Hot Desk

hot desk v,

to share a desk, office, or other work space between employees on different shifts or schedules; used here to denote the rotations of public health registrars and other medical trainees working in public health

MFPH Exams - Hacks for Diplomate Exam

If you're looking at this page, it means the dreaded Diplomate exam is on the horizon! Ideally you want to pass this exam the first time (or at least bank a paper). Maybe you're going for another shot and want to improve your performance. I was lucky and got through it first time. Here are my top ten tips to passing with flying colours!

1. Think long distance not sprint!

Many of us are used to the university way of life, cramming revision (and first time learning) into the month proceeding an exam. However, you may need to rewind this way of thinking. The Diplomate Exam is more like taking the A levels again. Plan to start your studying at least six months before. You may think this is too early but seriously, there is a lot to get through.

2. Work from the Syllabus

This may seem like an obvious choice but there are a number of trainees/registrars who think that studying their MPH notes alone is to get through. It is not. MPH notes were to get you through the MPH. The Diplomate exam is completely different. Download the syllabus from the FPH website. I found it useful to further categorize topics. For instance, some topics are clearly just needing definitions, e.g. "the prevention paradox" whilst others need more in-depth, e.g. "the design, evaluation and management of immunisation programmes". I grouped this latter topic with "choices in developing an immunisation strategy" and created a framework for immunisation. I also divided Section A: Epidemiology into two parts, i.e measuring health and illness and study design. Whatever you choose to do, go through the syllabus with a red pen and aim to understand everything. To this day, I can still tell my mother what each word means!

The trick to passing the Diplomate Exam is to aim to have a pass answer on each topic of the syllabus.  There's no point having a nine out of ten on a couple of answers when you fail on the seven out of ten rule. So when you go through the syllabus, make sure you know everything, at least a pass answer on everything.

3. Pace yourself

Again this sounds so obvious but it is a trap that many trainees/registrars fall into. Make passing Diplomate Exam a priority. Your Deanery allows you to have study days, use them. For instance, my deanery allowed us a day off a week in the third and second month leading up to the exam for private study and two days in the final month. I used them. You may think that you're letting your trainer and team down but think about it, it's in their interest to have you through the exam and back to full time work quickly. If you are unlucky to have a trainer who is unsupportive, be assertive. You need to get the Diplomate Exam so tell him/her that until you do, you're working part-time (if taking study leave) or not to load up projects on you.

Related to this is to make a timetable. Divide up your syllabus into doable chunks (allowing for holidays and possible crises). Then work from your timetable each day, week and month. I was so intent on completing each part of my timetable that I studied on trains each morning and evening going to work and every evening I set aside a few hours to study. I studied Saturday (in between running a house!) and took Sundays off. The pounds piled on despite exercise efforts, so yes, it really is like being a teenager again! At least this time, the spots only last 6 months!

4. Get Filing

You're probably wondering what I mean by this but it is simply get organized. Before I started my study, I went out and bought ten large ring binders. I then named them: Epidemiology, Statistics, Other Research Methods, Health Information, Medical Sociology, Communicable Diseases etc. I then compiled everything I had on each topic into each ring binder, adding and subtracting as I studied. It was really useful to have my thoughts and work organised in one place on each topic.

5. Befriend Google and Wikipedia

What did we do before Google? Don't know what generation numbers mean? Don't bother getting a lengthy answer from a fellow trainee/registrar in UKHSA Health Protection, just google it! I had no idea what epidemic curves entailed so it did a search on it and found the website of UNC School of Public Health (North Carolina Center for Public Health Preparedness). They had a great powerpoint talk called "Epidemic Curves Ahead" that explained it brilliantly. You may view this tip sceptically but hand on heart, googling is what fellow passes also raved about.

6. Ask a friend

Not the 'Who wants to be a Millionaire' variety, more knowing that where you work is resource ripe for picking! Public Health comprises of people from different backgrounds, all with expertise in different areas. For instance, I did not know much about the 'Health and Social Behaviour' section (i.e. nutrition) so I tracked down a dietician working in public health, booked a slot with her and we went through the syllabus. Within a couple of hours, I had covered that whole section, including receiving useful reading. I did the same for genetics, finding a friend who was a geneticist and emailing them what I needed to know (basic genomic concepts, aetiology, distribution and control of disease in relatives etc). Tied in with this is when I came across something at work that touched upon the syllabus, I made notes and filed them in my ring binders (see tip 4). For instance, if my trainer spoke to me about change management or if I was involved in a screening programme, I made notes as if I was a student learning the process. This does help.

7. Devise Frameworks

You'll come across this tip a lot. Sometimes called 'sieves' or mind maps (of sorts), it basically means that there are a number of questions that can be answered using a general framework. For instance, a question on setting up surveillance of a specific disease. It's not knowledge of the disease they're looking for but the definition, uses and components of a surveillance system. So if you had a framework answer already devised for surveillance, in the twenty minutes in the exam, you'll be able to immediately apply it to the topic without wasting time. Don't know where to start? Look at past exam papers and

8. Take Regular Quizes

There's no point cramming your brain if you're not going to remember it! I found it useful to devise a quiz to test me as I was going along. Simply, I used an A4 refill page per topic and wrote down things like: "focus groups - definition; use, analysis, presentation; ethical issues?; 7 strengths; 7 weaknesses; validity?; (3 points) contribution to public health research and policy?" As I learnt the topic, I wrote down the questions or prompts. The next day I'd test myself using only my questions. It ended up a useful way to test memory and also to learn frameworks, in a brainwashing manner. So even if one got panicked in the exam, such frameworks could still be recalled!

9. Test yourself with past papers

Some people work from exam papers, whilst others study them in groups. I found it useful to test myself (after I learnt a topic) with an exam question and then topped up my knowledge with the examiner comments. Whatever works for you is good, just don't think about going into the exam without seeing the past exam papers and knowing what the examiners are looking for. All past papers are on the faculty website. I'd also really recommend doing a mock exam. Most deaneries organise them, if yours don't, be proactive and seek out a nearby deanery that does and ask if you can go along. It's really worth it. I'd also recommend going along to a revision course.  In my day, it was Ed Jessop's Preparatory Part A course.  There are other courses on the market such as University of Birmingham.  Courses like that are a good way  top up your knowledge and is good measure of how ready you are.

10. Think like a student not an expert

Someone I worked with a long time ago said that his brother, a PHD in physiology, taught his fellow medical students physiology for a term. They all got As and he got a C. The reason? He answered like a Physiologist. This exam is about demonstrating knowledge of the topics in the syllabus not finding new knowledge. The examiners want to know do you understand public health and can you apply the knowledge in different circumstances. So if you're faced with a question on bowel cancer screening, for instance, they're not asking about what you know about bowel cancer, instead ask yourself is this a screening question, a sociology or an economics question? The clue is in the other words. Then apply your appropriate framework. We're all experts in something. Some of us are medics with expertise in the diseases. Others have management expertise or research backgrounds in epidemiology or social sciences. Think back to when you were an undergraduate. Remember you were demonstrating that you had learnt the issues and were regurgitating the facts. Switch your brain to that mode!

Tips for the Exam

1. Bring your own clock or watch into the exam. Sometimes the exams start late so the minute it starts, reset your clock/watch to the original starting time and work from your own clock not the one on the wall. This will help you to keep to your timings.

2. Have at least 6 pens with you. Many people buy a lovely fountain pen but unless your writing is worthy of being displayed as art, I suggest you stick to the biro variety with in built cushions (to prevent the dent in the middle finger!) Practise writing lots in the run up to the exam. We're so used to computers that we are likely to develop cramps in an exam. See it as getting your hand physically fit - write lots of Christmas cards, letters to long lost friends, shopping lists, a novel etc.

3. Buy earplugs. This is useful for the night before in the hotel. Given that you're likely to stay near the venue, this part of London is noisy and you'll be very grateful for the earplugs to help you sleep.

4. Start a fresh page with each question (in Paper II, use a clean page for each part of a question). The answers will be marked by different examiners. It also helps to indicate how many pages you have per answer. For example, you may write at the top of the page "Q4 2 of 5", meaning page 2 out of five pages.

5. Be confident! There will be people who will moan how difficult the exam is just before you enter the room. Don't listen to them! Tell yourself, you've come this far, you can do this!

Useful Links

Useful Reading

Grimes & Schulz's 11 articles in the Lancet (Lancet 2002:359). Everything you need to know about epidemiological research design. The articles form good frameworks from descriptive studies through to screening and bias. First article is "An overview of clinical research:a lay of the land" (Lancet 2002; 359:57-61)

For Research Methods, I admit, I had an unfair advantage. However, if a newcomer, look to "Understanding Clinical Papers" by Bowers, House and Owens (good for recapping statistics, risks and for critical appraisal). Ann Bowling's "Research Methods in Health" is a must, particularly for audit, evaluation, qualitative methods and surveys. Greater in-depth on qualitative methods, such as Delphi method, can be sought from Pope and May's "Qualitative Research in Health". For statistics, most people find Swinscow and Campbell's "Statistics Square One" and "Statistics Square Two" useful. Personally, if you're a numerical phobe, check out a social science version. Wright's "Understanding Statistics" is a good start (this book uses words not mathematics to explain statistics).

For Medical Sociology, try Scambler (Ed.) "Sociology of Medicine" - by no means the greatest on the market but good for creating easy-to-recall frameworks on health inequalities, lay perspectives etc. For greater understanding, try Sarah Nettleton's "Sociology of Health and Illness" or if absolutely clueless, go straight to the chapter on health in Anthony Gidden's "Sociology". It's always a good place to start! For social policy, the chapter on health services in Baldock et al's textbook, "Social Policy", is excellent, especially on rationing. "Public Health for 21st century" is good on partnerships and community work and a new book "Public Health and Primary Care" (Oxford University Press) is a useful source on practice based commissioning and other new developments.

For management, check out Charles Handy's "Understanding Organisations". I also used health knowledge website (see above) and did a management course. For health economics, I did a day course in University of Oxford, googled and emailed friends!

Last but not least, the old chestnuts, Donaldson & Donaldson's "Essential Public Health" and the "Oxford Handbook of Public Health". You may laugh but they are great for devising frameworks.