How to prepare for FRCPath Microbiology part 1

What is the FRCPath examination?

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

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

How many parts are there in the FRCPath Microbiology?

Two, part 1 and part 2.

Who can take FRCPath Part 1?
Am I eligible to enter the FRCPath Part 1 exam?

As per RCPath,

“Medically qualified candidates are required to have trained in a recognised Regional Specialist Training Programme in microbiology or virology for a period of normally not less than 12 months.

Non-medically qualified candidates are required to have trained in a recognised training programme in microbiology for a period of normally not less than 12 months. In addition, they must be state registered or the equivalent of state registered in another country.”

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

If you are an overseas graduate:

If you have been in an MD microbiology programme for more than one year, you are eligible.

What if you have been in a programme that is not a typical medical microbiology training programme, like a PhD or DNB? It is difficult for anyone to answer unless they have been in your position. I believe RCPath would accept if it is a recognised academic programme on microbiology, but you must ask your seniors in the programme. Also, ask on Facebook and WhatsApp group, but weigh the information obtained on the internet carefully. RCPath will not answer your question on this subject but they will refund your money if they think you are not eligible.
So you may want to apply and see.

How do I apply for FRCPath Microbiology part 1?

RCPath conducts the FRCPath examination. You can apply through the RCPath website. See this link below. You may also find information about the fees here.

https://www.rcpath.org/trainees/examinations/exam-apply-and-pay-online.html


Now a little more information about CICE and FRCPath part 1

FRCPath Microbiology part 1

  • The examination is held twice yearly – spring and autumn

  • This examination is open to doctors (Medical route) or clinical scientists specialising in microbiology (Science route).

  • Medically qualified candidates are required to have trained in a recognised Regional Specialist Training Programme in microbiology or virology for normally not less than 12 months.

  • Non-medically qualified candidates are required to have trained in a recognised training programme in microbiology for normally not less than 12 months. Also, they must be state registered or the equivalent of state registered in another country.

  • Single three-hour paper; 125 MCQ ( note: RCPath also says that extended-matching questions could be there – see this page).

  • The pass mark is set by the Panel of Examiners using an objective procedure (individual question review to create minimum standard).

Combined Infection Certificate Examination (CICE)

  • This exam is offered twice yearly – in the Spring and Autumn.

  • Candidates are expected to have trained in a recognised Regional Specialist Training Programme in Combined Infection for a period of normally not less than 12 months.

  • The examination comprises two papers, each comprising 100 Single Best Answer (SBA) questions, i.e. MCQ.

  • The curriculum is the core knowledge in Medical Microbiology, Virology and Infectious Diseases.

  • The pass mark is set by an independently-chaired standard-setting group where individual questions are reviewed to create a minimum standard using a modified Angoff process.



How long would I need to prepare for FRCPath Microbiology?

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

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

Is there any Curriculum/syllabus for FRCPath Microbiology?

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

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

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

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

Who can be my sponsor?

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

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

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

Is there any course for this examination?

There are not many courses available.

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

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

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

Is there any more information that I should know?

Will FRCPath help me to get a consultant job in the UK?

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

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

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

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

FRCPath microbiology books. Which books you may read?

Oxford Handbook of Microbiology and Infectious Diseases is a must-read for this examination, but it is not the only book that could help you. Please see this page for a list of books that I and many other trainees find useful.

FRCPath Microbiology resources: What guidelines should I read for FRCPath Microbiology?

The guidelines are one of the essential materials for this exam. This is a British examination, so you should try to follow UK guidelines where available. You may use European or US guidelines, especially where British guidelines are not available. If you have been working in the UK, you can pick up the difference between local and US or European practice. If you are an overseas candidate, you must be careful about these differences.

You can check this post to find out what online resources you can use. Some websites may have many other guidelines not relevant to infection (e.g. RCOG website). You may skip them. Collect the guidelines and put them in your exam file.

FRCPath Microbiology questions: Where can you find questions to practice for FRCPath Microbiology?

RCPath does not allow storing the exam questions in any format. So it is unlikely that you will find any official question bank. However, you can find sample papers here.

There are many other resources where you can find questions to practice. Check this post.


How to prepare for the examination - general tips

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

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

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

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

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

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

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

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

What journals I should read for FRCPath Microbiology?

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

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

Antibiotics and Vaccines

You must read all the antibiotics being used in the UK. The best place to find them is BNF.

If you are struggling to access the names of the antibiotics – you can find a list made for you here. Make a copy for yourself; it is free to use.

You may get question-based on these antibiotics. Make a list of these antibiotics and read about them –

  • nature,

  • mechanism of action,

  • mechanism of resistance,

  • genetic basis of the mechanism of action/resistance,

  • clinically relevant PK/PD,

  • unique adverse effects (e.g. eosinophilic pneumonia from daptomycin)

  • unique characteristics of antibiotics etc.

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

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

Laboratory aspects of microbiology

UKHSA SMI is the national standard for UK laboratories. The SMIs are also good to read for theoretical knowledge that you may struggle to find otherwise. You may not need to read the whole SMI. Mark the important areas and keep a marked copy in your file (or make a note). For an example –

You can find some SMI summaries that I made on this page.


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

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

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

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

Infection control

Infection control is an important area for UK microbiology.

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

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

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

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

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

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

  • Typing and its role,

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

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

  • Theatre ventilation,

  • CJD related issues,

  • Sharps/needlestick injury,

  • COVID-19 related infection control measures etc

Learn from others’ experiences: Posts written by people who have taken the FRCPath examination

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