FRCPath Part II (microbiology)
4 papers across 2 days (2 on each day, may be in variable order):
- 2.5 hour paper including essay (choose 1 of 2 options) + SAQs (around 10)
- 2.5 hour paper including critical appraisal (choose 1 of 2 options) + SAQs (around 10)
- 3 hour OSPE including 2 face-to-face stations (9 minutes each)
- 3 hour case-based question paper (10 cases)
SAQ = short answer question
OSPE = observed structured practical exam
This is definitely an exam where it helps to have spent time doing clinical micro and ID rather than just putting your head down in the books (although you will need to do this too). It is almost certainly easier to do this later on in training and given the significant cost, it is worth thinking about when you are likely to have the best chance of passing. It was also pointed out to me that although passing is great – you also then start paying more for RCPath membership.
My experience and from chatting to others is that the content of the papers is quite variable. For example there seem to be a lot of GU medicine in my papers whereas in previous sittings there was none at all so it isn’t that easy to predict. However certain things do seem to come up with regularity e.g Legionella and water, theatre ventilation etc.
Although there were a couple of rather esoteric questions, these are only worth a couple of marks and in general I thought the questions were fair although it certainly helped to have had inpatient and outpatient experience in addition to the laboratory side.
It is probably likely that it has been a while since you have done a non-MCQ based exam! When you first start trying to gather your thoughts, the sheer volume of information you could try to learn may seem insurmountable. There is not a lot of specific material available (a few questions on the RCPath website) – It is worth asking your colleagues who have sat it recently whether they have any notes, questions, essay plans etc that can form a starting point for your revision. Once I had an idea, I largely based my revision around the SMIs and clinical guidelines available (see below). It does sadly require both breadth and depth of knowledge.
I cannot stress enough how useful it is to have people to revise with. I was part of an excellent WhatsApp group where we posed each other questions most days in the run-up to the exam – this keeps you abreast of what other people are looking at, highlights gaps in your knowledge and really helps boost morale when you can’t face revising any more!
SMI = Standards for Microbiology Investigations
It is definitely worth practising a few timed essays. I found that I kept getting cramp in my hand, not having written so much all in one go in a really long time, so get your hand muscles in training.
I found it useful to put together rough structured essay plans for the things that I thought might come up e.g outbreak management, laboratory incident management, business case writing, OPAT services etc
Be aware that the essay questions in the exam tend to be very structured and will essentially give your essay structure through a series of sub-questions you are required to answer – the time can be pretty tight for this so even if you know lots, if it isn’t relevant to the sub-questions then it may not be worth putting it in.
OPAT = outpatient antimicrobial therapy
This is worth practising. You are often required to write an abstract for the paper you are given (and you may be given the subheadings required for it). This usually has a word limit of 250 words. A tip I learned is that 250 words is roughly an A4 page of normal writing. You will waste a lot of time if you keep counting.
I did not manage to predict the papers which came up on my exam but it is worth having read the important infection relevant papers from the previous year and have critically appraised them. Although perhaps not worth a large number of marks, there often seem to be some quite specific statistics questions on this paper, so it is a good idea, if stats are not your thing, to find a good critical appraisal book to remind yourself of which tests are used for what, how to calculate basic measures eg sensitivity, specificity, PPV etc. Remember that critical appraisal is a common part of many of the post grad exams in other specialties – I found some useful questions on the College of Emergency Medicine website and there are also specific books available.
You will have a choice from 2 papers. I chose mine based on a quick read of the questions I was going to have to answer! Other people looked at the length of the 2 papers and chose the shorter. The focus of the paper might also influence which you choose e.g whether you are more comfortable with clinical or more basic scientific research. Whatever you choose, try not to waste too much time deliberating.
PPV = positive predictive value
For both the critical appraisal and essay papers, think about whether you want to do the essay/critical appraisal bit or the SAQs first. I chose to do the SAQs first. My rationale for this was that if I ran out of time during the SAQs, I would definitely lose marks just through not having attempted the questions whereas if I was going to run out in either of the other sections, I could just bullet point what I was going to say and hopefully get at least some marks.
I roughly allocated an hour to the essay/critical appraisal and 1hr 30 to the SAQs. Go in prepared to write quickly ( but legibly!)
Face-to-face stations: this could be (e.g) discussion of clinical management of a case or role-playing conversations with other healthcare professionals. Consider your approach to difficult conversations e.g angry surgeons/site managers etc. Remember this is what you do every day anyway so try to imagine you are just at work! I found the examiners friendly and did try to guide you when you were flailing around a bit.
The other stations may test a similar range of knowledge to the SAQs but with a more practical focus. There may be some microscopy to do but there is no wet lab. This may sound simple but it is very much worth knowing what things look like – for example, you might know that a particular bug ferments lactose but do you actually know what colour change you would expect? On my paper there were still a lot of basic microbiology tests that we don’t really use in the lab I work in, so it is worth making sure you know about these (and what the positive and negative results look like). Expect things like gram stains, plates, PCR interpretation, antibiograms but also things on general lab safety etc.
Short answer questions
The sizes of the boxes should give you an idea of the length of answer required. You do not need to write loads. If you don’t know the answer, it isn’t negatively marked so it is definitely worth a guess.
Remember that when a question asks you to discuss management of a case this should include things you would do in the laboratory, treatment, infection control actions and public health actions if any.
Long case questions
This was my last paper and by that point everyone was exhausted! These include a lot of information (around an A4 page of results and clinical scenario per question) You will spend a lot of time reading during this paper and it is tiring and can be difficult to concentrate. It is quite easy to make silly mistakes by forgetting pieces of information that are given early in the questions e.g penicillin allergies etc so highlight anything you think important.
Again the length of answer expected is dictated roughly by the box size.
We hope this is of some use to you if you have this exam on the horizon. Below is a list of useful revision resources.