Anonymous #1
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MSCAA preparation

This is a brief piece. I hope to include more detail over the coming days and weeks, tackling questions, uploading notes on key areas, and compiling advice from people who passed the exams. This is also my own perception of what to do. I may be wrong in parts, or still have the wrong approach. Do what is best for you and whatever judgement you make after counselling many people.

Background:

The MSCAA is an organisation which is an alliance between various medical schools trying to set a common standard of assessment between medical schools. The reason i am writing this piece is because the types of questions are not what you typically will find on question banks, nor what is typically faced by medical students in prior exams. It is highly possible to have sailed through every exam in medical school, go through vast quantities of question banks, and then catch yourself struggling for these exams. A large number of students who have sat the exam have attested to the difficulty of these exams. They are arguably harder than final exams of prior years as more and more medical schools are either making a majority component from the MSCAA, or using it entirely.

Some of the individuals who write the questions in the question bank have been my teachers, and expressed negative sentiment towards question banks. To paraphrase, one stated that question banks assess knowledge, but what exams he wishes to set do test synthesis.

If you have managed to get to the final year of medical school, you likely have not only excelled in GCSES, A-Levels, entrance exams, and difficult practical and written exams so far, but have overseen a large body of competition to do so. If you are still struggling, do not be disheartened, your struggle is shared by the majority of students.

You might ask yourself what the cause of suddenly struggling is? The answer is two fold:

  1. The most important factor is that the questions are now designed in a manner which deliberately assesses synthesis of a variety of conditions, across epidemiology, symptoms, different steps in treatment pathways, management, inline with what is commonly observed applied practice. Pattern recognition is not enough to pass exams anymore.

2. Most question banks have slowly started to include questions that focus more on application rather than pure pattern recognition. However, this isn’t to my observations adequate.Students who have sailed through previous exams and are using the same technique might find themselves struggling when it comes to the new style of questions.


Having myself almost certainly failed the written finals, as a student who has never failed any practical or written exam in medical school, i will share my reflections as to what approach and mindset i believe is required. Given most students haven’t even been given the sample MSCAA mocks , and universities have done little to warn us of this shift, or prepare us given they have typically set questions that heavily rely on pattern recognition.

Thought process:

Going through question banks, one is often trained to improve in connecting a set of symptoms together, often in obscure scenarios , to form a diagnostic picture. This sort of method of learning is important and essential, but it appears it is not enough to pass the MSCAA for many - or at least do well on it.

The style of questions in the MSCAA test synthesis. Rather than knowing different patterns for a particular condition across just the level of symptoms, you may be required to apply epidemiology as to what is most likely in that subgroup. There is also another layer to this. You are often asked to identify the most likely cause of a particular set of symptoms, or most likely contributing condition or drug. The answers often have two or three options which appear to be tempting, and the way to identify the correct one is to have an awareness of what the patient is going through, but to have also understood the different causes to such an extent, you can begin to think your way around what is the most likely contributing factor.


In a question bank, you might be given an obscure scenario and told to identify what the diagnosis is. For instance, a patient may have sudden deterioration in kidney function evidenced by rise in urea and creatinine among other signs. They might also have other symptoms which might tell you what sort of process or pathology is behind that acute kidney injury. The MSCAA however, might test this, but will also push you further and ask you what the most likely cause is for a patient presenting in that situation.

In order to get the answers from question banks correct, you need to understand the features of AKI, know them well, and know the various subtle ways they present, being able to interpret blood results and the clinical picture.

For the MSCAA questions, you might need to think deeper about pre-renal, renal, and post-renal causes. You might need to apply epidemiology to sift through very rare, and very common causes of acute kidney injury from a list of options given. It would be quite easy to look at a list of options and not know where to start because they all seem applicable to the patient, but epidemiology might set one apart. Exam technique is also required in sometimes applying logic. If a patient has been on a drug for their entire life, is that likely to present with an acute kidney problem, as compared to a slow growing tumour, or a condition which is known to progress?

Some of those at the head of the MSCAA who teach at my medical school have also expressed a desire to set questions which reward people who have been on the wards. So when learning, it might be worth considering what often appears on the wards, what people tend to do, procedures, and the like thereof. This is essential when it comes to what would you test first, what would you scan after, what would be the best way to monitor. If you’ve only memorised management and their usages, but not the relevance of each step in the management and what you’d practically be sending tests for and chasing up as a FY1/2, you might drop a lot of marks on these types of questions.


In preparing for my resit exams, here is the new approach i will use:
  1. Ensuring that i cover definitions, epidemiology, signs and symptoms, tests, management, prognosis for every condition, making note of practical bits of clinically relevant information. For example, if i am learning about C.Diff, i will want to know in what population it is the highest risk in, if management changes in subgroups, what you’d do first in a patient with this condition, and how it is managed on the wards. I would then consider whether tests are sent first, if it is a clinical judgement, what is done in severe forms of the condition, what is the first line antibiotic, and what is given if that itself fails. If i have time and feel up to it, i might try to consider if the management changes in patients in whom C-Diff might be particularly dangerous, or perhaps in those patients who continue to have a recurrence for it. I might also consider what protective measures may be in place - how long do we keep them in hospital? When we send them home, what advice would we give?

2. Pattern recognition is essential. Medicine is in large part, pattern recognition. One should not neglect it and it is an essential part of revision. However, I will try to synthesise the information , and think of myself as working with real patients and wanting to know clinically relevant applied knowledge, rathe than pure pattern recognition and memorising a large body of knowledge.


These are questions i will constantly be asking myself:
  1. Which investigation is most likely to confirm the diagnosis?
  2. Which mechanism best explains…?
  3. Which is(or would be) the most appropriate next step in management?
  4. Which additional investigation is most likely to confirm the diagnosis?
  5. Which of the following would you want to investigate first in this patient to monitor treatment?
  6. Which mode of imaging will you use first?
  7. Which mode of imaging will confirm the diagnosis?
  8. Which is the most appropriate therapeutic change?
  9. Which is the most suitable initial treatment?
  10. Which clinical feature is most specific for…?
  11. Which treatment is most appropriate to…?
  12. Which further investigation will help to establish the diagnosis?
  13. Which is the most likely causative organism?


3. I will begin to write my own questions, in the style of the official exam and the MSCAA past papers. In order to do this, i will not only combine parts 1 and 2 of the three steps, but also consider common things in hospital, which would evidence having attended and seen how common things are dealt with practically. What happens when you are an FY1 and a patient complains of pain after surgery? What if there is something coming out of their wound? Would colour matter? What are best conservatively managed? When would i be calling my senior right away? What would i be doing - and what are the limits of what is expected?

Here are a few key topics and the sorts of things i will be covering - though it will be far more:

Cardiology: Often combined with emergency medicine. Here's a short list of generic things, definitely not exhaustive:

1. Emergencies - ACS, Stable Angina, Arrhythmias.

2. Surgical - anti-coagulant, anti-platelet therapy for valves, for people post surgery, higher risk. What valves and when? When are indications for an AS valve replacement? What about an MR valve? What anti-coagulant therapy is indicated before and after? What if they are bleeding? They have a big list of medications prior to their surgery, what are you going to stop?

3. Chronic: When would you give statins? When would you stop them? How do you monitor it? What other prophylactic medication is given post emergencies or long term?


3. Respiratory:

1. Emergencies: COPD patients - know the algorithm inside out for both management of COPD acute and chronic (know the pathways) Asthmatics, people with a pneumothorax - look at what i wrote earlier.

2. When would you prescribe LTOT? What would you monitor at different stages of emergency treatment to assess the patient is responding? What would you do first in acute settings. What scans are typically done, what scans are not done, what are overkill? Example: PE - do you scan right away ? Do you test the blood first? Do you scan/test depending on other factors and risk?

3. Principles: What organisms will cause infections in the upper lobe? What about in those immunocompromised? What about in specific groups of people? What complications of respiratory infections can there be - how do you deal with them? When would you treat home, when would you refer to secondary care?


3. Gastro:

1. Know your acute Chrons/UC management well

2. Know the chronic management of both conditions well, especially in terms of guidelines. It is not enough to know them generally, you have to know when you'd take it a drug up and when.

3. Azathioprine and TPMT!

4. Coeliac disease - how it's different from IBD, when you'd suspect and test it. What histological signs would you see for it, what are the most sensitive tests? Why do you need to test IgA?


Resources:

I hope to provide a growing list of resources. However, i would recommend the following:
  1. BMJ best practice- Medicinescomplete (BNF) in particular , the following pages.

2.
(1) Medicinescomplete has an excellent section on INR, Warfarin, pre-surgery and pathways better than i've seen anywhere else on this page: https://www.medicinescomplete.com/#/...bnf/_117346898

(2) b2: Oxfordmedical education have the best resources on fluids / oxygen prescribing:http://www.oxfordmedicaleducation.com/prescribing/
3. http://www.simplyrevision.org.uk/ind...-lectures.html (An excellent resource on everything, through lectures)
4. Oxford handbook of clinical medicine - emergency section algorithms.
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Anonymous #2
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thank you so much! I have retakes in 2 months, and I am brickin it too!

first time having to do resits for anything before, so your advice has really helped


good luck,

i saved everything you wrote and will be writing a similar plan x
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Anonymous #1
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(Original post by Anonymous)
thank you so much! I have retakes in 2 months, and I am brickin it too!

first time having to do resits for anything before, so your advice has really helped


good luck,

i saved everything you wrote and will be writing a similar plan x
Hey, i am glad it helped. I plan to include a serious amount more. Maybe we can all use this thread to help each other? I'm going to add the best notes i possibly can based on the exam papers and key things. So watch this thread, i'll be adding more.

I have a resit too, PSA/Finals. It has been a crazy time with the virus, so good luck, we will get through this, we aren't alone and we'll make it out of this.
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Anonymous #2
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(Original post by Anonymous)
Hey, i am glad it helped. I plan to include a serious amount more. Maybe we can all use this thread to help each other? I'm going to add the best notes i possibly can based on the exam papers and key things. So watch this thread, i'll be adding more.

I have a resit too, PSA/Finals. It has been a crazy time with the virus, so good luck, we will get through this, we aren't alone and we'll make it out of this.
you're amazing!!! sorry to hear youre resitting too!

honestly, this virus has removed my concentration and focus! it's such a stressful time for us final year medics, especially as awe are retaking!

im happy to do that! i was planning on just doing passmed again, but taking your tips into consideration! at the moment im writing out my notes, but if i see any useful things, i will happily put in the thread!

*Tip : turn off news updates, mute and archive whatsapp chats, log off all social media just to avoid all this coronavirus news!! its driving me crazy!*
Also are you doing online MCQ? mine is, and they want us to have a webcam so they can invigilate us and also take over our screens to make sure we re not cheating, which is wild considering other uni's havent done that for Online MCQs! Just grateful that I have chance to redo the exam!

Good luck with today x
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Anonymous #1
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(Original post by Anonymous)
you're amazing!!! sorry to hear youre resitting too!

honestly, this virus has removed my concentration and focus! it's such a stressful time for us final year medics, especially as awe are retaking!

im happy to do that! i was planning on just doing passmed again, but taking your tips into consideration! at the moment im writing out my notes, but if i see any useful things, i will happily put in the thread!

*Tip : turn off news updates, mute and archive whatsapp chats, log off all social media just to avoid all this coronavirus news!! its driving me crazy!*
Also are you doing online MCQ? mine is, and they want us to have a webcam so they can invigilate us and also take over our screens to make sure we re not cheating, which is wild considering other uni's havent done that for Online MCQs! Just grateful that I have chance to redo the exam!

Good luck with today x
I will be going through PassMed, but that's because i have a few months until my resit. PassMed is good for memorising, helping nail down some basics and foundations if you're going to have months where it's easy to just forget everything.

However, to pass the MSCAA it isn't essential and there's a better way, especially in the run-up.

I will do a post-mortem of my exam - both papers - without giving away the exact questions. I can remember about a hundred questions properly so hopefully that should come soon.
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Anonnnnn123
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Thanks a lot babe!!Can I ask if you think that MSCAA questions are more like MRCP 1 or MRCP 2?
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Anonymous #1
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(Original post by Anonymous)
you're amazing!!! sorry to hear youre resitting too!

honestly, this virus has removed my concentration and focus! it's such a stressful time for us final year medics, especially as awe are retaking!

im happy to do that! i was planning on just doing passmed again, but taking your tips into consideration! at the moment im writing out my notes, but if i see any useful things, i will happily put in the thread!

*Tip : turn off news updates, mute and archive whatsapp chats, log off all social media just to avoid all this coronavirus news!! its driving me crazy!*
Also are you doing online MCQ? mine is, and they want us to have a webcam so they can invigilate us and also take over our screens to make sure we re not cheating, which is wild considering other uni's havent done that for Online MCQs! Just grateful that I have chance to redo the exam!

Good luck with today x
Our first sit was open book. Google was not entirely useful to be honest with you. And i would rather do it without using the internet. Having said that, having someone look at you on webcam and monitor the screen remotely is just such silly pressure/can put me off

We'll all get through this. I will add some more things:

1. Post mortem of my exam , exactly what i found difficult, what i could have done in my revision to improve.
2. Notes on high yield topics
3. Essential management pathways
4. Common medical and surgical questions they might throw at us which FY1s/2s come across
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Anonymous #3
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Hi, thank you so much for posting this. This is definitely testament your character - that you are working so hard to help others. I'm in a similar situation to yourself - I failed PSA by 1% and have my online written exam (100% MSCAA q bank) in a couple of weeks. I am nervous for them, so everything you say is so helpful/reassuring!
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rosieieie1
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Also joining the thread - really useful! Am resitting my exam too (boo) but hopefully we'll all get through this
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#Annon#
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Thank you for the very informative post!

I find it very hard to find reliable information about MSCAA questions.

As you mentioned they are unlike most question banks, do you think it will be worthwhile buying MRCP question bank (instead of finals), like passmedicine for example?
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Anonymous #4
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Guys just a general question

If someone px acutely with heamodynamically stable AF and they're young and no obvious cause of af is found and in future they are suitable for cardioversion.. at what step do you order a transoesphageal echo???

After you stabilise their heart rate or b4?

The only person I saw in resus was a guy in his 50s with no bx and nobody did an echo.. he was just given beta blockers to sort him out.
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Anonymous #5
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(Original post by Anonymous)
Guys just a general question

If someone px acutely with heamodynamically stable AF and they're young and no obvious cause of af is found and in future they are suitable for cardioversion.. at what step do you order a transoesphageal echo???

After you stabilise their heart rate or b4?

The only person I saw in resus was a guy in his 50s with no bx and nobody did an echo.. he was just given beta blockers to sort him out.
I think you'd start all treatment and only do an echo if you suspect LVSD, mitral valve dysfunction. I think echo is just good practice and not explicitly endorsed in NICE guidance. I may be wrong!
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Anonymous #6
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Just a note that each individual uni choses there own msc questions from the bank to reflect their own curriculums!
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Anonymous #4
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(Original post by Anonymous)
I think you'd start all treatment and only do an echo if you suspect LVSD, mitral valve dysfunction. I think echo is just good practice and not explicitly endorsed in NICE guidance. I may be wrong!
But bmj best practice says do it if acute and no other cause found to ensure no emboli if u wanna cardiovert them.. argh..
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_infinity_
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I have the MSC online exam in 4 weeks. How many in your year failed and are resitting? Because our university are setting the pass mark and it is pass fail. Normally at our uni only about 10 people resit final year.
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_infinity_
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(Original post by Anonymous)
Our first sit was open book. Google was not entirely useful to be honest with you. And i would rather do it without using the internet. Having said that, having someone look at you on webcam and monitor the screen remotely is just such silly pressure/can put me off

We'll all get through this. I will add some more things:

1. Post mortem of my exam , exactly what i found difficult, what i could have done in my revision to improve.
2. Notes on high yield topics
3. Essential management pathways
4. Common medical and surgical questions they might throw at us which FY1s/2s come across
Please message me your post Mortem in case it is removed from here please. I would really appreciate it.
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Anonymous #7
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Thanks for this! Really appreciate the help you’re giving everyone especially during such a rough time.

I’ve got my final exam in a month. Previous years (who have also had MSCAA questions) have highly recommended using the Get Ahead question books. So if you can get your hands on any pdf versions then give those a go! They’re much more reflective of MSCAA and more difficult than passmed.

Good luck everyone
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medfoot
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(Original post by Anonymous)
Thanks for this! Really appreciate the help you’re giving everyone especially during such a rough time.

I’ve got my final exam in a month. Previous years (who have also had MSCAA questions) have highly recommended using the Get Ahead question books. So if you can get your hands on any pdf versions then give those a go! They’re much more reflective of MSCAA and more difficult than passmed.

Good luck everyone
hey hun do you have those pdfs you could send to me? could you DM me please?
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Anonymous #2
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(Original post by _infinity_)
I have the MSC online exam in 4 weeks. How many in your year failed and are resitting? Because our university are setting the pass mark and it is pass fail. Normally at our uni only about 10 people resit final year.
around 40 people in my year failed
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Anonymous #7
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(Original post by medfoot)
hey hun do you have those pdfs you could send to me? could you DM me please?
I don’t, sorry! But if you google it they should be somewhere on there or online through your university library.
These are the books
- get ahead surgery 250 SBAs for finals
- get ahead surgery 100 EMQs for finals
- get ahead medicine 300 SBAs for finals
- get ahead medicine 150 EMQs for finals
They also have speciality ones
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