The Specialist Certificate Examination (SCE) in Respiratory Medicine is set at the level of a newly appointed Consultant. It is compulsory for all trainees whose specialist training began in or after August 2007. It is recommended that Respiratory trainees consider taking the SCE in their third or penultimate year of training (ST5 or ST6). There is only one diet of the exam per year so plan ahead!
- 2016: 26th October (register 6th July – 28th September)
- 2017: 20th September (register 28th June – 24th August)
Failure in the exam will not impede progress through training, but a CCT cannot be awarded without it. Once the trainee has gained their CCT in Respiratory Medicine, they will be eligible to use the post-nominal “MRCP (UK) (Resp Med),” provided that the SCE in Respiratory Medicine has been passed.
The SCE consists of 200 questions in 2 x 3-hour papers. The questions are in ‘best of five’ multiple choice format. This format, in addition to testing core knowledge and comprehension, also assesses the ability to interpret information and to solve clinical problems. There will be five options – one correct answer and four alternatives to the correct answer. The four distractors will be closely related to the preferred option but less correct, therefore acting as plausible alternatives.
The pass rates for previous diets are reassuring:
Information on the SCE is provided by the BTS, the JRPCTB and MRCP(UK). The cost was £861, but GOOD NEWS, it has been reduced to £665 from August 2016. A factsheet on the rationale behind the cost is published by the MRCP. Practice questions and 2 mock exams are provided on the BTS site and a mock exam is on the MRCP(UK) website.
Each SCE Examining Board is charged with setting an exam that tests the scope and depth of knowledge set out in the relevant curriculum. This means assessing knowledge of the natural history and pathogenesis of relevant disorders, and the basic scientific principles and evidence base underpinning current clinical practice, in addition to knowledge of how to diagnose and manage everyday clinical problems. The exams must also include an appropriate number of questions on less common conditions, in proportion to their prevalence. The blueprint provides information on the weighting of different subjects.
Dr John Mucklow, Associate Medical Director for the SCE advises that “knowledge necessary to pass the SCE cannot be acquired from clinical practice alone, however diligent. As at every stage of one’s continuing medical education, clinical experience has to be complemented by directed reading and private study.”
Tips on how to prepare for the exam
Advice from Dr Adam Hill and Dr Ian Coutts, Secretary and Chair respectively of the Respiratory SCE Board.
- Work hard (like you needed to be told that!)
- Read the respiratory curriculum
- Attend MDM meetings in the various specialty blocks (and pay attention)
- Interpret lung function tests including spirometry, flow volume loops, full pulmonary function tests, exercise physiology and arterial blood gases in day to day practice
- Interpret chest radiology including chest radiography, CT scanning and PET scanning (look at the images before reading the report)
- Read all the Guidelines by the British Thoracic Society and guidelines from other Societies such as the European and American Thoracic Societies
- Read the key Respiratory Journals and keep up-to-date, for example the American Journal of Respiratory and Critical Care Medicine, Thorax, European Respiratory Journal, CHEST and many others
- Read relevant guidelines from NICE and SIGN
- Attend BTS Short Courses
- In certain areas, reading books can be very helpful: Thorax review new books. If you have a recommendation, let us know.
Tips from North East Thames trainees
- The SCE is very passable, but requires reading in addition to experience from clinical work
- Find a study-buddy and test each other on tricky areas
- If you read all the BTS guidelines you will have a good basis to pass, but this takes time to do it properly so plan ahead (some of the guidelines are very long and very dry!). There are no BTS guidelines on some subjects so make sure you are aware of up to date resources to help revise these areas.
Some helpful resources are already on the resources page (including the clinic aide-memoires which are summaries of BTS guidelines if time is short). Other SCE specific resources that trainees have found helpful include:
- Radiopedia for imaging – comprehensive site which you can use to test yourself identifying relevant pathology
- Figure 1 has some good images (eg CTs) and some pathology specimens
- Fleishner Society guidelines for solid pulmonary nodules and ground glass or part-solid nodules – old nodule guidelines (Qs in exam not yet updated to use Brock – as of Oct 2015 exam, confirmed by BTS)
- UW Medicine Pathology and University of Utah WebPath for basic histology of inflammatory, fibrotic, and neoplastic processes affecting the lung, as well as these presentations on slideshare with examples:
- SCE Respiratory Medicine questions written by a Chest Consultant, Dr Nawaid Ahmed. Download to iBooks and you can do the questions on your morning commute. Excellent, and FREE!
- Overview of CFTR mutations, diagnosis and treatment including new CTFR modulators, and standards of care for CF including antibiotic regimes and choices.
- Respiratory Physiology (from an anaesthetist’s perspective), and sites dedicated to making you a spirometryguru, and spirometryexpert – and a good explanation of LLN and Z scores
- An introduction to CPET and it’s interpretation, catchily named KeepingCPETsimple is perhaps not simple enough, but does include case studies. A more step-by-step approach is available in two papers from BJHM (intro to CPET and it’s interpretation), and some additional useful concepts are available from a course run by the University of Washington via UCL. There are also some hidden slides on CPET on the BTS e-learning website – look under “guidelines/published reports” on the right hand side bar. CPET is hard, so dedicate some time to it.
- Overview of occupational lung diseases from ERS White Book – questions seem to come up in the exam disproportionally frequently compared to practice (or maybe we’re just missing occupational lung disease!).
- All the ERS monographs and handbooks are good but unfortunately are not cheap. The ERS handbook aligns with the HERMES curriculum which has many similarities to the UK curriculum for Respiratory Medicine. Unfortunately the handbook is €70, and the ERS handbook self assessment book €60 (with €10 off for ERS members). There is also an app, with 1 module of questions free, but high costs for additional modules. The questions are pitched at the right level and cover many subjects, but not all are in the SBA format.
- European Society of Cardiology guidelines on PE, which is helpful in supplementing NICE VTE guidance
- Books to consider dipping into:
- Oxford Handbook of Respiratory Medicine £ 29.99 on amazon. Available as an app (through Dr Companion, free if you are at UCLH or the Whittington and make friends with your Postgraduate Education department). Good for reading on the tube. Overview of most of Respiratory medicine. Focused but thorough. No self assessment questions. If you only choose 1 book, it should probably be this one.
- Oxford Case Histories in Respiratory Medicine £40 on amazon. Varied histories with investigation results to analyse and self-test questions (not SBAs but still useful SCE revision).
- Lung Function Tests: a guide to their interpretation. £22.50 on amazon. An accessible and clinically focused guide through lung function interpretation, with brief sections on ABGs and respiratory muscle testing. Good worked examples with problems similar to those that come up in SCE questions.
- Respiratory Medicine Self Assessment Colour Review £25.99 0n amazon. Plenty of short cases with self-test questions.
- Blow away the Pulmonary Boards £27.50 on amazon. Aimed at American Board exams so not everything is relevant. But plenty of SBAs for extra practice for the SCE.
- Eureka Respiratory Medicine. £20.50 on amazon. Aimed at students but accessible and provides good overview of topics before getting into the guidelines. Is up to date and based on BTS/ERS/ATS guidelines so goes beyond what is expected of students. Good overview of anatomy, physiology and immunology. SBAs on all chapters, not aimed at SCE level but good starters (disclaimer – co-written by LJ!).
- Revision Notes for the Respiratory SCE £33 on amazon. This book has terrible reviews and is said to be basic, with bullet points and brief notes only. I haven’t seen a copy so can’t judge. Get in touch if you have used this book.
Also have a look at the Respiratory Futures BTS STAG forum, particularly for posts tagged SCE. A growing resource, with contributions from trainees across the country. Why not contribute your own tips?
Thanks to Will, James, Alex and LJ for contributions.