas: 50 points come from your SJT score 50 points come from your Educational Performance Measure- this takes into account any degrees including the BMedsci and any additional degrees, any publications you have (provided they have a PubMed ID number) and your decile score which is based on your previous exam grades.

After completing your application, you’ll be asked to rank all the Units of Application which are the different deaneries across the UK. At a later date you then rank all of the programmes within that Unit of Application which are all of the combinations of jobs available. This table shows the competition ratios for each Unit of Application in 2014.

The University careers team can offer career appointments and CV checks. You can book appointments on their online system here: Log on to the system (www.nottingham.ac.uk/careers/login) with your University username and password and then select “book an appointment”. Choose CV / Application Review (Faculty of Medicine and Health Sciences) to see a range of dates and times that are available.

‘If you’ve not been in touch with your personal tutor for a while, contact them now! If you want them to be an FPAS reference for you don’t forget to ask them if it’s okay to put them down and they might also want to see an up to date copy of your CV’ ‘If you know what speciality you want to go into after F2, it’s great to try and get a job in it for F1/F2 but definitely not essential. There’s time as an F1 to do taster days in specialities that you’re interested in’ ‘No one ever mentions what the procedure is if you are considering doing FP as part-time. The website https://www.eastmidlandsdeanery.nhs.uk/page.php?id=1778 has some info about LTFT (Less Than Full-Time) training but nothing on the application procedure itself. Cherry Cadiente (cherry.cadiente@nhs.net) is the person in charge of that in the Trent deanery and is very prompt in replying queries by email. She advises finding out if you have been successful at obtaining a post before applying. If successful, when you accept the post it is then that you indicate that you would like to work LTFT and then apply for LTFT. Once it is known that you wish to work at LTFT and your eligibility has been confirmed, the Foundation Programme will then see if there is another trainee they can match you up with as a job-share partner (if you already know someone who wants to work

part-time in your deanery, that is easier). Regarding Foundation post hours, part of the application process for LTFT once your eligibility is approved and a LTFT post has been confirmed is then for the trainee to discuss and agree with their designated Supervising Consultant (and job-share partner) around working hours/working days and ensuring that your 50% timetable meets the requirements of the curriculum. Once agreed, a LTFT Timetable Form is to be completed and returned so that they have a record of your LTFT timetable. The Foundation Programme only offers LTFT at 50%, which means that if you were to work at LTFT from the beginning and throughout your posts, your training time will be doubled (i.e. if your training programme is 2 years at full-time, at LTFT it will become 4 years).’

An informal guide to the AFP (academic foundation programme) from former President of the INSPIRE Nottingham Academic Medicine Society, Tom Jackson.

What is it?

A foundation programme with protected time to complete research, leadership or educational activities. The programmes are usually structured so have a 4 month academic block in F2, however there are variations (e.g. Newcastle AFPs have two academic blocks, 1 each in F1 and F2, and some programmes have integrated academic components such as ½ day study leave per week).

Who should consider applying?

AFPs are not just for people determined to pursue an academic career. They are a great opportunity to gain experience that will make you more desirable when applying for specialty training. The application process is also good practice for ST1/CT1 applications.

How does the application process work?

You apply for both AFP and FP. If you get an AFP you are withdrawn from the FP recruitment process, if you are unsuccessful you will go into the FP recruitment like anyone else.

You can apply to up to two Academic Units of Application (AUoA). These broadly map to the Foundations, with the exception of Thames, where all London Foundation Schools are combined into one AUoA, and East Anglia, where Norwich and Cambridge are separate AUoAs. Unlike the FP application, you rank AFP jobs at the point of application (rather than after being allocated to a Foundation School). This means you can rank only the jobs you really want, safe in the knowledge that if you don’t get an AFP you will have an FP application to rely on.

Each AUoA has a specific application process, but all involve shortlisting on the basis of evidence of academic achievement and completion of between 4 and 6 white-space questions (word limit 200 for each). Examples of these include: We recognise that applicants will have had varying levels of research, management and teaching experience. Please give one example from your post-secondary education career to date, of a research project, management or teaching experience and its significance to your application for an academic foundation programme.

Academic medicine requires an individual to work successfully in a team. Describe a time that will be relevant to your foundation training when you have worked as a successful member of a team and identify your role and contribution to this success.

Please give one detailed example to describe your contribution to academic life during your medical school career and how it will be relevant to an academic medical career (NB do not use examples previously used in questions 1 or 2).

Across our AUoA we are able to offer separate academic programmes focussed on research, education or management. Please explain your rationale for your choice of programmes.

Please give details of your special study modules or elective attachment (or proposal) and their significance to the development of your academic career.

Give one example of a non-academic achievement and its significance to your application for an Academic Foundation Programme.

The criteria for shortlisting will differ between AUoA. Thames is the only AUoA that publishes the scoring system that they use for academic achievement (see the Thames Foundation School handbook http://tinyurl.com/mqevz6p). No AUoA details how they assess the white space questions, but mapping your answers to the AFP person specifications should improve your chances.

The initial competition ratios vary greatly between AUoAs and are available in the “FP 2014 Interim Stats� which can be found at http://tinyurl.com/on9gxfn. However, because many students will only rank a subset of the programmes available, the raw competitions ratios are probably at best a weak guide to your chances of success.

Shortlisted candidates are interviewed. The interview dates and structure of these differs between each AUoA and in some cases will be different depending on which type of AFP you apply for. In general, the interviewers will not have seen your answers to the white space questions. A sample of different formats from the 2015 application are included below: Thames: 30 min to prepare with a clinical scenario and an abstract followed by 2 10 minute interviews separated by a 5 minute break. In the Academic interview you critique the abstract and discuss what you hope to gain from an AFP, the clinical interview requires you to present what you would do and justify your decisions. Each site has a different interview date - you can choose which site is best for you, irrespective of how you ranked the programmes.

Severn (Research): 20 min to review a full paper with the discussion redacted, then a 20 minute interview with a panel of 4. This is divided into 6 minute sections, the first on your reasons for applying for an AFP, second on an unseen clinical scenario and the third on the paper you reviewed.

Trent (Research): A research paper was given the applicants in advance of the interview date. There are two interview stations, each 10 minutes long. One requires a 5 minute presentation proposing

further work to follow from the study given followed by questions, the other covers key research themes (ethics, study design, leadership).

Yorkshire and Humber (Education): 3 stations – 5 minutes to give a presentation followed by questions, academic interview, clinical interview. All 10-15 minutes on a circuit like an osce Scotland (Research): 20 minute interview, questions covering research interests, personal qualities and professionalism Northern (Research): Two 15 minute stations, one academic, one clinical. No clinical scenario provided – the clinical interview was mostly about personal qualities and professionalism.

Following interviews you will be informed in late January of one of three outcomes 1) Offer of your highest ranked job that has not been allocated to other higher ranked applicants 2) Waiting list 3) Rejection If you receive an offer you must respond within 48 hours. If you choose to decline all offers then you enter the FP application. There is a cascade process whereby any rejected programmes are offered to the highest ranked on the waiting list. This is completed by mid-February.

Importantly, neither shortlisting nor offers are based on SJT scores. If you gain an offer you must achieve a “satisfactory” SJT score, but based on conversations with recruitment officers from 2 AUoA, it seems that “satisfactory” is not being in the bottom 0.5%!

How can I improve my chances of getting an AFP? 1) Do well in 4th year exams a. Your EPM score will form a major part of your shortlisting. It is rare to be shortlisted if you aren’t in the top half of your year 2) Present or publish work a. The BMedSci gives Nottingham undergraduates a natural advantage compared to the average medical student. However, many AFP applicants will have intercalated BSc, MScs or, rarely, PhDs. If you don’t have presentable work from your BMedSci or previous degree consider using an SSM or approaching a clinical academic in your field of interest to do some research. At a minimum look to present work at a student conference (the East Midlands Student Research Conference is free to attend - email the INSPIRE at Nottingham.inspire@gmail.com for details) however for some of the more competitive AUoA you really do need to present at a nonstudent conference, or better still be published in a peer-reviewed journal.

3) Get involved in teaching a. Anyone applying for an Education AFP must be able to demonstrate teaching experience, but it can also help an application for research or leadership.

4) Attend mock interviews

a. For the past 2 years INSPIRE has been offering mock interviews conducted by current AFPs. The have received excellent feedback. In particular that they improve the level of confidence applicants have about their interviews.

Is an AFP the only route into academia?

Absolutely not! In every teaching hospital there will be academics with more project ideas than time or juniors available to complete. The advantage of an AFP is that is give protected academic time, but if you manage your time well you can definitely do work as part of the FP and apply for an Academic Clinical Fellowship.

Where else can I find information?  Foundation Programme Website  AUoA websites  Email current AFPs in the AUoA that you want to apply to o INSPIRE has a growing alumni network that may be able to help you with this  This guide from UCL: http://www.ucl.ac.uk/medicalschool/staff-students/careers-foundationtraining/careers/FP_AFP_2015_Application_P_Dilworth_Aug_14.pdf ‘Before I applied I would have liked a few pointers on the interview process, so here's my experience with it. I had applied for the Perioperative Program in Trent (but the others went through a similar process/questions). About two weeks prior to the interview (which was on Jan 6), we received three journal articles about a particular topic (in our case it was about intra-wound Vancomycin for cervical surgery). We were asked to put together a very brief presentation about how we would take the research forward. The interview consisted of two parts, each in a different room. In the first part/room, two panelists asked ethics and leadership questions- what are the principles of research ethics, how would you go about getting ethics approval for a project, and what was the key turning point in research ethics. Then, give an example of leadership and what did you do, and what have you learned from that that would be useful in the AFP. In the second room, you present the presentation you've put together for five minutes and take questions about it for the next five minutes. The interview takes about 25 mins in total’

Preparing for the SJT The SJT stands for situational judgement test and aims to test how you would react in situations you might face as an F1 doctor. There are 70 questions- in part one you have to put the responses in order and part two is multiple choice. The official SJT website can be found here: http://sjt.foundationprogramme.nhs.uk and contains example practice papers. For our year the SJT was in December and was a 2 ½ hour exam. There was also an information evening held by the medical school before this to explain the format of the paper.

‘The most important point that should be voiced is that students should strongly be advised NOT to waste money on books or courses to prepare for the SJT. Only the official FREE practice papers online are worthwhile. I was advised the same by a friend in the year above, and so I didn't waste lots of time nor money on any courses, and I managed to score very well. I know friends that, for want of a better expression, screwed themselves over, by paying lots of money and going on lots of courses, learning those answers, confused themselves, and subsequently scored very poorly- some didn't even make the primary list. One friend did go on one of the courses and came back with her questions and answers, which we all went through afterwards. We also used several books and we found on multiple occasions that, when comparing answers to similar questions, the unofficial courses had totally different answers to the official GMC/SJT website. This led to intense confusion and frustration... But at the end of the day, the only source and answers that can be trusted are the official ones’ ‘The Oxford handbook for SJT is really useful and in addition to the official practice paper, felt like a reasonable amount of preparation. Don't let it distract you from preparing for finals which are more important. Also, don't bother with the expensive revision courses’ ‘When you do the practice tests, use the printed answer sheets to practice on- we all heard horror stories of people who’d messed up on the SJT because they filled in the boxes the wrong way and you don’t want that person to be you!’

Preparing for finals The finals OSCEs are split into OSCE 1 and OSCE 2. For our year, OSCE 1 consisted of 12 6 minute long stations and OSCE 2 of 5 15 minute long stations. The OSCE 1 stations require you to carry out an examination and then present your findings, they could also include any of the MACCs from CP3 as well as a radiology station. They may also combine two stations e.g. ‘examine this patient who is short of breath.’ The OSCE 2 stations test your ability to take a history, carry out relevant examinations, plan some basic management and may also include some data interpretation. There could also be a communication based station where you would have to explain something to a patient or counsel them about something. OSCE 2 may include a prescribing station and an acute care station although these could also be in OSCE 1.

The 2 knowledge papers are online and are mainly extended matching questions and multiple choice questions, similar to previous exam formats. There’s also likely to be images, data interpretation and prescribing calculations included.

‘The progress tests are easier than the real knowledge papers - don't be falsely reassured. On the other hand, doing well in the knowledge papers would be an easy way to improve your average mark if you were hoping for honours’ ‘I would advise students to use the study guide/learning objectives. They should be reassured that you cannot be asked anything that doesn't appear in the study guide/learning objectives... It might seem like a lot but, if you start early, it's more than manageable. In fact- it's a gift really!!! Use it wisely and you can stop yourself wasting time learning too much depth or unnecessary topics, which allows you to stay focused... AND.... If you read it carefully... All of the potential OSCE scenarios are hidden within the study guide too! OSCEstop.com was amazing. In summary my advice would be: Don't panic. Start early. Use the study guide. Practice practice practice!’

‘Find an OSCE group and get practicing early on! We started in July time and tried to set aside time once a week to practice. We’d have one person teaching the examination and then would each practice the station. We started with just learning the steps and then went on to cases we might get and questions. Don’t be afraid to give each other constructive feedback, it will really help in the long run!’

‘Interpreting data e.g. ABGs, ECGs, LFTs, blood tests makes up a lot of the knowledge paper, don’t neglect these topics when you’re revising’ ‘For me the radiology station was one of the most daunting. It feels silly, but practice presenting xrays as you would in the exam. In finals they’ll stick to the more common radiological findings and in our osces we were only given chest and abdomen x-rays’ ‘Get into the habit of always presenting whenever you’ve done an examination, present your findings, a few differentials and some simple investigations that you’d like to do next. In the exams it doesn’t matter if you don’t find all the signs as long as you present back confidently and in a logical way’ ‘I was surprised by how friendly the OSCE examiners were! If you’re not sure what they want you to do, ask and they’ll help as much as they can and try and point you in the right direction’ Websites and books we found useful: The FOOT book- the OSCE bible! http://learnorthopaedics.com/Learn_Orthopaedics/Home.html- contains notes and podcasts about lots of the MDD topics www.oscestop.com- contains practice mark schemes for OSCE 1 and 2 stations, topic summaries and data interpretation guides Medicine at a glance Surgery at a glance Essential examination Data interpretation for medical students http://radiologymasterclass.co.uk/- great tutorials and quizzes on common radiological signs http://radiopaedia.org/ OSCE cases with mark schemes- good for practice cases with each other

MACCs ‘If you do something get it signed even if you're not on that placement at the moment’ ‘If you do a more difficult MACC but don't feel happy about how it went, get it signed anyway and then you can practice without the pressure of running round trying to find one’ ‘The critical illness MACC can be done with the anesthetist in theatre’ ‘Try to do your IM injection in GP if you can’ ‘You can get catheters done in theatre at the start of the list and you don’t have to stay for the rest of the surgery’ ‘Try and get MACCS done as early as you can, there were people running around the hospital on the last day of CP3 trying to find a catheter to put in! I’d say if you’re offered the chance to do a practical procedure, don’t turn it down, the more practice the better. In the logbook there are suggestions of which attachment you should do each MACC in but if the opportunity arises, try and get them done wherever you can’

Looking after yourself The University counselling service is available to all students and appointments can be made by phoning 0115 951 3695 or emailing counselling@nottingham.ac.uk. You can also make an appointment to see any of the clinical sub deans by emailing Sue Hall at clinicalcoordinator@nottingham.ac.uk and the medical school will give permission for you to attend any medical or counselling appointments if you are struggling to get permission from your placement site. There are also student led sources of support available including Nightline which is open from 7pm-8am and can be contacted by phone on 0115 9514985, email at nightlineanon@nottingham.ac.uk or instant messenger via their website: http://www.nottinghamnightline.co.uk. There are also your team of trained MedSoc supporters who are there to support you. Their details can be found on their Facebook page: https://www.facebook.com/NottsMedSocSupport?fref=ts.

‘Talk to the F1s on the ward, it’s not long since they were in your position and they’ll want to help you out as much as they can’ ‘Enjoy the summer! It's the last one with some of your friends, don't start stressing too early’ ‘For people living away - try to eat with someone every night, you can cook separately and be in different flats but it makes sure you're not on your own all evening’ ‘Don’t forget you can contact the Medsoc peer supporters in the year above’ ‘Try not to compare yourself with everyone else while you’re revising, everyone prepares at a different speed and you’ll get there in the end’

Finances Below is the guidance issued by the medical school about travel reimbursement for each of the sites. Please note that these may change. There are a number of bursaries available to help towards the cost of electives and these are posted on Moodle through the year.

‘For CP3, claims for travel expenses should be submitted to the relevant award unit. For English domiciled students this is the NHS Student Bursaries. Further information is available from the Medical Course Office or from the NHS Student bursaries itself. Students on the GEM Course can claim travelling expenses through the NHS Student Bursaries see www.nhsbsa.nhs.uk/Students.aspx or on Facebook http://www.facebook.com/pages/NHSStudent-Bursaries/148320495240479 . Students placed at Lincoln, Boston or Grantham are able to claim course related travel expenses from the Trust. Details will be given to students at their Induction’ Travel reimbursement for the GP attachment In order to receive reimbursement towards travel costs, students must fulfil the following criteria: 1. Usually, a student must not be eligible for an NHS Bursary.

2. A student may claim if they have been awarded an NHS funded bursary as long as they are not*  an EU assessed Fees only award;  a Fees only Award where income has not been declared for means testing purposes; (applies to course commencing before 1 Sept 2012);  a seconded student 3. Students living within Nottinghamshire or Derbyshire.

4. The distance from the student’s term time address as recorded on the student database (SATURN) to the student’s allocated GP Practice must be more than 16 miles one way; distance verified at www.google.co.uk/maps.

If the student meets the above eligibility criteria, they will be entitled to receive reimbursement towards their travel costs to the GP Practice and palliative care placement for the attachment.

The student may claim the following mileage rate: 

33 pence per mile (NHS Student Bursary current rate), for any travel mileage in excess of the minimum journey as stated above.  Students are also eligible to claim an additional 5 pence per mile per additional passenger. In this circumstance you will be expected to provide the name and journey details for the additional passenger.  For example; a student who is placed at a practice 20 miles away from their term time address will be reimbursed 4 miles for each journey. Therefore a return journey would enable an 8 mile claim to be reimbursed. This will be reimbursed at 33 pence per mile.

However if there is an additional student travelling then this will be reimbursed at 38 pence per mile.

Alternative modes of transport (e.g. bus/train) may be used by students. However in such circumstances we are only able to reimburse the cost of travel based upon miles travelled using the payment structure above. Unfortunately we are unable to reimburse the direct costs attributable to public transport.

Planning your elective After a busy year and the stress of finals, the elective comes as a welcome break! Before going, you have to show the medical school confirmation from your host confirming your elective acceptance and also complete a risk assessment form. You’re expected to complete at least 240 contact hours. The elective is assessed with a satisfactory attendance sign off and a written report afterwards explaining how you met the objectives that you’d set for your elective. You can find written elective reports from the last few years here: https://medicine.nottingham.ac.uk/electives/reports.php ‘An elective in the UK may not be a cheaper option (unless you stay in Nottingham), and it's often harder to find funding from bursaries as many of them are for travelling abroad. Lots of the UK medical school have application deadlines well before we even find out what dates we are doing elective and there is also just as much admin as a foreign elective!’

‘Think about what you want from the actual placement and find someone that shares your view to go with’ ‘Don't be afraid to stay in the UK if that’s what you want to do’ ‘I used the 4 weeks off at the end of 4th year to plan mine, I literally had no idea where to go or what to do. I would recommend the MDU electives network, I just relied on that and decided on a country on a whim. My advice would be think about language barriers/logistics, what you want to gain from the elective i.e. beach and chill or get a better idea of future career. I feel those are the 2 important considerations’ ‘I'd say, if you aren't sure pick a broad specialty, have a template email requesting information and availability about electives that you can send out to as many places as possible and then the hard work is pretty much over. MDU electives network is really helpful for reviews from students, info about the hospital and most importantly emails. The earlier you send out things the better’ ‘Myself and 3 others have organised our elective after finding the link to the hospital on the website http://www.ameca.org.uk/. It is an organisation that has a database of African hospitals that are willing to take medical students. This website has a strong link with Nottingham Medical School as it is a charitable organisation set up in memory of a former Nottingham Medical School graduate by his parents. They also allocate a bursary every year. I think it has been previously advertised on the NLE but it is a very valuable resource’ ‘If you want to go to Auckland then you need to look at the university website. I think the applications opened in January last year when we applied’ ‘Before I started planning I wish I had thought up a realistic budget. And had an idea of all the bursaries that are available’ ‘I'd advise putting aside an hour and emailing any hospital in any country you fancy going to. The people you get replies from know about local accommodation and visas and everything like that so I just left that stuff till after exams to organise. I'm probably not the best role model for organising an elective but maybe just reassure them that if it all goes tits up and you have to re-plan, it's not an issue really!’