Exam technique

How the exam works

• 150 questions in 3.5 hours, on a computer at a Pearson VUE test centre in Australia or overseas.
• Each question has a stem and five options. You choose the single best answer.
• It is a computer adaptive test. The first question is chosen at random. Answer correctly and the next one is usually harder; answer wrongly and it is usually easier.
• Some questions are new ones being trialled before they count. You cannot tell which, so treat every question as if it counts.
• Your result is reported on a scale of 0 to 500, and 250 is a pass. It is worked out from the difficulty of the questions you answer correctly, not a simple count, so there is no fixed percentage to aim for.
• Wrong answers do not lose marks. Never leave a question unanswered.

What adaptive means for you

• Hard questions are a good sign. If the exam feels difficult, it is usually because you are answering well and it is testing you at a higher level. Do not read anything into how hard a question feels.
• One question does not decide your result. The exam keeps refining its estimate across all 150 questions. A run of tough ones is normal.
• Early questions matter as much as late ones. Each answer shapes what comes next, so read every stem properly from the very first question.

Pacing

• 3.5 hours for 150 questions is 84 seconds a question.
• Checkpoints: about question 50 at 70 minutes, and question 100 at 140 minutes.
• A timer is on screen. AM Vault's full mocks show the same pace line, so you learn what 84 seconds feels like.
• If a question has taken more than about 2 minutes, choose your best answer and move on. Time spent on one question is taken from others you could have answered well.
• Finish all 150. An unfinished exam may not receive a result at all.

The no-going-back rule

• Once you answer, you cannot return to a question or change your answer, and you cannot skip ahead. Each question must be answered before the next one appears.
• So make each decision once: read, decide, confirm, move on.
• Do not carry a question with you. If you were unsure, let it go. The next question needs your full attention.
• AM Vault's full mocks work the same way, so you practise this habit every month.

Reading a question

1. Read the last line first. "Most likely diagnosis", "most appropriate next step" and "most appropriate initial management" are different questions with different answers.
2. Read the stem once, carefully. Note the age, the setting (general practice, emergency department, remote clinic), the vital signs and the time course.
3. Predict the answer before you look at the options. If your prediction is there, it is usually right.
4. Then read every option. More than one option can be partly right. Choose the best one for this patient, now.
5. Eliminate. Rule out options that are wrong, unsafe or unavailable in this setting, then choose between what is left.

Choosing between two good options

• An unstable patient: resuscitation and stabilising come before tests and before definitive treatment.
• Next step or definitive treatment: if the question asks for the next step, the answer is often the investigation or action that has to come first.
• Australian practice: choose what an Australian guideline would do, such as Therapeutic Guidelines, the Australian Immunisation Handbook, RACGP and state guidance. Where Australia differs from the UK or US, the Australian answer is the right one.
• Law and ethics: the patient's safety, capacity, autonomy and confidentiality usually decide the answer.
• The least invasive option that works: between two options that both work, the simpler and safer one is usually best.

Image questions

• Name what you see before you read the options. For an ECG: rate, rhythm, axis, intervals, then ST segments and T waves. For a CTG: baseline, variability, accelerations and decelerations. For a growth chart: the centile, and whether it is being crossed.
• Let the stem guide you. It tells you where to look: palpitations point to the rhythm, crushing chest pain to the ST segments.
• Look for the clear abnormality. Exam images are chosen to show one main finding. If you are hunting for something subtle, step back.
• Then answer the question asked. Often the image gives the diagnosis and the question is what to do next.
• Other figures have their own first look. An audiogram: is there a gap between air and bone? Spirometry: what is the FEV1/FVC ratio? Visual fields: which side, and both eyes or one? A family tree: every generation, and any father to son? A study plot: does the confidence interval cross 1?
• Practise on full-size figures. In AM Vault, tap any figure to open it full screen. ECGs open at full size so you can count the small squares, as you would on paper.

Exam day

• Read the AMC's current candidate instructions before the day, including the identification you need and what you may bring.
• Eat beforehand and arrive early.
• Sleep matters more than one more night of cards. Keep the day before light.
• If nerves rise during the exam, breathe out slowly, then read the next stem. A racing heart is your body getting ready.

Where candidates lose the mark

• Spending 4 or 5 minutes on one question, then rushing the last 20.
• Answering "most likely diagnosis" when the question asked for the next step.
• Choosing a UK or US answer where Australian practice differs.
• Reading meaning into a hard question and losing confidence.
• Leaving questions unanswered at the end.