Here’s a detailed explanation of how GP trainees can manage stress during the Key Feature Problem (KFP) examination, with examples:

1. Thorough Preparation and Practice:
   Comprehensive preparation is crucial for reducing exam anxiety. GP trainees should:

• Systematically cover all topics in the curriculum, including less common conditions. For example, Case 17 in the 2020 exam involved secondary syphilis, which some candidates struggled with due to limited exposure in public clinics.
• Practice with past KFP cases, like the 26 cases from the 2020 examination listed in Table 1. This familiarizes trainees with the exam format and common types of questions.
• Use RACGP virtual library and clinical resources to access up-to-date guidelines and reference materials.
• Complete additional exercises provided in GCFM and ATFM study modules to enhance knowledge and clinical reasoning skills.

Example: A trainee preparing for Case 11 (anaphylaxis in a 12-month-old) could review pediatric emergency protocols, practice writing concise management plans, and discuss similar scenarios with peers or mentors.

2. Effective Time Management:
   Developing a solid time management strategy is essential. Trainees should:

• Allocate approximately 8 minutes per case during the exam.
• Practice timing themselves when answering sample questions to develop a sense of pacing.
• Use brief, point-form notes rather than full sentences to save time.

Example: In a 3.5-hour exam with 25 cases, aim to complete 7 cases per hour. If struggling with Case 23 (obesity management), quickly jot down key points and move on, returning later if time allows.

3. Comprehensive Case Review:
   Reading the entire case before answering is crucial. This approach:

• Provides context for earlier questions.
• Prevents misplaced answers.
• Helps in identifying key information.

Example: In Case 23, reading the whole case would prevent candidates from discussing bariatric surgery indications when asked about general obesity management, as this topic is addressed in a subsequent question.

4. Focused and Relevant Answers:
   Staying focused on the specific question asked is vital. Trainees should:

• Carefully read each question.
• Provide relevant answers without discussing unrelated topics.
• Re-read the question after answering to ensure the response is on point.

Example: In Case 25, when asked about non-pharmacological management of postpartum depression, focus on strategies like support groups or cognitive behavioral therapy, avoiding discussion of antidepressants.

5. Prioritization and Moving On:
   If stuck on a difficult question, it’s important to:

• Make an educated guess if possible.
• Move on to other questions to ensure all cases are attempted.
• Return to challenging questions if time permits at the end.

Example: If unsure about the specific investigations for ankylosing spondylitis in Case 8, note down the most likely options and move on, rather than spending excessive time on one question.

6. Stress-Reduction Techniques:
   Implementing stress-reduction techniques during the exam can help maintain focus and calm. These include:

• Deep breathing exercises: Take slow, deep breaths if anxiety rises.
• Positive self-talk: Use encouraging phrases like “I’ve prepared well for this” or “I can handle this challenge.”
• Brief relaxation techniques: Practice quick relaxation methods like progressive muscle relaxation between cases.

Example: Before starting Case 13 (end-of-life care), take a few deep breaths and remind yourself of your training in palliative care to approach the sensitive topic calmly.

7. Physical Well-being:
   Maintaining physical well-being is crucial for managing stress. Trainees should:

• Stay hydrated by bringing water to the exam.
• Bring a light, energy-boosting snack like nuts or fruit.
• Ensure adequate sleep the night before the exam.

Example: During a brief pause between cases, take a sip of water and a small bite of an energy bar to maintain focus and energy levels.

8. Post-Exam Reflection:
   After the exam, it’s important to:

• Avoid obsessing over specific answers.
• Reflect on the overall experience.
• Identify areas for improvement for future exams or clinical practice.

Example: If you struggled with Case 21 (Hashimoto’s thyroiditis), make a note to review thyroid disorders in more depth, rather than fixating on specific answers you provided. By implementing these strategies, GP trainees can better manage the stress associated with the KFP examination. Remember, some stress is normal and can even enhance performance when managed effectively. The key is to use these techniques to maintain focus, demonstrate knowledge, and apply clinical reasoning skills effectively throughout the exam.

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