FRCPath Examination in Clinical Biochemistry Dr Ruth Ayling

FRCPath Examination in Clinical Biochemistry Dr Ruth Ayling Chair, Panel of Examiners

FRCPath overarching structure Part 1 Stage A examination OSPE Clinical Biochemistry MCQ 1 x 3 hour paper (125 questions) Part 2 Clinical Biochemistry Module 1 OSPE Practical M Module 2 Cases/Critical appraisal Oral Module 3 Dissertation

Stage A examination – primarily a competency test but…. • you are also expected to build a significant knowledge base in Y 1 – engaging with a well structured Year 1 programme is essential

Step Out of your Comfort Zone T R O F M CO E N ZO

Stage A examination OSPE • 3 hours • 19 stations (9 minutes per station) • Practical procedures • Calculations • Interpretation of clinical data

Stage A Q 1 Answer

Stage A Q 2 Answer

Keys to your success • Part 1 FRCPath Knowledge – take a long run-up – adopt a systematic approach – correlate book knowledge with ongoing day to day experience – insist on regular feedback from your trainers

FRCPath Part 1 • 1 x 3 hour MCQ • 125 questions (86. 4 secs/question) • Single best answer • No negative marking

MCQ Format A Chemical Pathology Sp. R is preparing for FRCPath Part 1 What type of mock exam is likely to be most helpful for preparation? A Essay B MCQ C Oral D OSPE E SAQ

FRCPath Part 1 MCQ Theoretically, osmolality can be measured using any of the colligative properties of a solution. In clinical laboratories, which colligative property is most commonly used to ascertain the osmolality of serum and urine? A Depression of freezing point B Elevation of boiling point C Lowering of vapour pressure D Oncotic pressure E Osmotic pressure

Content of Part 1 examination Topic area Acid base homeostasis, blood gases Calcium and bone disease Cancer and tumour markers Cardiovascular and lipids Diabetes and endocrinology Inherited metabolic disease, genetics, paediatrics, pregnancy, screening Kidney, water and electrolytes Laboratory techniques Liver, proteins, enzymes Miscellaneous (eg IT, audit, QC, statistics, governance) Nutrition and gastroenterology Therapeutic drug metabolism and toxicology No of questions 5 5 5 10 10 15 15 15 10 5

FRCPath overarching structure Part 1 Stage A examination OSPE Clinical Biochemistry MCQ 1 x 3 hour paper (125 questions) Part 2 Clinical Biochemistry Module 1 OSPE Practical M Module 2 Cases/Critical appraisal Oral Module 3 Dissertation

Keys to your success • Part 2 FRCPath Skills and knowledge application – Wide ranging workplace-based experience with feedback • Shift lots of glass • Get your lab coat on • Optimize all clinical opportunities – Get people to set you practical exercises – Practice oral exam technique – Do a mock exam – Attend a course?

FRCPath Part 2 OSPE 3 hours 19 stations (9 minutes per station) • analytical outputs – e. g. electrophoretic strips, chromatography scans • clinical scenarios – e. g. sample requirements, investigation protocols • quality control and/or external quality assurance data • calculations – eg analytical, physiological or pharmacological

FRCPath Part 2 Module 1 Practical 3 hours • Part A Experimental design • Part B Data analysis • Part C Practical exercise

Practical Paper Part A • Write a validation exercise for a change of assay from a Jaffe based creatinine assay to an enzymatic based creatinine assay. • At the same time the renal team would like to move from the MDRD to the CKD-Epi equation. Detail a plan for this and how you would implement these changes. •

Practical Paper Part B • Using the data provided write a validation report and detail the clinical advice you will give to clinicians.

• Part C Using the samples required, measure enzymatic and Jaffe creatinine and determine if any differences are observed You are supplied with a Patient sample spiked with 100 nmol/L bilirubin, 1 calibrator sample and 1 QC sample Jaffe Method: reagent 1, reagent 2, water Take 50 u. L sample, 250 u. L R 1, 2700 u. L of water, 200 u. L of R 2 Incubate for 5 mins at room temperature, read absorbance at 500 nm Wait a further 5 mins and read absorbance again The change is absorbance is proportional to the concentration of creatinine. The calibrator value is 385 umol/L, the method is linear up to 1500 umol/L Enzymatic Method: reagent 1, reagent 2, water Take 20 u. L of sample, 800 reagent 1, 265 reagent 2, 2000 ul of water Read absorbance at 548 nm at 10 mins Product is stable for 5 mins

Answer notes • A passing candidate will be able to produce results from at least one of the assays. The practical has a strong element of time management in it as multiple reading as have to take place. Despite the samples being spiked with 100 nmol/L of bilirubin no difference between the results has been observed of this assay. Therefore the correct result should be to say that no difference was observed. • Excellent candidates will present their laboratory data in a neat and concise manner, using tables where appropriate and showing clear calculations etc.

FRCPath overarching structure Part 1 Stage A examination OSPE Clinical Biochemistry MCQ 1 x 3 hour paper (125 questions) Part 2 Clinical Biochemistry Module 1 OSPE Practical M Module 2 Cases/Critical appraisal Oral Module 3 Dissertation

FRCPath Part 2 Module 2 Written component 1 hour – 6 clinical cases 2 hours – 2 journal evaluation exercise Oral 2 x 20 minutes

Clinical Case

Answer notes • Candidates would be expected to:

Management Question You are three months into your Consultant appointment and are asked to represent Pathology) on the Trust’s established General Practitioner (GP) Liaison Group. This meets every two months to review clinical and support services provision by the Trust. After two meetings it is clear that there is general dissatisfaction with the Pathology services and Chemical Pathology seems to be singled out for much non-specific criticism. (‘Too slow’ and ‘unhelpful’ are familiar comments from the more vociferous GP’s). You ‘volunteer’ to conduct a formal review of user satisfaction among the GP’s as the basis for changes in service provision. What approaches to gathering the required information would you consider and why? What do you feel will be the key aspects of the services to GP’s on which you will need to seek opinion

Answer notes Approaches to Gathering Information Background Existence of any current service agreement and standards. Previous audits (if any) of service to GP’s Formal log of complaints from GP’s (general or discipline specific) New Information Audit of current service Questionnaire – validity? Design? Visits to selected GP’s (possibly with questionnaire) Views of laboratory staff Aspects of Service for User Opinion/Level of Satisfaction May include: Access (‘opening hours’) Request form design (personalised; multidisciplinary) Phlebotomy Services (? domiciliary visits) Turnaround times Transport of Samples and Reports Availability of Consultant advice Electronic Data Interchange POCT Support Management data on Pathology usage by practice CPA Status (awareness!) Participation in Clinical Audit Pathology handbook/Information sheets/CD (covering much of the above information) Some of the above will require an overall opinion, others (eg. consultant advice) may require discipline specific information.

Concluding Remarks • FRCPath examinations provide a rigorous and fair test of cognitive skills – Part 1 – Part 2 knowledge skills and application • Together with workplace-based assessments they sample all aspects of the curriculum • Candidates who are fully engaged in a well structured training programme have high probability of success