Preparing for FRCPath part 1 (Microbiology)

Preparing for a professional exam is a long-haul process, taking several months. As such, normal life needs to continue in the meantime – paid employment, on calls, shopping, cooking, exercise, childcare – and you need to figure out how to stay sane whilst trying to accomplish it all without feeling guilty about not spending every minute of the day revising.

Plan your study leave in advance, and take advantage of the days you’re allowed to take. If your rota organiser is sympathetic, ask them to avoid putting you on call for the few weeks leading up to the exam, especially intensive weekends. Even if you get compensatory rest after an on-call, you may find yourself too tired to do effective revision, in which case it may be a better use of your time to do something else instead.

I recommend setting up a working environment that allows you to concentrate with minimal distractions and be disciplined about your work time: no TV, no music, no phone. Plan your study time with one evening off per week. Two or three hours on a weeknight and five hours a day at the weekend is a plenty gruelling enough schedule for anyone!

Keep some element of a social life if you would go mad without it – if you know someone preparing for the exam at the same time, have a go at seeing if you work well together to cement what you’re learning and help fill in each other’s knowledge gaps.

I find a kitchen timer really useful – I set it for an hour of work, with 15-minute breaks between where I go to a different room and do a completely different activity (i.e. don’t just stay at your desk and browse the internet). I often play the piano during my breaks. When you’re working, WORK – effective, targeted revision according to your learning style.

Before you start, look through the curriculum and identify gaps in your knowledge. Some things will be very familiar to you because you come across them every day at work – don’t spend too much time on those topics, but concentrate on less familiar subjects. Keep an updated list as you go along – it’s satisfying to cross things off, and as you do past questions, you will identify new areas to study. This will also help when it comes to deciding what might fit into the last 40 minutes of revision before you call it a day. Sometimes it’s worth going back to the basics first to ensure that your knowledge is well-grounded and you understand all the jargon.

I also kept a list of how much time I spent on revision activities each day, so I could look back with satisfaction and see what I had achieved.

Try and keep your revision activities varied to help the information go in. Use different resources – textbooks, websites, notes and slides from courses, notes from seniors, past questions, flashcards.

As the exam is structured as multiple-choice questions, you will be faced with a big list of similar diseases, organisms, tests, etc. – and have to choose the one that fits the question stem. Bear this in mind when revising and keep notes of commonly occurring themes. Keep some categorised notes (Bacteriology, Virology, Parasitology, Mycology, and Infection Control) of these themes, which become useful resources in themselves. For each item in a list, you should include one or several distinguishing features that may appear in a question stem.

For example, distinctive bacterial morphology:

• Actinomyces israelii – Gram-positive branching filaments

• Pasteurella multocida – small ovoid rod with bipolar staining

• Corynebacterium – Gram-positive rods, in V shapes like Chinese writing

• Haemophilus ducreyi – oval Gram-negative bacilli, like shoals of fish

• Clostridium tetani – Gram variable bacilli with a rounded end like a drumstick

Other useful themes that emerged for me include clinical features of organisms causing pneumonia, causes and clinical features of rashes, modes of action of antibiotics/antivirals/vaccinations/toxins, side-effects, half-lives, clinical and laboratory features of different Mycobacterial or Clostridium species, ingredients of specialised growth media, and animal vectors. There’s no use accumulating vast amounts of knowledge about a particular organism or disease if you can’t fit it in a useful box.

There is no shame in relying on your short-term memory for some easy marks – if your brain works like that anyway! I use flashcards and write things out to test myself, especially for topics that I am less familiar with as a Microbiologist (e.g. antiretrovirals and their modes of action).

For example, I learned this little schematic for the structures of viruses:

• ds DNA herpesE, adenoC, papilloma, polyoma, vacciniaL

• ss RNA

– senseE RSV, metapn, influenzaS, parainfluenza, measles, mumps, rabies

+ sense rhino, rubella, entero, Hep A and C

• ss DNA parvo

• ds RNA rotaS

• Retroviruses HIV, HTLV, Hep B

(E = enveloped, C = circular, L = linear, S = segmented)

Though not comprehensive, it makes questions like this a bit easier:

• Adenovirus

• Vaccinia virus

• Influenza virus

• Parvovirus

• Papovavirus

• Paramyxovirus

• Reovirus

1. Negative sense SS RNA virus with 8 segments

2. Circular double-stranded DNA virus

3. Linear double-stranded DNA virus

4. Double-stranded RNA virus

There was nothing in my exam about viral cell cultures, which aren’t really done routinely anyway, so don’t spend too much time on that (if any).

Greenwood’s Medical Microbiology and Kudesia and Wreghitt’s Clinical and Diagnostic Virology are good basic textbooks. Senanayake’s Clinical Cases in Infectious Diseases helps to put various infections into a relatable clinical and public health context; I suggest one chapter a night as bedtime reading. I was lent a couple of books of MCQs in Medical Microbiology and Infectious Diseases that were published in the 90s – if you’re using old resources, just be aware of how much progress has been made since and that some things may be very out of date!

Note - Kudesia and Wreghitt's virology has not be update for many years now, hence, it best be avoided. You can use Oxford handbook.

A few useful websites I used include the Centers for Disease Control and Prevention, Standards for Microbiology Investigations, and the Green Book.

There are a few past questions released by RCPath, but if you ask your seniors, you may be forwarded big vague lists of questions that people have remembered from previous sittings. Some are more useful than others and don’t often come with reliable answers. I suggest working through the questions as a closed book exercise first before using all your available resources to figure out what you think the answers should be. Then check with whatever ‘official’ answers you have available – which you may or may not agree with based on your research!

In the exam, take your time. Work through the questions, reading them carefully, marking the answer sheets with answers that you’re confident about first. Then go through the remaining questions again, taking a little more time to figure things out. If you’re not sure, make an intelligent guess – it’s not negatively marked. Keep an eye on the time.

Good luck!

Jo Lumb (passed first attempt, September 2014 – now trying to figure out what this Part 2 thing is all about!)