What is after AMC 1 ( or AMC MCQ)?

Recently, I received email from a doctor who asked above question.

Guys, there are multiple options after AMC1. I will try to answer above question in this article.

I believe if you have done AMC1, you are planning to come to Australia and work as a doctor. I will also assume that you have done your IELTS/OET.

Basically, if you want to be fully registered in Australia, you have to do AMC 2 and 1 year of supervised training (internship) if you are coming after MBBS and want to follow general pathway of AMC. I have not discussed specialist pathway and competent pathway.

Option 1 would be to stay in your home country and continue doing clinical practice while awaiting for AMC 2. There are pros and cons about this option.
Pros -

* You will be practicing medicine and your will be building your clinical experience which will come with all your life.

* You will be earning money to support your venture about AMC exam

Cons -

* You will be working in your home country and my understanding is that you want to work in Australia as a doctor, but remember your experience will count at some degree even in Australia

* It is hard to pass AMC clinical exam with this option as you have no/little clinical experience in Australia

* You will be waiting for exam dates for about 18-20 months or may be longer

* It is difficult to find job as a doctor in Australia if you are overseas

Option 2 would be to come to Australia and wait for the exam

Pros -

* It is little bit easier to find job in medicine compare to 1st option
* You will learn about Australian culture

* Your English language and communication skill will improve (If English is not your first language)

* The best benefit would be lot easier to clear clinical exam

Cons -

* You may need to work in other areas while looking for job in medicine
* Finding job can be difficult in medicine in Australia and it may take up to 12 months or longer
* You need visa to enter in Australia - well, most of people will need

* If you cannot find any other job then it can be very costly to support yourself in Australia - cost depends upon where you live in Australia

Please read disclaimer before using the information in this blog.

Guidance for history station

It is a long time, I haven't written anything on this blog, as I was on holiday to India for Diwali and couldn't find time and Internet to write.

When I did my exam, I failed first time and I tried to analyse things and found that you can not guess or know what will come in the exam, but if you have systemic proforma which will cover almost everything then there is good chance that you will do well even if you don't know much about the station. I made this format for myself, but thinking that if I will publish this more people will use this. Below format will help you with stations which include history (brief and detail), examination and management. One of my facilitator in one course told me one day, that there is no such thing as brief or detail history. He suggested that I should include as much information needed for the station (certainly asking basic details like medication, past history and allergies etc are necessary for every station).

History station:

ü      Basic information: Name, Age, Sex, Independency and living situation

ü      Presenting complain

ü      HPC: Description of PC (PQRSTA)

·         Position

·         Quality/character

·         Relieving/aggravating factors

·         Risk factors

·         Radiation to other part (imp for Pain)

·         Severity/intensity

·         Setting/context

·         Timing

·         Associated features

ü      Other current Medical Problems

ü      PMHx

ü      If Paediatrics: Includes Pregnancy Hx , birth Hx, growth and development Hx

ü      Includes preventive history: Vaccination, Pap smear, Mammogram

ü      If Female (O and G): Periods, Pregnancy, Pap smear, Breast and Vaccination (Rubella, VZ, Gardasil etc).

ü      Medications includes ‘over the counter’, Herbal and vitamins

ü      Allergies

ü      Systems review – Head to toe

ü      Family Hx including spouse if indicated

ü      Social Hx: Living situation, Independency, Marital Hx, children, Smoking, Alcohol and other drug abuse

ü      Psychiatric history

Physical examination station:

General appearance

Vitals – temperature, pulse, BP, RR and Saturation

Skin, hair, nail

ENT and eyes

Neck, Thyroid and lymph node

Respiratory

Cardiovascular

Abdomen – always includes inguinal region, genital examination and PR examination 

UL and LL - Periphery

Includes office tests

ECG

BSL

Urine dipstick

Pregnancy test

Spirometry

Bladder scan

Management station:

Education and explanation

Initial management: stabilisation and emergency

Investigation

Management: drug management, procedure, non-drug treatment

Education, counselling and preventive

Family involvement

Referral to specialist/hospital

Ongoing management: follow up

Paperwork – Sick certificate, notification etc.

Please read disclaimer before using above information.

Tips for the D-day

I am pretty sure, you know everything what I am going to write here, however people tend to forget things easily and need reminder about important things.

This is really important day, as you are going to show off your all the hard work and skill in 3 and half hour. It is not only about expensive exam fees, it is also about a long waiting list and getting into job late. One of my school teacher told on one day that when you fail one year, do not think about salary you are going to earn on your first year of job, think about a year prior to your retirement.

As I mentioned in my previous blog, this is about presentation. If you know the stuff and cannot bring that out on the day, it is not helpful. Well rested and fresh mind work quicker and think better. I strongly recommend that you have enough sleep prior to your exam. Our biological clock is great. I recommend that you make your last few days schedule as same as your exam day. If your exam is in morning, do your practice in morning and vice versa. This will train your brain in that way and you will feel less stress on the day of your exam as it is your routine.

Make sure that you visit your exam centre prior to your day of your exam if you are not familiar with the centre, or at least ask someone who is going to come with you. Reach at your centre well prior to your exam time.

During your exam, when you are reading outside for 2 minutes try to concentrate on the topic and read carefully about what have they asked. Do not think too much what it will and I don't know this and those sort of stuff. If it is too hard, the expectation of examiner is low, so it is likely that you will pass easily. If your previous case went really bad, don't think about that otherwise you are going to perform badly on the new one. When you are inside, give your full attention to your patient and listen carefully. In examination, if you think something relevant say so, as examiners are not mind reader and won't give you any mark for not telling.

When you are consulting your patient, behave as a professional person. Don't be too unfamiliar or don't be too familiar. When you need to touch the patient, always ask for permission first (verbal consent). Warn them about what are you going to do and whether it will painful or uncomfortable. Wash you hand before and touching the patient.

When you are explaining something ask them about their understanding. It is possible that you might you few jargon without knowing, but if you ask them whether he/she has understand or not, then you are safe.

Just one sideline, when you are talking with patient in this exam, make sure you don't confront them in anyway (unless that's the case scenario). Most of them are 5th or 6th year medical students and they are being told that if the candidate is really sympathetic then help him. Use words like 'thank you' ' sorry' and 'please' freely. These words are not going to pass you, but if you don't use them, it is unlikely that you will pass. 

Keep in your mind that this exam is for an intern, not for a consultant. They are not going to ask you 'how to perform angiogram?', but they expect you to find out who is going to need them. They expect you to know how to take basic history and do examination. They expect you to know when and where to get help from. In other word, they want to make sure that you are safe doctor.

Please read disclaimer before using above information.

Books you need to read for AMC exam

Reading in medicine is unlimited and there is no fix curriculum. Below is a guidance which book is more important for you to read for the exam. This is not official AMC guidelines, this is only from my experience. Also read AMC MCQ exam specification booklet (available through AMC website) and clinical exam specification booklet (link). There are few booklet and material available through various sources. If you need to purchase them there are various online  (usually cheaper) and offline bookstore available to purchase. These two bookstores will be nice to visit - Bookdepository and Fishpond. Another great online bookstore is obviously Amazon.com.

• A must read books:

1. Anthology of Medical Condition
2. AMC Handbook for MCQs
3. AMC Handbook of Clinical Assessment (for part 2, but should read for part 1 if you can)
4. General Practice by Dr J. Murtagh
5. Oxford Handbook of Clinical Medicine
6. Oxford Handbook of Clinical Specialities
7. The Australian Immunisation Handbook - freely available from  Australian Government websiteImmunisation Handbook 
8. Assessing fitness to drive - freely available from website

• You should read these books:

1. Fundamentals of O & G by Llewellyn-Jones
2. Essential Paediatrics by Hull
3. Royal Children's Hospital - Paediatric Handbook
4. Textbook of Surgery by Tjandra
5. Practise tips by Dr J. Murtagh
6. Patient Education by Dr J. Murtagh
7. A Systemic Guide to Physical Diagnose by Talley and O'Connor - DVD comes with the book and that is really helpful for physical examination
8. Diabetes management in general practice - freely available via RACGP website 

• Use as a reference:

1. Davidson's Principles and Practice of Medicine
2. Harrison's Principles of Internal Medicine
3. Ethics and the law for health professionals by Ian Kerridge
4. Australian Family Physician - journal by RACGP - website , available free online, printed copy will need subscription.
5. Medical Journal of Australia - website
6. Therapeutic Guidelines - various available

Please read disclaimer before using this information.

Clinical Exam preparation

Most of the people who prepare for AMC exam have question like 'how to prepare?', 'how much time should I give?","what should I read?", Is there any bridging course can I do?" and "where can I find more information?".

This exam is multi-station OSCE - Objective Structured Clinical Examination. In simple word, there will be multiple short cases. You have cleared AMC MCQ, so you have knowledge. Now you have to show that knowledge and clinical skill to your examiner and your patient. This exam is more sort of communication skill testing with your medical knowledge and skill.

When you want to prepare for this kind of exam, you should practice that in real life. If you are working in Australian system, it is much easier to do that, otherwise you can practice with your colleagues/friends. Practice is the only solution for this exam. Practice, practice and practice until you feel comfortable about that station.  When you are practicing, practice like you will do in real exam. Do not spend more than 8 minutes in any case. Now you will need mock cases, you can write by yourself or ask your friend or supervisor to do that for you. AMC Handbook of Clinical Assessment is great book to get idea about the cases. I recommend that you read and revise this book at least 3 times before your exam. There is also one DVD from AMC - Multi-station Structure Clinical Assessment out there, which gives you more idea about the exam procedure rather than cases.

How much time should you give for preparation? Answer of this question depends upon your clinical experience in your country and in Australia or similar system, whether you want to give full time or part time and what's your personal life circumstances. Ideally you should give 3-4 weeks of intense (full time) if you have Australian Clinical experience. You will require more time if you are out of the field or outside Australia, but 2-3 months is sufficient time according to my experience. If your speaking is poor and having difficulty in IELTS/OET speaking, then doing IELTS/OET during this time is also useful, as this exam will be in same language "English".

You should read above book and see DVD (if you can) for exam preparation. On the top of your AMC MCQ reading you should read following books/DVDs (Whole list is exhaustive and I will post in one blog together).

Talley and O'Connor's Clinical Examination: A Systematic Guide to Physical Diagnosis

John Murtagh's General Practice, Practice tips and Patient education

I come across this nice bookstore which is cheaper than other sites and it delivers books free worldwide. If you are in Australia and would like Australian website Fishpond is the anotherone to go.  

There are lots of bridging courses around by reputed source if you are in Australia. I am not aware of any good course outside Australia. Below are few institutions who run bridging courses for AMC candidates. They are costly, but I will recommend you to do at least one if you are not working in Australia. VMPF and RACGP (Sydney) are intense courses for lots of information and practice, but are really expensive.

• VMPF - Victorian Medical Postgraduate Foundation
• Monash University in Victoria
• RACGP - In Melbourne, Adelaide (2 hours a week for 10 weeks) and Sydney (full day/week for 10 weeks)
• Centre for International Medical Graduates, Queensland
• Postgraduate Medical Education Council of Tasmania
• Northern Territory General Practice Education

Clinical Exam tips and resume writing are coming soon!!

Please read disclaimer before using the above information.

AMC Clinical Examination

I have recently received few queries about clinical examination, so I thought I should write bit about clinical examination first and then go back to intial topics. Writing for AMC clinical exam requires more than one blog, you will need bit more patient to read me.

I will start with the exam procedure. Before you take clinical exam, you have to cleared AMC MCQ exam and according to new rule, that is the only requirement. You don't have to have any clinical experience in Australia before you take the exam, but clinical experience in Australian Health gives you more chance to pass.

There are 16 active stations and 4 rest stations.

16 active stations includes general medicine, general surgery, psychiatric, 3 X paediatrics and 3 X O&G cases.There are 4 rest stations and you don't have to do anything over there, it is just REST stations, and they are not marked.

Each station will be of 10 minutes duration, 2 minutes for reading (outside the room) and 8 minutes for actual case performance. Case can be anything but usually mixture of history, examination, differential diagnoses, investigation, management, counselling/education to patient or clinical procedure.

For passing the exam, you have to clear 12 out of 16 including 1 in paediatrics and 1 in O&G. If you passed 13/16, but failed either all 3 paediatrics or 3 O & G, they you are failed. If you passed 10 or 11 cases then you will have chance to do re-test (8 station exam without payment of fees). In re-test, you have to pass 6 out of 8 to pass the exam. If passed 9 or less cases then you have to appear for new exam and have to pay exam fee again.

For more information, please refer AMC exam specification booklet or visit website. Please read disclaimer before using the information.

Disclaimer

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