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Welcome to PMP Main Page
This page is linked to
PMPs are considered to be the most difficult part of the examination by most candidates. There is nothing as important as doing, as many practice mock PMPs as you can, and if exam anxiety is one of your problems it is quite important that you get extensive exposure to PMPs from everybody you can think of.
There are several PMP books around but memorising the answers probably will only help to a limited extent, as the questions can be different and even if you get similar questions the discussion may not take the same direction as in the book. However books can give you an idea about the breadth of questions that can be asked and help stimulate thinking.
It is important to have a method of thinking about how to answer PMPs but unfortunately there is no one method that can be universally applied. In general it is true to say that your thinking can be guided by physical, psychological and social aspects, short, medium, long term and multi disciplinary assessment and management.
Following might help you to orientate yourself to the different sort of questions you can be asked, and different ways of thinking about them.
Hopefully you will be able to apply what appears below, under most circumstances.
Repeat the question to the examiners, (if you feel uncomfortable about this thinking examiners will get annoyed (it is unlikely that this will happen) you can at least repeat the salient points) so that the question sinks in to you and the examiners can clarify again if you haven't got it right. It will also give you valuable thinking time.
Think aloud by mentioning the main issues involved in the question. "The main issues involved in this situation are.......... ".
Tell the examiners what your sources of information are going to be. "Sources of history in this case in addition to the patient are going to be relatives, GP, CPN, past notes" etc.
You can mention that you would take a detailed history and do a thorough MSE, but don't stop at that. Mention the important points you would like to specifically cover in your assessment. "I would like to specifically find out about .................... " .
Tell the examiners what your diagnosis and differential diagnoses is going to be.
Your management plan comes next and
you can conclude by mentioning the short and long term prognosis.
To illustrate some issues in answering PMPs, lets look at few examples.
The casualty officer requests you to see a 24 year mother who has attended the A&E department with her 6 month old baby. She complains that the baby is not gaining weight. Tell us how you would proceed?
While thinking along above lines you will also have to think about the hidden question in this PMP.
How many mothers you know will attend the A&E with a complaint of the baby not gaining weight? Obviously the examiner appears to want you to talk about non accidental injury, but you will also be talking about looking at the growth
A patient presents with a complaint of hearing voices talking about himself. Tell me your management from beginning to end until you discharge the patient? (a real exam question, one candidate was asked)
Though above advice can be applied in answering, the problem with this question is that it can be answered in extensive detail. Therefore it is important to think how you are going to tailor your answer for 7 minutes. If you spend lot of time, without mentioning the salient points examiners want to hear, you will loose valuable time, that can be spent scoring marks with another questions.(this happened to the candidate in question)
A logical method of starting the answer therefore would be to start by saying "I am going to mention the main points in the management", thereby giving yourself the chance to go into minor details, only if the examiners want to.
Most questions involve some aspects of risk assessment or risk management and therefore requires the candidate to identify this early so that the examiners can be given the opportunity of asking question about it.
A notable example field is child psychiatry, as most problems can lead to questions about Childhood Sexual Abuse. If you don't mention this and if the examiners mention it, it is likely that you may have lost valuable marks, you could have otherwise been able to score.
Some examiners seem to get satisfied quite easily, after only a few questions about a topic and would like to take you around on a tour of a number of subjects. It is not difficult to spot these examiners as they seem to change the direction of questioning quite frequently. (a little like knight's move) Go into salient points only, once again, as this sort of examiner will be more interested in the breadth of your knowledge. (e.g. one examiner started with a question about bi polar affective disorder and moved to Lithium, detention, driving, offending, writing court reports, and finally to drug abuse)
Rarely examiners will try to surprise you by asking questions you may never have thought you would get.
e.g. You have been appointed as the new consultant of a substance abuse service. Tell us how you would start your job?
This question obviously needs keeping your nerve, and showing that you take charge of the situation. Common sense is enough for you to be guided in answering, and you have to mention about issues such as, Reporting to the personnel department, visiting your unit/s, introducing yourself to the ward and MDT staff, having a meeting with the nursing manager/ward sister, and reading the operational policy of the unit etc.
Little bit of active thinking helps, and this can be illustrated by following question.
One of your ward nurses brings a patient who complains of panic attacks, and asks you for advice. Tell us how you would respond?
Whatever approach you take, it is important for you to let the examiners know that you know that the panic disorder is a chronic one, needing relatively long term care, and therefore you would want to refer the patient to a psychiatric team for management. In this example as well, the examiners would like to hear that you will take charge of the situation and provide appropriate advice, rather than taking over his care.
Other examiners are quite particular that you pick up the point in question.
e.g. A question one candidate was asked was,
A 52 yr. old Cypriot presents in panic. He tells you that he visited a brothel and a prostitute whipped him until he bled. He tells you that he is quite worried that he may have contracted AIDS. How would you respond?
Candidate in question went into details about AIDS, and panic, and so forth, but the point in the question was that the patient can't catch AIDS by being whipped (bled or not) and therefore needs reassurance and support to deal with his guilt. (probably due to cheating his wife)
This appears a bit eccentric, (don't forget your examiners are psychiatrists, and therefore can be eccentric at times.) but if you start by saying that you would keep in mind that the patient won't catch AIDS by being whipped, however you will keep an open mind and start from the first principles by doing an assessment, you will be on safe grounds.
If anything is not clear please clarify with the examiner and make sure that both of you are talking in the same language.
A candidate was once asked about managing a patient who had morbid ideas. When the candidate mentioned about considering admission depending on the outcome of the assessment, the examiner interrupted the candidate to say that he has already told that the patient harboured morbid ideas. The candidate managed to save himself by saying that, in that case he would admit the patient immediately. However he would have been better off if he clarified at the beginning itself, what the examiner meant by morbid ideas? (Suicidal ideas in this case!)
It is quite possible that the examiners may not know as much theory as you know, however it is wiser to agree with them and bring your point across in a non threatening manner. Once an examiner didn't agree with the candidate on the diagnosis of a moderate depressive disorder in a patient who had suicidal ideation. As the examiner thought that the diagnosis would be severe depressive disorder, the candidate handled the situation by mentioning that, "well you can call it severe depressive disorder but if you apply strict ICD 10 criteria, the presence of suicidal ideation will not automatically make depressive disorder severe".
In the discussion that followed the candidate was able to talk about the diagnostic criteria of depression and how they are applied in clinical practice.