Source: RCPath website
From Autumn 2017 onwards, the format of the FRCPath Part 2 Medical Microbiology examination has changed. The changes, which have been approved by the General Medical Council, are designed to make the exam more accurately reflect the role of the consultant microbiologist in modern NHS practice; to be in line with new, revised curricula in Medical Microbiology specialty training; and to strengthen the reliability of the examination.
The new-format examination will last two days and be structured as follows:
Structured essay paper and Short-Answer Questions (SAQs): 2 ½ hours
1 essay (from a choice of 2) followed by 10 SAQs.
SAQs to be based on clinical and laboratory scenarios and to include:
- Data interpretation
- Report validation
- Laboratory management, including quality assurance, laboratory error/incidents, lab safety
- Clinical investigation and management
- Infection prevention and control
- Anti-microbial stewardship
Critical Appraisal Paper and SAQs: 2 ½ hours
1 journal article to critically appraise (from a choice of 2) followed by 10 SAQs (as described above).
Practical Scenarios: 3 ½ hours
- A series of images, data and other laboratory-based material will be presented with clinical scenarios for which candidates provide interpretation and construct management plans.
- Clinical scenarios and laboratory material evolve with additional information during the exam to simulate day-to-day clinical practice
Objective Structured Practical Examination (OSPE): 3 hours
At least 15 stations.
These are some scenario’s that we encounter in our day to day practice. You can practice these as a part of your preparation. I suggest you should also read the associated topics. For example, if you are preparing the answer for HBV, read about HCV, HIV as well. Most of these problems can be answered from relevant UK guidelines.
- Management of a child found with scratch marks on his face in the morning. A bat was found in the same room in the morning. What should be the management?
- A lady had a normal delivery. Some herpetic lesions were noted in the perineal region during delivery. What would you advice to the clinicians regarding the management of mother and baby.
- 16 weeks pregnant school teacher had contact with a boy in her class with suspected Parvovirus B19 infection. What would you advice to the clinicians? What test would you perform?
- 20 weeks pregnant lady had a tick bite. The GP is asking you for advice.
- 28 weeks Pregnant lady had contact with chickenpox. What would you advise the clinicians? What additional information would you need to make a decision?
If this lady was 39 weeks pregnant with an imminent delivery, what should be the management?
- 39 weeks pregnant lady with chicken pox presented to labour ward and she was in a bay with three other patients before the clinical team came to know about chicken pox. The consultant contacted you for advice immediately. What advice would you give?
- A baby born of hepatitis B positive mother (serological status unknown). Describe the tests you would do and management.
- A renal transplant patient presents with deteriorating renal function? What are the possibilities? What serology/molecular test you would consider? What should be the management?
- A pregnant lady presented to the midwife. Her son developed a rash the day before. What information would you ask for? What tests would you do? What advice would you give? Your laboratory informed you that there is no booking blood, what changes would you make in your management plan?
- A young boy presented to the A&E after having a needlestick injury from a discarded needle in a playground. This playground is in an area known to have problems with IV drug abusers. What should be your advice?
- A nurse presented with a needlestick injury. The source is an IV drug abuser, who refused test for blood borne virus. What advice would you give?
- A patient presented after a pub brawl. He suffered from a human bite on his face. What advice would you give?
- You have received a call from a doctor in accident and emergency. She has a patient, brought in by police, with a history of sexual assault. What advice would you give? What tests would be required? What precaution should be taken when a specimen being taken and being transferred to the laboratory and after that.
- How would you do the work up for renal transplant?
- An immunosuppressed patient presented with colitis. The gastroenterologist is asking for your advice. What investigations would you recommend?
He reported back to you after a couple of days that some inclusion bodies have been found in HE stain. What would be your management strategy?
- Patient presented with hepatic impairment. What virology tests would you recommend? Patient had a complaint of sore throat few days before this episode – what test would you ask for?
- GP is requesting a Zika virus test for a patient recently returned from Cuba. She is planning for a pregnancy. What other information you should ask to assess the case? What advice would you give?
- Your A&E consultant has called you out of hours that a suspected MERS-CoV patient is going to be admitted within the next hour. What would be your course of action?
- A GP is asking for your advice regarding investigation of chronic fatigue syndrome. What would be your advice? Explain.
- GP is investigating a patient with a possible history of tick bite. Your result C6 – reactive, Immunoblot IgG: P41, ospC reactive. IgM P41, ospC reactive. What would be your advice?
Please note these are not past papers. These questions are made by me based on the common issues in the NHS. These questions are intentionally not formatted like a proper long question you will find in the examination. These will however will give you an idea of the type of question you are likely to encounter in your part 2 FRCPath Microbiology.
- There is a plan for consolidation of pathology services in your region. Your hospital might lose its laboratory in the consolidation process. Please write a report to the trust board explaining its impact on the service you are providing to your users.
You are the clinical lead of the microbiology service of a large university hospital. Your hospital is due to become a hub in a consolidation process. Please write a report to the trust board how your laboratory is going to provide the expanded service. What are the challenges the laboratory might face? What support you might need from the trust management?
- Your hospital had a large number of C difficile cases last year. Please write a report on your plan for the next year. How you are planning to reduce the C difficile rate?
- You have been asked to deliver a cost improvement program to reduce the cost by 10% for Microbiology-virology service. Please write a report to trust board how you are going to provide a lean cost effective service without affecting the patient care.
- You have been approached to provide a result only service. Please write a report to the users about its merits/demerits.
- You have been notified of an error in the processing of the genitourinary medicine specimen over a week. The internal quality control was not properly monitored and it failed several occasions. A very junior member of staff was involved in monitoring of the process, who failed to recognise and report the problem. How are you going to investigate? Write a report for the board and a report to the users. What steps are you going to take to assure the users?
- Your surveillance has shown an increase in the number of VRE cases in renal unit. Write a letter to the renal consultants about the issue and any action that you might want to take. Explain about VRE and its implication.
- Your laboratory needs a system of screening for carbapenemase producing organisms. Discuss various options – their advantage and disadvantages.
- A GP surgery in your area has failed to meet the antibiotic prescribing reduction criteria (QP). They have asked you to deliver a lecture on how they can improve their antibiotic prescribing. Describe the points that you are going to discuss.
- Draft a 3 year antimicrobial stewardship strategy and action plan for your region – aiming towards community practice mainly.
- You have been asked to consider a proposal for providing more active support to the community/GP practice as a microbiologist. At present you only offer telephone based advice to the GPs and community practitioners (Like multiple sclerosis nurse). Suggest a plan how a community based microbiologist improve the service. Will it be a cost effective model? Or discuss the advantages and disadvantages of such a practice model.
- You have been asked to provide a plan to reduce the hospital acquired gram negative bacteraemia rate by 50% by 2020. Please discuss and draft a plan how are you going to achieve the target.
- You are the microbiologist in a large university hospital. The rate of Staphylococcus aureus prosthetic joint infection is higher than the national average in your hospital. The surgical site infection group has asked your opinion on the universal Staphylococcus screening programme as opposed to the targeted Staphylococcus screening programme. Please write a report with your recommendations.
- You are a microbiology consultant in a district general hospital. You have to provide a plan for developing a molecular service for your laboratory. Please outline your strategy for the next 5 year period. Please list what measure you would take to achieve quality control/accreditation.
- Your laboratory is due for a UKAS visit for ISO 15189. How are you going to prepare your laboratory for this visit.
- You are the clinical lead of the microbiology laboratory. Your laboratory is due for a renewal of the managed service contract. Please prepare a report how you envisage the microbiology and virology service to evolve over next 10 years.
- Your laboratory is using an old unix based LIMS, with limited technical support from the manufacturer. Please write a business case for a new LIMS.
- You are the infection control doctor of your hospital. You have received a report of a Legionella pneumonia in a patient who has been in hospital for 2 weeks. Please describe how you are going to investigate and manage this case.