One of the trickiest bit of the Royal College of Physicians’ DTM&H paper is the Preventive Medicine paper. This is a flat out written paper, which comprises of ten questions, each valued at 20 marks. The candidates have to answer five questions. There is only ONE hour time to answer this paper, which means, effectively, about 10 minutes to answer each question. There are likely to be multiple parts and sub-parts to each question, with marks break up given for each of them. Now, surprisingly, this is apparently one of the papers where the South Asia GHHM cohort has performed quite poorly. I am highlighting some of the techniques that have been discussed throughout the year, and which perhaps help in augmenting the score on this paper in this post.
1. Time Management
The biggest challenge for the preventive medicine paper is time management. Answering five questions, each of 20 marks, is no mean feat. It needs to be emphasized that no more than ten minutes should be dedicated to each of the questions. It is important to dedicate equal attention to each of the questions, especially since over-writing one, means it is taking time, and marks away from another.
For preparation, it needs to be kept in mind that we are no longer habituated to hand write answers, as we once did in our school or medical school days. Yes. This paper is handwritten, so of course, your handwriting will also matter. The examiners, despite being busy clinicians, are thoroughly engaged in trying to decipher the materials we put on paper, and the least we can do is to make their lives a little easier by writing a legible hand. One strategy that one of the moderators for this year suggested, and which worked well for him, was to write the answers leaving one-line gaps between each point. This would enable the writing to look less cluttered and more organized.
The best way to go about this is by starting to hand write answers from the very beginning of the GHHM course. The weekly activities, and the Short Answer Questions, both provide an option to hand write the responses. More on how to frame the answers in the next point.
2. Framing the Answers
Since time is of essence, the answers must be no bullsh*t stuff. Anyone who has gone to medical school in India, and has written Preventive Medicine exams, can attest to the fact that the marks scored by them is (in most institutions) directly proportional to the amount of writing they put down. I am an MD in Preventive Medicine myself, and though I had the great fortune of going for my Residency to a program which did not measure the weight of the answers in grams, but in content, yet, I must say, the approach of “fake it till you make it” is virtually universal in the Preventive Medicine exam world. If you think the same trick will work here, you’re in for trouble. So, some strategies on how to frame the ideal answer for the DTM&H examination:
- The answer has to go straight to the point.
- They must be written in bullet points.
- I went one sub-bullet point in, but I have been told to keep things simple, and not expand to more than one sub-level.
- The answer MUST address the specific query in the question. Some of our questions did not ask about the programmatic approaches to prevent and control a disease, but the evidence for their effectiveness. So, it is not about discussing the approaches, but actually talking about why the approaches work.
- The answers must be completed in ten minutes. For most people, that means about 1-1.5 pages of writing.
- There is no need to frame elaborate introductions and conclusions.
- Graphs or diagrams (for example, I drew the outline of a Cholera Treatment Center plan for a question) can be attempted, without spending too much time on them.
- I answered a couple of questions in tabular forms, reducing the load on writing stuff. I did not spend time drawing margins or lines, but just tried to keep the writing formatted to look like a table.
- Make sure that the answer that you are writing is properly numbered and ordered. The instructions might ask you to order the answers in the ascending order. I always make it a point to answer whatever questions I attempt in the ascending order anyway, so it was not a time issue for me.
- It is not clear whether you are allowed to use your own pens or the RCP will provide pens for you. We were told that the RCP will provide us with their pens for the preventive medicine paper, but at the last moment, we were told that is not the case, and we need our own pens. It was a mad scramble for many, and one should always be prepared for such eventualities prior to the exam.
- Use the Short Answer Questions and the Group Activity questions for writing practice. Time yourselves, and note down however much time it took for you to write the answer on the script.
- These answers can be scanned or clicked as a photo and uploaded to the respective group activities. I had created a Google Folder where all the study materials like these answers, journal articles, etc. could be dumped for reading later on.
3. What topics to prepare
The questions asked in the Preventive Medicine section are broadly application oriented. There are certain topics that need to be mugged up, but even for those, simply regurgitating rote learning content is not likely to be helpful. For example, a question on outbreaks is virtually guaranteed, in one form or another. However, instead of a “What are the steps of outbreak investigations?” type of brain dead question, it is likely to be more intricate. They might talk about an impending measles outbreak in a refugee resettlement. Or they might talk about floods in a tropical country, and preparedness to deal with outbreaks of water-borne diseases. Or they may state that you have been informed about an unusual number of cases of a known infectious disease, or even unusual presentation of a common/ uncommon/ emerging infectious disease.
The principles of answering remain the same, but in practice, one has to think and adapt their knowledge to suit the particular topic in the question.
Preparing for the Preventive Medicine paper requires a change from the usual approach we have adopted while dealing with our Community Medicine ordeals. We need to think practically, and insert materials combining our practical experience with theoretical knowledge, to make the answers well rounded and readable. At the same time, we need to practice hand writing answers so that the physical dexterity necessary for writing answers is maintained.
All images of Calvin and Hobbes are sourced from different Internet sites. I do not own anything. Copyright likely belongs to Bill Watterson. I am using them under the principles of fair use.