A significant milestone in specialty training and necessary in the road to becoming a Consultant Neurologist, the Specialty Certificate Examination in Neurology is a useful opportunity for revision and improvement of clinical knowledge and clinical reasoning skills but can be an anxiety-inducing experience for many trainees. Here we provide a collection of resources and tips that were useful in our own preparation for the SCE. This is still based on our personal experiences and represents a biased view so bear this in mind when you are constructing your own tailored revision plan! We apologise if in places we are stating the obvious, but we hope this will be of use to those contemplating the exam from different locations and circumstances.

Deciding to take the exam

There are no entry requirements for the Neurology SCE and you are free to sit the exam whenever you feel best, based on your level of confidence. The MRCP website states that “trainees in UK training posts would normally take the SCE in their penultimate year of higher specialty training” however you can choose to sit the exam whenever you feel would be most useful for you. But bear in mind that you have to pass the exam before your last ARCP in order to complete your training.

Whichever time you chose, however, you should allow some time for revision. As the exam covers the entirety of the Neurology curriculum from localisation to differential diagnosis to management and current guidelines you can never be too prepared. Every part of clinical experience during your training, learning on the wards and in clinic, teaching sessions locally (particularly Clinicopathological conferences and Journal clubs) will form a solid knowledge basis and will be invaluable along the way. Every little part of learning-on-the-job will help, as will any extra days of revision.

Since this is your opportunity to consolidate your knowledge ahead of becoming a Consultant, you may like to frame your learning for the long-haul rather than “just get through” the exam. For example, making an electronic document with lists of important differentials or investigations, and tables of genes, neurophysiology patterns, or auto-antibodies. You can revisit these shortly before the exam, and refer to via your phone next time you encounter a pertinent clinical situation.

Format

The Neurology SCE is a multiple choice single best answer exam and uses a best of 5 format. All 5 answers could potentially be plausible, so clinical judgment is needed. The examiners will avoid double-negatives, and other ambiguities. There is a total of 200 questions divided into 2 papers. Not all subspecialties and topics are equal contributors so have a look at the useful “Blueprint” with the exact number of questions per topic before you start:

http://www.mrcpuk.org

Remember that in addition to clinical topics the exam includes ethical questions, statistics (odds ratio!) regulations (driving, even flying!), and other topics that could be relevant in your practice as a Consultant Neurologist. It will also include data interpretation, including the basics of neuroimaging, EEG, NCS/EMG and pathology.

Some thoughts on approaching revision

First, take comfort that your day-to-day Registrar duties will expose you to the kinds of clinical problems alluded to in the questions. Second, try to organise your ongoing reflections from clinical activity and formal teaching sessions in a way that helps you see your knowledge building, and that you can easily refer back to. Third, aim to have a systematic approach to revision that means you will set aside a regular amount of time, consider the topics to be covered, and where you most need to focus effort.  Fourth/finally, it is important to note the topics and questions which came across as the most difficult ones while you are revising and read them again about a week or two before the exam date.

It can be hard to find the time amongst long working days, extra-curricular projects, and commitments outside of work. Some ways to claw back time include: using podcasts (if driving) or phone apps (on the bus or train) keeping relevant NICE guidelines open on the computer while doing specialty clinics; admitting to your colleagues you are sitting the exam, and encouraging them to quiz you and coach you in the spare moments of the day; spend some concentrated time mapping all the many things you want to learn, chopping this into small pieces, and committing to filling in just one each evening. Think about what will work best for your circumstances, and try to stick to it.

Consider which topics you feel you need to learn from scratch, and which you feel you have a good grounding in. For the former, you might want to find a book, course or relevant guidelines and articles to direct your learning. For the latter, consider using question banks early, to check if your knowledge is at the appropriate level, and discover holes to fill.

If at all possible, encourage a colleague to sit the exam at the same time, so you can share the highs and lows, and (if you find it productive) study together. Having a “study-buddy” can help you keep motivated and can be useful in employing active learning methods, such as creating and sharing summary sheets per topic, quizzing each other or giving/receiving feedback. Remember that we forget what we learn extremely fast (only 25% of learned material remaining at 6 days as per Ebbinghaus’ Forgetting Curve1), so make sure to employ strategies that are shown to enhance retention. Useful evidenced-based strategies include: Retrieval practice: trying to recall material from memory, creating a summary sheet without consulting the material you read or taking frequent quizzes,  Spaced repetition: scheduling your retrieval practices to increase memory consolidation, and Interleaved practice: alternating topics. For more information on learning techniques “Make it Stick” is an excellent, easy to read book!2

Resources for revision

After you have planned ahead and decided to sit the exam there are many resources to help you along the way. We have divided these into Textbooks, Articles, Question banks, Guidelines and Multimedia. There are also several courses that can help you prepare for the exam, a useful course list can be found here: https://www.theabn.org/page/neurology_courses. Some come with handy course booklets, we found the medication section of the ILAE Registrar course very useful. We have tried to include links wherever possible although these may become out-of-date in the future.

By discussing with colleagues, this list has become long; we do not wish to suggest you need to absorb it all!

Articles

  • Practical Neurology https://pn.bmj.com/
    The official journal of the ABN. All of the journal is clinically relevant, practical and extremely useful for trainees (e.g. articles covering practical management of venous sinus thrombosis, mimics and chameleons of infectious encephalitis). But for the purposes of revising for the exam there are two sections that we found truly must-reads:
    The Bare Essentials Series for all main topics: an excellent review of specific conditions as well as neurophysiology interpretation, management etc. Also great resources for localisation such as the brainstem rules of 4: https://pn.bmj.com/content/11/3/167
    The Key messages tables from the Rare cases and CPCs: these are great for recognising rare syndromes.
  • ACNR https://www.acnr.co.uk/
    You are already here! Great resource of practical, up-to-date tips that are useful in clinical practice.
  • Continuum, Lifelong Learning in Neurology https://journals.lww.com/continuum/pages/default.aspx
    This the official journal of the American Academy of Neurology (AAN) for continuous medical education. Published every 2 months, each issue is aimed to be an in-depth update around a single topic area in Neurology. With self assessment questions after each issue as well as an accompanying podcast it is an extremely useful resource, and the questions are good preparation for what to expect at the SCE
    AAN membership is required to access these, but many hospitals and universities provide access through OpenAthens.
  • Other particularly recommended articles include Dimachkie et al 2013 on chronic acquired demyelinating polyneuropathy variants https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098937/
  • An excellent summary of all forms of ataxia: Evaluation and Management of ataxic disorders an overview for Physicians – https://ataxia.org/wp-content/uploads/2017/07/Evaluation_and_Management_of_Ataxic_Disorders-An_overview_for_Physicians.pdf

Mock Tests/ question banks

a) Resources designed to match the UK SCE (therefore aiming to cover the right topics, in the right level of depth, and in a similar question style)

b) International resources/not matched to UK SCE

  • Ebrain http://www.ebrain.net/
    An excellent resource of training materials with a huge question bank.
    They provide a Formative test once a year for all Neurology trainees. Outside the window for the Formative test though you can still retake tests from previous years.
  • AAN question of the day
    This is available in app or web format. It gives one MCQ per day from the AAN’s question bank and is free for AAN members. Great to fill the time on your commute.
  • AAN Neuro SAE
    https://www.aan.com/education-and-research/online-learning-programs/neurosae/
    Very useful question bank of 100-150 MCQs across 20 subject areas, although some guidelines may differ slightly from UK best practice.
    You can anonymously compare your performance with other trainees who sat the exam.
    Cost of $99 for AAN members and $149 for non-members.
  • Board Vitals https://www.boardvitals.com/neurology-board-review?occupation-select=medical-board-reviews
    Large quantity of questions, aimed at the USA market so difficulty level and topics may differ slightly to UK.
    From $146 to access

Books

  • Neurology A Queen Square Textbook, 2nd Edition https://www.wiley.com/en-gb/Neurology%3A+A+Queen+Square+Textbook%2C+2nd+Edition-p-9781118486177 This is a comprehensive textbook covering the whole of the curriculum, written by UK Neurologists. It is an excellent read that you could always go back to and can help you not only in preparing for the exam but also before starting a new rotation or specialty clinic. It is quite pricey, so would be worth consulting your library if available.
  • Aids to the Examination of the Peripheral Nervous System, 5e https://www.amazon.co.uk/Aids-Examination-Peripheral-Nervous-System/dp/0702034479 This slim “atlas”, with detailed illustrations and clinical pointers to understanding lesions of the peripheral nerves and roots, is thin enough to come with you to the ward or clinic. By consulting it when a clinical query arises, it will help cement those movement/ muscle/ nerve/ root associations in your mind.

Guidelines

Below we provide a list of some UK guidelines that were useful specifically in exam preparation. Many other guidelines exist that are very useful in clinical practice and not included here!

As a rule of thumb, if more than one guideline is available on the subject, always follow NICE guidance!

Multimedia

  • ABN Boot Camp lectures  https://www.theabn.org/general/custom.asp?page=ABNbootcamp2020
    This is an excellent resource covering the basics of Acute Neurology. Useful for the exam but also for new ST3 trainees or those returning from a period Out Of Programme.The BootCamp takes place yearly but lectures are available online at the ABN website
  • ABN lockdown lectures https://www.theabn.org/page/lockdownlectures
    These are also a great resource, the obstetric and acute weakness lockdown lectures are still available online from the ABN.
  • AAN Online Learning (requires subscription) – video lectures covering a large range of topics; for example there are very helpful lectures on brachial and lumbosacral plexi
  • Podcasts are great if your commute involves driving
    Brainwaves by Jim Siegler https://brainwavesaudio.libsyn.com/
    Aimed at a USA audience but at a helpful level and with a huge back-catalogue. Available free on all major podcast platforms.
  • Continuum audio – companion podcast to the Continuum journal. For example, the sessions on trigeminal autonomic cephalalgias, and intracranial hypotension.
  • Youtube – Particularly useful to review the basics of interpreting investigations. Some useful channels here:
  1. EEGucation channel https://www.youtube.com/user/EEGucation/playlists
  2. Vascular anatomy , clinical cases and vascular imaging https://www.youtube.com/channel/UCcFOPnIMW5NtPKJAR0fDxkw/videos
  3. Neurophysiology https://www.youtube.com/watch?v=WmmV3xiYAdE&t=12s
  4. Neuro-ophthalmology https://www.youtube.com/channel/UC5HcfsELV0W9AqtvJvpQQSg/videos

For topics requiring some visual understanding, consider using websites

Top tips for the actual day

  • Arrive early, booking takes more time than you think.
  • Your ID documents MUST match your booking exactly (including middle names). Check and double check, and triple check spelling to avoid disappointment.
  • There is no negative marking so do make a guess. You can “flag for review” and come back to the question later.
  • The questions stems are quite short, so do read each word carefully! For example, is it asking you about chance of inheritance, or chance of displaying symptoms (incorporating penetrance).
  • Time flies quickly so do consider reviewing your time and the number of questions left halfway through the exam.

Wishing you the best of luck!