SCE in acute medicine - passed in the first attempt

I passed my SCE in acute medicine in the first attempt in November, 2022. 

PREPARATION 

Here is a link of materials I used:
Sample questions from here:
https://www.mrcpuk.org/mrcpuk-examinations/specialty-certificate-examinations/specialties/acute-medicine
https://www.mrcpuk.org/acute-medicine-sample-questions

Study PRN
https://www.studyprn.com/dashboard

Onaxamination 
https://www.onexamination.com/

Books:
Oxford handbook of acute medicine 
https://academic.oup.com/book/29868
ALS, resus UK manual ( which all ALS candidates get when they do their RESUS ALS course)
https://www.resus.org.uk/shop

Websites:
https://www.nice.org.uk/guidance
https://cks.nice.org.uk/
https://www.acutemedicine.org.uk/specialty-certificate-examination/
http://internalmedicineteaching.org/resources.html

Other links:
Society of acute medicine SCE webinar and course - free for SAM members 
https://www.acutemedicine.org.uk/
This was held in October, 2021 and October, 2022 - I was emailed a link to the session as I was a SAM member. 

TIMELINE:

1. I subscribed to the online pools ( study PRN, onexamination) in February, 2022 
2. I did the MRCP SCE sample questions here:
https://www.mrcpuk.org/acute-medicine-sample-questions and scored only 33% ! 
3. This showed that I needed to work a lot of motivated me to take this seriously 
4. I did at least 20 questions on a daily basis. I made notes and saved links on my laptop to look through later on. 
5. I downloaded the onexamination app on my phone and quizzed myself whenever possible
6. I had completed all pool questions by August.  
7. I went through the oxford handbook of acute medicine and focused on topics I was weak in. 

STUDYING WITH A CHILD(REN)

My daughter was 4 years old. She was going to preschool till August and that was three days a week from 0900 to 1415. Hence I made it a habit not to study when she was home. I studied from 1930 onwards when she was in bed. 
This gave me time to play with her and give her undivided attention and also allowed me to focus 100% on my exam without feeling guilty when she had fallen asleep. 
After August, she started school from 0845 to 1530 and this gave me more time when I was at home to study. But when she came, my books/phone/laptop were all hidden away and would come out when she went to bed at 1930. 
Hence I had limited hours - so I started early, in February. 
Some colleagues prefer to study with their children around - which is fine as long as you do focused preparation. For me, less hours per day, more days and high quality focused preparation helped me. 
For example, for my MRCP 2 prep, I did 4 to 6 months high intensity studying- with at least 4 hours ( no child at that time ) whereas for SCE, it was 10 months preparation with 2 hours per day and some days, I could not do any studying. 

HOW I STUDIED 

1. Did pool questions from one topic 
2. Made notes 
3. Studied the same topic from Oxford Handook of clinical medicine 
4. Went through NICE guidelines of the same topic as well. 

SPEED OF STUDYING 

I started very slow. My wife and I were binging on TV shows so initially, it was 1 hour of netflix, 30 min of studying and I slowlly increased my study time. By a few weeks, luckily we did not have any good shows to watch so I was studying around 2 to 3 hours a night. 

WORK 

Luckily, I was a supernumerary doctor in my rotations in my ST5 training - ICU, cardiology and infectious diseases. So, I was not part of the rota ( I was on the med reg on call rota). Hence, after doing the ward rounds with the team ( and using the SCE knowledge from the cardiology topics I had studied from) and doing cardiology clinics , I had some time at work to study as well. 
As it was not very taxing, I could study easily from 1 to 2 hours at work. 
So in a day, I would be able to give 4 to 5 hours to the SCE exam. 

ON CALLS 

I did not do a lot of studying during on calls as I like seeing unwell patients, clerking and helping the team instead of staying in a room studying, waiting for a bleep to see an unwell patient. This is my personality which not everyone understands and hence, I decided not to change my routine and continue giveing my 100% when I was on call. However, when there was no patient to see, I would do a few questions on my phone just to keep myself in the loop and not to break that rhythm. 
Nights were a bit easier as we had a full team and I got enough time to go through more questions when it was a bit relaxed as I am unable to sleep at work. 

CLINICAL RELEVANCE

The best thing about SCE is the clinical relevance. However there are some things which are practiced differently. For example ( please note this guideline could change) , a stable chest pain patient who has some risk factors seen in ambulatory care with normal troponins should have a CT angio as an outpatient. However due to long waiting lists, some trusts do stress ECHOs instead. Now, if you are doing a lot of clinics, it will become a reflex to choose stress ECHO instead of a CT angio and hence you will not score on this question. 
So I learnt that I should study the NICE guidance and made it a routine to go through the NICE guidelines of whatever case I was seeing- although I may not always be able to apply that. 

HOW THE SCE EXAM HELPED ME 

I remember doing a question about Hemichorea/Hemiballismus Associated with Hyperglycemia - and I actually saw such a case! 
Similarly, my knowledge of NICE guidelines and doing SCE pool questions helped me manage a few other patients I may have had to ask my consultant for assistance for. 
So, overall this exam preparation helped me become a better doctor, clinician and most importantly, gave me the confidence to work as an acute clinician. 

POOL BOOKS 

There are some very good books with questions , however they are mostly outdated. Hence, I did not study from any books when it came to parcticing pool questions. The questions asked in the test are based on the latest NICE guidance

            

ONLINE POOL QUESTIONS 

There is always an explanation - read that even if you get the questions correct. There is also a link of a journal topic on it/NICE guidance so read that as well. As the pool questions will not be repeated by you could be tested on a similar topic discussed in the explanation of the pool question you missed because you knew the answer to a question. 

                                  

EXAM BOOKING

This is through the RCP website and you can book an exam nearest to you. 
The exam centre is a second party provider - Pearson Vue 
I was lucky enough to get a slot in York, which is a 30 mile drive from where I live.
Remember to print out the admission document, keep your identity documents. 

BEFORE THE EXAM 

Find out where the exam is, book a hotel if it is a long drive. As my exam centre was just 50 min away, I just drove to it from home. 
I also checked nearby restaurants and could not find anything nearby ( there is an hours break between the 2 papers so there is not a lot of time) hence I decided to take my food with me. I had an insulated lunch box and ice packs so I kept a cold sandwich, a can of coke , crisps and druf fruit. 
I went through my notes a day before the exam and MRCP UK pool questions which I had done before. 

THE EXAM DAY

The exam hall was Pearson Vue - which is the centre for other tests, like the driving test so do not be surprised to see very young candidates - trust me, they will not be sitting for their SCE exams!
You will have your ID check, then will be given a locker. You are to put everything in it, including car keys and wallet. You cannot take anything in the exam. 
They have water, tissues, a wipe out board and a board marker in the test. 

It is all computer based - you can flag questions, go back and can recheck all your answers.

I was given a seperate room so that candidates who were there for other tests would not disturb me. 

THE QUESTIONS 

There are 2 papers - 100 questions in each, with an hours break in between the 2 papers. 
Each paper is 3 hours long so it is a 7 hours long test from start to finish! If you include the drive , for me it was 9 hours door to door. 
I will be very honest with you - they were not easy. But looking back, I did manage to answer at least 50% easily - this is what you should focus on. 
It is about the best option here , and some of the times it is an educated guess- but for 50% of the questions , you just answer immediately without doubting yourself 
These questions are based on NICE guidance, some pool questions ( especially the MRCP website ones) which you need to focus on. 
DO NOT bog yourself down with the questions you do not know. When I started my test, I did not the answer of questions 1 to 5 , so I made an educated best possible guess and moved on. 
I finished the test one hour before the end time so I went back and rechecked my answers - I made quite a few corrections, especially to the ones I was not sure about. 

I finished before time and once I was 100% sure, I clicked on submit. I was allowed to leave the room when the 3 hours were over ( so it is pointless to end the exam before the 3 hours are over). 
There is a time at the top end of the screen ( which you can hide) to remind you of the time. 
I went out, was informed that i have to report back at least 15 min before the next paper , so I essentially had 45 minutes. 
I quickly ate, came back in and started with paper 2. I was again able to have enough time to go through the questions and was done at 1700. 

SOME TIPS 

1. Start preparing for it early. 
2. Do not study when your kid(s) are awake - enjoy with them. 
3. Do a small amount everyday - persistence is key. But also remember that on some days, you will not be able to study at all ( like on a busy on call shift)
4. Not all clinical practice is 100% based on NICE guidance in the NHS - follow NICE guidelines for each topic. 
5. Not all NICE guidelines can be implemented at work - due to logistical reasons ( eg - CT angio vs stress ECHO for stable chest pain patients who need further investigations) 
6. Whenever you see a case at work, try to read the NICE guidelines for that topic 
7. Focus on pool questions - this will give you an idea of what preparation you need. 
8. You do not need a lot of books to study - I did not even study the Oxford Handbook from cover to cover, just the topics I had identified from my pool questions I was weak in. 
9. Take it seriously. I had done a mock exam in February, 2022 - 9 months before my exam by going through the sample questions here: 
https://www.mrcpuk.org/acute-medicine-sample-questions So I knew I need to up my game if I wanted to pass. 
10. The onexamination app is brilliant for studying on the go/on the loo. 
11. Focus on the questions you can answer correctly in the exam. Make an educated guess for the rest 
12. Avoid out of date books - like books published in 2015. Instead, focus on up to date online pool questions, NICE guidance. 
13. Working in the NHS does help - but even with it, you have to put in a lot of effort. It is not an easy exam and needs quite a lot of preparation.