Hot Desk

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 FPH Membership Exam

The FPH Membership Exam (OSPHE) - or objective structured public health exam to give it its full title - is a completely different beast to the Diplomate Exam. While the latter tested your knowledge of public health, OSPHE is geared towards testing your skills and application of public health knowledge. The skills being examined are your communication skills (presentation and listening), data handling and interpretation, your reasoning and judgement skills and your ability to deal with uncertainty or conflict. There are 6 stations, each lasting 8 minutes, and you have 8 minutes preparation time for each station or scenario. The stations will vary in topic or situation but they are all geared towards testing your ability to carry out public health duties. It is worth remembering that the standard you are being examined against is that of a public health trainee half way through their training and not a qualified consultant.

1. Practice makes perfect!

Unlike the solo swotting for the Diplomate Exam, preparation for Membership Exam involves practising OSPHE scenarios. It is worth setting up or joining an OSPHE practice group amongst your fellow public health trainees. How regularly you meet is up to you but certainly for the 2 months leading up to the OSPHE exam, it is probably worth meeting each week. Meeting in groups of three is also more productive as you can take turns playing the candidate, actor and marker/examiner. Another recommendation is to poach a consultant in public health (medicine) and ask them to observe you. A drawback with working with colleagues is that your colleague may not as intimidating as an actor would be playing a disgruntled councillor! Still, practising preparing and conducting the scenario within the allotted time (8 minutes preparation and 8 minutes examination) is good practice in itself. You can supplement your practice by practising with your boyfriend/girlfriend/partner/friend for the layperson scenarios. (This can be a good way to check if you can explain terms in lay language and avoid jargon!)

2. Do at least one mock exam

Most deaneries (like the South East Deanery) run mock OSPHE exams at least once a year. You should tune into the grapevine to find out when and where a mock exam is taking place prior to your OSPHE. You should also do a preparation course. The Northern Deanery runs an excellent OSPHE preparation course in Newcastle at regular intervals throughout the year. This course includes a mock exam with real actors and so gives you a very good taste of what to expect. See the Northern Deanery's website for more details.

3. Structure your answer

Some people think that they can pass the OSPHE on everyday experience alone. This is not true. There is a structure to the answer. After all, you only have 8 minutes to present your argument and seek a resolution. Don't worry, you don't need to have a whole lot of frameworks like the Part A exam. You don't want to have your answer too structured on paper as you'll get too preoccupied with following it that you'll forget to make eye contact and interact with the role player. I found that thinking about how I would approach the scenario in real life helped to clarify my thoughts because in real life, I wouldn't enter a meeting without establishing what were the expected outcomes nor would I leave without any action points agreed upon or a follow up meeting arranged.

The structure I used consisted of the following: 

1. Introduction - stating who I am and why I was here (e.g. "The Director of Public Health asked me to meet with you today" - see your scenario for details), knowing who I was talking to and asking what their concern was. This enables you to gage their feelings or expectations about the topic. 
2. Structured notes - on one sheet of paper, I had a boxed overall public health message, 3 to 4 key points or messages to address the task and an action plan/way forward which consisted of actions to do now and to be done later. 
3. Summary - at the end of the role play summarise the argument and actions agreed.

Don't have too complicated a structure! If you do, you may fail to pick up on any conflict or challenge that the role player may throw at you. Always think about the public health aspects or implications (i.e. what do you need to do with the information in terms of public health?)

4. Scan the scenario's opening paragraph before you start

Before you start, quickly establish what the scenario is about, who you are talking to, what they need to know and who you are and what may be expected of you. That way, you can help yourself get into the role you are meant to be playing. It is also useful to set off the brainstorming part of your brain. Recently, the material with the OSPHE scenarios have been reduced to one or two A4 pages. This may mean that you'll have to rely on your knowledge of the topic or a similar previous experience to respond appropriately to the scenario.

5. Find the actor in you!

The actor is not the only role player in the room. You are role playing too! An OSPHE examiner once told me that those who do well are those who are prepared to interact with the actor. It is important to note this as sometimes the actors are told to throw in a question or a comment that is completely unexpected. For example, you may have a councillor who wants to meet you about changes to the emergency contraception services at pharmacies but unknown to you, he may be using the meeting as a pretence to attack the morality of providing GUM services to teenage girls. You have to be prepared for this, so it is useful to think of situations where either you or someone you've observed used good negotiation skills and remember what they said. In this instance, you could state "Let's go back go the issue of teenage pregnancy being high in this country." You can reach for agreement or common ground on this issue. You don't have have to find a solution, you must just stay objective, bring the evidence for and against to the community. Overall, be prepared to expect the unexpected and be prepared to be distracted. What you need to be able to do is to decide if the questions are probing or deliberating distracting.

6. Find patterns in the scenarios

OSPHE scenarios can be divided into 4 categories: 
Health Improvement; 
Health Protection; 
Health Services 
Health Intelligence. 

The types of audience you talk to can also be divided into 4 groups: (1) Health professionals (GPs etc); (2) the Media (radio interview or newsprint); (3) Managers or the Chief Executive and (4) Lay members of the public (councillors, voluntary groups, local residents etc). 

Some patterns can be seen within the categories. For instance, with health services, the issue of funding a treatment for a patient is quite common. This may involve telling a patient that you cannot fund the treatment because NICE found it ineffective or that it is a new treatment requiring enrolment in trials. It could also require you to advise a Chief Executive on whether or not to fund a treatment on little evidence. (In this instance, remember that if you fund this person, you'll have to fund others and work out how much this could cost and the impact this would have on cutting funding to other services or treatments). Another health service type question may involve looking at data of mortality rates from surgery. Be careful with this question that you do not get too caught up with talking about the data that you forget about clinical governance (audits, existing protocols etc) and actions to be taken. Screening can pop up too so it's worth knowing the screening criteria and finding out why population screening of prostate cancer or whole body MRI screening or why breast screening is not offered to women aged under 50 years.

For Health Improvement, be aware of the big topics such as obesity, smoking, teenage pregnancy and binge drinking. Sometimes cancer crops up under this topic too (it could be part of a media interview on postcode lottery). Throughout, try to bring in the public health message of prevention. I use the acronym SSSAE to jolt my memory (that is, reduce Salt, reduce Saturated fat, cut out Smoking, reduce Alcohol and Exercise). Also revise how to do a health equity audit, health impact assessment and health needs assessment.

7. Know How to Deal with Data

When faced with a table of data, scan immediately for case mix, trend, seasonality and ask yourself is it comparable and why only one/two year(s)? Then think of effects of chance, confounding factors, bias and validity. Make sure you remember how to interpret confidence intervals, standard errors and direct and indirect standardisation.

8. Avoid Jargon

It will help you to write out statistical and epidemiological terms and test yourself by saying out loud what the terms mean in your own words. It may help you to visualise yourself as a teacher teaching the term to someone. A good way of dealing with with jargon is to use a metaphor, e.g. when describing a false positive on a screening test, you could refer to a smoking alarm going off when there is no fire and the anxiety that can cause. I found that when describing a systematic review to a lay person, it helped to allude to the media. "You know how in the press you can read one day that drinking coffee is bad for you and then the next day the newspapers report that there is a study saying it's good for you? Well, a systematic review can prevent that by bringing together all the studies, checking their quality and then provide you with a definitive answer."

9. Handle the Media

If you can, it may be worth your while doing a media training course before doing your OSPHE. If not, there are two standard structures you can use to handle a media interview. If there is a crisis, you can use the 3 R's - (offer) Regret, (give a Reason) and (offer a) Remedy. For other interviews, you can structure your answer with ABC - Answer the question or Address the issue, Bridge the conversation onto your public health message and Communicate your public health messages. Try to have 3 key messages with at least 2 statement of facts.

10. Be sensitive and confident

When talking to your audience, especially lay people, show empathy for what they are feeling. Sometimes you're talking to someone whose family member or friend has died or they be worried about a particular issue. Do not dismiss this as you'll end up in danger of bulldozing your facts through to them! Listen to them before you have to break any bad news. Always try to offer some solution at the end. You will have to balance empathy with being decisive and assertive. Be confident. Don't undermine yourself, know your own expertise. It is also good to show confidence in others, for example in a chemical incident scenario, "We can obtain further details from the fire officers on the site" or "Our smoking cessation team will be able to help." In other words, know your own limits and think whom you would normally work with in reality. In relation to a tricky role player, an effective way of dealing with conflict is to acknowledge the person's position before introducing your argument. You're more likely to influence them this way.

Resources

Check the Faculty of Public Health website for OSPHE examples and information on the structure of the exam. There are plenty of OSPHE practice scenarios in circulation within Deaneries and on the web. An example is the Severn Deanery website.