70. Part 2 FRCPath reflections and Desert Island Antibiotics

In this Episode, Callum reflect on his recent runaway success passing the FRCPath Part 2, passes on some tips and tricks for the exam, and then we talk about what 3 antibiotics we would take with us to a Desert Island (that has all pathogens and environments where you would find said pathogens, so not just a desert apparently).

'Prepping to Pass' episodes mentioned: 40, 42, 43 & 50.

The Table and Links mentioned in this episode can be found here: https://idiots.notion.site/70-Reflections-on-Part-2-2023-a193fd830c9b4d6c9381107471fcdbca

Transcript

Jame 0:20

Callum are you sitting down

Callum 0:23

you. more? Remain sitting down? I'm afraid the results are in, I'm afraid. You're positive. Part two, positive. That's right. I broke out the anecdote clason, just for this. I'll put it by later. So Callum has his part two. I never thought I'd see the day. Yeah, you just need to do yours now.

Jame 1:00

abSolutely not. I'm never going near that exam. I'd rather have the 1200 pounds. Thank you very much.

Callum 1:05

There's more.

Jame 1:06

this is a cause for celebration. What are you drinking?

Callum 1:11

I am drinking a glass of port.

Jame 1:13

Glass of port. I have a Talisker dark storm. The only decent bottle of whiskey I have in my house right now. Cheers.

Callum 1:23

Cheers.

Jame 1:25

Oh, ah. Good Foley work being done there with that opening of the,

Callum 1:33

Thank you. Although I actually think that the new editing software that I'm using is so good at editing out background

Jame 1:40

Oh, I'll edit out all of that, won't it? God,

Callum 1:43

Yeah. Also, and it's not laughing, so we've stopped laughing on the what?

Jame 1:47

I edit. I was laughing as well. Oh yeah. Okay. I forgot. That's why we have to manually do the anecdote, klain.

Callum 1:53

Yeah.

Jame 1:54

Oh, so how do you feel about it?

Callum 1:57

Mainly relieved, I think.

Jame 1:59

Yeah.

Callum 2:00

Yeah. It is one of those things where it was just a lot of work and to have to, I also don't know how I could have prepared better. I felt like I prepared well

Jame 2:12

Yeah. Yeah.

Callum 2:13

If you work really hard at something and then it's not good enough, that's pretty crushing I think.

Jame 2:17

Yeah I remember thinking that for the earlier exams, for the MRCP part one, I I failed it the first time round. And I remember thinking, what else can I email? What other books can I buy? What knowledge do I not know? And the thing about the postgraduate exams is that they don't they don't email you back saying, oh, by the way, you didn't answer these questions. And these are the ones you need to work on. They're just like, you failed. See you later. Don't come back without 600 additional pounds to slip in our back pocket. Do you know, like you, you don't get any guidance And

Callum 2:50

There's no learning. This is not, you learn by revision, but the actual examination part is not about learning, and I don't think that's the purpose of the exam. The purpose of the exam is a check. To instill like confidence in the profession and that, that specialty. But it's still, it could be for learning as well. They could give you feedback.

Jame 3:09

A. No, but apparently that 1200 pounds pair trainee

Callum 3:14

No, this episode stop this celebration episode.

Jame 3:19

oh sorry. You're right. Look yeah, you're prepared for it really well. You're revising super hard and of course we've got episodes I. Dedicated to revising for the UK exams and one episode about the US exam that we did with Sarah Dong of the Febrile Podcast. Is there anything else that you think that you should add to those? Is there something that you that you did that we haven't mentioned before? Now?

Callum 3:42

Yeah, I think I've got different reflections, but I think everybody is going to want to revise in a different way and we'll learn in a different way. I. And we'll have different pressures and priorities in our life. So certainly, actually whenever I was revising, as hard as it was, every time I was revising, I was like, Elisa, not Ollie and Elisa don't have two kids and no sleep.

Jame 4:06

Ha.

Callum 4:07

So I was like, shout out to him for passing because honestly it was three months of just working all day and revising all evening and

Jame 4:16

So you're referring to a friend of the show? Ollie Banister who was on the part two episode.

Callum 4:21

Yes

Jame 4:23

yeah. Believe me. I,

Callum 4:24

it was one of those things actually, I, didn't really have any other prior, so I could just take my whole life. I. Ben it and focus entirely on the exam. Pretty much. And that was a bit of a luxury in some ways. And that meant I revised in a very intense way. But if you've got other life pressures, it's, it must be even more difficult. So it could also be,

Jame 4:49

be clear, your first piece of advice is to stave off having children until all your professional exams are finished.

Callum 4:56

I. I think what I'm trying to say is that what I did for the exam might not work for everybody. And I felt quite fortunate to be able to just come home and from work and study.

Jame 5:09

Yeah, but you're just admitting a privilege that you had, like that, that the exam, the part two It is like an intense exam and you need to, dedicate some time towards it. How you do that and how you divide that amongst, you and your partners and your kids and your job and your hobbies and all that's up to you. But, making the point that it's difficult and you need to take it seriously. I think that's perfectly worthwhile saying.

Callum 5:34

Yeah. And

Jame 5:35

dunno, who was treating a 1200 quid exam was a bit of a laugh. But anyway, if you,

Callum 5:39

There's something a little bit enjoyable as well about being able to say I'm focused on this one thing and nothing else matters. same thing, clinical medicine where you're like really busy and something like an emergency happens and there's something quite, it's quite satisfying about that because you can just, suddenly, everything else in your head doesn't matter, and all you're focusing is on that one thing.

Jame 5:57

Yeah. Yeah.

Callum 5:59

There's a sort of clarity that comes with it.

Jame 6:00

Absolutely. Yeah. When you're at a, an arrest you could have as many bits of paperwork to do as you like, but until you are no longer required to jump up and down on someone's chest, I'm afraid all that, I'll have to wait.

Callum 6:12

Yes.

Jame 6:12

So Did you think about the exam?

Callum 6:15

I came on the exam feeling relatively positive actually, because I came out thinking the things I revised came up structure of the exam. Was would made sense. The questions were couched in a clinical setting that made sense to me.

Jame 6:33

Yeah. Yeah.

Callum 6:34

questions were wor worded very clearly. There was nothing that I was confused by. I managed to put something down for every question

Jame 6:42

They didn't name a bug and you had no idea what that bug was, that kind of thing.

Callum 6:46

I got. There was one thing that was like, it was like the name of an organism and it was like, gave you the first part and you had to give the species name. And it pretty common. It's Nope, absolutely mind blank here. There, that was not, that was a very small part of the exam.

Jame 7:03

Ah, yeah. On. Just before you go on Cal, just remind people of the structure of the modern Part two

Callum 7:09

part, so the part two exams, so it's part two in the. Fellowship for the Royal College of Pathologist Exams, which is for medical microbiology and is equivalent exams for virology. And the structure of the exams is three parts to it. Two papers in the morning and afternoon, and then one of the papers is split in two. So one part is a written exam and it's got. Short word answer questions. So it's, there'll be a stem, about patients or a clinical scenario, and then you'll have to answer a series of questions which is like a short text, to write a short answer. And then the other part.

Jame 7:43

not, so it's not best of five it's

Callum 7:45

There's no multiple choice. No. Multiple choice. And there's another part of that, which is complex scenarios, which, oh my God, they were complicated. We talked about that briefly on an earlier episode. And then the other part of the exam is something called an objective structured practical examination where you have. Stations of nine minute duration where you have to either interpret a result or answer some questions to honest. That is a bit of a weird bit of exam because it was essentially a written paper, but nine minutes per question and

Jame 8:16

And you're acting it out

Callum 8:17

no, most of it was written. There was only two scenarios, which were communication station and the time pressure was intense. Like some of the questions, I was frantically writing for nine minutes solid. It was it was a weird exam structure. It it was like, we need to do something that's a structured, practical exam.

Jame 8:34

Yeah,

Callum 8:34

It's ended up being more of a written paper.

Jame 8:37

But time

Callum 8:37

So I'm not sure about that. I'm sure it will evolve,

Jame 8:39

That, that's replacing a very clinical, sort of part of the exam. That was like a day of long.

Callum 8:45

well, not clinical laboratory, really

Jame 8:47

Lab stuff

Callum 8:48

I think overall I thought the exam was Run, organized I had a pretty positive experience. Yeah. And then I guess we, we talked before about how to prepare for the exam and I came out and I guess maybe there was some things, we can list all the knowledge that you need to know. I, and I guess what you probably want to know when you're revising is what is the highest yield stuff like you want to do? You want to make sure you've covered the parts of revision that are the most likely to come up and are gonna be the most useful in the exam, but also in real life. And you want to avoid spending hours and hours doing stuff, which is maybe gonna give you a few marks.

Jame 9:29

Ah, yeah.

Callum 9:30

So efficiency is the name of the game, I think, when there's this much to cover. So I wrote down things and shout out to Katie Hill, who was my co-conspirator in a vision world. And I couldn't have done this couldn't have got past the exam about her there. And we were feeding back to some colleagues about how they could revise, and we wrote down What I wrote down what I thought the highest yield content was from highest lowest. So I'll just run through that and I think we've discussed this all on a previous episode, but this is just my thoughts on what I found the most useful stuff in the exam.

Jame 10:01

Yeah, but all that, was before you'd set it, and now you've got a direct personal experience of it. So go ahead. Go ahead.

Callum 10:08

yes. So yeah, this just my thoughts and obviously you've heard from Rob and Ali and obviously we heard from Philippa and Vicki as well, that really helped. So listen to those episodes. So the highest yield content I thought was the uca, so E-U-C-A-S-T, the UCA guidance documents. On the UCaaS website, there's lots of things. Actually just knowing the break points, the clinical break points table, it's on version 13 in version 14. Soon in New York ATT might the, actually there was quite a

Jame 10:37

I wonder if what'll be moved to sensitive at higher doses and what'll be kept the same. Oh.

Callum 10:41

what sensitivities will be removed. The that was really useful and actually just having a good idea

Jame 10:47

Now you have now annoyed half of microbiology, Callum. Sorry. As an aside by saying sensitivities instead of susceptibilities, but if you say susceptibilities, you'll annoy the other half

Callum 10:57

Too sensitive. So the new cast documents are great. And actually something I hadn't quite realized that would be coming up so much was, what breakpoints are available for this organism and the stuff I would never memorize. So that's a bit

Jame 11:11

what I mean, but you're right because it's in the UCaaS document and it's never more than a Google and two clicks away. So like when something like that did come up, what did you

Callum 11:19

How don't you just have it as a favorite on your bookmarks? Oh, okay.

Jame 11:24

I'm talking about the maximum distance,

Callum 11:26

Oh,

Jame 11:26

from the Yeah. But so what did you say when it said what blue bones are available for, this thing

Callum 11:31

I said why? For the right answer.

Jame 11:35

Alright, so you really just had to know the break points for every bug and every drug.

Callum 11:38

It was more like, okay a 40-year-old, this is a fake question, 40-year-old women presents with, and the symptoms suggested with pyelonephritis, her urine culture grows. This Klebsiella, Oxy. Here's all the things that have been tested.

Jame 11:53

my favorite. Klebsiella by the way.

Callum 11:55

Yeah. Here's the things that have been tested and. I'm just making this up on the spot, but I'm really hoping this wasn't in. Yes. And then it says, how would you report the sensitivities? And essentially, you need to know what sensitivities you would suppress, what comments you might add, and, what breakpoints there are, all the caveats. And actually, you know what, it fine. It was like, I was not surprised to go to the results, then that's why we were doing

Jame 12:22

That's what you'd be doing, yeah. God, I wonder what Ollie did there, because unlike Nidosh Royal Infirmary North, Nidosh Royal Infirmary South doesn't suppress any results. They've released everything.

Callum 12:35

Yeah, I don't agree with that approach.

Jame 12:37

Yeah, you can take it up with them. But yeah. But anyway, I guess it's different strokes for different folks. But yeah. Okay. So the UCAS guidance documents. I already thought they were pretty yield. We will have a

jame_2_12-14-2023_221952 12:52

Yeah.

callum_2_12-14-2023_221952 12:56

There's documents which are, specific scenarios. So antimicrobial susceptibility testing in special circumstances, any updates. To be honest, like pretty much everything on the UCAS website. The new definitions of S, I, and R would be a really useful thing to read. Expert rules, resistance mechanisms, guidance documents.

jame_2_12-14-2023_221952 13:18

Yeah, we've mentioned the carbapenem resistance mechanisms document before. It's particularly high yield, but it's not the only one by any stretch.

callum_2_12-14-2023_221952 13:25

and some, it seems like a lot when you go into the websites, loads of documents, some of them are one or two pages and the other thing, and this is the key, this is the key for every single one of these things, actually, which Katie and I did, was it is really hard to read a document I memorise it. So don't do that. Read the document and then think what questions would I ask if I was writing an exam? wHat could they examine me on here? And then write those questions down and then within your study group or just yourself, have those questions written down and then try and answer them and write down what you think the answer is as well. And that was super high yield because I made some really hard questions about the UCAS documents and then you're like, Oh, I don't know if I can answer these, but that, that was really helpful because it basically. Was a big part of the exam was what do UCAS say and you know for these purposes of the exam And I don't know if I, we agree with this. We definitely don't agree with this. What UCAS say is gospel you know if they say something then that is the truth and the only truth

jame_2_12-14-2023_221952 14:31

Yep. Yep.

callum_2_12-14-2023_221952 14:33

Although I guess you could justify it otherwise, but maybe not. So that was probably the high sealed stuff I think the next high sealed was the UK SMIs, which we're big fans of and we've referenced a lot. I they meet the meet the morons events at Fizz 2023. I was very fortunate to meet one of the microbiologists involved in setting them up. So that was really cool.

jame_2_12-14-2023_221952 14:52

Oh, that's cool. I had no idea.

callum_2_12-14-2023_221952 14:55

Yeah, I was like, I felt really embarrassed because who are you? And then it was like, turns out he's a very famous microbiologist. That was cool. So yeah, the UK SMIs, the flowcharts the exclamation and there was a couple of questions which were like, you've got this sample type, what sort of cultures are you going to set up, Which is something that I didn't really know, and I think I have a better idea of I think, the sort of structure of the question was something along the lines of here's a sample type, here's the clinical details, what plates would you set up and what growth conditions and and that is tricky stuff to know. So you're not going to memorize every single situation, but you just, again, using your clinical judgment, you can work out from first principles. If it's not, if it's a sample type where you're going to be worried about anaerobes, get the anaerobe plate. So it's more important to be like, If I'm looking for this type of organism, what plate and what growth conditions am I going to set up? And then think about it from that perspective rather than trying to memorize every single specimen type and what culture plates go up.

jame_2_12-14-2023_221952 15:57

Ah

callum_2_12-14-2023_221952 15:57

You can just work it all from logic. sO yeah, UKSMI is really high yield. The next thing, and this is something I think I, this is something I think I, when I was one point in the exam was like, Oh, I wish I'd spent more time on this, which was clinical guidelines.

jame_2_12-14-2023_221952 16:15

Yeah. Which ones in particular, because it's not like we've got a guideline for everything, right?

callum_2_12-14-2023_221952 16:21

anD I thought you were going to ask that there, because actually I think this is why I didn't spend as long on it, and why the SMIs are so good, because you go for the SMIs, the standards for microbiological investigation, and they're all on the same website, they're all on the same formatting, and it's very clear where they are.

jame_2_12-14-2023_221952 16:37

Yeah. And every lab has to, every accredited lab does it that way. There may be little variances, but you have to do it the SMI way if you're going to be an accredited lab in the UK. So from the diagnostic point of view, it's much more standardized.

callum_2_12-14-2023_221952 16:53

Yeah, but clinical guidelines for a management infection, because infection is multi system and everyone's got their little slice of the pie, you often find that there are clinical guidelines by a huge number of societies and also there is guidance from different parts of the world to bear in mind and some of them are competing. So infective endocarditis is a good example and we've covered that in a lot of detail.

jame_2_12-14-2023_221952 17:22

Yeah, it's, but it's an excellent example, Cal, because, it used to be that there were three sets of guidelines, BSAC 2012, AHA 2015, and ESC 2015. And now, in 2023, there were two new guidelines released. The ESC, European Society for Cardiology updated their guidance. And WikiGuidelines, a completely new entity, released an endocarditis guideline. I, one assumes that the Royal College of Pathologists would not respect the WikiGuideline and might expect you to use ESC instead.

callum_2_12-14-2023_221952 18:02

which is interesting, but, I don't know, maybe there is somewhere there is a list of here all the clinical guidelines relating to the management of patients with infection What I want and I want to make sure I've gone through them all. And the other reason why I thought I wanted to have spent more time on this, which was that. One, it's really useful clinically to have a good knowledge of these guidelines, but two,

jame_2_12-14-2023_221952 18:26

Yeah.

callum_2_12-14-2023_221952 18:27

they're not asking you about, first line management. They're asking you about third line treatment. They're asking you about the complicated situations. It's not straightforward. And that's that's exam. In general was this isn't an examination of, oil need to know the simple basic stuff No, you do really want to know that but also the more complicated Difficult the penicillin allergic the loss of IV access the allergies that you know, these are things

jame_2_12-14-2023_221952 18:58

Yeah. Yeah.

callum_2_12-14-2023_221952 18:59

But yeah, the main clinical syndromes that you want to make sure you've covered. So that's the third highest yield. The fourth highest yield, there was quite a few questions around about infection prevention control. And as someone who doesn't, that's not a big part of my job. As a trainee, although I probably will be as a consultant, which is weird. And that was something that I definitely was worried about going to an exam, and I'm glad I worried about it. Now, I think in previous episodes we talked about doing the, you have to read the healthcare technical memoranda, you have to read all the healthcare building notes, and

jame_2_12-14-2023_221952 19:37

What do you think?

callum_2_12-14-2023_221952 19:39

I didn't read them. I didn't even open any of them.

jame_2_12-14-2023_221952 19:43

Okay.

callum_2_12-14-2023_221952 19:44

But, I have

jame_2_12-14-2023_221952 19:46

colors, the part two. That's interesting.

callum_2_12-14-2023_221952 19:48

idea, maybe scripted pass, you don't get any feedback. The two things there is that, my my study buddy did read them, and I mean we talked about it but what I did instead was I went on the Healthcare Infection Society Infection Prevention Control Foundation course, or rather I did the pre learning for that because The live section wasn't up and running yet, and we're doing that at the moment. And, you know what, that is really good. Particularly, if you can do that before your part two, particularly the synchronous bit that I'm doing this week, because the scenarios, listening to the scenarios and doing the activities, I'm like, this is perfect revision for the part two.

jame_2_12-14-2023_221952 20:33

For UK trainees, this is because you can, attend I think it's six seminars over two years and then the sort of 4 course that used to be run at Colindale. And all of that sort of equals the Foundation Certificate in Infection Prevention and Control. If I had my druthers, I would make that mandatory for all ID trainees. I think that's everything you need to know about infection prevention and control. And,

callum_2_12-14-2023_221952 21:00

areas it's too much. So there's a lot of stuff about like molecular, sequencing, outbreak management. It's a bit too much, if I'm honest, a bit over

jame_2_12-14-2023_221952 21:09

A basic idea about what they're doing end. Do you know?

callum_2_12-14-2023_221952 21:13

I think my only, the course gave you most of the stuff and a lot more that I didn't need for the exam, although I wasn't learning for the exam, I was learning for the course. I think you need to learn it.

jame_2_12-14-2023_221952 21:23

Hi.

callum_2_12-14-2023_221952 21:24

But the things that I think you need to add on to that if you're doing it that way for the exam would be some of the high yield nitty gritty stuff. I think you can think about the main topics they're going to examine. So they might examine, water safety ventilation. Decontamination of instruments or just decontamination in general but, ventilation, water safety and decontamination are the free ones, and then like lab design, and safety I think it's probably worth advising us what's like a question that it could do? So what's a scenario that you could be faced with? Here's a diagram of this, fill in the numbers. So really having it really clear in your head what are the air changes in each room of a theatre? What is the air flows? Where is your input and extract? How are safety hoods designed? What happens in the laboratory spill? What happens for like an outbreak meeting? Who do you invite? What's your agenda? How do you manage that? And what the exam was really good at was, instead of just saying what is this? It was, the infection control was built into all the questions. So it was like, here's a scenario, and then the scenario ramped up and got more complicated. And then it would be like, okay, now there's an infection control or public health issue, how do you deal with this? So it felt realistic. It was, quite, quite a really good way of examining that and making it relevant to the clinical picture. But if you didn't know. It was a really hard question, and if you'd memorized it, then it was an easy question.

jame_2_12-14-2023_221952 22:54

Hi.

callum_2_12-14-2023_221952 22:56

Yeah, so I didn't read the healthcare technical memoranda, although I did speak to someone who had. That was just my experience. I don't know if that will work for everybody. Maybe the thing is, work with some other people and each take one. Get the key points out and tell it to each other because, honestly, it takes a long time to read them, I've been told. Next on the list I have is the NECWAS, so that's the National External Quality Assurance System Service, System? Oh God, what's it stand for? Yeah, National External Quality Assessment Service. You know about them.

jame_2_12-14-2023_221952 23:31

Yeah, they laboratory practice by sample and making sure that you process it in the right way and get the right answer. Is that there, those guys?

callum_2_12-14-2023_221952 23:39

Yes. For the exam, you should know what the difference between quality assessment, quality assurance, quality

jame_2_12-14-2023_221952 23:45

Ugh

callum_2_12-14-2023_221952 23:45

Yeah, just making that's a good point to mention there. Yeah, NetQuest run this national system and, to be honest, is really high quality. Everyone subscribes to it. And It's to do with your laboratory accreditation. It's quite hard to pass, but what they also do is they send out monthly questions, which are like, here's a sample, here's a clinical scenario, and it's doing the clinical knowledge or application of knowledge and laboratory testing. And honestly, those questions are so good for exam revision because they're written in a way and are the same similar difficulty to the exam.

jame_2_12-14-2023_221952 24:20

Okay.

callum_2_12-14-2023_221952 24:21

And one of our retired consultants had collated all of them, so she'd been receiving them monthly, collated them into folders and written down like her answers. And it was absolute gold. And I think we, we discovered that quite late into revision. If people are doing Yeah, the NECWAS. Questions, if you, if someone's been so good to hold, I don't know if they hold a backlog of them, honestly, they put a lot of time and effort into writing questions which are based in current practice or difficult areas. And they're really well written, they're realistic and they're really relevant to the exam. So if you can do those. Yeah. Wow. I don't know if that came up in the other revision

jame_2_12-14-2023_221952 25:25

It Callum, this is the first I'm hearing of it. But the, you tell you what the real good thing about that is, even if Nequa set that question like ten years ago, and the answer's changed you can update answer, if

callum_2_12-14-2023_221952 25:36

true. Yeah. Yeah neck wasp. Thanks for doing that. And now we're slightly getting less high yield, I'd say,

jame_2_12-14-2023_221952 25:44

many have you got to

callum_2_12-14-2023_221952 25:45

to pass. Got three

jame_2_12-14-2023_221952 25:47

Three more to go.

callum_2_12-14-2023_221952 25:47

Four more? Parasitology, right? So I've done a diploma in tropical medicine and

jame_2_12-14-2023_221952 25:51

Okay, so your advice is to go back in time and do the DTMH?

callum_2_12-14-2023_221952 25:57

no. There was a bit of parasitology in the exam, which is usually here's a picture of some sort of parasite, here's a clinical scenario, what do you think the diagnosis

jame_2_12-14-2023_221952 26:07

Aye.

callum_2_12-14-2023_221952 26:09

And I don't think they're ever going to ask you the nitty gritty, but they are expecting a, a basic level. So either you've done the diploma, in which case revise what you did there, particularly in your, stool microscopy and parasite identification stuff. And if you haven't done that, then I guess try and find some other way of, some places run parasitology courses where you get to do microscopy, you can buy various books, which maybe have images, to be honest, and I think. Sometimes you can work things up, because they always give you a clinical vignette about the case. So sometimes you actually didn't need to know what the image

jame_2_12-14-2023_221952 26:48

so that's giving you a steer.

callum_2_12-14-2023_221952 26:51

Yeah, it was additive. It was additive. I was like, oh, I think it's that, but this clinical scenario fits more with this, so I'm going to go with that answer. Yeah what we did to revise for that, and actually for quite a lot of the things was, and if you were at Fizz then you would know that I'm very interested in this, it was just game based learning. So we made quizzes, and like flashcards, so I spent quite a lot of time making quizzes to test myself or little games and questions. So for Parasitology you just got loads of images. Flashcards, I had to walk through them and memorize them. So that's probably a good way to to learn it. I think it is a bit of an uphill struggle if you haven't done the diploma. Because I have, I, I found that bit relatively easy, but, because it was just revising stuff that I knew from before. sO I don't really know what you would do otherwise, if I'm honest.

jame_2_12-14-2023_221952 27:44

And yet, there must be a proportion of people that are sitting in Part 2 that didn't do the DTMH. Because most do it right. Probably of UK trainees, maybe about, I'd call it 60 or 70 percent. Not 100%.

callum_2_12-14-2023_221952 27:58

Just remember how I felt before I did that and I was working in ID and parasitology just felt this huge unknown area that I had no grounding or framework to think about and every time it came up I was worried about it and to be honest anytime there was some weird infection thing I was like it could be some sort of parasite and it was scary I really didn't like that feeling I really remember that and now that I've done it I feel a bit more still I feel a bit like that to be

jame_2_12-14-2023_221952 28:24

Yeah, but it's so characteristically different from our day to day job, which is bacteriology and a bit of virology. Some mycology if you happen to work in a transplant or a hemog center. But, other that I most of our job is taken up by fighting off bacteria. Do you know what I mean? And that's why started going through the bacteria first,

callum_2_12-14-2023_221952 28:46

we'll get to Parasites and we'll talk through or we'll get someone on who knows

jame_2_12-14-2023_221952 28:49

We will, 2028 or 2029, something like that.

callum_2_12-14-2023_221952 28:53

Maybe I've got a plan. So yeah, I, I guess as with all revisionists, it's more about finding your gaps and your blind spots and being very focused on what do I not know and what might come up. And Parasites is a good example of that. Parasitology did come up. I wouldn't say in a huge degree. So if you didn't know any, you can maybe get away with not revising

jame_2_12-14-2023_221952 29:12

Oh yeah.

callum_2_12-14-2023_221952 29:13

I think it's relatively high yield. It's not that hard to learn basic parasitology. So next thing, interpretation of serology results like virology. And I really didn't know, going to the exam, how much virology I was going to need to know. And what I felt like coming out of it was, like, there was some really complicated virology stuff. Which I was like, oh god this is horrendous.

jame_2_12-14-2023_221952 29:35

Oh yeah, can you give an

callum_2_12-14-2023_221952 29:36

I can't give a specific example, but just,

jame_2_12-14-2023_221952 29:39

non specific example?

callum_2_12-14-2023_221952 29:41

non specific So Anonymizing it, so some sort of rare virus, it presents in someone, and then, it turns out that there's a healthcare contact, turns out immune suppressed people have been exposed to what you do. So then you need to know, what the diagnosis is, and then you need to know what the treatment is, and then you need to think about what the treatment is in immune suppressed people and the public health implications. It was honestly a great question, like the way it was worded. I remember reading it and being like, they've done a really good job here, and this is terrifying, like awful which is a weird sort of way, I guess because I've done so much education stuff now, I have a totally different view on exams. Sometimes read exams and be like, wow, I don't think I could write a question this good. But the main high yield activity, I think, was just really honing and understanding how do you interpret virological To your basic serology of all the viruses, I think that's the level of virology they're looking at it wasn't a big part of the example, but I do that from the SMIs really. And the green book and on the similar scenes being, we talked about this in the other episodes, but virology

jame_2_12-14-2023_221952 30:50

The green is the vaccination, handbook, produced Health England, similar to the red book in the U. S.

callum_2_12-14-2023_221952 30:57

sO virology and pregnancy and the scorch infections, and a big shout out to Sarah Dong and the Febrile Podcast. That scorch episode that they've got, and the infographic associated with, I just read that again and again, because I was like, that is gonna come up. But there will be something about that, and maybe there wasn't. But I think that's pretty high yield as well. And that's three into one, actually. The virology stuff, interpretation of Serology, Virology and Pregnancy in Scorch, and then the green book. I think virology is important, but the mainstay of the exam is bacteriology. And actually, of all the stuff I've just mentioned, difficult to treat. Infections or drug resistance, at, shout out to you, Jane going through the carbapenemase producing enterbacterioles and all the guidance around that was gold. And on the way down to the mock exam in Leicester, we listened to the podcast episode that, and that was really useful, I was really happy to have got that really solid in my head. And that was just because I kept listening to it. Final thing to say, and I'm sure that I've said this before, which is always remember your safety clip when you go into the exam.

jame_2_12-14-2023_221952 32:13

What do you mean by that? What do you mean by that?

callum_2_12-14-2023_221952 32:15

I mean by that? So the safety clip is, Remember to always in each question, think about the clinical scenario, which is, I think for me where I default to, as soon as I'm like, someone asked me a great clinical question at work in microbiology. I'm like, yes, do this test and, treat them with it. And I get so into it and love it. And then I hang up the phone and then the consultant's so did you tell them that they need to be in a side room? And you're like, Oh my God, that's such an idiot. I need to run the back and feel very silly. The safety clip is clinical laboratory and laboratory safety really there, but like the laboratory aspect of the case. Infection prevention control is the I and then P is public health and it was a bit of a forcing function and I've been told to do that and I found that helpful because sometimes I found myself writing screeds about the clinical scenario or in a communication station that's going on about it and then I would always try and pause and think okay is there any laboratory safety considerations. Is there infection prevention control implications and do I need to form public And I think that probably just stopping and thinking about it did pick up a couple of And to be honest, probably that approach is different for other people. So my default is to think too much about the clinical. And I imagine that if you are, in a different professional group sitting the exam, you probably default to what you're used to. So avoid that tendency, both in when you're answering the questions, but also when you're revising. So I really forced myself to, to focus on the bits of practice that I wasn't so familiar with. And honestly, I didn't really, if there was stuff like Staph aureus, I didn't revise that. But why would I revise that and spend all day, every day doing stuff about Staph aureus?

jame_2_12-14-2023_221952 34:04

So you didn't revise stuff like that, but just because you ate your bread and butter.

callum_2_12-14-2023_221952 34:09

yeah.

jame_2_12-14-2023_221952 34:10

yeah. That's really interesting.

callum_2_12-14-2023_221952 34:15

Yeah, I think, I hope that's additive to the other episodes that we've had. And, to be honest, I spent so much time, revising and thinking about the exam and was really felt I think a feeling, that's a very logical like thought based thing there. I think the feeling that I had, which was being overwhelmed, feeling a bit hopeless, it felt like an impossible task. It felt really miserable at times. Not always, but a lot of the time. If you're feeling like, if you're approvising the exam and you feel like that, then, that's not a you problem. That is just It's just a difficult exam and, you'll get through it.

jame_2_12-14-2023_221952 34:54

Difficult and the financial stakes are high and you know if you want to be a microbiologist you got to pass that damn exam.

callum_2_12-14-2023_221952 35:03

Anyway, good luck to everybody that's revising and sitting it and thanks so much to all people that really helped so much, like work colleagues and I guess one thing to be aware of is that you were gonna probably need to get some study leave and stuff. And also ask people for help, so I asked quite a few people at work that I knew were, like, good at explaining things and had a good understanding of stuff that I didn't understand. And they don't need to be consultants, just any, another trainee or, other professional groups. So yeah, big thanks to everybody that, that helped. And if you're revising, don't be afraid to ask people. Because I don't think people normally come forward and say, do you need a hand with this? Because people don't tend to do that. But nobody I approached and asked for help was like, of course not. Like people really made a big effort to help revise.

jame_2_12-14-2023_221952 35:49

Yeah good departments really do come to help you get time off yes but also you know help with your revision you know should you need it.

callum_2_12-14-2023_221952 35:59

If you're in a really small department and there's only a couple of consultants, you probably, people are maybe more proactive in helping I think because I'm working in quite a big department, maybe people felt like. Oh, like other people are helping and everyone's busy, but maybe that's good because then you can, approach people on a case by case basis. I don't know.

jame_2_12-14-2023_221952 36:20

yeah

callum_2_12-14-2023_221952 36:22

So yeah, part two, done.

jame_2_12-14-2023_221952 36:24

Part two positive. For your

callum_2_12-14-2023_221952 36:27

two positive. Yeah, it doesn't, it still doesn't really feel real to be honest.

jame_2_12-14-2023_221952 36:31

Wait, going to lord it over me as the more qualified infection doctor on the show?

callum_2_12-14-2023_221952 36:36

To be honest, and people, it's not a secret that Jamie usually does the prep when I do the post for the podcast. So I think Jamie usually comes across as the person who knows more because you've spent ages reading it and I'm just coming across it the first time. So that's Hope that some of the stuff that I've spent ages revising we can talk about in the podcast. Because there were some things I was like I actually listen, I couldn't remember what we talked about, so I went back to episodes that we'd done to revise them because I, I can't remember everything that we talk about in the show, so I found that really helpful. So I hope with that

jame_2_12-14-2023_221952 37:11

Did you,

callum_2_12-14-2023_221952 37:12

continue to provide content that's useful for people for the exam.

jame_2_12-14-2023_221952 37:16

Maybe at this point we could try and spruik our episode prep did you look at them at all?

callum_2_12-14-2023_221952 37:23

Yeah, I found the tables that you do. For, so for example, the, difficult to treat gram negative, that was really helpful, really clear. It's here's a table, it's green and it's red. I found it, not great if you're colorblind actually but people, maybe you've got a reader that helps them with that. Sorry if that's you, maybe we need to change that. But the yeah, I found them really helpful if I was like going back and actually I use it clinical practice as well.

jame_2_12-14-2023_221952 37:53

Yeah I've started to refer to the, the drug choice. And, we talk pharmacokinetics of different antibodies that we use and what gets in where and how high levels are urine. And I've found myself referring to that in order to justify. slash win arguments. Clinically yes, we can use this or no, we no, we we should use But yeah, the, I don't know if we've ever actually announced this on the podcast, but we've started issuing prep notes. So I, I. the prep for the episode like Callum says. I used to do that as word documents, but I've, on the advice of Sarah Dong from Febrawl Podcast, I moved Notion, so that's where she keeps all of her infographics. From the podcast. She has this great big database that's searchable. I we'll be doing any of that. My notes are not as pretty as Sarah's because I just don't have the talent.

callum_2_12-14-2023_221952 38:53

god, I don't know how she does it, it's absolutely incredible.

jame_2_12-14-2023_221952 38:55

She doesn't spare time presumably because she's working on the show. But the prep notes now go in Notion and when we're talking on the podcast we're reading. And Notion is really good at one thing, which is making your crap notes look fancy. So thing I really like about it. And you can also do drop down tables, so not everything has to be on the page at the same time. And it just looks nice. Are wanting to know what my references were for the show, or you want to go over, the content of the show after or even to refer back to it, then you can now the footnotes of every episode, there's the Notion can navigate to the relevant episode from there. Not all episodes have notes, so The that are reports from conferences or ones where me and Callum are just don't have,

callum_2_12-14-2023_221952 39:48

For example, this episode.

jame_2_12-14-2023_221952 39:49

Like this episode and, a arguing about atypicals and antibiotic stewardship starts at home, all that sort of stuff. But like those ones don't really have because it's just us gabbing off. Ones like, say the Nobbling the Nonfermenters miniseries, the notes there. For and Pseudomonas and Asthenita Bacter. Arguably, Calum, they're some of the best work I've ever done.

callum_2_12-14-2023_221952 40:11

You've done some good work outside the podcast, because I've seen it. Actually, occasionally at work I'm like come across a guideline, and then I'm like, this looks, this is really good. Oh, it's Jane Water, that's

jame_2_12-14-2023_221952 40:20

Haha, oh really? Okay yeah, handiwork is still splattered across Nadosh Royal Infirmary. Okay, that's good to know, actually.

callum_2_12-14-2023_221952 40:28

No, it's, it's really good. There was one that you did which was viral infections in pregnancy.

jame_2_12-14-2023_221952 40:33

Yeah.

callum_2_12-14-2023_221952 40:34

You know what, actually We should put that in the notes for this episode.

jame_2_12-14-2023_221952 40:39

If you like, yeah, if you

callum_2_12-14-2023_221952 40:40

Because I've never seen it so well that you have this table which is it's different viruses and it's it's really simple, like, when does the rash start and when you're infected. And I think that was quite a high yield for the exam to just try and

jame_2_12-14-2023_221952 40:53

Oh yeah, the infectivity of each virus is before onset and after onset of symptoms yeah,

callum_2_12-14-2023_221952 40:59

very simple, very clear, so I'll dig that out and we should put that in because I think that's a good example of a high yield fat that you just need to know when, I think that's pretty basic epidemiology, isn't

jame_2_12-14-2023_221952 41:13

mean it's all, it's also that, that, that guideline that you're talking about in viral infections of brain disease, it's also I think quite a good example of how I think guidelines should be done. And I think we should have an episode on this because I guideline development work with in, up north. And. I One of my talents, such as it developing easy to read. And I think there are some, I think actually a lot of infection trainees are involved in guideline work, both,

callum_2_12-14-2023_221952 41:44

Yeah, there's so much to manage. We can't get involved in every single case. So it's really, the onus is on us to make sure if we want people to use antibiotics correctly, to have guidelines that are really clear and easy to use and make people make it easy to do the right thing. That's my catchphrase at the

jame_2_12-14-2023_221952 42:00

Yeah, make it easy to do the right thing. Perfect, Callum. And there's loads of ways to do it badly. Tons and tons of references and what's meant to be an easy to use guideline? No. Including it all in black and white? No. Just having a wall of text with no divisions between it? No. And there's other, examples like that. And yet I see that in microguides from trusts all over the country.

callum_2_12-14-2023_221952 42:24

Yeah. Interesting. End this episode.

jame_2_12-14-2023_221952 42:29

Another

callum_2_12-14-2023_221952 42:29

On a completely unrelated note there was a recent email sent out by the British Infection Association, we're big fans

jame_2_12-14-2023_221952 42:39

Oh yes. No I've heard them. I've heard of them. I understand that they sponsor the UK's premier infectious disease podcast, Callum.

callum_2_12-14-2023_221952 42:47

yeah, it's really weird to say that and shout out to, to, to Kelly Bicknell, who's who sent us in this question,

jame_2_12-14-2023_221952 42:55

Oh Oh this is a listener mail feature, is it?

callum_2_12-14-2023_221952 42:57

Yes, listener

jame_2_12-14-2023_221952 42:58

Okay, I'll have to think of a

callum_2_12-14-2023_221952 43:00

they sent out Question which was asking everyone to reply to a survey with their desert island antibiotics.

jame_2_12-14-2023_221952 43:09

The Will I read out the

callum_2_12-14-2023_221952 43:11

yeah, do you want to read out the

jame_2_12-14-2023_221952 43:13

Yeah, okay, so You're stranded on your desert island getaway. As the sun beats down and the waves lap the shore, it's just you, the island, and your survival bag, luckily containing your three choice antimicrobials. But which three, oral antimicrobials, did you choose and why? Choices could include antibiotics, antihelminthics, antifungals, and antivirals. And we'd love to hear why you took them, and please use generic drug names. There we go.

callum_2_12-14-2023_221952 43:44

Yeah, and they give you a load of details about the potential exposure, but you're on a desert island.

jame_2_12-14-2023_221952 43:49

Yes.

callum_2_12-14-2023_221952 43:49

monkeys, mongoose, rats, caves, freshwater lakes, rivers. Brackish water, soil, trekking, shellfish. Pretty, pretty good exposure history in some ways. And yeah, so what free antibiotics are we going to take? Maybe, should we alternate? I feel like we're going to agree on some things. I think you probably need to write them down, so that we can't steal each other's You're going to say something, and I'm going to be like, what? Why did I do that?

jame_2_12-14-2023_221952 44:15

Just wait a wee sec. Sec here, Callum. Who isn't going to include doxycycline as one of their

callum_2_12-14-2023_221952 44:23

Of course,

jame_2_12-14-2023_221952 44:23

Not I, and not you either, Big Mr. Part 2.

callum_2_12-14-2023_221952 44:27

It treats so many things. It treats gram positive, some gram negatives maybe malaria you've got your Lyme, another rickettsia it's really broad, it's pretty well tolerated. I guess the only consideration I have slightly against that is it's a tropical desert island, so am I going to be able to get, shelter from the sun? I don't want to get a photosensitive

jame_2_12-14-2023_221952 44:50

Ah, there's trees, Callum.

callum_2_12-14-2023_221952 44:53

Okay that's fine then. Yeah,

jame_2_12-14-2023_221952 44:54

You can go into a cave, but watch out for the histoplasma when you do that.

callum_2_12-14-2023_221952 44:58

Yes. Yeah.

jame_2_12-14-2023_221952 45:00

number one's gotta be doxycycline. It does skin, it does chest, it does urine, really, but all your tropical, it does malaria prophylaxis, so prevention is better than cure there. Implicated to treat, diseases ad nauseum, or your Borrelias. To like, eh? Yeah, so docks to cycling's number one for both of us. Okay.

callum_2_12-14-2023_221952 45:20

I was thinking about number two and I decided on cotrimoxazole

jame_2_12-14-2023_221952 45:23

Okay. Now, I'm on train choo But why are you? Picking it.

callum_2_12-14-2023_221952 45:30

I went for that because I think it added a little bit like say you have a pendant You know some sort of intra abdominal nasty. I can't get an operation It's going to be a decent backbone. It's got a similar ish spectrum to Co Moxiclav, which was the one I was toying with as well. But what swayed me towards Co Trim was that it covers some more of like parasitic diseases as well.

jame_2_12-14-2023_221952 45:51

Okay. Interesting explain your work.

callum_2_12-14-2023_221952 45:54

Now, I'm struggling to remember here now, but it's going to cover some parasites. PCP? I don't know why we suddenly get PCP.

jame_2_12-14-2023_221952 46:07

Yeah, I guess PCP cover

callum_2_12-14-2023_221952 46:11

I've literally thought this up in the last two minutes, so I don't know if I put too much thought into it. Why should I have picked Coltrane?

jame_2_12-14-2023_221952 46:17

I No I think pick cotrimoxazole too, because you need something that's going to cover staphs and streps and skin. I this question, it's three drugs, right? They're all oral. You can't treat everything. To prioritise what you're going to treat. Think you should choose your three things to treat, like a virus and a mould and a bacteria and stuff. I think you should choose the stuff that's most likely to cause serious infection that you can do something about. Want to waste your three choices on three antiretrovirals. Desert island, just stay away from everybody. Get it. So I think doxycycline because it's got wide spectrum of things that you could use it for. A wide set of scenarios. And cotrim too. Skin and soft tissue infection? Yup. Infection? Yup, it even has a little bit of anirobe cover, although there are no breakpoints for it and it's certainly not as good as metronidazole. Yeah, a little bit, couple of papers, somebody told me this, in fact, the great Kate Jeffery BIA president, told me this, like, wow, I never knew that, right? We were talking about it in the context abscess because we, regimen we choose cotrim and metronidazole, but because of concerns about metronidazole neuropathy, we would drop it and just use cotrim monotherapy, and I was like by probably of the anaerobes are dead if it was GI origin abscess, but she was like, also, cotrim has a bit of anaerobe cover enough to set breakpoints, for

callum_2_12-14-2023_221952 47:48

And this is a teaching on anaerobes recently, and I dug into it a bit more detail, we need to talk about this some more in an episode. But, when I talk to people about spectrum of action, I usually draw a grid, grandpas have cock eye, grandmas cock eye, I draw it out, and then I put a little box in the middle of the grid. of the GWED that says anaerobes, because I'm like anaerobes can be in any of these, and you have to think about them specifically. And then I usually have a little box for pseudomonas aneurysi. That's how I talk about it on a very basic level, but then I always reflect on anaerobes. And what I learned when I was prepping for the anaerobes session was I was like most things are facultatively anaerobic and there's not many things that are obligate anaerobes where they're only anaerobic. Most things can choose to respire in either way. And. And I was like so why would an antibiotic not work, so say it's an antibiotic that works against a gram negative. Why would it suddenly not work against an anaerobic gram negative? And I guess it's like how we dichotomize medicine, we categorize things, but there's a spectrum. So there's certainly going to be some anaerobes, like there's loads of anaerobes, like particularly oral anaerobes, that'll be treated by bog standard

jame_2_12-14-2023_221952 48:53

Yeah, true.

callum_2_12-14-2023_221952 48:54

of the anaerobes in your mouth are going to be Are you going to be gram positive cocci, anaerobes streptococci and stuff like that. Yeah, I re considered how I think about anaerobes. It's not, it's like a completely separate thing. It's just it's too complicated. Anyway, I'm rambling on now because we need to do an episode on anaerobes once we've finished our gram

jame_2_12-14-2023_221952 49:13

I know. Any year now, Callum. I Think Kotrim as well, cover, does skin, does urine, maybe intra abdominal if you're lightly punctured by a by spike or whatever is on this blasted desert island that you're that on. So I think Kotrim, Doxy, Artemis or

callum_2_12-14-2023_221952 49:29

to the episode has turned into this massive discussion now. So what's our fir what's your third antibiotic? I'm not really sure about this, I'm struggling. I've written something down, which I will tell you, but I don't really know. If it's the same as me, I'll be shocked.

jame_2_12-14-2023_221952 49:43

Lumaphantron.

callum_2_12-14-2023_221952 49:45

Oh my god! I've written down Rheumat,

jame_2_12-14-2023_221952 49:48

I'm allowed a couple a combination drug,

callum_2_12-14-2023_221952 49:51

to the combination, I've written Rheumat.

jame_2_12-14-2023_221952 49:53

Have written

callum_2_12-14-2023_221952 49:54

had you written down Cotrim as your Had you written down Doxy, Cotrim and Re

jame_2_12-14-2023_221952 49:57

I haven't down anything, but those are the three things I think I need to take. So malaria Callum has killed half of all humans that have ever lived.

callum_2_12-14-2023_221952 50:06

Yeah.

jame_2_12-14-2023_221952 50:06

so I think that any power site that is that important, as long as I'm in a place that's actually a malaria zone, I need to be able to treat malaria, not just prevent with doxycycline, but actually, I'm assuming that we have infinite supplies of all these antibiotics, by the way, but also treats, Now, you could make the argument that TB is a similarly impressive killer of human beings. And certainly in the century, it, I think it outstrips malaria. John Green have to promote how TB Particularly John

callum_2_12-14-2023_221952 50:38

deserted desert island, which is what I understand it to be, who are you going to get

jame_2_12-14-2023_221952 50:43

Ah, but maybe I acquired it years ago, and now it's just been reactivated. Didn't think about that, did you Callum? But here's TB requires like three or four drugs and huge month long regimens and I can't waste all my three options on anti tuberculous medication. So I just accept that if I get TB I'm going to die and also if I get any fungal or any fungal pathogens that can't be treated by Cotrim or any viral things that I'm also going to die. And I just concentrate on bacterial and parasitic stuff. And what's the biggest parasite in the world? It's malaria.

callum_2_12-14-2023_221952 51:20

But then I wonder about if you're not got good hygiene should we be taking Praziquantel or Albendazole? And then we've got something that's decent. Because I do wonder if Cotrim and Doxy has too much overlap.

jame_2_12-14-2023_221952 51:31

wee, so desert island together, aren't we?

callum_2_12-14-2023_221952 51:32

It seems like it

jame_2_12-14-2023_221952 51:33

Oh, okay, enough. Seeing as pals that we've picked the three things together, I suppose we'll have to stick together,

callum_2_12-14-2023_221952 51:38

I can't believe that. I honestly This isn't being faked like that. I wrote it down so I can, you can see it here actually in the

jame_2_12-14-2023_221952 51:46

I'll believe you, I'll believe you.

callum_2_12-14-2023_221952 51:48

Yeah, maybe moxifloxacin is some of the good, I don't know.

jame_2_12-14-2023_221952 51:51

Maybe, I'll Moxie is, it's got it's got grand neg, it's got some anaerobe cover. Only thing it doesn't cover is Pseudomonas. But, just stay away from the islands, water supply system, sewage facility, and intensive care unit,

callum_2_12-14-2023_221952 52:04

the main thing, the main answer to this question is not which free antibiotics it would be, it's what would you do to the infection, what infection prevention control measures would you institute in the island,

jame_2_12-14-2023_221952 52:13

yes, okay, yeah.

callum_2_12-14-2023_221952 52:14

If she's a water supply systems,

jame_2_12-14-2023_221952 52:16

with leaves.

callum_2_12-14-2023_221952 52:17

that's a real mess.

jame_2_12-14-2023_221952 52:19

Moxie is a good idea Callum, but I would be betraying myself as a, as an infection specialist if I chose a quinolone for one of my three antibiotics. I'm afraid that will have to stay in the bin.

callum_2_12-14-2023_221952 52:34

That's an excellent note to end on. Thanks very much.

jame_2_12-14-2023_221952 52:37

Cheers buddy. Here's to you.

callum_2_12-14-2023_221952 52:41

Thanks. Cheers.