My prep for the part 1 exam (FRCPath Microbiology)
drsuryabrata@gmail.comby Dr Saishruti Iyer (2021)
I decided to appear for FRCPath sometime last year when a senior recommended that it would be a good escalation step in my career. I had not decided firmly as to when I would appear for the exam, and then, around June 2021, I decided that I would write it in the spring session of 2022. I initially read random books; then went through the Microregistrar website and the RCPath website to understand about the exam. I started sincere studies from September onwards when I would study 2-3 hours a day and have a big break on the weekends. After January, I spent more time with the preparation. I spoke with a few seniors, followed some pages and did my preparation in the following way.
I have tried to summarise my experience while preparing and writing the exam. Hope it helps you.
Books
- Oxford textbook — Every topic, every line, even the tables – there were questions based on graphs, diagrams, e.g., Vancomycin trough levels, etc., DO NOT IGNORE ANY LINE.
- Tutorial topics in infection – Brush through this book. It is a very easy language, but some tables and questions at the end are very helpful. They help you learn how to approach a certain question.
- Oxford book on epidemiology of infectious diseases – chapters 3, 4, and 7. Only these chapters are to be read, but questions came word for word. Even a few graphs on the detection of outbreaks
- Orange book on MCQs– Try and solve this as many times as possible. It helps you save time during the exam on repeats as you are well-versed in the language.
Also, it helps you understand the examiner’s mindset as to what are the patterns of questions that could be asked.
- Mandell’s book of infectious diseases – I referred to this only for transplants and infections in the immunocompromised. But reading these topics helps you strengthen concepts on infections in the immunocompromised. Chapter 304, 305 (hardly 15 pages).
Guidelines
SMI
This is the most important guideline I felt all through the exam.
There were questions from in between the lines, e.g., the guidelines we might think are insignificant, e.g., infection in a prosthetic joint; there was one question from there on infection in sickle cell disease.
- SMI bacteria – read all thoroughly.
Last two are the ones on ESBL and Carbapenemase; read them along with EUCAST, and understand the concepts of ESBL, AmpC, and Carbapenemase well. Many questions are based on these. - SMI virus – the charts will save your time very efficiently during exams as these are asked as direct questions. Just learn them thoroughly.
- SMI lab Qc – only Q2 is important. And just from this one document, there were nearly 5-6 direct questions. They seem simple if you have read this bit. Simple questions and easy to answer.
BHIVA
- Read the guidelines on (read only the recommendation part that is the first 3-4 pages of every document) – PEP, PReP.
- HIV management – along with combinations to be used in co-infections and co-morbidities-for eg: HIV-Tb, HIV-Hep B, HIV preg, HIV-cardiovascular.
- This document will also help you understand the side effects of most drugs, so if you have read this and Oxford well, you need not worry about interactions and side-effects of HIV drugs separately.
- HIV in preg separate document
- HIV in TB separate document
- Learn the list of HIV defining illnesses from WHO. Direct questions were there.
- There is one document on management of opportunistic infections in HIV-just brush through this superficially to read what treatment and Px if any is needed.
Green book
- You can read this well to save time on guessing and thinking.
- They don’t ask for doses, routes, etc., so we can skip that, but be clear on your concepts on Px for various health conditions like VZV in the mother, Hep B in the mother, or say, asplenia.
- Read well PEP in contacts, which type of vaccine to give when; eg: there was a question based on the use of the capsular vaccine for HIV.
- Travel related vaccines.
- The idea is simple broad and not very detailed preparation, the exam seems direct if you have covered the syllabus in totality. Good luck for your preparation.
EUCAST
- I read through the breakpoint guideline, expert guideline – only aminoglycoside part.
- The document on resistance detection for Carbapenamase and ESBL
- And the intrinsic and rare resistance types.
- There are direct questions based on penicillin resistance in Strep, AmpC, AmpC inducers , BLNAR in Haemophillus , flowchart for Carbapenamases.
- These are small documents but your concepts on resistance , interpretation etc helps you choose from options easily.
- NICE- there is a list on microregistrars.com for the important NICE documents, I downloaded them and just scrolled through them again and again , as I felt these were the most volatile and different from what we practice here in india.
NICE
- TB documents are important, especially for diagnosis, infection control measures, and treatment.
- Read the PHE/NICE document on hepatitis – direct questions (reading these clears your concepts and helps a lot during exams. These are not huge documents if you make notes or highlight them in your first read well).
- I did not learn the doses for any drug, only the duration for some important diseases, including second-line or IV options.
- Also, see when to start antibiotics. It helps you answer clearly questions like “NO treatment needed.”
RIDDOR for Brucella
- This is just a flowchart, but there is a definite question on brucella I feel. A senior told of one asked in the previous exam as well and for ours too.
BSAC endocarditis
- Just mug this up well. When to test, what to start and when.
- When to stop antibiotics? Everything is a potential question.
PVL guidelines
- Should read this guideline.
Other lists and topics I felt were important
- Basic knowledge of mutations—e.g., types, how they happen. It gives you an insight and for some googlies that they put in, you can make intelligent guesses. e.g. on resistance types.
- Resistance to common viruses – eg ganciclovir in CMV , HSV to acyclovir, oseltamivir in H1N1 , HCV etc. not in details but just common genes or mechanisms. I just read these briefly and got an idea from simple pubmed articles
- MDR-TB drugs and resistance to INH and RIF. Just know the patterns, ADR of second line therapy, etc.
- List of Notifiable diseases
- Common travel-related infections, e.g., encephalitis or the VHFs, This helps you during revision. You can make one-page long notes that you can quickly scan through.
- Also, I felt that Streptococcus of every Lancefield group, including nutritionally variant ones, is important. At least 8-9 questions were there around Strep – identification, diseases, management, and sensitivity. Oxford is really good,. You can correlate this with SMI and other documents.
- Also, Px and malignancy associated with Strep bovis were common questions.
- BIA Learn Infection Questions are good to test your preparation level.
- Recent update on COVID I had read, but only one question in my paper.
The idea is to read broadly and not get too many details. Good luck to all of you.
Links
https://www.gov.uk/government/collections/standards-for-microbiology-investigations-smi
https://www.bhiva.org/guidelines
https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
https://www.nice.org.uk/guidance
