EXAM Formats EXPLAINED

Medical schools use various exam formats to test students on their understanding of what is taught. All medical schools utilise SBA questions and OSCEs in examining students, but some medical schools also use other forms of exam formats in addition to this. We address the main ones here. If there is a question style/exam format you’d like us to cover on this page, contact us and we’ll try our best to include it in our next edit. 

 
1. Single Best Answer (SBA) Questions Explained
What is it?

SBA questions are similar to Multiple Choice Questions (MCQ) in the sense that students are given four or five answer options to choose from. The challenge with answering SBA questions is the fact that more than one of these options may be ‘correct’ factual information. This means that among the few ‘correct’ answers, you will have to be able to weigh these answers according to the question text and choose the best answer. These questions usually test factual knowledge and a degree of knowledge application. 

 

Example (taken from GeekyMedics)

Sandy Hughes, 67, presents to A&E with chest pain. She describes 12 hours of a sharp chest discomfort on inspiration, which started suddenly just after she arrived back from her flight to Florida. Her oxygen saturation is 94% on 2 litres of oxygen and her respiratory rate is 28. What is the most likely ECG finding for this patient?

A) Right axis deviation

B) SI QIII TIII pattern

C) Sinus tachycardia

D) ST elevation in three contiguous leads

E) Widespread saddle-shaped ST elevation

How to Prepare

When answering SBA questions, a good method of practice would be to perform what is called a basic “cover test” – i.e. you should be able to cover the answer options and still be able to produce an answer just by reading the question. However, in your exam, just as with normal MCQs, you should still be able to eliminate a few options that are wrong to narrow the answers down to two or three options. Every single bit of information provided in the question stem matters – even seemingly trivial pieces of information like the age and ethnicity of the patient. For example, the first line drug treatment for hypertension would be an ACE inhibitor in a patient below 55 years old; but if the patient were of Afro-Caribbean descent, the Single Best Answer would be to administer a Calcium Channel Blocker instead. 

 

The foolproof way to score highly in your SBA exam is to know your content very well. Many question bank websites exist to help you identify the gaps in your knowledge and doing many practice SBA questions can help you gain familiarity with the style of question you will receive in your exam. As expected, the question banks that will work best for you depends largely on the medical school you go to. We’ve listed a handful of popular question bank websites below, but ask your seniors in the years above you to see if there are particular question banks or books that will work particularly well for your curriculum!

 

Popular question bank websites: -

  1. BMJ OnExamination: https://www.onexamination.com

  2. PassMedicine: https://www.passmedicine.com

  3. PasTest: https://www.pastest.com

  4. Doctor Exams: https://www.doctorexams.co.uk/Home.aspx?AspxAutoDetectCookieSupport=1

  5. QuesMed: https://quesmed.com

  6. Confidence by Meducation: https://confidence.ac

2. Extended Matching Questions (EMQ) Explained
 

What is it?

EMQs also offer a number of answer options to choose from. However, these options are usually presented in the form of a list and this list will usually function as answer options for a number of questions belonging to the same theme. EMQs are usually used to test applied knowledge and diagnostic reasoning.

 

Example (taken from The Royal Australasian College of Physicians Divisional Written Examinations 2015)

Theme: Back pain 

Option list: 

A. Ankylosingspondylitis. 

B. Aorticdissection. 

C. Prolapsedintervertebraldisc. 

D. Lumbarspondylosis. 

E. Vertebralfracture. 

F. Intervertebral disc infection. 

G. Pars interarticularis defect. 

H. Metastaticmalignancy. 

For each patient with back pain, select the most likely diagnosis. 

Question 1 

A 23-year-old man has a 6-month history of lower back pain. His pain is predominantly at the thoracolumbar junction and in the right buttock. The pain is worse in the morning and he has difficulty in getting out of bed. There is some improvement during the day. Examination shows restriction of lumbar spinal movements, particularly lateral flexion. 

Question 2 

A 32-year-old lady presents with acute onset of low back pain. The pain is constant and is not significantly affected by posture. All spinal movements are painful and difficult. Three weeks earlier, she had a urinary tract infection, which had been treated with amoxicillin. 

How to prepare

Few question banks exist for EMQs as not all medical schools conduct this style of exam. From our previous list of SBA Question Bank Websites, PassMedicine also includes EMQs in its “Medical Student Finals Revision” package. “EMQs for Medical Students Volume 3: Practice Papers” is also a good resource if you are short on practice questions – find the pdf version of this book here.

 
3. the osce/ocape Explained

What is it?

If you had to go through Multiple Mini Interviews (MMIs) during your medical school application days, you’ll find the Objective Structured Clinical Examination (OSCE) to be of a very similar concept. While schools like UCL also terms it the Objective Structured Clinical and Practical Examination (OCaPE) for pre-clinical students, it all means the same thing. The OSCE is used to assess the student’s competency in clinical practice settings. Most stations function like written exams and involve the application of scientific knowledge, but in a full circuit, a few stations are usually set aside to specifically test Ethics and Law, Statistics, or clinical procedures such as Basic Life Support. Some stations may involve interacting with an actor under the watch of the examiner. Each station has a fixed structure and every student will receive the same questions/tasks. Students are marked against an objective mark scheme, with marks awarded for correct answers and some marks allocated for communications skills, hand washing, and professionalism.  

How to prepare

When preparing for your OSCEs, the most important thing is to practice doing and explaining things out loud. If you are preparing for clinical procedure stations, try to practice on friends, medical mannequins from your university Clinical Skills Centre, or even your pillows if you are practicing at home. Look for a reliable group of friends who will practice with you. Get used to explaining what you are doing out loud because this is what you’ll be doing in your exam. If you can find a mark scheme or checklist of the things you need to do, have it at hand to make sure you don’t miss important points.  There is little variation in how clinical procedure stations will be presented in your exam, so know these like the back of your hand. For good demonstrations on how each procedure should be performed in the exam setting, GeekyMedics has a YouTube channel that provides OSCE guides.

When preparing for knowledge or interpretation-based stations, try going over your lecture notes and coming up with a list of testable diseases, syndromes, or abnormalities. Go through these systematically. Here are seven things you should consider when going through each disease: 

  1. Disease/Syndrome/Abnormality 

  2. What symptoms would you see in an affected patient?

  3. (If genetic disease) What is the inheritance pattern of this disease?
    (If transmissible disease) What is the mode of transmission of this disease?

  4. Which tests would you perform to confirm the diagnosis?

  5. What test results would you expect in an affected patient?

  6. Explain the pathophysiology of this disease.

  7. What is the best course of treatment/recommended medication? 

Of course, the questions you receive in your OSCE may not always be presented in this order. Often, the scenario will describe a patient with a set of symptoms and you will be asked a series of questions based on this. Sometimes, you may even receive laboratory results, images of histological or microscopic slides, or even videos of abnormal movements. If there is a specific name for a particular symptom, e.g. Chvostek sign in a patient with hypocalcaemia, you usually are required to give this name in order to receive the full mark. In this case, simply describing the symptom as a “twitching of a facial muscle” will not cut it, although saying this aptly demonstrates that you know how to identify this symptom in a patient and link it to the correct disease. If there are two or more diseases with similar symptoms, similar pattern of inheritance, similar pathophysiology, similar mode of transmission, you should know their differentials in order to distinguish one disease from the other. 

Don't forget Pharmacology! Know: -

  1. Drug names and classes (especially gold standards and first line treatments)

  2. Mechanisms of action

  3. Side effects

  4. Drug elimination kinetics e.g. first order elimination

  5. Antidotes to use in an overdose (if applicable) 

Pronounce drug names out loud when you practice – you’ll be surprised how quickly similar-sounding names start to blend together – do you know the difference between pyridostigmine, pilocarpine, phenoxybenzamine, phentolamine, phenylephrine, phenelzine, and phenobarbitone? Well, you would if you practiced out loud. 

4. the anatomy "spotter" examination Explained
 

What is it?

Anatomy is often tested using “spotter” exams. Such exams require students to be able to identify bones, joints, nerves, vessels, and other bodily structures on cadavers. Usually, pins or other forms of markers will be placed on the structure, or structures are isolated from the body. Students are then required to either name these structures or answer a question based on this structure. Different universities run the “spotter” differently. One way the “spotter” is run is by having up to 50 structures placed strategically around a room. Students will have set amount of time for each question e.g. 30 seconds. When the buzzer sounds at every interval, students rotate around the room to answer the next question. 

How to prepare

Atlases are very helpful when learning anatomy as they are systematic and clear in labeling each structure. However, to study for the “spotter”, it is vital that you familiarise yourself with the actual prosections or diagrams of cadavers as it often comes as quite a shock to students when they realise that arteries, veins, and nerves actually look quite similar in real life when they are not labeled red, blue, and yellow respectively! This Online Human Anatomy Quiz is great for quizzing yourself using images of cadavers. If you don't have free access to models or prosections, many students swear by the Essential Anatomy app and use it as a 3D virtual atlas - this is great for familiarising yourself with bones or structures that are difficult to visualise (these bones are usually in the skull!). Make sure you know where structures lie in relation to each other, where important foramina are located, and what passes through each foramen. Most importantly, don’t forget your dermatomes and myotomes because these are easy marks!

 
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