How to prepare for FRCPath Microbiology part 1

The FRCPath or Fellowship Examination of the Royal College of Pathologists is the postgraduate pathology examination in the UK. The Royal College of Pathologists sets the standards, develops and delivers the examination.

It is designed to test the trainees in the UK training programme for the 17 pathology specialties (including microbiology and virology), but is also open to overseas graduates who intend to become fellow of the college.

Two, part 1 and part 2.

As per RCPath,

If you are in the UK infection training programme, you will be guided by your ES. You are expected to take it at the ST3/ST4 level.

Links to look for

• https://www.rcpath.org/trainees/examinations/regulations-and-guidelines/frequently-asked-questions.html

• https://www.rcpath.org/trainees/examinations/examinations-by-specialty/medical-microbiology.html

Most trainees consider 6 months to 1 year an adequate time to prepare.6 months (approx)

However, it is a difficult question as it depends entirely upon you. How much time can you spend revising for the exam? If you are in the UK infection training programme, speak to your educational supervisor.
If you are an overseas graduate, what is your baseline knowledge of microbiology and how it is practised in the UK? Only you can answer these questions. If you are unsure, do a gap analysis (discussed later) and give yourself a little more time.

The curriculum for this exam is the RCPath curriculum for the UK training programme. The curriculum is designed keeping UK infection practice in mind. You must go through the curriculum, write down the subjects mentioned there, and ensure you have covered them while preparing. You can find the curriculum here.

https://www.rcpath.org/trainees/training/training-by-specialty/medical-microbiology-2021.html

It is a huge document. Go to the appendix 1: Syllabus

You should concentrate on the first part - COMBINED INFECTION TRAINING (CIT); you may review the 2nd part as well, which is HIGHER INFECTION TRAINING IN MEDICAL MICROBIOLOGY. However, 2nd part is being higher speciality training is more relevant to part 2, but the division might not be that strict, when it comes to the exam.

When you apply, you will need a sponsor. For trainees in the UK training programme, it is your educational supervisor.

As per RCPath, a sponsor should be your educational supervisor, or the head of the department, or someone who has a similar level of involvement with your training. Ideally, he should be a fellow of the college. However, a fellowship of the college is not compulsory.

Signed sponsorship forms must be uploaded with your application form. Find up to date information here – https://www.rcpath.org/trainees/examinations/regulations-and-guidelines/frequently-asked-questions.html

There are not many courses available.

• The Royal College of Pathologists runs an International Trainee Support Scheme. I have received feedback that it was helpful. RCPath will assign a mentor to guide you. However, you may need to confirm if it is available for you.
  https://www.rcpath.org/international/international-medical-graduates/international-trainee-support-scheme.html

• There are courses run at a local level or for small groups. You can ask about these courses on the WhatsApp group. (Join the Facebook group and ask for WhatsApp invite there)

• Please note that I do not run any courses. However, I would be happy to help if you want. You can use the Facebook/WhatsApp group.

Yes. If you decide to take the exam, you must read all the relevant materials on the RCPath website. This website is the authentic source of all exam related information. Always check for the most up-to-date information. Read the FAQ

RCPath links -

• https://www.rcpath.org/trainees/examinations.html

• https://www.rcpath.org/trainees/examinations/regulations-and-guidelines.html

• https://www.rcpath.org/trainees/examinations/regulations-and-guidelines/regulations-guidelines-and-policies.html

• https://www.rcpath.org/trainees/examinations/regulations-and-guidelines/frequently-asked-questions.html

• https://www.rcpath.org/trainees/examinations/examinations-by-specialty/medical-microbiology.html

I have no expertise in this field. You should speak to a reliable specialist and relevant organisations like GMC. Following links may help you to get more information.

https://www.nhsemployers.org/publications/working-and-training-nhs
https://www.gmc-uk.org/registration-and-licensing/join-the-register/before-you-apply/working-as-a-doctor-in-the-uk

You can search the RCPath website for guidance on CESR route, which is an alternative route if you were not trained in a UK training programme.

https://www.rcpath.org/trainees/training/specialist-registration/cesr.html

• Do not rely on doing MCQ alone. You may do many MCQ, but a question might still come from an area you have not covered. I am a strong believer in reading textbooks. Do MCQ, but make sure you choose a textbook you like and read it. Do MCQ and make notes in that textbook—underline, make margin notes, use stickies, etc. Make notes – you want to cover the whole subject once in 2-3 days before the exam. Make notes and mark the book so that you can read the topic in a few minutes.

• When you have a question, read around the topic. For example, if you see a question on the resistance mechanism, you should read about the resistance mechanism of other antibiotics.

• Make a group or at least find a partner to study with. Making lists of high yield information is fine, but you may find questions on the management of infection or an infection control scenario. Here, your group would help. Pick up a topic – say, management of C difficile diarrhoea. From the guidelines, one person can discuss the management of C diff diarrhoea from the guideline. Then you can pose questions on the variations – what if the patient has severe C diff diarrhoea? What if it is recurrent C diff diarrhoea? What if the patient is also on another antibiotic? It would help if you covered the guidelines and clinical cases this way.

• There are Facebook/WhatsApp groups available – you should join them (link below).

• Make an exam file—it could be a physical file or an online file, even a Microsoft OneNote notebook. Collect all the materials in that file. Gathering all that you need to read will help you pace yourself. Make an excel or Google Sheet file and list all the reading materials. Please go through them and decide how much you need to read about these topics. This is a gap analysis. Generate a traffic light system. The topics you are confident about – mark them green. Those you don’t know anything about: -red. Those you need to revise – amber/yellow.

• Practice MCQ – Time yourself. I recommend you do 150 questions/3 hour rate. You may not find a set of 150 questions – if you are doing a fraction, like a set of 20 questions, – try to do it in 20–24 minutes. For the online test, you need to ensure you are used to sitting in front of the computer for a long period at a stretch. If you are confident, then it is OK. If not, – practice sitting in front of the computer for a long time (4-5 hours). If your exam is not online, you can ignore this advice.

• MCQ – you can do MCQs from any book, but remember that you need to adapt the answers to reflect UK practice. You may also need to choose the areas wisely – we do not see many parasitology cases, so do not spend a large portion of your time on parasitology. Oxford Handbook of Infectious Diseases and Microbiology and the curriculum should give you a good idea of what to read.

• In the exam, answer all the questions. If you do not know, go for your best guess.

You may read at least these three journals. You need to go back one year from your exam day and browse through the important topics – any significant development, new drug, emerging disease, policy change. The examiners keep themselves updated from the journals, and it often plays an important part when they set the question.

• The Journal of Antimicrobial Chemotherapy (JAC)

• The Journal of Hospital Infection (JoHI)

• Journal of Infection (JOI)

You should subscribe to – Health Protection Report. These are the latest surveillance reports from PHE and should help you to keep yourself up to date.

There is not much point in learning an antibiotic not used in the UK except “New antibiotics and treatment modalities”. Check the FDA website for new antibiotic approvals. Pipeline antibiotics are less important – cast an eye on them to find anything unique.

• Novel antibiotics: https://www.fda.gov/drugs/development-approval-process-drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products

• Pipeline antibiotics: https://www.pewtrusts.org/en/research-and-analysis/data-visualizations/2014/antibiotics-currently-in-clinical-development?utm_campaign=LM+-+ARP+-+Innovation+Update+March+2021+-+3+11+21&utm_medium=email&utm_source=Pew

For vaccines, use Greenbook. There is also a list of MCQs that you can use to test your knowledge.

• Greenbook – https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book

• Greenbook MCQ – https://www.gov.uk/government/publications/immunisation-knowledge-test-for-professionals

Read syndromic algorithms carefully – it tells you what tests to do in a particular clinical situation.
Read the tests – e.g. Catalase test – which bacteria are positive/negative. Are there any unique points in those tests?
From the virology SMIs- read the algorithms, comments, the footnotes.
Bacterial identification – read the introduction; how are you going to identify them. These SMIs have loads of bacteria that are clinically less relevant – you may have to be a little selective (for example, I may not read about Dermabacter in detail).
Susceptibility test – You must read the EUCAST guidelines. You may not need to remember every breakpoint. Still, you should read the explanatory notes, marker antibiotics, which antibiotics are commonly tested, intrinsic resistance, various resistance mechanisms and how to identify them, phenotypic patterns etc.

Links

• SMI – https://www.gov.uk/government/collections/standards-for-microbiology-investigations-smi

• EUCAST – https://eucast.org/

• Health and Safety – https://www.hse.gov.uk/

• UKAS – https://www.ukas.com/resources/publications/laboratory-accreditation/

I recommend reading about (this list is not exhaustive) –

laboratory safety aspect – good laboratory practice, categories of the pathogen, containment lab types, laboratory emergency procedures -spillage, safe disposal of materials (autoclaving, incineration etc.), transport of specimen.

Laboratory quality – External quality assurance, Internal quality assurance, vertical audit, horizontal audit, Second Generation Surveillance System (SGSS), validation and verification, measurement of uncertainty, laboratory accreditation, key assurance indicator and key performance indicator.

Infection control is an important area for UK microbiology.

It would be best to have an infection control book as a baseline, e.g. Damani. Many NHS hospital infection control guidelines are available online – a quick google search should be sufficient. Make sure you read national policies like- EPIC3.

The Scottish National Infection Prevention and Control Manual is an excellent resource. Healthcare Infection Society‘s main area of interest is infection control – utilise their resources. You must read relevant health technical memoranda (HTM) – water, ventilation, decontamination.

Some examples of infection control topics that you may want to read –

• Infection control measures (type of isolation, PPE, cleaning) for various infections – C diff, TB, measles, chickenpox, meningococcal disease, VHF, GRE.

• Post-exposure management for infections like – PVL Staph aureus, meningococcal disease,

• Outbreaks – types, outbreak control team, managing an outbreak,

• Typing and its role,

• When to inform the infection control team and public health,

• Hospital water safety, ventilation and decontamination – standards, how to troubleshoot a problem (e.g. Pseudomonas in the water supply in ITU)

• Theatre ventilation,

• CJD related issues,

• Sharps/needlestick injury,

• COVID-19 related infection control measures etc

You may still have a lot of questions. Please check other posts on this website written by trainees who took the exam and wrote about their experience. Join the Facebook and WhatsApp groups and speak to other trainees. Follow me on Twitter and Youtube.