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MFOM Part 2 – Regulations & Guidance

INTRODUCTION

Membership of the Faculty of Occupational Medicine (MFOM) is intended for registered medical practitioners who are committed to the full-time or part-time practice of occupational medicine, and confers formal recognition of competence. It is the highest level of Specialist professional qualification in Occupational Medicine recognised by assessment by the FOM and its syllabus is detailed under the general regulation & guidance page.

It is a normal requirement for those who aspire to being on the Specialist Register as Specialists in Occupational Medicine in the UK and will be awarded to those who have completed the requisite Higher Professional Training, together with MFOM Part 1 and MFOM Part 2 examinations, and demonstrated appropriate competencies through workplace-based assessments and a research dissertation or equivalent evidence.

Membership may also be available to medical practitioners outwith UK Specialist Training. Successful candidates will normally have completed satisfactorily a prescribed period of supervised training in one or more approved posts and have submitted an acceptable thesis, dissertation or substantial published work.

These regulations and guidance give further detail related solely to the MFOM Part 2 examination.

ELIGIBILITY

P1.
Regulation

Normally, before applying to sit the Part 2 examination a candidate must fulfil the eligibility requirements M34 to M37:

 

M34.
Regulation

Before applying to sit the MFOM Part 2 examination a candidate must have passed their MFOM Part 1 examination. See Regulation M9 for conditional exemptions. Doctors who enter the GMC Specialist Register under European Union (Recognition of Professional Qualifications) Regulations 2015 are exempt from the MFOM Part 1 examination.

 

M35.
Regulation

If enrolled in an approved post or programme recognised for higher specialist training in occupational medicine in the UK, the candidate must also provide evidence, following local Annual Review of Competency Progression (ARCP) panel review, of having achieved the end competencies of ST4 training.

 

M35.
Guidance

The competencies referred to are those defined in the approved Curriculum for Higher Specialist Training in Occupational Medicine, and elaborated with guidance in the Specialty Training Handbook. Candidates must normally submit the evidence referred to in M6 with their examination application. Exceptionally, and at its own discretion, the Faculty may accept later submission of this evidence; but in all circumstances it must be received before the examination is sat.*

 

M36.
Regulation

If not enrolled in an approved post or programme of specialist training in the UK, the candidate must also provide evidence of at least 4 years of full-time practical experience or training in occupational medicine (or the equivalent pro-rata) in a post or posts acceptable to the Faculty.

 

M36.
Guidance

Among other things, the SAC will normally seek evidence of:

(i) a sufficient breadth, as well as a sufficient duration of experience in occupational medicine (across a range of settings and covering a range of occupational health problems of a kind encountered in specialist training or practice); and

(ii) structured employment involving the support and, ideally, the formal supervision of a senior occupational physician of consultant status. Normally the applicant will need to hold such a post for at least 6 months within the 12 months prior to their application to be eligible to sit the MFOM Part 2 examination; the practice of occupational medicine must be a substantial component of their work.

Proof of equivalent practical experience and/or training outwith UK specialist training (M37) must be received at least 4 months before the Part 2 examination date, so that the SAC has an adequate period in which to assess eligibility under M37.

EXEMPTIONS

M37.
Regulation

Candidates who have passed the AFOM examination in its entirety will be exempted both the MFOM Part 1 and MFOM Part 2 examinations, provided that the date on which they sat and passed the AFOM is not more than seven years before (a) their enrolment (or re-entry) into an approved post or programme recognised for higher specialist training in occupational medicine in the UK (b) if not enrolled in higher specialist training, their application for Membership.

View regulations and guidance M38 – M39

COMPONENTS OF ASSESSMENT

P2.
Regulation

The Part 2 MFOM examination will comprise the following sections:

1. Multiple Choice Question Paper (MCQ)

2. Modified Essay (Structured Short Answer) Paper (MEQ)

3. An Observed Structured Practical Examination (OSPE)

All three sections are compulsory

 

P3.
Regulation

The MFOM Part 2 examination will normally be held over two days. The MCQ, MEQ and Photographic and Occupational Hygiene papers will be held on the first day at one or more centres. The OSPE will be held on another day, normally, about a month later, and may be at one or more centres.

THE EXAMINATION SYLLABUS

P4.
Regulation

The syllabus for the MFOM Part 2 examination will be based on the competencies for higher specialist training in Occupational Medicine in the United Kingdom (UK), as defined in the latest version of the Faculty’s GMC-approved specialist training curriculum.

 

P5.
Regulation

Questions may be asked on any part of the syllabus. Collectively, the 3 component sections of assessment will aim to sample systematically from the curriculum across examination sittings.

 

P4 – P5.
Guidance

Details of the competencies on which the examination syllabus is based can be found within Section 2.2 of the Faculty’s Specialist Training Curriculum for Occupational Medicine.

 

THE PASS STANDARD

P6.
Regulation

A candidate’s performance in each section will be assessed relative to an external standard set by the examiners. Raw marks may be adjusted to preserve a common standard between examinations.

 

P7.
Regulation

Candidates will be required to pass all three of the sections listed in A2 at a single sitting.

 

P8.
Regulation

No candidate will normally be allowed more than six attempts at the part 2 examination. However, Regulation F3 makes provision for the Faculty’s Specialist Advisory Committee (SAC) to consider a candidate’s eligibility to make a further attempt or attempts, subject to acceptable evidence of additional education experience.

 

P6 – P8.
Guidance

There is no provision in the Regulations to roll-over or ‘bank’ passes from one sitting to another.

MULTIPLE CHOICE QUESTIONS (MCQ) PAPER

P9.
Regulation

This 2 hour examination paper will comprise of 120 questions in the format of single statements or stems with up to five completions, or related responses. Normally, questions will be in the ‘single best answer’ format – i.e. candidates will be required to choose from the alternatives the most appropriate or fitted response.

 

P10.
Regulation

The 120 question MCQ paper may include up to 20 pilot questions for standard setting purposes. (These items, which may appear anywhere in the paper, will not be used when calculating candidates’ scores, but may be used in relation to regulation A6.)

 

P11.
Regulation

Answers must be recorded on the machine-readable sheet provided. All questions are compulsory. A negative marking scheme will not be employed.

 

MODIFIED ESSAY QUESTION (STRUCTURED SHORT ANSWER) (MEQ) PAPER

P12.
Regulation

This 3 hour examination paper will comprise approximately 10 written essay questions, most of which will be highly structured with multiple parts or subcomponents. Each question is worth 10 marks. All questions are compulsory.

 

PHOTOGRAPHIC/OCCUPATIONAL HYGIENE PAPER

P13.
Regulation

This 50 minute paper based on 2 sections, comprising (a) photographic illustrations and (b) materials relevant to occupational hygiene, will be sat on the day of the MCQ and MEQ papers.

 

OBSERVED STRUCTURED PRACTICAL EXAMINATION (OSPE)

P14.
Regulation

The Observed Structured Practical Examination will comprise 6 assessment stations – (a) two 30 minute stations based on long clinical cases (patients and/or role play actors); (b) four 10 minute stations based on short clinical cases (usually, patients with clinical physical signs); (c) Photographic/ occupational hygiene Paper (‘station’). All stations are compulsory. General guidance on the OSPE (see below) is for illustrative purposes only; the exact content of questions and administrative arrangements may vary.

 

APPLICATION FOR ADMISSION; COMMUNICATION OF RESULTS

P15.
Regulation

Applications for admission to the examination must be made by the advertised closing date and submitted via The Faculty’s online application system, together with such other evidence as the form dictates to confirm eligibility under regulation A1. All applications must be accompanied by the appropriate examination fee (see General Regulations & Guidance). Details of times and places of examinations will be available to candidates well before the due dates.

 

P16.
Regulation

Results of the examinations will be communicated to the candidates in writing as soon as is practicable. In no circumstances will results be given by telephone.

 

SYLLABUS

The syllabus will be based on that defined by the GMC-approved training curriculum for higher specialist training in Occupational Medicine in the United Kingdom (UK) – i.e. the Specialty Registrar’s training curriculum. Doctors in specialist training posts and those outwith such programmes may find it helpful to read Section 2.2 of the FOM’s Specialist Training Curriculum for Occupational Medicine.

By careful selection of examination questions, the examiners will aim to offer a broad coverage of this GMC-approved training curriculum across examination sittings.

COMPONENTS OF THE MFOM PART 2 EXAMINATION

MCQ Paper

The MCQ paper will last for 2 hours. The paper will contain 120 multiple-choice questions in ‘choose one response from five’ format. This means that in each question candidates will be presented with a stem and five possible answers, from which they must choose the single best answer (only one answer is the best one, although several may be true in part).

The purpose of the MCQ examination is to test factual knowledge to the standard appropriate to a specialist in Occupational Medicine. Thus, candidates can expect to be tested across a wide range of common and important occupational health topics, sampled across the whole syllabus.

All questions are compulsory. 20 pilot questions distributed at random will appear for trialling and/or standard setting purposes will appear in the paper. Responses to them do not count towards a candidate’s final score. They are part of a range of quality assurance measures the Faculty has instituted across its examinations.

 The marking system for the MCQ examination is as follows:

  • One mark (+1) is awarded for each correct answer
  • No mark is deducted for an incorrect answer (a negative marking scheme is not used)
  • No mark is awarded or deducted if a question is left unanswered
  • Candidates should be aware that no mark will be awarded for any answer that is partially erased, smudged, or a double response to a question. In these circumstances the Faculty cannot safely interpret the candidate’s intentions.

The pass mark in the MCQ examination will be assessed relative to an external standard set by the examiners. Raw marks may be adjusted (scaled) to preserve a common standard between examinations.

Some sample MCQs are given for information at the end of this page.

MEQ Paper

The MEQ paper will last for 3 hours and will usually comprise 10 MEQ-style questions, completed at a single sitting. Questions will normally be given equal weighting.

Most of the questions will be highly structured and divided into sub-sections, each of which will carry no more than 4 marks. Some questions, however, will be designed to assess the candidate’s ability to analyse, appraise, and write occupational health reports; and these may not be so highly structured. The question sheet will indicate the number of available marks for each subsection.

The purpose of the MEQ examination is to test ability to apply knowledge to clinical practice to the standard appropriate to a specialist in Occupational Medicine. The paper may contain questions from any part of the syllabus.

Candidates should ensure that their responses are legible, and are written in their mark books. They are encouraged not to submit answers on additional sheets of paper.

The pass mark in the MEQ paper will be assessed relative to an external standard set by the examiners. Raw marks may be adjusted (scaled) to preserve a common standard between examinations.

Some sample MEQs are given for information at the end of this page.

OSPE

The OSPE comprises 7 parts, 6 of which (including the long and short clinical stations) will be held at either the Clinical Skills Centre, Northern General Hospital in Sheffield or another suitable venue. The 7th part comprises a photographic/occupational hygiene paper and will be held separately (see below).

In all there will be 2 hours 20 minutes of assessment (with a small additional amount of waiting time between some stations), comprising:

  •  2 long (30 minute) clinical stations
  • 4 short (10 minute) clinical stations
  • 1 photographic/occupational hygiene paper of 50 minutes, involving occupational hygiene plus a range of photographic illustrations.

The long and short clinical stations will be run/observed by a pair of examiners. Faculty staff members will be present to enforce time limits. At times an auditor (who will be assessing the performance of the examiners, not the candidate) or a trainee examiner may be present but will take no part in the examination. The stations will be run on a circuit and candidates may commence the circuit at any of the long or short clinical stations. Depending on the number of candidates, it may be necessary to run two circuits simultaneously. If so, to standardise the assessments as far as practicable, each station in the two circuits will have broadly similar cases with similar tasks and questions.

The photographic/occupational hygiene paper will take place at a different time to the other OSPE stations, but on the same day as the MEQ and MCQ examination papers.

In general terms:

Long and short stations

  • The focus at the long stations will be on testing the ability of candidates to take a clinical and occupational history; to discuss the relevance of the clinical findings to occupation; to make an assessment of the occupational health and vocational aspects of the case; and to formulate a suitable action plan. (Candidates may be expected to discuss differential diagnoses and be generally aware of the most common treatments and any relevant occupational implications; but detailed knowledge of treatment regimens is not required.)
  • The focus at the short stations will normally be on the ability to elicit physical signs, correctly interpret them, and discuss their occupational health and clinical consequences.

 Photographic/occupational hygiene paper

  • The photographic/ occupational hygiene paper will focus (a) in part, on practical aspects of occupational hygiene (and may include photographs of various pieces of equipment relevant to exposure assessment and/or personal protection); and (b) in part on a diverse range of illustrative materials relevant to occupational medical practice.

Further details of each station type are given below. This guidance is for illustrative purposes only. The Faculty reserves the right to vary the content of questioning, within the general framework of: 2 long clinical cases, 4 short clinical cases, 1 photographic/occupational hygiene paper.

Stations A (The mental health case station) and B (The disability case station)

Role players may be used for the mental health and disability patients. (There is evidence that the use of role players for such cases improves consistency.) Specific written instructions will be provided to the candidate prior to commencing the station. Candidates will be expected to spend 20 minutes taking an appropriate clinical and occupational history and developing a management plan for the patient. (In the mental health there will also be an expectation, normally, that candidates make a diagnoses; however, such information may be provided for the disability case.) A pair of examiners will observe the candidate’s ability to communicate with the patient and will assess the content of the consultation. During the final 10 minutes the examiners will question the candidate in regard to clinical, ethical and employment issues pertinent to the case in question.

Stations C to F (Short cases 1, 2, 3 and 4)

These stations will each comprise one short case of 10 minutes. Two examiners will be present at the station. The candidate will be given clear verbal instructions prior to commencing the case. Patients will be drawn from the typical spectrum that an occupational physician could reasonably expect to see in daily practice (e.g. a musculoskeletal, abdominal, neurological, respiratory, cardiac, or dermatological case). Typically, the candidate will be asked to examine the patient and will be expected to elicit and correctly interpret the relevant clinical signs. 6 minutes will be permitted for the physical examination. The candidate will then be asked some questions about the case, focusing particularly on the occupational relevance of the findings to case management. The examiner or pair of examiners will ask all candidates the same or similar questions, and will use a pre-designed marking scheme for each case.

Photographic/occupational hygiene paper

In the photographic section, the candidate will be presented with approximately 5 illustrations and, where relevant, a short scenario; he/she will be asked a number of pre-scripted questions by the examiners. The illustrations may relate to the diagnosis, management, and prevention of occupationally-related disease or ill-health.

In the occupational hygiene section of the paper, candidates will be tested on occupational hygiene, and will be presented with scenario(s) in the form of photograph(s) and or diagram(s) showing work processes. They will be presented with approximately 5 illustrations and will be asked a number of pre-scripted questions. 

This station will examine such topics as: knowledge of common work processes/activities and their associated hazards and risks, approaches to conducting workplace risk assessments, interpretation of non-clinical workplace data and the effectiveness of control measures used (in practice) to minimise or prevent exposure. 

The questions will typically be based on a specific workplace process/activity. Candidates may also be required to interpret occupational hygiene and toxicological data, such as may be found in workplace risk assessment reports, or to identify and discuss typical occupational hygiene tools and items of personal protective equipment. Questions may be illustrated by photographs or actual pieces of equipment – e.g. pictures of individuals exposed to physical, chemical, biological or ergonomic hazards; sampling instruments; face masks.

Marking

Of the total 250 OSPE marks, 80 are available for the short cases, 80 are available for the long cases and 90 are available for the photographic/occupational hygiene paper. The pass mark in the OSPE will be assessed relative to an external standard set by the examiners. Candidates will be scored across a range of competencies from the Approved Core Curriculum (e.g. 1.1 (i) of Good Clinical Care and 3.3 Communication Skills).

Raw marks may be adjusted (scaled) to preserve a common standard between examinations. Candidates’ total marks across all stations, adjusted/scaled as necessary, will be compared with the overall pass mark.

They will not be required to pass every station or any particular station. However, they will be required to reach a bare minimum pass standard in certain key competency areas which are not directly tested elsewhere in the Part 1 and Part 2 MFOM examinations. These will include: candidate’s approach to, and communication with, the patient; their capacity to manage the patient’s concerns; and their ability to take a detailed history, conduct a suitable clinical examination, elicit clinical signs and reach an appropriate diagnosis.

Other comments

In preparing for the clinical elements of assessment, candidates for the OSPE may find it advantageous to practise their clinical skills by attending a suitable course or by a short-term attachment to a hospital unit.

MFOM Part 2 Example Questions

The MCQ paper will contain around 120 multiple-choice questions, normally in the one from five (best of five) format, whereby candidates must choose the ONE best answer from five possible answers.

MCQ Example 1

Which ONE of the following has been most clearly associated with the development of skin cancer?

(a) Welding

(b) Nickel

(c) Electromagnetic fields

(d) Polycyclic aromatic hydrocarbons

(e) Chromates

 

MCQ Example 2

Which is the most accurate statement regarding Carpal Tunnel Syndrome:

(a) It Is more common in males

(b) It can be associated with exposure to vibrating equipment

(c) Occupationally related cases do not respond to surgery

(d) It can be excluded if nerve conduction tests are normal

(e) Adson’s test is a useful clinical test for diagnosis

 

MCQ Example 3

Which ONE of the following is most true about case-control studies?

(a) They are used to study many health outcomes associated with a single exposure

(b) They are usually retrospective

(c) Cases should be prevalent cases of the disease

(d) Controls are often relatives of the cases

(e) Controls should be as similar as possible to cases except that they do not have the disease of interest

 

MCQ Example 4

Orf:

(a) Is caused by a paramyxovirus

(b) Typically starts as a pustular lesion

(c) Is common in pig farmers

(d) Scarring is a common consequence of infection

(e) Vaccination is not useful in controlling infection in animals

 

MEQ Example 1:

(a) List 3 low molecular weight substances that are known to cause occupational asthma. (3 marks)

(b) List 2 high molecular weight substances that are known to cause occupational asthma. (2 marks)

(c) List the 4 investigations that are the most helpful in the diagnosis of occupational asthma. (4 marks)

(d) Which of the investigations that you have listed is the first line investigation of occupational asthma thought to be caused by a high molecular weight substance? (1 mark)

 

MEQ Example 2

Write short notes on your approach to assessing the following pre-employment scenarios:

(a) An individual with asthma applying to become a firefighter. (3 marks)

(b) A doctor with HIV applying for a consultant job as a surgeon. (4 marks)

(c) An individual who has recently had a heart attack applying for a job as a taxi driver. (3 marks)

 

Date last modified: 27/06/19