The Faculty of Public Health Part B Membership exam is the final stage of the route to membership of the Faculty through examination, but by no means the last step of becoming a Specialist in Public Health. Examiners from across the UK and from all domains of Public Health develop scenarios to test candidates’ abilities to understand and explain public health concepts and respond appropriately to questions and challenges in various settings (examples are available on the Faculty website). As examiners, we are committed to maintaining the standards set by FPH, but also committed to developing the next generation of Public Health leaders as excellent communicators and experts in all aspects of Public Health.
I was asked to write this blog, on behalf of my fellow examiners, after I had tweeted some tips based on reflecting on performance in the exam. One of my Registrars wrote a blog on how to prepare and pass the exam – this blog gives the examiner perspective. As examiners, we wrote an article to help highlight how best to approach the exam. We had become concerned that some candidates are developing an approach to the exam which structures their answers but reduces their chance to succeed. These tips below, buidling on the tweets, are offered to all candidates with the reminder that, as examiners and colleagues: we want you to pass!
- Prepare to listen, hear the question, answer in a way that makes sense to that person, be it Director of Public Health (DPH), journalist or MP.
Too many candidates enter the room with their first answer prepared- forgetting to listen to the question. In a role play, examiners are keen to see that you are responding appropriately to the audience and answering the issues they raise. It is better to focus on listening to the question and answering the way you would in real life. Candidates are sometimes so determined to introduce themselves (which is not necessary) that they miss the first question altogether.
- Be ready to present/explain tables and charts – it’s what we do – but remember your audience. Don’t treat the DPH like you would a lay person.
If there are tables and charts in the pack, it’s likely you will need to understand what they say, and demonstrate this. This is a core skill of Public Health and we expect this to be done well. A trap some candidates fall into is in guessing the next question: “would you like me to explain confidence intervals” to which a reasonable reply might be “of course not- I’m your DPH!”
- Let the role player ask their questions. The pack doesn’t give you the structure, the questions do. Let us lead you through.
There are significant numbers of candidates who struggle because they don’t understand the format of the exam. The role player has a list of questions that they ask in order. These should elicit the information we need to mark the candidate. In general, scenarios are designed to build – so that the role play makes sense. Offering to give a speech, trying to tell us information that has not been requested, and answering questions you wish had been asked are all ways to run out of time and fail to complete the station.
- Don’t be just anyone – speak with passion about public health principles. Care about outcomes, inequalities and efficiency.
This is a “show’s how” exam where we are looking to see you have internalised Public Health concepts. Great candidates engage with the role play and come across as advocates for Public Health. This is far better than the trite “This is an important public health problem” statement repeated at every station by some candidates. There are no marks available for this.
- Have a good look at any data. Is it numbers, rates, percentages? Be clear when explaining or answering questions.
Sometimes the scenario makes clear that the data has come from a poor quality source; a student project or similar. Might this mean that there are errors in the data? It’s vital that we use the right terms; confusing number of deaths with death rates is a sign a candidate hasn’t studied the material. Be accurate – the difference matters.
- Check the role player is understanding you. Keep eye contact- sometimes role players will look confused or upset- this is part of the station.
There is little scope for conversation in most scenarios- sometimes we really have to rush to get through the questions. Taking notice of how role players respond is an important part of the exam. Picking up on responses is a key skill in the “listening” competency. If you are asked the same question twice, it usually means its important and you did not answer it correctly the first time. Don’t try and skirt round it or just repeat what you said the first time.
- If you have to explain a table or graph – share it, show me, point it out. Be sure I understand your explanation.
Great candidates really do this well. Positioning themselves in a way that allows them to share their papers, point at the information they are describing, and looking at the role player to see if they are understanding the explanation. Done badly, it can appear that candidates are just hoping not to be asked about it.
- Be ready to say if you don’t know. No “I’ll email you” or “I’ll get back to you”, sometimes you just don’t know – that’s ok.
The issue with the answer “I’ll email you” or similar is that the question has been asked and needs to be answered. If asked “Do we need to close the shop?” the possible answers are Yes, No and I don’t know. All can be valid, and the mark scheme will make this clear. The questions are scripted to last 8 minutes and the role player strives to complete the station within that time. Sometimes a scenario runs faster and most candidates finish a station a minute or so early. It will be obvious from the role player that the scenario is complete. It is quite okay to use this spare time to look at your next scenario.
- Remember to make eye contact. It’s a conversation. The examiner role players are willing you on.
Some candidates have clearly not prepared the “acting” side of the exam. Great candidates have a real conversation and engage the role player. This means they pick up on the mood and responses as well as the substance of the questions. Comments like “I know this must be difficult” and “I can see why you might think that” often reflect an understanding of the other point of view.
- Be yourself. You have got this far because of who you are. Serious people think you are amazing. Show us why.
We really do want you to pass. Many examiners are also Educational Supervisors, they are all involved in training and want to give candidates the chance to shine. We don’t want an act – just you being your best you. Read the material, listen to the questions, engage in the scenario and show us why one day soon, you will be a consultant.
Links:
- Journal of Public Health ‘How to do well at the OSPHE’ https://academic.oup.com/jpubhealth/article/38/1/189/2362659
- Sample scenarios on the faculty website https://www.fph.org.uk/training-careers/part-a-b-exams/part-b-exam/part-b-exam-preparation/
- Registrar blog on Part B https://betterhealthforall.org/2018/06/06/the-winner-of-the-2018-fph-mcewan-award-shares-her-advice-on-preparing-for-the-part-a-exam/
Better Health For All 
You say you want “acting” but also “answer the way you would in real life”. Make up your mind. I answered the way I would in real life, answering that way has got me through 10 years of working in public health without getting fired, impressing people along the way, and yet my answers were unsatisfactory for the exam.
In the real world there is more than one way to answer a question, and your success in your role would not depend on just 8 minutes with someone. The problem with exams is that a marking criteria narrows the field of acceptable responses to what can be measured. Candidates could say some amazing and insightful things in that 8 minutes but if it’s not what appears on the marking sheet, they won’t get any credit for it. Who even knows what the marking algorithm is? How are letters converted to numbers and averaged across stations? Not even the examiners know.
In the real world if you misread the situation you’d get a chance to repair any damage, and you’re unlikely to lose your job. In the exam, do this more than once and you fail. The future of your training and your finances are on the line (particularly if you are a non-medic, already getting paid less than your medic peers), your job now dependent on what you say in just 48 minutes. If you do fail, you will be told the area you failed, but not why, so you just have to guess at what to do differently next time. Effectively a £900 gamble to see if you get it right. No pressure.
The exam feels very artificial, made up of fictitious scenarios. In my experience these were almost entirely local authority situations, not where my strengths lie, not where I intend to work in future – not where public health is in Scotland and Wales.
The structure of the exam is also an issue. It inherently disadvantages people with neuro-diverse brains, those from non-English speaking backgrounds and those from non-British culture. The structure makes it logistically difficult to offer reasonable adjustments based on individual need. The cost of resitting putting unfair financial pressure on a small number of people who find themselves having to resit multiple times. Again, even if you get paid less than your peers you don’t get a discount on the exam costs.
Most registrars in training ARE amazing, but this exam does not enable all candidates an equal opportunity to showcase their talents.