How to prepare for FRCPath Microbiology part 2

So what is different between part 1 and part 2? Let us check the purpose of these two examinations.

Part 1 is designed to assess the trainee’s knowledge and understanding of the scientific basis of medical microbiology, virology, and infectious diseases.

Part 2, on the other hand, tests the knowledge at a much deeper level. Whether the candidate can apply their knowledge appropriately and safely and practice as an unsupervised specialist in the speciality.

While part 1 looks for a breadth of knowledge, part 2 focuses on the depth of knowledge.

Medically qualified candidates must have passed the Part 1 examination and are required to have trained in a recognised regional HST programme, including CIT, in microbiology for a period of normally not less than two and a half years.

Non-medically qualified candidates must have passed the Part 1 examination and have at least four years’ experience in a laboratory recognised for higher specialist training

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

RCPath part 2 examination has gone through many changes – from a 4-day exam with wet practical to the current format of two papers – one being OSPE (Objective structured pathology examination).

Paper 1 (3 hours)

• 5 complex scenarios on microbiology and infection prevention and control – each having 7-10 sub-questions. The questions will be on infection control or clinical scenarios, which may have a laboratory result interpretation component.

• 10 short answer type questions (SAQ), each with 4-5 sub-questions. SAQs are based on the clinical scenario, lab practice, lab safety and infection control.

Paper 2 (3 hours)

• Objective Structured Pathology Examination (OSPE) – 15 stations (each lasting 9 minutes) + some rest stations. The topics will be clinical scenarios, laboratory practice, infection prevention, data interpretation, and research methods. At least two stations would be face to face to assess communication ability.

It is most likely that both the papers will be taken on a single day, but the sequence may change (i.e. paper two may come first).

The marks from both the papers would be combined, so it is possible to compensate if you get low marks on one paper and high marks on the other.

If you have read the specialty-specific guidelines carefully, you might be confused as RCPath still refers to the older format with essays in that document. It has been changed. There is no essay in the exam anymore.

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

(see – Part 2 >medical microbiology part 2 examination > FRCPath Part 2 Medical Microbiology exam changes)

Storing FRCPath papers is considered a copyright violation by RCPath, so the only official source of sample papers are RCPath website. You can find those papers here

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

• https://www.rcpath.org/uploads/assets/6b4240aa-94fc-4d9d-bb4817beb58eae70/Medical-Microbiology-Part-2-Paper-2-Sample.pdf

Where can I find more questions?

The curriculum for this exam is the RCPath curriculum.

The RCPath curriculum highlights what knowledge and skills a trainee needs to acquire to practice in the UK. I recommend treating this as a guide to ensure you have not left any areas mentioned in the curriculum unprepared. However, how much you need to read on each topic is not defined.

You can find the curriculum here –
https://www.rcpath.org/trainees/training/training-by-specialty/medical-microbiology.html

This 2014 curriculum is going to be replaced by the new curriculum –https://www.rcpath.org/trainees/training/training-by-specialty/medical-microbiology-2021.html

You can read the whole curriculum to gain an understanding, but you must look the Appendix 1: Syllabus (of the 2021 curriculum) to make your reading list.

This examination will test whether you can independently work as a consultant. So you have to acquire in-depth knowledge of each subject/subsection. Here is an example -

• What are the Vaccines available in the UK?

• Live and inactivated vaccines with examples.

• What affects the vaccine efficacy

• What vaccines would you/would you not give in special situations like pregnancy, immunocompromised state.

• Vaccination programme.

• How do you conduct the yearly influenza vaccination in the UK?

• What are the indications and contraindications of different vaccines?

• What would you do in an outbreak situation?

• Where do you give post-exposure prophylaxis? (different clinical scenarios and what intervention do you make) and so on.

Your focus must be to pick up the topics from the curriculum and think about the clinical/infection control scenarios that may arise from it. So as a part of the preparation, pick up the topics – write them down in your exam file, collect relevant materials, and think about what scenario you may encounter when you are practising in an NHS hospital.

This is a mock examination run by the Glenfield Hospital, University Hospitals of Leicester.

Medical Microbiology FRCPath Part 2 Mock examination

There could be local training programmes that are not advertised and not open to trainees of another region. You may need to speak to your training programme director.

You may find information about other courses by networking with other candidates. Join the WhatsApp and Facebook group. WhatsApp group is invitation only. request for an invitation on the FaceBook group.

This entirely depends on you. How much time would you be able to use every day to prepare for the examination?

Usually, 6 months to 1 year is a reasonable time to prepare for the examination.

The books for part 1 and part 2 are almost similar. However, you have to gain much more in-depth knowledge about any topic(s) that you are reading. Hence, textbooks are important.

FRCPath, is a British exam, hence, you will be asked about common problems in the UK, and you answer should be based on how we solve those problems in the UK. This is especially important for overseas trainees. However, UK trainees also pay attention to the difference between the UK, US and European microbiology practices.

I suggest using oxford handbook and a standard textbook as your base.

Make notes on the margin of your textbook, use OneNote, or make handwritten notes. You must be able to go through all the reading materials in a few days just before the examination. You should gather information from various sources - textbook, reference book, guideline, lectures, decision support tools and consolidate this knowledge in one place.

Consider this: Staph aureus, related infections, treatment, infection control, guidelines, lab issues, resistance patterns, etc., should not take more than 5-10 minutes to revise in the week before the exam.

• Oxford Handbook of Infectious Diseases and Microbiology - is a must read.

• Comprehensive Review of Infectious Diseases by Andrej Spec - one of our trainees found it helpful.

• Medical Microbiology 9e Patrick Murray

• Mims’ Medical Microbiology and Immunology, 6e

• Jawetz Melnick & Adelbergs Medical Microbiology 28 E

• Medical Microbiology: A Guide to Microbial Infections: Pathogenesis, Immunity, Laboratory Investigation and Control, 19e

• Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases

• Kucers’ The Use of Antibiotics

• Identification of Pathogenic Fungi

During my examination, I used Cowan and Steel as reference to cross-check the properties of bacteria. However, my exam was an old-style wet practical. In my opinion, you do not need this book, but you may use it if you want to cross-check the identification or tests for bacteria. It is an expensive book; you may find a copy in your lab.

We use various decision support tools in our day-to-day practice. I believe UpToDate is the most commonly used decision support. Other tools are BMJ Best Practice, Sanford Guidel, Johns Hopkins Guides, etc. Beware that many, if not all, of these are US-based. So you must be careful about the difference in practice.

You must have read some infection control books for part 1 and may have read one on statistics. If you have, those books should be sufficient. There is plenty of information on various websites. You should be able to supplement your knowledge from these sites.

Recommended books are

• Damani for infection control

• A book of your choice for statistics (please do not ignore medical statistics)

The same list of guidelines that you used for part 1 is important here. Make notes and link them with your bacteria, virus or infection notes. Here is a list that can help you. Add any other guideline that you found important/useful.

When I was preparing for my examination, my consultant told me to read these three journals.

• The Journal of Antimicrobial Chemotherapy (JAC)

• The Journal of Hospital Infection (JoHI)

• Journal of Infection (JOI)

Go back 1 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 on 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 UKHSA and should help you keep yourself up to date.

https://www.gov.uk/government/collections/health-protection-report-latest-infection-reports

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

https://bnf.nice.org.uk/ or https://bnfc.nice.org.uk/

Here is a list of antibiotics from BNF. You can make a copy and use it to make your notes.

You may want to learn –

• 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.

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

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

The questions will have a clinical scenario with laboratory result interpretation and laboratory result-related problems in the new format. You will also be asked to solve problems that we may encounter in the laboratory like a failed Bowie-dick test, laboratory error, spillage, exposure of staff to a potentially dangerous pathogen, and error in sensitivity patterns.

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.
Specimen processing – We follow National SMI or its local modifications.
Susceptibility test – We follow EUCAST.

Infection control is an important area. If you are a UK trainee, you must have worked with your infection control team. Attending the regular handover/catch-up meetings, outbreak control meetings, taking infection control calls, and participating in an SUI would help you understand the infection control issues in your hospital. Arrange a visit to the Sterile Processing Department (SPD)/Central Sterile Services Department (CSSD) and attend a few decontamination meetings. Attend a few ventilation and water safety group meetings. You may find that there is a nominated microbiologist for all these groups.

If you are an international medical graduate – you may or may not have the opportunity to attend all these meetings. Still, I believe you can more or less make up for it by diligently reading the relevant guidelines. You may need a little guidance – I recommend using the Facebook group to clear your doubts.

It would be best if you had 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.

I think 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.

Health technical memoranda – https://www.gov.uk/government/collections/health-technical-memorandum-disinfection-and-sterilization

DH health building notes – https://www.gov.uk/government/collections/health-building-notes-core-elements

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 it’s 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

• Make a study group. Keep it small 2-4. You will be able to cover more topics if you divide it between yourself. One person can do the first reading, give you a brief and then you can read it to get a better understanding. Practice questions together. Your study partner may pick up points that you may have missed. Use WhatsApp or the Facebook group to find a study partner if you don’t have one.

• Do a gap analysis as early as possible. Write down all the topics you may have to read through the curriculum. Use a traffic light system. You are confident about the topic- mark it green. You do not know anything – red. You may need to read more – amber.

• This is a huge exam; unless you are systematic, you are highly likely to miss something. It is extremely important that you make your reading list first. Go through the curriculum, speak to other candidates, your seniors, your consultants and make a reading list. This is perhaps the MOST important step in your preparation.

• Make an exam folder – collect all your materials in a filing system from where they are easily retrievable. Time is important. You may not want to look for something you have already searched for once. You should be able to make you last revision within a week. It is only possible if you make your reading list and your own notes. You may not want to read a 70 page guideline again a day before the exam, just because you did not make notes/highlighted the relevant points when you first read it.

• Google image search – whenever you are reading something, use image search to find out how it looks (if relevant, for example, a rash or a sinus in a prosthetic joint). You may retain the knowledge better.

Sleep well the night before the exam.

Make sure you take all your communication with Royal College and your ID.