[update] 2013 MD2 MCQ and SAQ exams finished, OSCE on Friday

On Monday and Wednesday, I completed the MD2 MCQ and SAQ exams for this year. In general, I think they were very fair exams. There were a few harder questions which were there to separate out people.

I generally like MCQs better than SAQs, although I find SAQs a lot better than essay questions/extended response. It is hard sometimes to know what the examiners want you to write for extended response. And SAQ is better, but sometimes it is also hard to know exactly what they want. With MCQs, it is a lot less ambiguous, unless the question is worded badly. An example of this would be: what exactly is the "best" approach?

I got a bit put off by today's SAQ paper with the number of lines given for some responses though. In some of them, I feel like I can answer the question fully in three lines if answering exactly what is asked (eg giving a list). But because there was more space, I was wondering if they wanted more of an explanation, so I gave some anyway. At least in this year's SAQ, unlike last year's MD1 SAQ, we were not required to write completely non-stop from start to finish as a test of our writing speed.

There was one question where they asked eight different causes of seizures though. Eight causes! Not precipitants. I was struggling with this, but then realized that hemochromatosis and Wilson's Disease were probably causes (wasn't 100% sure though) so I wrote them down and it seems like they were right. What was frustrating though was that I wrote MEOS instead of MELAS as a cause of seizures! Argh! So close... I had 60% of the letters there!

I also recall giving quite a few pretty "out there but possible" answers after my standard answers when I couldn't think of anything else to write in the space, just to see if I could score a few extra points. One of them was regarding the possibility of the patient having a hemolytic anemia before the first HbA1c reading for their diabetes, explaining why the HbA1c rose this time compared to 6 months ago. I hope the examiners have a laugh at that.

Finally there is something else which I was somewhat amused by, although it may sound strange. Following on from my table tennis "ACE inhibitor" comments from my med jokes, I have been joking that "if a multiple choice option is ACE inhibitor, and you don't know the answer, choose the ACE inhibitor". Actually, ACE inhibitors are first line for hypertension, heart failure with reduced ejection fraction and chronic kidney disease. They are very useful for reducing cardiovascular events.

Although it was a joke which stemmed from table tennis playing, from personal experience of practice tests, the advice is actually mostly true. As an example, the best treatment for reducing progression of diabetic nephropathy is not actually good blood glucose level control. This sounds very counter-intuitive indeed! But the best treatment is actually using an ACE inhibitor. One of the nephrologists told me: "The three most important things for chronic kidney disease are: 1: good blood pressure control. 2: good blood pressure control. 3: good blood pressure control".

However, even though there have been 1-2 questions when using an ACE inhibitor was the correct answer in MCQs in some practice tests I have done, there was not one question with ACE inhibitor as a possible answer in the MCQs this year! Such an oversight of one of the most important drugs in medicine...

Oh and final point on the MCQs and SAQs, unless I missed something completely, there were absolutely no questions at all regarding EP! I am very grateful that the University of Melbourne has not overemphasized this portion of the course (which may be known in other unis as PPD) to the detriment of the more "traditional" aspects such as basic sciences, history taking, clinical examinations and hard knowledge of conditions, aetiology and presentations; which I hear is the case sadly in some other medical schools in this country. At least so far in the Melbourne medical course, we had none of this rubbish of reflective essays with rigid marking criteria. Well, we did have reflective essays, which were a bit annoying, but at least they were pass/fail and we could properly reflect on experiences. At no stage was I required to bend the truth and give a false reflection in order to pass an illogical marking scheme like what some people from unis in NSW were required to do.

Anyway, OSCEs are on Friday. I did not perform as well as I would have liked in the OSCEs last year, although I feel that I have improved my clinical skills this year significantly. I hope it shows up in the results.