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Author: Nawaf Dandachi

  • How to Pass the AMC Clinical Exam. First Time Success Guide.

    How to Pass the AMC Clinical Exam. First Time Success Guide.

    An AMC Part 2 Clinical OSCE Examination Study Guide

    Imagine having spent 6 to 7 years of medical school and tens of thousands of dollars on examinations, tuition, and books in order to gain your first doctor job in Australia. Imagine doing well on all these other exams but failing in one final exam. And failing this exam is severely impacting your chances of gaining a job in Australia. If you are wondering what examination I am talking about, it’s known as the Australian Medical Council Part 2 Clinical OSCE examination. The AMC Clinical Exam has a reputation of being one of the most difficult medical assessment examinations, and one that International Medical Graduates (IMGs) frequently underestimate. This error has led to many candidates failing this examination. This situation is even more painful when you learn that the AMC clinical exam is in fact a straightforward examination to study for, and it requires nothing more than readily available medical knowledge, practice and organization.

    Before diving into tactics and strategies. Here’s a brief overview of the AMC clinical exam:

    • The AMC Clinical Examination is the second of two examinations that comprise the AMC Clinical Certificate. The AMC Clinical Certificate is a prerequisite for many IMGs in order to gain general registration in Australia.
    • The AMC Clinical Exam is set at the standard of a final year medical student in Australia.

    Play the AMC Clinical Exam by the rules.

    The AMC clinical exam is like a game, you need to play by the rules. I have heard others say it is like a dance and you have to know the steps well.

    The exam itself is set at the standard of a final year Australian medical student (and the AMC calibrates its exam questions against Australian medical schools). The exam, therefore, is quite “doable” with the appropriate preparation and understanding of its nature.

    Many IMGs love the format of this examination. They get to interact with standardized patients and diagnose their problems. The play-acting element makes the AMC clinical exam quite interesting, but that doesn’t mean it’s easy to pass.

    And even though you can take the AMC Clinical Exam again if you fail. Clearing it the first time around gets closer to your goal of a medical career in Australia.

    Preparing for the Australian Medical Council Part 2 Clinical OSCE examination can be frustrating. You know it’s a graded pass or fail and that there is a low pass rate. It is expensive and takes a lot of your time away from other pursuits, so no one wants to deal with taking it more than once.

    Here I have assembled the most important pieces of advice for International Medical Graduates who are thinking about or preparing for the Australian Medical Council Part 2 Clinical OSCE examination.

    Format of the AMC Clinical Exam

    The AMC Clinical Exam is a 3 hour and 20-minute examination. That tests for skills necessary for a doctor to work under supervised clinical practice. This is done using 16 different simulated clinical scenarios.

    Most of the time, the scenario is pretty straightforward, you’re a physician meeting a patient in an office that is presenting with some sort of problem that you are asked to address.

    A clinical encounter usually consists of a patient-centred interview, physical examination, sharing your clinical impressions and further workup required, and patient counselling and education.

    The examination assesses your command of the spoken English language, measuring clarity, pronunciation, word choice, and how easily patients can understand your questions or statements. It also assesses your communication and soft skills, including how well you provide information to patients, whether you put them at ease, helped with making decisions, etc.

    Last but not least, the AMC Clinical Exam assesses your clinical reasoning through data collection and data analysis by requiring you to take a focused history driven by a differential and conducting a focused physical examination.

    You will deal mainly with role players and usually the examiner does not ask any questions but just observes your performance. There are sometimes real patients with, for e.g., rheumatoid features, cardiac murmurs, peripheral neuropathy, joint problems, liver symptoms but they are a rarity.

    In general, the patients and examiners are very supportive and want to help you even though you might not believe this. So please listen to them carefully, they often try to give you valuable hints. On many occasions, there is a second examiner present who is there to assess the process of the examination itself and rotates through the stations. The examiner does not judge your performance, so please do not worry about their presence.

    AMC Clinical Exam

    Textbooks for the AMC Clinical Exam

    It is important to remember that the Australian Medical Council Part 2 Clinical OSCE examination assesses your knowledge of the most common diseases in Australia.

    Australian Handbook of Clinical Assessment

    Finding the perfect resource is crucial. The Australian Handbook of Clinical Assessment is by far the most important resource to passing this examination. It should take under 4 days to get through this book. This book includes detailed sample cases for the majority of cases encountered in Australia. It gives you a very comprehensive explanation of the examination process, has incredibly important hints for the different clinical areas with fantastic examples with detailed explanations of all aspects of the scenario.

    Each chapter is prefaced with the most valuable explanatory notes which I encourage you to read thoroughly.

    A great example is an introduction to “The Psychiatric Consultation” which covers in a very brief and precise way what you are expected to consider when examining a mental health patient. I recommend being aware of topics but working through them in a thorough way, realizing that a scenario can easily change.

    For example, Right Lower Quadrant pain in a female patient might be appendicitis in one exam but could be ectopic, a twisted ovarian cyst, renal colic, or domestic violence in another examination.

    You need to have a good understanding of the underlying issues.

    The examiner will generally know very quickly if a candidate has just rote learned a case, and is regurgitating facts, but not demonstrating a thorough understanding of the case.

    I believe that the publication of this particular book has allowed International Medical Graduates to understand the nature and requirements of this examination much better than ever before and it is really important to know about the expectations and to understand the importance of for example critical errors.

    Key Components of AMC Clinical Exam Stations

    Differential Diagnosis

    Reaching a diagnosis involves the process of establishing a “differential diagnosis,” in which all possibilities for a patient’s symptoms are initially considered.

    The possible causal factors are then narrowed down through a systematic collection of information, which makes some diagnoses more likely and rules out others.

    The goal of differential diagnosis is to systematically collect information on the pattern of symptoms to allow you to accurately diagnose what is causing them. Knowing the key buzzwords for the prototypic cases is necessary to nail the diagnosis.

    If in one station you are presented with a 40-year-old female patient with right upper quadrant pain who happens to be obese, you will right away think Cholecystitis. But there are still other diagnoses to consider in this scenario.

    Having someone else quiz you on differential diagnosis tables or challenging yourself by covering up part of the information is useful. So I would recommend studying differential diagnoses from the very beginning of your preparation period, and follow up 1-2 days before you take the examination to keep them fresh in your mind.

    History Taking

    For history taking, it is useful to memorize a skeleton to structure your history-taking. It is generally expected that you cover every category, even if superficially, with every patient, just like in real life. Different categories will yield richer information with different patients. Here is an example structure:

    • Chief Complaint
    • History of Present Illness
    • Review of Symptoms
    • Past Medical History
    • Past Surgical History
    • Social History: Living Situation / Drugs-Alcohol / Sexual History / Smoking
    • Family History
    • Medications
    • Allergies

    All of this should be addressed with every patient and should be recorded in your notes, even if very briefly. This is the basis of the first part of the encounter.

    Physical Examination

    The best way to prepare for the actual physical examinations manoeuvres is to study with a partner. I recommend using the Oxford Handbook of Clinical Examination and Practical Skills to brush up on physical examination skills. A YouTube search will get you to what you’re looking for as well.

    Study Partners and Flash Cards

    I know of many International Medical Graduates who have tried to practice for the AMC Clinical Exam by using Skype or over the phone but the problem is that you do not get to interact face to face and in person with your study partner, and that’s what the AMC Clinical Exam is currently all about. Although it should be noted that the AMC is now establishing a virtual clinical examination.

    If at all possible, rather than practising over a video chat or phone call, work on practice cases in person with other International Medical Graduates, family members, or friends.

    Your live partner does not have to be a doctor, or even in a medical field, all you need is someone to practice with or on. This way, you can try out your communication and interpersonal skills before facing standardized patients during the actual examination.

    Ideally, you have a third partner who can keep time and give feedback about issues like time management and communication skills.

    I suggest practising AMC Clinical Exam long cases with a partner at least twice, and then create flashcards for all the cases.

    Include the patient’s name, age, primary complaint, and vital signs on each of these cards, shuffle them and practice again.

    Since you won’t know which specific cases will show up on your AMC Clinical Exam, shuffling the flashcards simulates a random selection process, which is similar to what you’ll experience on your examination day.

    Also, if you don’t perform well in a certain case then put the corresponding flashcard in a different batch. Ideally, you should organize a real trial exam of a number of cases in a row with your partners, in order to simulate the actual AMC Clinical Exam.

    Try to get as real and authentic as possible. For example, hang the stem to the station on the wall or a door and pretend that you come into the examination room. It helps you to understand the pressure of the exam and to learn how to put a bad performance behind you.

    Time Management for the AMC Clinical Exam

    It is important to time yourself while practising. You cannot perform well if you don’t know how to stick to the time limits. You might think you are going to do okay even without practicing with a timer, but in reality, on the day of the examination, you will be too nervous and stressed to even think about time.

    But if you have practised all of your cases with a timer then your brain will be much better at managing the time for you. Therefore you will have one less problem to worry about, which will enhance your performance.

    Be aware that sometimes there will be a bell ringing during the exam and the examiner might interrupt you after 4 minutes to say “Please move on to your next task” or “It is time to move on to your next task”.

    The Importance of Empathy in the AMC Clinical Exam

    As funny as this may sound, remember that being “human” gets you points in the AMC Clinical Exam.

    Empathy is something many medical associations feel is lost in patient encounters in the new generation of doctors and is something the panel wants you to demonstrate to your patients.

    When you practice before your examination, remember to flex your empathy muscle and make sure your “patient” feels heard and supported.

    Practice PEARLS in each of your patient encounters: Partnership, Empathy, Apology, Respect, Legitimisation, and Support.

    What To Do A Few Days Before The AMC Clinical Exam Day

    The AMC Clinical Exam can be tough if you haven’t developed the stamina for it.

    To prepare for the real thing, I suggest selecting 16 sample cases from amongst the ones you find most difficult and practice performing them a few days before the examination.

    Do this with the same time limits and allotted breaks that you would face on the examination day so they can stay fresh in your mind.

    Simulating the actual exam will give you a really good idea of how rough the exam day is going to be. This will also, allow your brain and your body to adjust and make you more ready and energetic on the day of your AMC Clinical Exam.

    Relying on too many study resources will just leave you overwhelmed. The only primary resources I believe that you need are mentioned in this post.

    We are all different and will experience different emotional and physiological responses to the examination stress, which also influences our social and family environment. Many candidates exhibit symptoms of anxiety or sometimes even depression which needs to be addressed possibly with a referral to a counsellor.

    A healthy balance of mind and body is important and can be supported by relaxation techniques, massage, physical fitness exercises, etc.

    If you’re travelling to the AMC Clinical Exam interstate, allow sufficient time to familiarize yourself with the location of the examination centre. Make sure to have a relaxing evening before the examination day, that might include a massage, a romantic dinner, a walk on the beach, a concert, or whatever tickles your fancy.

    Do not study on that day, what you haven’t learned by then would not be something you would catch up with tonight.

    What To Do On The Day Of The AMC Clinical Exam

    On the day of your AMC Clinical Exam, you should have a good breakfast. Pamper yourself, put your favourite make-up on, dress up a bit, wear loose clothing, most of us start to get very nervous and to sweat a bit and no doubt you’ll feel uncomfortable if you have tight-fitting clothes on with a sweat stain under your arms.

    Try to stay calm and remind yourself that these patients are only actors and they are not sick. The AMC provides all the necessary tools. However, you might have to ask for them and then the examiner will produce them for you. In some stations, things are on the desk and you just have to grab them and it is surprising how often a candidate will not use the provided things, such as cotton wool for sensory testing, etc.

    However, remember to bring the following items to the examination centre:

    • Confirmation notice
    • Unexpired Primary Identification bearing your name, photo, and signature
    • Comfortable professional clothing
    • Clean white lab coat
    • Standard Non-Enhanced Stethoscope

    The following items are not permitted in the AMC Clinical Exam:

    • Electronic devices such as beepers, recorders, watches, cameras, cell phones and other devices
    • Study materials: any type of notes, reading materials and study summaries
    • Other medical equipment

    Carefully Read the Stem of Every AMC Clinical Exam Station

    While reading the stem, every word has a meaning.

    If the stem mentions that a male patient is an abattoir worker, this can be an extremely important fact that. For e.g., he might suffer from Zoonosis, a disease transmitted by working with animals.

    If the stem says that a female patient is on tamoxifen, she probably has or had breast cancer.

    If you are not sure about any aspect regarding the stem, you will have an opportunity to ask the examiner for clarification. The scenarios are usually single topic stations, so the main diagnosis will be apparent fairly early on.

    If, for example, it seems to be a case of cholecystitis, try to demonstrate an organized, structured, and focused approach, honing in on the main problem. However, keep an open mind and talk about differential diagnoses as well, because you might just think it is “cholecystitis” but in reality, it might be pancreatitis or something else.

    This becomes especially important if the patient or the examiner makes comments like: “Dr. last time I had cholecystitis, it felt quite different.”

    Prick up your ears and rethink if the patient is trying to give you a hint that this case is something different.

    Occasionally, one station can contain two separate issues. For example, a paediatric case might be complicated by a parent with a psychiatric or social problem and you might be expected to cover both topics.

    If you deal quite well with the paediatric component but ignore the parent’s drinking problem you could still be at high risk of failing the station.

    In summary, in most stations, you should have a good idea about the task and a well-structured plan of approach in your head at the end of the reading time.

    How to Approach the Patient in the AMC Clinical Exam

    Demonstrating good communication skills, empathy and patient-centredness is an important component of the AMC Clinical Exam. To open the encounter with the patient, I would like to recommend the GRIPS approach:

    G: Greet the Patient

    R: Build a Rapport with the Patient

    1. Introduce yourself and state your position as a doctor
    2. Ensure Privacy
    3. Social Courtesy

    In simple words, greet the patient, smile, and introduce yourself, state your purpose, ensure the patient is comfortable and make good conversational history.

    (Note: Prior to COVID-19, it was generally a good idea to offer to shake the patient’s hand. I would advise against doing this now. Instead, look for a bottle of antibacterial liquid and make a deliberate show of using good hand hygiene).

    Here’s a basic outline:

    1. Knock on the Door Before Entering the Room
    2. Enter the Room
    3. Clean your Hands
    4. Introduce Yourself, “Hello Mr / Ms ______. My name is Dr ____. I’ll be taking care of you today. What brings you in?”
    5. Patient: “ABC”
    6. You: “Is there anything else you wanted to address today?”
    7. Patient: “ABC”
    8. You: “That sounds very important. I’m glad you came in today. Could you tell me more about ABC?”

    History Taking in the AMC Clinical Exam.

    When taking a history be mindful of your body position, sit upright with an open stance towards the patient, but not too close, and relax, that way you appear more confident. Keep your back straight, lean forward a little bit, and keep your arms relaxed in your lap or on the desk. Try to be super nice to your patients but don’t be fake. It is really important to form a doctor-patient relationship, this is why eye contact and smiling are essential.

    Relax your facial muscles and smile (but not in breaking the bad news stations). Speak, not too fast, avoid being monotonous, and don’t be too loud. Use a moderately pitched, soft voice. It is very useful to ask one or two non-medical-related questions during some of my patient encounters. Show genuine empathy and build rapport, for example, by asking about kids’ names, education and how they like their job where appropriate.

    If, for example, your patient is a retired music teacher, ask her what type of musical instruments he/she plays or which instrument is his/her favourite.

    Just by asking these simple questions, your patient will feel much more comfortable for the rest of your encounter and they might even give you a few hints here and there.

    Let the patient speak as much as possible, and use as few questions as you can. “Could you tell me more about the pain?” ends up being much more efficient than “Did the pain radiate anywhere?”.

    Although of course if it’s an important question and the patient has not elaborated you can be more specific.

    Where appropriate, you can ask how an issue has affected someone’s life. This can lead to appropriate referrals that will help a patient be compliant with treatment.

    Try not to interrupt the patient although you might have to interrupt if the patient goes on and on. If they use terms that you don’t understand, ask them for an explanation. Continue to work your way through the skeleton as above. Make sure you’ve covered all of the elements mentioned above before you move on to the exam.

    Summarize your understanding of the history of the present illness and ask if there is anything he or she would like to add. This reinforces to patients that you are listening to what they are saying. It’s perfectly appropriate to finish with a few quick and direct questions.

    Before commencing your physical examination at each AMC Clinical Exam station, encourage the patient to ask questions whenever possible. They are there to help you and might put you on the right track or give you clues in which direction to go.

    You might ask the patient “Now if it’s okay with you I would like to do a few physical examinations to help me narrow down my diagnosis, but before I proceed is there anything that you feel might be important that you would like to mention?” or “Any questions you want to ask me?” or “Anything else you want to tell me?”.

    Some patients will give you a few hints but others will not, which is fine because this question only takes a few seconds to ask and it can help you if you have somehow missed asking something very important.

    One important thing in the history station is to respond to the patient’s complaints. For example, if he or she has got pain, you could ask the examiner to provide painkillers, or if the patient has photophobia you might offer to dim the lights in the room.

    If the patient is forgetful or confused, they will likely answer your questions by stating, I don’t know or I can’t remember. In such cases, ask your patient, “Is there anyone who knows about your problem, and may I contact him to obtain some information? “ If the patient doesn’t know the names of their medications or is taking medications whose names you don’t recognize: Ask the patient if they have a prescription or a written list of the medications. If not, ask them to bring their list with them as soon as possible.

    If the patient is hard-of-hearing, face the patient directly to allow them to read your lips. Speak slowly, and do not cover your mouth. Use gestures to reinforce your words. If the patient has unilateral hearing loss, sit close to the hearing side. If necessary, you can also write your question down and show it to them.

    If you encounter a crying patient, allow them to express their feelings, and wait in silence for them to finish. Offer them a tissue, and show empathy in your facial expressions.

    With the current pandemic situation, it’s probably best to avoid reassuring gestures such as placing your hand lightly on the patient’s shoulder or arm.

    Don’t worry about time constraints in such cases? Remember that the patient is an actor and that their crying is timed for a certain amount of time. They will allow you to continue the encounter in peace if you respond correctly. If the patient is angry, stay calm and don’t be frightened. Remember that the actor is not really angry, they are just acting angry to test your response.

    Let the patient express their feelings, and inquire about the reasons for anger. You should also reasonably address the patient’s anger.

    For example, if the patient is complaining that they have been waiting for a long time, you can validate their feelings by saying, “I can understand why anyone in your situation might become angry under the same circumstances. I am sorry I am late. The clinic is crowded, and many patients had appointments before yours.”

    Reassure the patient that now that it is their turn, you will focus on their case and take care of them.

    If the patient is anxious, encourage them to talk about their feelings. Ask about the things that are causing the anxiety. Offer reasonable reassurance. You can also validate the patient’s response by saying, “Any patient in your situation might react in this way, but I want you to know that I will do my best to address your concerns.”

    Performing a Clinical Examination in the AMC Clinical Exam.

    Before you touch the patient, wash your hands with soap and dry them carefully. Make sure your hands are warm, so rub your hands together if they are cold.

    Similarly, rub the diaphragm of your stethoscope to warm it up before you use it. Do not auscultate or palpate through the patient’s gown.

    As you proceed, be sure to ask the patient’s permission before you uncover any part of his or her body (eg, is it okay if I untie your gown to examine your chest? or can I move the sheet down to examine your belly?).

    You may also ask patients to uncover themselves. But you should expose only the area you need to examine. Do not expose large areas of the patient’s body at once.

    After you have examined a given area, cover it immediately. If the patient refuses to let you physically examine them, don’t push.

    What to do if a Patient Refuses a Physical Examination.

    A patient in severe pain may initially seem unapproachable, refuse a physical examination, or insist that you give them something to stop the pain first. In such cases, show compassion for their pain. Say something like “I know that you are in pain.” Offer help by asking, if there is anything you can do to help them feel more comfortable?

    It’s good to ask if the patient has taken any painkillers in the past few hours and if they are allergic to any painkillers before you prescribe any.

    Then ask the patient’s permission to perform the physical examination first then offer painkillers next. If the patient refuses, gently say, “I understand that you are in severe pain, and I want to help you. The physical examination that I want to do is very important in helping determine what is causing your pain. I will be as quick and gentle as possible, and once I find the reason for your pain and to reach the diagnosis, I should be able to give you something to make you more comfortable.”

    If the patient still refuses to cooperate, skip the physical examination or manoeuvre, and document the fact they declined the exam.

    Conducting the Physical Examination.

    During the physical examination, always examine the heart and lungs, even if very briefly.

    Then move on to examining the system of interest to the chief complaint, eg abdomen, shoulder, neurologic, etc.

    In other words, the exam should consist of listening to the Heart and Lungs + “The system of interest” depending on the chief complaint.

    You can examine a body part that the patient says hurts.

    Be gentle, do not poke too hard, apologize or say something nice as you do it, and do not repeat a painful exam manoeuvre.

    If you see a scar, a mole (nevus), a psoriatic lesion, or any other skin lesion or bruise during the physical examination, you should mention it and ask the patient about it even if it is not related to the patient’s complaint and think about abuse as a possible cause.

    When doing a physical examination, it’s often easy to get wrapped up in thought and not explain what it is you’re doing. Thus, you should show and describe that you’re performing a particular exam.

    For example, if performing an abdominal exam and observing the patient’s abdomen, an out-loud statement of “Your abdomen doesn’t look distended, and there doesn’t appear to be any bruising” may earn valuable points as an alternative to simply staring at their abdomen for a few seconds.

    Please note that you cannot do the following physical examinations in the AMC Clinical Exam:

    • rectal
    • pelvic
    • genitourinary
    • inguinal hernia
    • female breast
    • corneal reflex examinations.

    If you believe one or more of these examinations are indicated, say them to the examiner.

    Physical Examination in the Online Version of the AMC Clinical Exam.

    During the online format of the examination, you cannot perform a physical examination but you have to ask the examiner for the findings.

    Please use the same approach.

    Firstly tell the patient that you will ask the examiner for the findings and then be pleased to the examiner and it does not hurt to say “Thank you” at the end.

    Regarding the vital signs, the examiner will normally provide pulse, blood pressure, respiratory rate, oxygen saturation, and temperature but you should always specifically ask for them.

    However, if you suspect a possible difference in e.g. blood pressure in the right and left arm, or if you expect an orthostatic or if there is a chance of coarctation of the aorta, you will have to specifically request the specific corresponding findings like blood pressure in right and left arm, blood pressure while lying and standing and radial as well as femoral pulses.

    You need to realize that the examiner will only give you findings if you specifically ask. For example, it is pretty useless to ask “What are the findings on inspection of the abdomen?” or “Are there signs of liver failure?”, the examiner most likely will respond “What are you looking for?” This wastes a lot of time.

    Please ask straight away “On inspection, I am looking for distension of the abdomen.” The answer will be “It is” or “it is not.”

    Ideally, you should tell the examiner at the same time why you are performing an examination and what you expect to find and what the underlying problem could be, e.g. “I am looking for tenderness in the right iliac fossa over the McBurney’s point to confirm or exclude likely appendicitis.”

    After the physical examination, you must “close” the encounter with some kind of compassionate statement that acknowledges the patients’ frustration by sharing what you think might be going on, and some of the tests that you will order:

    • “I’m so sorry you’re dealing with this back pain, it sounds frustrating”
    • “After hearing about your symptoms and doing the physical examination, I’m going to go over what I think might be wrong and what we can do to further figure it out.” This is a good indication of your intent to transition.
    • “I’d like to order a few tests to address the most likely cause.”
    • “Thanks again for your time. I’m very glad you came in today to get this taken care of.”
    • “Do you have any other questions or is there any other aspect of your health care we haven’t already discussed?”

    If you don’t have time for a full mini-mental status exam, at least ask patients if they know their name, where they are, and what day it is.

    Note Taking

    During note-taking, do not make up history or physical examination findings. Only write information that you obtained. Note any pertinent positive or negative history or physical examination findings. Note the diagnostic tests that you recommend and make sure these directly address your differential. Do not order unnecessary tests that you cannot justify. Do not order invasive or expensive tests if you can achieve the diagnosis with a less invasive and/or less expensive test.

    Phone Cases

    The AMC Clinical Exam will also include one or two phone cases, where a patient or a patient’s relative calls you with certain symptoms.

    As with other encounters, patient information will be given before you enter the examination room. Once you are inside, sit in front of the desk with the telephone, and push the speaker button by the yellow dot to be connected to the patient.

    Do not dial any numbers or touch any other buttons. You are only permitted to call the patient once. Treat this as a normal encounter and gather all the necessary information. To end the call, press the speaker button above the yellow dot.

    As in the paediatric encounter, there is no physical examination. Here’s a basic outline:

    • Take a focused but thorough history.
    • Express empathy and use patient-centred communication skills.
    • Decide if the patient’s concern can be addressed over the phone or if the patient needs to come into the clinic or the Emergency Department to be seen in person.
    • In general, if the patient expresses pain, fever, wound redness or discharge after a procedure or surgery, then they likely need to be seen in person and examined.
    • When in doubt, ask the patient to come in to be seen. If you think that the patient needs to be seen in person, do not let them talk you out of it such as by saying it is too late at night, or that transportation is difficult, this is likely a distractor. So apologize for the inconvenience, explain to them your differential and why it is important to be assessed in person.

    Management and Counselling

    You should be able to establish a probable or even definite diagnosis after a proper interpretation of the history. Make sure you have a systematic approach and plan your approach to physical examination, investigations and management:

    • What would be the three most likely differential diagnoses?
    • What would be important to concentrate on in physical examination and investigations to confirm or exclude diagnoses?
    • Were there other important factors or risks in the patient’s history supporting one of the diagnoses over another?
    • How do you explain the diagnosis and differentials including prognosis and possible complications to the patient?
    • What is the most appropriate management for the main and other differential diagnoses, including lifestyle, counselling and prevention?

    Often the diagnosis is clear very early, so tell the patient what you suspect it is in lay language and terms the patient understands. Ask the patient if they know the diagnosis and what they know about it.

    If the patient seems hesitant to accept your diagnosis or advice, be prepared to change your mind if the evidence doesn’t support your diagnosis. This is very much a patient-centred examination and it is always appreciated if you draw a picture, a diagram or a decision tree as there are pen and paper on the desk to make your explanations clearer for the patient and the examiner and you can always add that you will give them a hand out to take home so they can remember what you said.

    Investigations

    Regarding investigations, it is not a good idea to ask for “Complete Blood Count, Electrolyte Sedimentation Rate, C-Reactive Protein, Urine Electrolytes, Liver Function Tests, etc.”

    It is best to be specific and indicate to the examiner the relevance of why you order the test, what you suspected and what the test results would mean for either diagnosis or management and treatment.

    Show perspective rather than ordering irrelevant and unnecessary tests!

    For example, don’t just order a complete blood count in a patient with a suspected chest infection. It is much better to focus on the white blood cells count to exclude leucocytosis.

    Order simple investigations first, especially office tests if applicable, and more complex investigations like CT and MRI will come later.

    The most valuable office tests are the urine dip-stick, urine pregnancy test and finger prick for glucose.

    Do not order unnecessary tests that you cannot justify.

    Do not order invasive or expensive tests if you can achieve the diagnosis with a less invasive and/or less expensive test.

    You should also explain to the patient the diagnostic tests you are planning to order. In doing so, you should again use lay language and terms.

    For example, we need to run some blood tests to check the function of your liver and kidneys, or you need to have a chest x-ray and a CT scan of the head.

    You might further explain the latter by saying, The CT scan is a form of x-ray imaging that gives us clear images of sections of the body.

    Specific Types of Patients You May Encounter in the AMC Clinical Exam.

    If you encounter a reserved, unemotional, or upset patient, remember that this is by design. Continue to engage the patient despite their difficult attitude. One of the best ways to do this is to describe your observation and ask them about it: “I see you are angry, would you like to talk about it?”, or “You seem quiet, is something bothering you?”

    If you encounter a patient who uses drugs, alcohol, or tobacco, you will not have time to counsel them on each issue, although you should address them directly. One possible way to do this is to say supportive words such as “I’d like to spend more time with you to discuss this. Will you be back in 3-4 weeks so we can discuss it then?”

    Wrapping Up With the Patient.

    Always state the plan in layperson terms and if the patient is comfortable with the plan moving forward. Don’t use medical jargon, but simple language.

    Sometimes you may want to use a medical term like “Subarachnoid Haemorrhage” to demonstrate your knowledge to the examiner. But you also have to explain in simple terms to the patient, i.e. that this is the space between the skull and the brain or ask the patient if s/he understands what you are talking about in the examination. The patient most likely will answer “Yes, I have heard that term before”, so there is no time wasted.

    Explain the treatment options including both pharmacological and non-pharmacological options.

    Explain red flags e.g. Hypoglycemia & Hyperglycemia in Diabetes & what to do if they happen.

    Always ask for their understanding and if the patient has any questions. Don’t be too firm in your advice to the patient, rather present options. It is the patient’s choice what they are comfortable with.

    Don’t be sucked in to say “Oh, yes, you definitely should have a hysterectomy” for example in menorrhagia. It is only one option of a range of management possibilities.

    Make sure the patient understands the options available to them clearly.

    If the patient does not accept your advice, e.g., Jehovah’s witness refusing to have a blood transfusion or have their children immunised, all you are expected to do in such a situation is to accept their point of view but to explain the issues and consequences to the patient.

    In rare circumstances, you might have to refer to a guardianship board.

    If the patient cannot pay for certain tests or treatments that may not be covered by Medicare, reassure the patient by saying, “Not having enough money doesn’t mean you can’t get treatment.” You might also add, “We will refer you to a social worker who can help you find resources.”.

    The comment of “Don’t worry” does not go down well with the patient because even it is a trivial problem, the patient would be worried and they would think that you just don’t understand their chief complaint which is not a good start to develop a doctor-patient relationship.

    Make Appropriate Referrals

    Never forget that you’re acting as an intern or a junior medical officer. Don’t hesitate to ask for help or a second opinion from a senior doctor. At least mention that you would ask or check with them if you’re unsure. In some stations, it’s important to refer the patient to a specialist.

    But. do not refer a patient to a senior doctor without explaining to the patient exactly what will happen. It is a mistake to try to get out of a situation by saying “I’ll refer you to the orthopaedic surgeon.”. You have to be quite specific about why and what will happen there.

    Follow Up

    Hand out a reading material they can take home so they can remember what you said.

    Always provide a safety net by arranging a follow up often the next day, but maybe a few days or weeks later.

    Be willing to reassure if indicated and medically possible and do not hesitate to arrange admission to the hospital if indicated.

    Everything counts from your attitude, manner, voice, to your language. Don’t end the consultation in a way that patient feels more confused, threatened, without an option, or not being taken care of.

    If time constraints dictate that you choose between a thorough physical examination and an appropriate closure, give priority to the execution of proper closure with:

    • Initial diagnostic impressions.
    • Initial management plans:
    • Need for follow-up tests
    • Ask the patient if they have any other questions or concerns.

    Failing Some Stations

    Most candidates fail a few stations, so be prepared for that.

    Often there is one scenario that you might not know much about at all and you soon think that you have failed that station.

    Remaining calm in unexpected or difficult circumstances is the key to surviving stations or even the rest stations. You may never know that you will still pass that station even if you don’t know much or you feel so bad.

    It is extremely important not to think about it any longer, once you have moved past that station, clear your mind, forget about it, put it behind you and concentrate on the next station and believe in yourself. Even if a candidate fails the examination, it is not a disaster. A wise man said: “Failure is only a word, not a sentence.”

    One Last Word of Advice

    The last and the most important advice that I can truly give you is PRACTICE, PRACTICE, and PRACTICE.

    The only way to pass this exam is to prepare well. The preparation time required will depend on your medical knowledge, your communication skills and how familiar yourself to the Australian healthcare system.

    You may know every little detail in your book. But this is worthless if you cannot perform well. So please make sure not to rush and take as much time as necessary to practice a few times before you schedule your examination.

    The Aftermath

    Just a reminder that you also should look forward to your life after the examination and that means finding a job. Remember you need to have all your paperwork ready for provisional registration with the Medical Board of Australia.

    The most common hold-ups are lack of current language certificate as it has to be within the last 2 years and the certificate of good standing from medical authorities in every country where you have been previously and currently registered. It happens regularly that International Medical Graduates are delayed or refused registration because of some aspects of the paperwork being missing.

    Related Questions.

    How Do I Pass the AMC MCQ Exam?

    Nawaf has also written a guide to the Part 1 Exam where he shares his tips for success. You can read this post here.

    Do I Need to Sit the AMC Clinical Exam?

    As a basic rule of thumb if you gained your medical degree from a country outside of Australia, New Zealand, the United Kingdom, Ireland, Canada or the USA. And you do not have a specialist qualification. Then you will need to sit the AMC exams. However, there are a few exceptions to this rule, these include gaining registration through similar processes in other countries, such as completing the USMLE and PLAB and completing the Workplace Based Assessment program (which is an exception to having to sit the AMC clinical exam). For more information see our Standard Pathway Q&A guide.

    How Do I Obtain a Job After Completing the AMC Clinical Exam?

    The first thing to know here is that you can actually apply for jobs after you pass the AMC Part 1 MCQ Exam. Generally speaking, you will need to look for a vacant Resident Medical Officer type of role in a public hospital. One that the hospital has not been able to fill with local graduates. Unfortunately, a medical recruitment company is unlikely to want to help you with your search so you need to look for and apply for jobs directly. More information is available in our Standard Pathway Q&A guide.

    What Is the Cost of the AMC Clinical Exam?

    As of July 2021, the cost of the AMC Clinical Exam is $3,530AUD

    Can I Sit the AMC Clinical Exam More Than Once?

    Yes. Although there is generally a long wait for each exam.

    What Is the Format of the AMC Clinical Exam?

    The AMC clinical examination is an integrated multidisciplinary structured clinical assessment.

    The examination comprises 16 assessed stations and 4 rest stations.  It is administered either online via a video conferencing format at a location organized by the candidate, or when health restrictions are allowed, at the National Test Centre in Melbourne (NTC).

    Candidates rotate through a series of stations and will undertake a variety of clinical tasks. All candidates in a clinical examination session are assessed against the same stations.

    Most stations are of 10 minutes duration (comprising two minutes reading time, and eight minutes assessment time).

    Stations may use actual patients, simulated patients, or videotaped patient presentations. Other relevant materials, such as charts, digital images and photographs may also be used in the examination.

    How Long Is a Pass on the AMC Clinical Exam Valid For?

    There is no expiry date for the AMC Clinical Exam.

    Can I Sit the AMC Clinical Exam Outside of Australia?

    Unlike the AMC MCQ exam, all of the in-person clinical exams occur at the National Testing Centre in Melbourne. However, with the advent of the AMC Online Exam, you can now sit this anywhere.

  • How to Pass AMC Exams – Part 1 AMC MCQ Comprehensive Guide

    How to Pass AMC Exams – Part 1 AMC MCQ Comprehensive Guide

    An Australian Medical Council Part 1 CAT MCQ Examination Study Guide.

    Are you wondering how to pass the AMC exams? Well. Having passed the Australian Medical Council AMC Part 1 CAT MCQ Examination in the first go, I am often asked by doctors questions like “What’s your secret?”, “How can I plan my study schedule to pass the AMC Part 1 CAT MCQ Examination?”, “How long should I study for it”, and “What’s the best study plan?”.

    Chances are, if you’re reading this post, you are preparing to take the AMC Part 1 CAT MCQ Examination within the next few weeks to months, and are looking for actionable advice about how to set yourself up for success in the here and now. I’m going, to be honest: if I had a single secret or silver bullet, I would tell you. The harsh truth is that if you want to pass the AMC Part 1 CAT MCQ Examination, work as early as possible with concerted efforts to build a solid knowledge base that you can then consolidate during your dedicated study periods.

    In this article, I will try to point out the ideal way of doing things. Things I wish someone would have told me while I was preparing. things that would have saved me a lot of money and time (spent scouting for the ideal resources).

    Here’s a summary of what I learnt about how to pass the AMC exams:

    • Start as Early as Possible.
    • Commit to An Examination Date to Give You Something to Plan For.
    • If Possible Study Whilst Undertaking Clinical Rotations or Work.
    • Make Sure You Choose Your Preparation Resources Wisely.
    • You Should Use John Murtagh’s General Practice, the AMC Handbooks and Question Banks to prepare most effectively.
    • Try to dedicate study time each day and take plenty of breaks.
    • Work out the areas you are most week in and focus on them.
    • Try to do some practice where you emulate the actual conditions of the AMC Part 1 CAT MCQ Exam.
    • Work out if you have problems in areas such as time management, understanding the answers, overthinking questions and address these.

    There’s a lot more to it than just that. So let me give you some further details about my approach:

    Starting Early to Pass the AMC MCQ Exams.

    Believe it or not, my preparation for the AMC Part 1 CAT MCQ Examination started at the beginning of the 5th year of medical school. As I went through clerkships, I knew one thing. Studying hard would certainly put me at an advantage for the AMC Part 1 CAT MCQ Examination

    Your best first step in preparing for the AMC Part 1 CAT MCQ Examination is to plan far ahead. Thinking about the AMC Part 1 CAT MCQ Examination 4 to 6 months before your scheduled AMC Part 1 CAT MCQ Examination preparation will ensure that you have enough time to identify appropriate resources, create a daily schedule that works for you, and cover all the material you will need to review before your AMC Part 1 CAT MCQ Examination.

    One thing you do have a fair bit of control over is when you sit the examination. There are normally a few examinations scheduled every month. If you are aiming to sit in a certain international location you might be a bit more limited to when you sit but if you do have an option, pick a date that allows you plenty of time to prepare for it.

    But also, don’t procrastinate around picking your date. Don’t start studying first to get to a certain point before picking your AMC Part 1 CAT MCQ Examination date. It is always helpful to have a hard timeframe to be aiming for. It will keep you motivated.

    Exactly How Long Should You Study to Pass The AMC Part 1 CAT MCQ Examination?

    No matter when you take the AMC Part 1 CAT MCQ Examination if you want to pass in the first go it is critical to have a dedicated study period with no other significant obligations to consolidate your knowledge and hammer home AMC Part 1 CAT MCQ Examination preparation.

    The answer to this question depends on a lot of factors, two of the most important being, your knowledge baseline, and the amount of dedicated time you have.

    Exactly how much-dedicated study time you need depends on how far out you are from core clinical rotations in medical school. Is your knowledge recent or is it rusty? If your schedule does not allow for a prolonged dedicated study period because of clinical or personal obligations, then incorporating study over 6-8 months is sensible.

    In my opinion prolonging dedicated study more than say 8 months is not advisable, however, as the likelihood of forgetting topics studied at the beginning of your review period increases with increasing time spent studying.

    Also, factor in giving yourself enough breaks in between studying in earnest to avoid burnout.

    Building a Firm Foundation: The Importance of Clinical Rotations to Passing the AMC Exams.

    The most common question types in the AMC Part 1 CAT MCQ Examination are “What is the most likely diagnosis?” and “What is the next best test?” rather than “What is the mechanism of action of the appropriate antibiotic?” or “What is the makeup of the genome of the most likely causative virus?”

    As we know from adult learning theory, interleaved practice is crucial to consolidating knowledge and making memories stick. This involves making associations between patients and disease processes you see on clinical rotations and the textbook versions of their diseases you read about in clinical resources like RACGP and Better Health Victoria guidelines, journal articles, review books, and question banks.

    Studying hard pays dividends in both directions: clinical experiences in which you can put a face and a story to a disease increase the salience of the medical information you are reading while gaining a deeper understanding of patients’ disease processes will make you a more engaged and effective physician.

    Because of this, there is no better time to consolidate clinical medical knowledge pertinent to the AMC Part 1 CAT MCQ Examination than during clinical rotations.

    Tip. Squeeze In Study Time At The Hospital Or Clinic.

    If you think about it, there is often a ton of downtime during hospital rotations. That period between completing your rounds and returning home might as well be a black hole where the free time goes to disappear. So how can you fit in some valuable moments of studying while not appearing nonchalant?

    First, study primarily on your tablet or laptop rather than on your phone. This prevents people from thinking that you’re just browsing on your phone. Second, nobody will look twice if you’re reading John Murtagh’s General Practice or RACGP and Better Health Victoria Guidelines during the day, especially if you’re looking up topics related to your patients. Reading up on your patients and their conditions from textbooks during the day will also free up time in the evening for other resources such as question banks’ practice questions.

    But What If You Are Not Working or Studying At the Moment?

    Not every International Medical Graduate is studying or working clinically when they prepare for the AMC Part 1 CAT MCQ Examination. Especially those already in Australia. But in my opinion, it’s a big advantage if you are.

    Here are a few options you may wish to consider that may help.

    1. Consider using your networks to obtain an extended clinical observership. If you have colleagues or family or friends that work in general practices or hospitals. Ask if they can connect you with someone in charge. Even being able to spend a day a week in general practice or an emergency department will be an advantage for you.
    2. Consider returning home to undertake some more clinical practice. This option not only helps with your study. But also will update your recency of practice.
    3. Obtain employment in another clinical role. It may be that you have sufficient qualifications or can gain qualifications to work in another capacity in a healthcare setting. Examples might be as a nurse or phlebotomist. Working as a nurse in Australia (if that’s something open to you) can be a particularly good way to prepare for the AMC MCQ exam process.

    I have specifically not added options such as clinical bridging programs. As, whilst useful for other purposes, I don’t think they give you the real experience of patients to enable your learning for the AMC MCQ Exam.

    What Are the Best Resources for the AMC Part 1 CAT MCQ Examination Preparation?

    A common misconception is that using more resources equates to better AMC Part 1 CAT MCQ Examination performance. One pitfall of utilizing too many resources is that you tend to dabble in each resource rather than focusing on comprehensively utilizing all the material in a handful of high-yield resources.

    In my view, it is important to select three or four high-quality resources and focus all of your attention on the material within these. Your study schedule should include enough time to thoroughly and completely review all of your selected resources.

    In my experience, doctors commonly fall into the trap of assuming that “If I review ‘everything’ in each of these study resources, then I’ll be more prepared than if I only reviewed a single resource”, or so goes the argument. This is a fallacy. Based upon my experience and the consensus of several peers the highest yield resources are:

    Getting through the entirety of your chosen books and question banks and understanding each topic should be your top study priority.

    What Textbooks Should You Use for the AMC MCQ Examination Preparation?

    Many preparation books exist for each subject area, but doctors should avoid studying from 20 books at the same time. Instead, the best strategy is to use a single book. John Murtagh’s General Practice rates highly. It provides a very good review of all important subject areas tested. Do not underestimate any details presented in John Murtagh’s General Practice book. Even the most minute detail can come up in the form of a question on the AMC Part 1 CAT MCQ Examination.

    Even after reading the book multiple times, you may find details that you had missed before. It is imperative to read the small italicized font that you thought wasn’t important, the captions on the images, and the labels of any diagrams.

    Although you might find some sections of the book less interesting or easier, do not skip any of them. I aimed to have everything in John Murtagh’s General Practice memorized, to the best of my ability. The main advantage of using this is you get an excellent but yet detailed overview of the syllabus. The drawback being it’s time-consuming.

    Why this book in particular and not other books? It is true that the AMC MCQ (and the clinical) test across a range of specialties. But Murtagh’s book is considered “the bible” for general practice in Australia and it provides the Australian medical context that no other book does. Its also recommended by the AMC themselves.

    Should You Subscribe to Question Banks for the AMC MCQ Exam?

    Practice questions are the most important part of the AMC Part 1 CAT MCQ Examination preparation, I cannot emphasize that enough. Since the AMC Part 1 CAT MCQ Examination is a multiple-choice examination, it is important to practice applying your knowledge by utilizing question banks, or QBanks in short.

    Avoid using “handed down” questions or so-called “Recalls” that are circulated for free. These are often very poor in quality. And often suffer from “recall bias”.

    Commonly used question banks include AMEDEX and AMCQBank. Make sure that you choose a question bank that gives detailed explanations about why an answer is correct and the others are incorrect. Below, I get into more details on how to approach practice questions, but as a general rule of thumb, you should put a lot of your focus and energy into working through Question Banks.

    They provide hundreds of practice questions that you can take either timed or untimed as full Examination, sections, or by category. They also offer explanations for each answer.

    How To Use Your Question Banks Effectively?

    If you have questions banks to study with. Which you should. Then you want to know how to make the most of them. It’s not as difficult as you might think to make the most of these. Use these tips to make them work for you:

    • If you miss a question, make a note of it and come back to try those questions again at a later time. With just about any question bank, you’re going to have the ability to flag questions if you have a problem with them or if you can’t get them right. That way, you can check your flagged questions later for study or to try and answer them again.
    • Don’t assume that a question bank, or even a couple of question banks, is going to be enough. You need other study materials of different types as well. For example, videos and flashcards are a good idea too. These can help you break up the monotony of just one topic and also help you get a better understanding of the subject rather than just memorizing facts.
    • If you get a question wrong, read through the information that you’re given about just why that answer is incorrect. If you don’t know why it’s the wrong answer, you run the risk of making the same mistake again. Also, read the reason why the right answer is correct. This will help you remember the answers better the next time.

    AMEDEX Question Bank.

    AMEDEX question banks include various question categories covering all topics as well as updated explanations and references. There are approximately 1300+ questions in this question bank. This question bank is considered to be the emperor of the AMC Part 1 CAT MCQ Examination.

    Whenever I’m asked about how to study for the AMC Part 1 CAT MCQ Examination, I will mention the AMEDEX Question bank and give this one simple piece of advice. Use it. The AMEDEX question bank was the closest thing to the real thing I found during my study preparation.

    The vignettes are close to the length of the actual AMC Part 1 CAT MCQ Examination, and questions are also similar in difficulty. I did AMEDEX 3 times before my AMC Part 1 CAT MCQ Examination. I attribute my success in large part to this.

    Many doctors use this resource to get comfortable with the question style. Because practice questions are so critical to effective AMC Part 1 CAT MCQ Examination preparation, make sure that you are using your AMEDEX question bank in a way that most closely replicates real-time AMC Part 1 CAT MCQ Examination conditions. This means using timed-mode and using randomized, mixed blocks as you get more familiar with AMC Part 1 CAT MCQ Examination style questions.

    Initially, you will want to do subject-specific questions to get familiar with and master the concepts that are tested in each subject area, but later on, you should transition to randomized, mixed questions. Using too many subject-specific questions during your prep will give you far more comfort than you’ll have on the Examination day.

    You will need to train your brain to do the mental acrobatics needed to quickly switch from one subject area to another, within time constraints. After your first complete pass through the question bank, do a quick take through all the questions to see which ones you got wrong or right.

    Identify weaknesses and high-yield topics that you struggled with, and work on solidifying your knowledge base in these areas. Then take a second pass. After your second pass, you should go back and do a complete review, spending most of your time on the questions that you got wrong as well as the questions you are uncertain about but got right.

    AMCQBank Question Bank.

    Is another good yet more expensive option and consists of 1,800 on-line questions; similar to AMEDEX question bank. It has a large question bank with an excellent library feature that breaks down the topics covered by each question. The answer explanations that AMCQBank provides are excellent, and they are easily searchable at any time. One of the best parts of doing practice questions is how much you learn from the answer explanations.

    Should You Attend Any Courses for the AMC MCQ Examination?

    There are a number of courses available to help you with preparing for the AMC MCQ. Generally, these also include question banks for you to practice on, with the added benefit of their being instructors to assist you in understanding the reason behind certain questions.  You will also be studying with other students so this can help from a motivation perspective.

    I did not use any courses and personally I don’t feel that they add any benefit over and above having question banks and other good resources and a study group.  So my recommendation would be to save your money for other things.

    Are Flashcards Helpful for the AMC MCQ Exam?

    I recommend also using flashcards to document important concepts or points that you learned. Use Anki to make your flashcards. The web version is free.

    Anki’s spaced-repetition method is ideal for long-term learning and retention. Every flashcard you make should be concise and prompt a short, to the point answer. Be diligent, and keep up with making flashcards on concepts and points that you learn from practice questions. This will give you an extremely solid knowledge base for the AMC Part 1 CAT MCQ Examination.

    Here’s what I recommend. When you’re reviewing your question banks, make short and to the point flashcards for any question, you missed or guessed correctly on. Do your cards the next morning before beginning with a few review cards. This will help you avoid making the same mistakes again on the question bank and the real AMC Part 1 CAT MCQ Examination.

    So if I missed a question about shock, for example, I’d make a short sentence about the key concept or try to replicate the vignette. Then I’d put just the important info that I didn’t understand quite right before.

    Remember these shouldn’t be elaborate flashcards. Don’t waste too much time on making the flashcards and have no time to study them. Make sure they’re in a quick question and answer format. There are also some flashcard banks that you can check out on different subjects if you don’t want to create your own.

    Preparation Strategies to Pass the AMC Exams.

    Here’s how I recommend you prepare for this examination.

    Balance out your schedule. You want to make sure you’re studying about the same amount each day between now and the day that you’re going to take your AMC Part 1 CAT MCQ Examination. That means you should be looking closely at how many days you have available and what you need to study to find a good amount to do each day. Don’t get too rigid about the schedule and study plan that you have.

    You need to be prepared to make changes that fit your life. If something has changed, and you don’t have as much time to study each day as you thought you did then adjust your schedule to reflect that. If you have some areas that need even more practice than you thought to go ahead and change that too. This plan only works if you make it.

    Some claim the only way to ace the AMC Part 1 CAT MCQ Examination is to study 14 hours a day; I disagree.

    Yes, you need to study a lot, but not so much that you’re sleeping less than 8 hours a night. Take frequent, short (15-minute) breaks. Take a day off from studying periodically, exercise and maybe even meditate. Stay attuned to when you feel overworked, and cut back accordingly.

    If you’re a bit of a workaholic, and grinding through the question banks two times makes you truly happy, that’s okay too. Don’t try to dramatically change your way of life during your dedicated study period. You’ve already come so far and had your fair share of successes: do what you can to stay true to that best version of yourself.

    Distractions are the worst enemy of efficient studying. Avoid them at all costs! Stay far away from the computer except for using the question banks. That includes emails as well. Just set up a vacation message in your email, so others will understand.

    If you can achieve a dedicated study period in the end, make sure you do nothing else except study, eat, drink, use the bathroom, and sleep.

    Sometimes the questions in the question banks can be tough. Be not dismayed, but rather use that as motivation to study even harder to overcome it.

    Don’t just sit down and do several hours of questions all in a row. Mix things up a bit and go through some questions and then switch out and watch some videos or read some text. By going to different things each time you come back from a break, you’ll give your mind something different to focus on, keeping you from getting too bored with the study.

    Study the topics that you don’t know. Take the time to figure out where your weak points are. These are the things you want to spend the most time on. Schedule your hardest subjects each day, if you have three subjects, you’re not as good at, schedule one of them for each day you’re studying. Then, schedule the topics that you’re about average or less than average on for every two to three days.

    Finally, plan the topics you feel confident in every four to five days. Many doctors slip into the habit of studying the subjects they’re already confident in, but if you’ve mastered a subject, spend time focusing on areas that give you trouble.

    Study with a friend or study group, and use mnemonics, even humorous ones to help you memorize the material. Remember that the amygdala (emotion) is connected to the hippocampus (memory).

    Schedule breaks, research shows that the ideal amount of time to study is 52 minutes, followed by a 17-minute break. This gives you time to really dive into the material and then relax, take a breath, and process what you’ve read before you start up again.

    Even though you’re working hard to get the passing score, that doesn’t mean you should ignore having some fun. Schedule in some breaks that are a little longer than 17 minutes or a lot longer and take some time to have fun with your family or friends. This is going to help you feel a lot better jumping back into studying, and who knows, you may perform better too.

    Set realistic goals. Do not set reading plans that you cannot possibly fulfil. Even then, you will inevitably fall behind at the time. Let it not discourage you, but catch up as soon as you can. If you finish a task before schedule, great! Don’t use that as an excuse to do something fun, however. Instead, start doing the next item on the list immediately. Trust me, you will fall behind eventually, so you should get an early start to prepare for that.

    Some claim the only way to ace the AMC Part 1 CAT MCQ Examination is to study 14 hours a day; I disagree.

    Nawaf DANDACHI

    Should You Change the Date of Your AMC MCQ Exam?

    As you are approaching the date of your examination you may start to worry that you have not prepared enough.

    It’s okay to change your AMC Part 1 CAT MCQ Examination date. But do so for the Right Reasons. While you should not hesitate to move your AMC Part 1 CAT MCQ Examination date if you’re not feeling 100%, try not to change your AMC Part 1 CAT MCQ Examination date in response to self-doubt.

    The AMC Part 1 CAT MCQ Examination can cause extreme anxiety. But once you have an AMC Part 1 CAT MCQ Examination date, try your best to stick to it, or you can find yourself constantly pushing back your AMC Part 1 CAT MCQ Examination date and self-doubting, preventing the most efficient study plan, and risking burnout.

    Remember most International Medical Graduates pass the AMC MCQ exam at some point. You won’t know 100% whether you are going to pass without sitting it. So better to sit and fail and get feedback than never to sit at all.

    What to do If You Are Sitting for the Second or Third Time.

    If you are retaking the AMC Part 1 CAT MCQ Examination, focus your preparation on the areas where you struggled. Thankfully, the feedback sheet from your previous AMC Part 1 CAT MCQ Examinations provides graphical performance profiles for each station category. These will allow you to see where you need to concentrate your efforts.

    How To Do Well In Your AMC Part 1 CAT MCQ Examination.

    If you can, get a great night’s sleep the night before the AMC Part 1 CAT MCQ Examination. Anecdotally, doctors and admissions counsellors report that this night of sleep is an important and easily accomplished AMC Part 1 CAT MCQ Examination-preparation goal.

    Know how to get to your AMC Part 1 CAT MCQ Examination site. Do a practice run in advance. There is nothing worse than feeling rushed on the morning of the AMC Part 1 CAT MCQ Examination.

    Get to the Pearson VUE AMC Part 1 CAT MCQ Examination site at least 45 minutes early and be sure to have a current picture ID with your name and signature, an acceptable form of a secondary ID bearing your name and signature, along with a printed copy of your scheduling permit.

    Think of the AMC Part 1 CAT MCQ Examination as 3 mini-tests, that is, three blocks of 50 or so questions each.

    Focus solely on the question you are on, complete it, clear your mind, and move to the next question.

    Answer every question. Wrong answers do not count against you. You cannot proceed to the next question without answering the question before.

    You’re Earning Points Not Losing Them

    When we typically take an Examination like the AMC Part 1 CAT MCQ Examination, we see every question as an opportunity to lower our grade. This is a common reason we’re always anxious throughout and after the AMC Part 1 CAT MCQ Examination. We just focus too much time and energy on what we don’t know. But instead, think about earning points!

    Think about getting excited about the questions you know well and see your grade getting higher. If you have a difficult question (which you will) shrug your shoulders at it, guess, and think that getting it right may only help your score. This shift in mindset can help you so much during your preparation and the AMC Part 1 CAT MCQ Examination.

    You’ll feel more confident and not give too much weight to the questions you don’t know. When you’re answering a question that should be the only question that you’re thinking about and when you’ve answered it, you should put it behind you and jump in with the next one. Don’t think about a question once you’ve answered it, or you could find yourself second-guessing your answers.

    Be sure you have checked all the questions before hitting “end.”  Don’t let the timer go off on its own, press “end”  to submit your test.

    If you can manage your time wisely, you’re going to be in much better shape to get the scores that you’re looking for.

    Keep in mind the average amount of time you have per question is generally about 100 seconds and learn how to keep your thought process within that 100-second mark. That way, you have time to think about the answer, but you aren’t going to run out of time before you answer every question.

    How to Plan Out Your Breaks During the AMC MCQ Examination.

    The AMC Part 1 CAT MCQ Examination is long. 3.5 hours to be exact, so it’s all about pacing. Make sure you have a game plan.

    When will you take your breaks? During the last few weeks of your preparation, try to do a few sections of questions in a row. When do you find your energy tanking? This is probably a good time to introduce a break during the real AMC Part 1 CAT MCQ Examination.

    After doing thousands of practice questions I felt I had developed a pretty good sense for how long each question should take, so once that internal alarm went off, I would pick the answer I felt was the most correct and move on. I took a 5-minute break between every 50 questions, in the end, neither fatigue nor timing was an issue.

    I left the AMC Part 1 CAT MCQ Examination centre with absolutely no clue what my score was going to be. Furthermore, I was pretty confident I had surpassed 250 but was unsure beyond that.

    What Are the Reasons Why Doctors Fail the AMC MCQ Exam?

    The passing rate of the AMC Part 1 CAT MCQ examination throughout the years is approximately 53%. However, it can be argued that most candidates do not fail due to a lack of medical knowledge. Failure is caused as a result of one or several of the following:

    • Poor time management, i.e., not finishing due to time running out.
    • Not reading or understanding the question properly, i.e., If you don’t have the correct information to start how can you choose a correct answer?
    • Not knowing how to navigate through the answers, i.e., getting confused with your options.
    • Thinking at too high a level. The examination is set at the level of a graduating medical student in Australia. So if you think like a GP or Specialist you may not be satisfied with any of the answer options.
    • Not understanding Australian medical and social culture: Australia does not deal with many of the serious things that are experienced in other countries, therefore things that may not be so serious in your country may be quite serious in Australia. For example, if a young child has whooping cough. In your country, you are likely to treat them and send them home with follow up. In Australia, this is often considered so serious that you would hospitalize them.

    What to Do About Poor Time Management.

    An effective technique to combat poor time management is called cycling. It may seem strange at first but once you master this it will take you less time to answer the questions, and you will always end up finishing ahead of time.

    How to use cycling can be found on page 44 of ‘Mastering Multiple Choice’

    This is explained and should be initially practised on a paper exam.

    After you have been studying for some time, make sure you also go on to the AMC website and try their online mock AMC Part 1 CAT MCQ Examination. It is the same questions as in the AMC Handbook of Multiple Choice Questions, so it won’t be new study material, but it is important that you know how to use the AMC Part 1 CAT MCQ Examination and are comfortable with it when you sit the AMC Part 1 CAT MCQ Examination. You don’t want to waste important time during your 3 hours learning to use it.

    What to Do About Not Reading And Understanding The Question Properly?

    This is a common problem. There are two techniques to overcome this.

    The first is you have to acknowledge the importance of the nonmedical.

    Each question in the AMC Part 1 CAT MCQ Examination has taken hours of labour by several examiners to write before being tested and reviewed by other examiners and then tried in the AMC Part 1 CAT MCQ Examination, 30 non scored pilot questions.

    Every single word in the question is important. So if the question mentions things like clothes or patient’s concerns or similar nonmedical information, do not ignore this as it could be the clue to the answer and of course, this also applies to the annoying words like not and except that change what the question is asking.

    This is also why practising amateur recall questions is often a bad idea. As generally, they do not capture these sorts of nuances.

    The second technique that will assist you in your AMC Part 1 CAT MCQ Examination preparation is to try to think like the examiners.

    Have you ever heard the saying ‘to catch a criminal you must think like a criminal?. Well, this is similar, to successfully take the AMC Part 1 CAT MCQ Examination you must think like an examiner. If you understand how to write an AMC Part 1 CAT MCQ Examination question you will understand how to read one.

    Most examiners use ‘Constructing Written Test Questions For the Basic and Clinical Sciences’ or similar to guide them on writing questions.

    Chapter 4 will give you templates and detailed instructions on how to write a question. You will find if you write your questions for each topic you study it will also help you remember the details you are studying. This is also great to do with a study partner, located anywhere. Choose a topic to study, write a set number of questions each e.g. 5 or 10, and then email the questions to each other to attempt.

    What to Do About Not Knowing How to Navigate Through the Answers?

    You will find some great techniques to use for this in ‘Mastering Multiple Choice’ from page 53 onwards.

    What to Do About Thinking At Too High Level?

    Most doctors who sit the AMC Part 1 CAT MCQ Examination are already medical professionals in their own right. They have usually studied medicine for more than 8 years, have been working in a clinical environment for several years, and have often begun studying and working in a specialist environment. So by the time you sit the AMC Part 1 CAT MCQ Examination your medical knowledge is quite high and developed. So you need to make sure you bring it back down to an undergraduate level. Commonly, people sitting the AMC Part 1 CAT MCQ Examination do the worst in their area of specialty because they are thinking at too complex a level.

    What to Do About Not Understanding Australian Medical And Social Culture?

    There are several ways you can gain knowledge about this. If you are in Australia, get out into the community. Talk to people on the street, watch Australian TV dramas like Neighbours and Home and Away and join a hobby club or group. It might sound like a waste of time but the information you learn from an Australian about the culture you can not find in a book.

    Use Google to locate things near you that might interest you. Council community centres are a great place to start because they are usually close to where you live and their classes/activates are free or cheap e.g. $5. You can also use online resources such as newspapers like The Advertiser or The Age, a Google Australian newspaper to get an understanding of the type of things that are important in Australia, you can also see what local medical stories are included. Some online medical resources include RACGP AFP (this is free in Australia, but you may have to pay if you are overseas) and Better Health Victoria. These can be used as support for your main study material.

    Summary

    1. I would recommend you study from a textbook first. John Murtagh’s General Practice is the most suited.
    2. After finishing the textbook, revise all the notes you took thoroughly.
    3. Then move on to the AMC handbooks, there are 2. The handbook of MCQ and the annotated MCQ. Take notes of the questions. Read the explanations carefully. Be sure to know why the correct option is correct, and why the other options are not.
    4. After finishing both handbooks, revise all the notes you took thoroughly.
    5. Now it’s time for the question banks. Use the same approach for the question banks, carefully reading the explanations, and taking notes.
    6. After finishing both question banks, revise all the notes you took thoroughly 
    7. By now you’ve studied the textbook thoroughly, solved all the questions, and revised them 3 times along the way.
    8. Be sure to check the growth milestones, school exclusion guidelines for communicable diseases in children, cancer screening guidelines, and the immunization guidelines. Always follow the latest guidelines on RACGP and Better Health Victoria websites.
    9. Be sure to know common ECG rhythms and important XRAY presentations, for example, Pneumonia, TB, or Sarcoidosis.
    10. Revise all the notes you took thoroughly again. The key is always revising after finishing a step so the information stays fresh.

    Although the AMC Part 1 CAT MCQ Examination is a difficult Examination, with diligent and focused work, it is possible to be prepared and confident on AMC Part 1 CAT MCQ Examination day.

  • Australian Medical Council Exam: How Hard? Preparing for AMC Exam.

    Australian Medical Council Exam: How Hard? Preparing for AMC Exam.

    This Post is Part of a Series on All You need to know about the Medical Career Pathway in Australia.

    If you search enough on Google and look enough on facebook you will readily find lots of opinions about the Australian Medical Council examinations process. Given that a lot of the readers of this blog are international doctors we wanted to present you with some factual information about the AMC exams. So we have engaged some real doctors who are currently going through or have been through the process.

    In relation to the question about how hard the Australian Medical Council Exam is. The answer to this obviously depends on a range of factors, including how much time you put into preparing for the exam and how close your own medical school training is to the Australian context. There are actually two separate exams to complete the AMC. A Part 1 Multiple Choice Exam and a Part 2 Clinical Exam. According to the latest report from the AMC in one year, there were 2663 AMC MCQ (Part 1 Exams) sat with 1,559 candidates passing. That’s a pass rate of about 58%. For the AMC Clinical Exam 597 candidates passed out of 2,165 candidates assessed. That’s less than a 28% pass rate. So we would say that the first part of the AMC exam is fairly hard and the second part is extremely hard.

    Read on to find out more about the process of the AMC Exam, including how best to prepare.

    Eligibility Requirements for the Australian Medical Council Exam

    In order to be able to sit for the AMC Exams you must first establish what is called a portfolio

    how to establish a portfolio for the Australian Medical Council Exam
    1. You first create a registration with the AMC website.
    2. You should also check that your medical degree is awarded by an institution recognized by the AMC. The AMC recognizes most but not all medical schools which are listed with the World Directory of Medical Schools. There is a handy search on the AMC site.
    3. You must then also create an EPIC account and confirm your identity with the ECFMG (located in the United States).
    4. You get an EPIC id in about 3 working days, which you use to establish your AMC portfolio.
    5. You upload your qualifications to EPIC. As you do so YOU MUST REQUEST that EPIC send a report to the AMC.
    6. EPIC notifies you and the AMC when they have completed their check.

    This whole process will cost you $500 AUD to register with the AMC and about $205 USD for EPIC (more if you are wanting more than one qualification verified).

    Once EPIC reports back in the affirmative to the AMC you will be allowed to request to sit for the AMC Part 1 Examinations.

    There is no actual work experience requirement to sit the AMC Part 1 Examination and you can, in fact, start preparing for this whenever you like. But of course, you will not be able to sit the exam without a verified medical degree. So you can start studying for it in medical school but won’t be able to sit it till after you graduate.

    The Part 1 MCQ Examination

    The AMC Computer Adaptive Test (CAT) MCQ Examination is a computer-administered fully integrated multi-choice question examination delivered in one sitting that lasts 3 and a half hours.

    There are regular invigilated examinations in Australia as well as a number of sessions available in examination across the world.

    The examination itself consists of 150 “A-type MCQs”. You must select the one correct response from amongst five options. 120 of the questions are “live” questions, which mean they count towards your score. The remaining 30 questions are being piloted and don’t count towards your final score. You do not know which questions are being piloted so you have to give your best for all 150.

    You are expected to complete all 150 items and must complete the 120 scored items. Failure to complete all 120 scored items in the examination may lead to insufficient information for a reliable determination of your ability and therefore a result on the AMC adaptive scale.

    According to the AMC the MCQ Examination

    focuses on basic and applied medical knowledge across a wide range of topics and disciplines, involving understanding of the disease process, clinical examination, diagnosis, investigation, therapy and management, as well as on the candidate’s ability to exercise discrimination, judgment and reasoning in distinguishing between the correct diagnosis and plausible alternatives.

    AMC MCQ Examination Booklet

    So the questions are a mix of more basic knowledge as well as clinically focused. The standard is set at the level of a newly qualified graduate of Australian medical schools, who is about to commence intern training.

    The content is “blueprinted” according to patient groups as follows:

    Adult Health (Medicine)Adult Health (Surgery)Women’s Health (Obs) (Gyn)Child HealthMental HealthPopulation HealthTOTAL
    352515151515120

    There are many different books you can study to pass the exam but there is no right or wrong answer to which book needs to be studied. The AMC has a long list of books and other sources that they recommend for the examination some of which can only be bought in the AMC bookstore.

    You may read all the books in this world and still fail or you may read just one book and pass the exam. Many candidates are currently preferring to study John Murtagh’s General Practice book. Along with this it is important to be practising examination questions. So you really should study the Handbook of Multiple Choice Questions with explanations and try to do as many past papers as possible.

    Some candidates still prefer to do Kaplan USMLE Step 2 lecture notes in place of John Murtagh. The advantage of Murtagh over Kaplan notes is that Murtagh can be studied for the clinical exam also.

    You should practice as many MCQs as you can. There is also an official online practice exam through the AMC website.

    Strict Rules For the MCQ Examination

    Sitting the AMC Exam involves first registering to do the exam with the AMC and then paying the required fee. You then must register with the exam centre vendor which is currently Pearson-Vue. You have a 12-month authorisation period to select an exam. You can change your exam venue within a limited period of time but once you are locked in it is difficult to alter your date and time.

    You need to bring appropriate identification with you on the day.

    There are strict rules for the MCQ exam which you must abide by. You should read all the official instructions carefully. You are not allowed to bring tissues (e.g. Kleenex), paper of any kind, pens/pencils, or rulers. Your mobile phone must be switched off and placed in an allocated area of the room. Bags are also placed in the allocated area of the room. Food and drinks are not allowed in the computer examination room.

    They provide you with a whiteboard and pen for making notes. The whiteboard is collected by examination supervisors at the completion of the examination.

    Family members are not allowed to wait in the examination venue. They must wait outside the building of the examination venue.

    Because the MCQ exam is computerized you will receive your result fairly quickly in about 4 weeks. You get a print out which indicates where you performed overall, as well as the range for all candidates appearing for that particular exam. You also get a breakdown of your performance in the question domains. This is useful if you don’t pass to know where to put your efforts next time.

    You need to score 250 or more to pass. Less than 60% of candidates pass. Although this score is probably depressed somewhat by those candidates sitting more than once.

    It currently costs $2,720 to sit for the MCQ.

    The AMC Clinical Examination Part 2

    Once you pass AMC MCQ exam, you are then able to appear for the AMC Clinical exam. These are all held in Melbourne at the AMC’s purpose built examination centre.

    Clinical Exam Format

    The Clinical exam format is a 20-station multidisciplinary structured clinical exam which assesses your skills in Medicine, Surgery, Gynecology and Obstetrics, Pediatrics, and Psychiatry. There are 14 scored stations, 2 pilot (non-scored) stations and 4 rest (non-scored) stations.

    As of 2019 the result is graded as either clear pass or clear fail. Prior to this borderline candidates were offered a retest. However, the AMC found that the time between examination and retest was becoming so long that the results were not meaningful.

    You must pass 10 or more of the stations to pass the exam. The pass rate is incredibly low. About 28%

    It is recommended that you should study the Handbook of Clinical Assessment and practice roleplays as much as you can. You may want to attend a course. Candidates also study different notes such as Karen notes, and the VMPF notes. John Murtagh’s General Practice is also worth revising.

    It is extremely wise to form a study group and there are many groups around where you can practice what is called “recalls”, which is when a candidate who has previously sat the exam attempts to reconstruct the station.

    The cost of sitting the Clinical Examination is currently $3,530.

    Frequently Asked Questions

    Question: What If the AMC does not recognize my medical school?

    Answer: It is possible that your school is new or has not been considered by the AMC. Check first that it is on the World Directory of Medical Schools. You can enquire of the AMC if they will accept your school but there is no guarantee.

    Question: How often can I sit the MCQ exam?

    Answer: As many times as you want. But given its cost, most people try to only sit it once. Like most other exams your chances of passing are best the first time and diminish over time.

    Question: How often can I sit the Clinical exam?

    Answer: You can sit as many times as you want but there has often been a backlog so the AMC over the years has tended to prioritize newer candidates. Again it costs a lot of money to sit this exam and your chances of passing diminish as you repeat the exercise.

    Question: Do you need to clear one of the English language tests, such as IELTS or OET to sit for the AMC MCQ Part 1?

    Answer: No. It might be wise to put this off till after you have passed the MCQ Part 1 as there is a time limit over which the result can be accepted.

    Question: Do you need to have cleared the English language requirements, such as evidence of comparability or the IELTS or OET to apply for an internship and a work visa?

    Answer: Yes, you definitely do. Unless you can prove your English language proficiency in other ways, which is normally difficult for most IMGs.

    Question: How high should you score in your English test?

    Answer: From a regulatory point of view an overall band score of 7.0. with a minimum of 7.0 in each component is required for the IELTS. Similarly, for the OET, an overall score of B and a minimum of score B in all four components is required. However, many employers will look at these results and look for candidates with even better scores than the minimum.

    Question: Do you need to clear the AMC Clinical Exam Part 2 to apply for a position?

    Answer: No you don’t. But if you get a position prior to completing your Part 2, you will have to clear it as part of your provisional registration before you can apply for general registration. Generally speaking candidates with both AMC Part 1 and 2 are preferred by employers. over just Part 1.

    Question: Are their alternatives to the AMC Exam process?

    Answer: For an IMG coming through the Standard Pathway there is no alternative to sitting the MCQ.

    If you don’t wish to come through the Standard Pathway then your only other options are to try to gain full registration in one of the other competent authority pathway countries first, for e.g. completed the PLAB in the UK. But if your ultimate goal is to work in Australia then this is really delaying things.

    In relation to the clinical examinations, you may be eligible to undertake a workplace-based assessment as an alternative to the AMC Clinical Examination if you are able to gain a position at one of the 10 services which are authorised by the AMC to conduct a workplace-based assessment for the AMC Certificate.

    Services which offer Workplace Based Assessment

    Program providerLocation
    Central Coast
    Local Health District    		Gosford and Wyong,
    New South Wales
    Flinders Rural Health SAMount Gambier Hospital,
    South Australia
    Hunter New England Local Health DistrictNewcastle, Armidale and Tamworth,
    New South Wales
    Illawarra Shoalhaven Local Health DistrictISLHD Hospitals,
    New South Wales
    Launceston General HospitalLaunceston General Hospital;
    North West Regional Hospital,
    Burnie; and Royal Hobart Hospital,
    Tasmania
    Mid North Coast Local Health DistrictKempsey District Hospital (with some support from Port Macquarie Base Hospital), New South Wales
    Monash HealthVictoria
    Rural and Outer Metropolitan United Alliance (ROMUA)Goulburn Valley Health, Shepparton,
    Victoria
    WA Country Health ServiceBunbury, Geraldton and Kalgoorlie,
    Western Australia
    Wide Bay Hospital and Health ServiceHervey Bay and Maryborough Hospitals,
    Queensland
    South West Sydney Local Health DistrictCampbelltown Hospital
    C/- AMC updated Oct 2021

    Useful Resources:

    Australian Medical Council Website

    AMC MCQ Guide

    AMC Clinical Examination Guide