Preparation Tips for the Psychiatric Formulation and Management in the RANZCP Exam

This short article is intended mainly for RANZCP exam going candidates but may be useful for other psychiatry exams where a long case is an exam component. If you are done with the written exams, you must have by now read several textbooks about psychiatry. The Long case is about converting theory into practice, which requires you to develop a navigational system to guide you through the complexities that arise in patient management. It also requires you to look beyond diagnoses and adopt a problem solving approach.

Here are some tips to help you start this journey.

• Approach the exam with complete conviction:  Give it your best shot. You don’t want to pay the college for stress, again! Passing the exam is priceless! As Thomas Jefferson said: “Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude.”

• Develop your Psychiatric Interview Skills :The most important part in the Long case is the interviewing technique and the formulation (data synthesis). This alone accounts for 60% of the OCI marking scheme.

• Make full use of your clinical work:  Approach cases in your clinical practice like exam cases. Aim to vary the type of cases; e.g. acute case, chronic case, eating disorder case, dual diagnosis etc. These do not need to be done necessarily with examiners, but if you can avail a supervisor or a mentor you’re at an advantage.

• Develop your Formulation Skills: The aim is to be able to formulate any case that you are confronted with in 10 minutes thinking time. Reserve the other 10 minutes for management. This requires a structure (template) and  knowledge of biological, psychological, social and cultural models for  each psychiatric condition. This should then be followed by a succinct time specific narrative that requires presentation skills underpinned by a presentation template. So a forensic case of stabbing, with partial amnesia and neurological deficits (true exam case) should be no problem. Real world clinical practice is busy and the ability to formulate and develop management plans in 20 minutes or less is a valuable skill to possess.

• Develop Strategic Management plans and Communicate them well: Present the management in a structured manner and have a sound knowledge base about medications, psychological treatments and social treatments for each psychiatric condition. There is an art in presenting management so that you prime the examiner to ask you the questions that you want – and  believe me it works! Be aware of issues for Indigenous and migrant populations and answer questions succinctly. A competent knowledge base  will equip you to answer any questions the examiner asks you along with evidence based treatments.

• Focus on the person: One of the most powerful tools to passing the long case is  summarized well in the quote by William Osler “Ask not what disease the person has but, rather what person the disease has.

Doing all of the above will most definitely increase your chances of passing the exam. However, if you want extra help in incorporating the described techniques, feel free to contact us. Here is a video covering the above in more detail. Further articles on the 4 questions that help in psychiatric formulation and the basic principles have been added to the blog.

Don’t forget to drop us a line if you’ve got any extra tips.

This article is written by Dr Sanil Rege. Sanil is a Consultant Psychiatrist and co-founder of psychscene.com. He is pursuing an MBA at the Melbourne Business School.  You can follow him on Google+