Ten key steps for the KFP

The KFP is about key steps.   You’ve been walking the study path for some time now and the time for deep learning is long passed.  The focus now should be on putting your best foot forward.

Here are some critical points to remember when approaching the KFP:

• It is a method by which the key decision-making steps in making a diagnosis are assessed.
• The KFP is assessing your competence for safe, independent decision-making in Australian General Practice.
• The ‘technique’ of the KFP is to display your clinical knowledge and reasoning in a way that can be easily understood and fairly marked.
• The best way to approach the exam is start ‘thinking about your thinking’. If this concept is not familiar to you, there are some great clinical reasoning resources and books you should explore.
• Knowledge alone will not enable you to pass the exam.
• Technique alone will not enable you to pass the exam.

Combining strategies to demonstrate the contextual application of your knowledge is the key to success!

General Steps:

• Think about your thinking:
• • Break your thinking down into logical steps, even for basic consultations and problems. For each consultation consider the ‘top diagnosis, an alternative, and the diagnosis not to be missed’.  If you can’t do this, ask yourself why?
  • Recognise your strengths and weakness – what topics are you comfortable with and which ones scare you? – How does this affect your approach to the question?
  • Recognise biases – consider how your personal and work experiences influence your clinical decision-making. How do you mitigate against your biases?

Take steps along the path to reach your desired destination

STEP 1: 

Breathe – the week before, the day of, and in reading time.   A stressed, tired and nervous mind does not make good decisions in clinical practice and in the exam.

STEP 2:

Use your reading time effectively.   Plan your timing (approximately 7.5 minutes per question) and list some strategies that will help you to approach the questions holistically.  These might be surgical sieves, considering a systems-based approach (e.g. cardiovascular, respiratory), Murtagh’s masquerades, the RACGP Domains of General Practice.   These strategies come in handy when you are ‘stuck’ for answers.

STEP 3:

Read the stem of the question only.  Do not read the subsequent questions.  Is this a diagnostic dilemma or the type of question that requires a problem list?   Think of the question as a ‘clinical scenario’, imagine the patient is sitting in front of you.    This strategy can assist in ensuring a practical approach and can more efficiently draw on your clinical knowledge in context.

STEP 4:

Consider the patient’s age, gender and initial presenting complaint.   Just for now, ignore the other key features.  Generate a differential diagnosis now using a surgical sieve to ‘catch’ all the possibilities. If you don’t start the question thinking broadly, you run the risk of coming to a diagnosis prematurely and missing rare and/or dangerous diagnoses.

STEP 5:

Read the stem again (not the questions) focusing on the key features.   You may like to jot down the key features on a separate piece of paper to help clarify them for you.  Narrow down your differential list to contextualise it for this patient.  Ranking the diagnoses in order of likelihood can be helpful, as well as highlighting the diagnoses not to be missed.

STEP 6: 

Now you can answer the questions.   Right about know you are probably feeling frustrated with these tips as you haven’t even started answering the questions!   You’ll be surprised however at how ‘front-ending’ your thinking will make answering the questions more accurate and smoother.   It also makes you more likely to put down the right answers!   This technique is akin to what we do as clinicians when the diagnosis is not obvious initially – we ask more questions, explore the diagnosis more, and gather more information, before we embark on further investigations.

STEP 7:

Every answer should have a purpose.   Don’t put down an answer that won’t influence your decision-making about the case.  Use your initial differentials to generate your answers.  Think of the historical and examination features, and investigations which will help you rule-in or rule out your diagnoses.

TIP 8:

Check your answers – the CAATCHHH technique will help with this.

• C – Can I make more my answers more specific? Be prescriptive.
• A – Are these the most correct answers? Ranking helps here.
• A – Are the answers dissimilar from enough from each other? Display your knowledge
• T – There should be no abbreviations – write what you mean in full.
• C – Context: Have I considered this?   It makes an enormous difference.
• H – Have I repeated information in the stem? Regurgitation doesn’t test knowledge.
• H – Have I over-coded? Don’t have two pieces of information on the same line.
• H – Have I answered the question? eg. symptoms vs signs.

STEP 9:

Make sure your answers can’t be misinterpreted.    The KFP is a fair exam.   The examiners can only award you marks based on what is written.   If the meaning of your answer is unclear or can be misinterpreted there is a risk that you will not be awarded marks.   Take the time to say aloud (in your head) your answer and consider how it might be interpreted by others, especially if English is not your native language.   It can help to write down how you might explain it to a patient if appropriate to the question.

STEP 10:

There should be as much importance placed on exploring the alternative diagnoses as confirming the obvious one.    Demonstrate that in the KFP and in clinical practice and you will be a great clinician!

For more exam techniques you may be interested in A Diagnostic Approach to the RACGP Exams.