Tips on the KFP exam for FRACGP - things  I haven't seen anywhere else.


By now you've done the practice KFP on the RACGP website and also seen past papers floating around. You've also seen general tips/hints re: the exam. Here I've written 5 tips that I have not seen covered in great depth elsewhere online. It's not meant to be comprehensive.


At the end I've provided 7 links to other websites with good tips on written/OSCE. Also this website builder has no spellcheck, so calm the inner grammarnazi.


The KFP is a challenging paper; not necessarily because the questions require deep knowledge, but because the knowledge required is very case specific. This would be fine in real life where you can probe by asking the patient/whoever else more questions to see what they need.


Sadly you can't do that in the KFP. Exam technique is very important to get every advantage possible.

I can't speak from particularly high authority on the exam, except to say that I did it fairly recently and fairly well. I also think I had pretty good exam technique.


For god's sake ignore the rest of this website. It's of zero interest to you, I promise. I had nowhere else to post this up, and didn't want to put it up publically on facebook and get unwanted input/commentary/debate from people not sitting the exams. I should really be posting this on a blog website.


1. Time

Time management would seem to be pretty generic advice, but I get fairly specific here. Let me put it into context.


After I walked out of the KFP, pretty much everyone was shocked and confused! It was definitely hard.. But I was really surprised at the amount of people didn't 'finish' the exam. They worked through it start to finish, and didn't quite make it.  

There were 20 questions on the paper, and a lot of people had missed up to 3 questions. Some even more.


Which is a shame, because I think 3 relatively easier questions were amongst the last 5. And all of them fell right after a question that everyone found difficult, one that everyone spent a good 15 minutes on.  And I don't suspect that these 3 easier questions were weighted less, because they weren't "easier" as such, just more conventional and familiar.


The thing that makes time management in the KFP trick is that no two questions are equal: and I'm not talking about weighted marks.

The questions are varied in that some require a lot of thinking, others don't. Some require more typing, others require minimal typing.


So the first point regarding time (yes, a tad generic) - if you can't think of an answer at all, put something down, mark the question for review (for yourself, so you can come back to it later), and move on.


The 'put something down' part of this is important for 3 reasons. Firstly, it might be correct, secondly, when you come back to the question to rethink, it gives your mind some stimulus. Thirdly, you might not get time to come back to the question. But if you're really stuck, skip, skip, skip ahead.


There is also another strategy that I found extremely helpful. In fact I'm sure it's the only reason I finished the paper and had time to review every question I wanted to:


I took the total exam time, subtracted 10 minutes for reviewing only.  

Ignoring these 10 minutes I wrote down the time on the clock which represented 1/3rd of the total time for answering questions, and also half time, and 3/4 time.


I then aimed to complete 1/3rd of questions in 1/3rd of the time. This was a rough guide.

I aimed to complete 1/2 the questions by half-time. This was a red flag.

So on, so forth.


I'd strongly advice people use a vaguely similar technique. 


Obviously you shouldn't allocate time to individual single questions; there is too much variance between questions to meaningfully be able to assign time.  But 1/3rd time is good as a gauge, and 1/2 time is pretty critical - if you reach half time, and you've perfectly answered only 30% of the question, something isn't right.


And here is something quite specific to the KFP: "Hurrying up" doesn't necessarily mean rushing through questions and answers. 

In fact this is quite hard to do for a lot of questions.

"Hurrying up" can merely mean looking at a question, thinking "this will take a while" and skipping to a picture based question that asks for a spot diagnosis.


Sounds pretty basic, but I'm sure a lot of people weren't doing this. This might explain the last minute flurry of key strokes I heard around the exam room while I had finished everything. 


I think the other determinant of the amount of time people spend on the questions is the next point...



2. Breadth vs Depth


How broad should my answers be? 

"Please provide 3 points for the management of this condition"

Do they want 3 different pharmacological options, Or is 'pharmacological treatment' just one of the 3 points? 


A lot of the time, you get a sense of how broadly/narrowly to answer a question. A lot of the time in the KFP, you're not sure.   


So how broad/deep should you be in your approach?  This is interesting one. It's probably the hardest thing about the KFP, not knowing whether to give very specific details, or give broad categories of response.  

Conventional wisdom for the KFP exam is that if you're not sure, err on the side of breadth by thinking broadly about categories, but be as specific as you can about what you're describing. If that sounds unhelpful, it is. 


Just know that when the exam panel decide the marking schemes/answers to the question, it's a battle. 

Every doctor has their own views about what is a reasonable answer, and I'm told it gets debated quite hotly!


So if 10 or so doctors, who are writing the exam paper, can't easily come to a conclusion, how can you? Well, that's the thing about General Practice, that viewpoints vary. 


But just remember, with a panel of doctors debating answers, chances are that breadth will be favoured simply due to the variety of viewpoints presented by the different people at the table.


4. Read all parts a, b, c, of the question before answering


Again, this is very KFP specific. This is not quite your 'read the question carefully' patronising tip.  Rather, this helps address the commonest issue in KFP, which is knowing how broad to be in your answers.

Questions usually have a part a, b, c to them. 


parts a, b and c are on different 'screens'. i.e. you'd have to click to see part c. It's not on the same page.


This small detail is quite relevant.  Often Part b could have an answer that could be quite broad.  Then part C of the question turns out to be a more specific aspect of part b. Sounds confusing. Let me illustrate.


Question 8,

part a) Patient x has y symptoms, and asks you if they should increase their dosage of drug z 

part b) List 5 things you would discuss with the patient as part of their management

part c) What relevant side effects would you discus with the patient.


Now, when answering part b), it's possible you could only come up with 4 points, and spend 3 minutes trying to think of a fifth point.

Then after moving to part c), you would probably think 'damn, I should mention 'discuss side effects in part b)' 

Had you spent the 4 seconds to scan parts a), b), c) to start off with, you could've saved yourself 3 minutes.


It also works the other way around, where reading part c) makes you realise that you are being too specific in part b).

e.g. question 8

part a) xyz

part b) the patient's results come back showing metastatic carcinoma. What are 5 important things to communicate to the patient?

part c) what are 5 good communication strategies you can use to break the bad news empathetically?


Now clearly here, when answering part b) had you listed 'offer to call up family, and allow patient to express emotions' as 2 separate points in section b), that's a waste of answers, because clearly they want those kind of things in part c).

Believe me this happened quite a few times in my KFP paper.


Lost minutes to be found everywhere.




4. How much to write


The answer is not too much. I realise this sounds vague, but you DON'T need to write in sentences. Dot points are fine. 

If the question is "what are 5 things you would want to elicit from the patient when taking their history"


One of the 5 things could be: 


"I would ask the patient about her family history of breast and ovarian cancer".  It's long, conveys no extra information.


"Family history of breast/ovarian cancer" is minimal, and enough. 


I know this doesn't sound like a big deal, but consider that there are around 20 questions, with 2 or 3 parts each (a, b, c), with each requiring anywhere from 1 to 7 points to be written.  That's a lot of typing, and a lot of registrars type quite slowly.


Even if you type quite fast, it's handy to know this to reduce the workload and mental energy. Do what's necessary, nothing more.


A lot of answers in KFP paper should just be  a few words - anywhere from 1 to 10.


If you're writing longish compound sentences, consider if that one sentence actually represents 2 or more points that should be broken up.


5.  On the day prep


Earplugs. Yep. 


When someone told me to bring earplugs to the exam, I thought that sounded crazy. Then 3 other people who'd done the KFP before recommended ear plugs. So I complied, and man was I glad... 


You're probably used to doing exams in pin drop silence. This is the complete opposite. There is so much clickety clacketing that it is actually deafening. It's a short answer question on a computer with 30 people in the room. Most of us have never done this before, and it is awfully distracting.


So here is a short list of things to consider


> Earplugs

> Dress in layers - at least 4 times in my room, candidates asked for the heating to be turned up, down and sideways. Imagine how distracted they were

> By all means go to the bathroom during the exam- the exam is a marathon. Going to the bathroom even as a sabbatical, let alone to void, was a good break

> Ask for a day off before the exam if you think it might help. Not necessarily to study but to relax, even just to get a sleep in on Friday to catch up. You'll be surprised how sympathetic your supervisor might be.

> Remember, it's hard for everyone. So that means ignore how badly you think you might've done on the last question. Probably everyone else is as confused as you.