The Diploma in Immediate Medical Care. Hints and Tips from St Emlyn’s

I recently sat the Diploma in Immediate Care and thought I would share with you some of the things I learned along the way and some of the resources I used. This is a very personal reflection and not endorsed by the Faculty in Immediate Care in any way. I’ve tried to make the information as accurate as possible, but would always recommend you check the Faculty website for the official guidance.

Introduction

The Diploma in Immediate Care is a post graduate examination aimed at “level 5 practitioners”, “designed to test the knowledge, skills and behaviours of pre-hospital emergency care practitioners”. Doctors, Paramedics and Nurses all sit the exam, many of whom are already working in prehospital care, but some who are looking to apply for positions or training programmes.

There are two sittings a year, in January and July, held at the Royal College of Surgeons in Edinburgh. The exam consists of a 180 question “single best answer” (SBA) paper (time limit three hours) and a “objective structured practical exam – OSPE” which is 14 stations (12 of 8 minutes and 2 extended stations lasting 16 minutes).

I sat this exam after some time working in prehospital care with my local air ambulance, but candidates come from paramedic, nursing and medical backgrounds, with a range of experience from many years of PHEM to none at all. The Diploma is seen as an excellent addition to applications for either PHEM training or and a “desirable” criteria on paramedic applications.

In this blog post I will endeavour to pass on some of the things I learned while revising for the exam, as well as linking to resources that may be helpful. The Faculty of Prehospital Care (FPHC) has published an excellent review of both PHEM exams (there is also a Fellowship exam) . This is also an excellent resource when first setting out whether the exam is for you.

Application

The exam is increasingly popular and applying early is recommended. The application process is relatively straightforward and the regulations clear (although not cheap at £725!). Usually the College only open applications after the previous diet has been completed, so August and February are the dates to watch out for. After sending of your form things are relatively quiet and the College only communicates with you when it really needs to. Don’t panic! They will be in touch. And to be fair were always utterly delightful on the phone (I think the accent helps).

What’s in the Exam?

The Faculty publish a very thorough curriculum from which you’ll be expected to know all the “Level 1” content. I found this document really pretty dense and have to admit that for the SBA particularly I used the “ABC of Prehospital Emergency Medicine” as my template for revision. Although slightly out of date (it was published in 2013) the episode titles correlate very well with those in the curriculum.

What to revise and recommended resources

As mentioned the ABC of Prehospital Emergency Medicine is an excellent place to start. It’s also really important to know the “Faculty Statements” – there was at least one OSPE stations specifically on one of these.

I made a chart of the topics and ensured I’d read (and made notes) on them all. I really did go back to A-Level/Undergraduate type revision with different coloured pens and flash cards!

For the SBA I also found writing my own questions (and answers) helped me focus on the type of things that could be asked.

As well as the “usual” type of medical questions, there are also some things unique to prehospital care, such as “Blue Light Driving” (easy stuff for the paramedics!). This guidance from the East of England tells you all you need to know (and more).

There’s a load of information on the “National Ambulance Resilience Unit” (NARU) website. This document about Major Incidents is particularly useful.

You’ll need to know the NATO phonetic alphabet for at least one OPSE station (as well as good radio technique).

FOAMEd Resources

With the superb range of free, open access, medical education sites and podcasts there are loads of resources that you can access. These are just a few of my favourites

These are specifically designed for the DipIMC exam and go into depth about lots of the topics needed (the ones about the “rarer stuff such as drowning are particularly useful)

Produced by Tim Nutbeam (who also edited the ABC book) and Clare Bosanko these podcasts go in depth into PHEM topics, often well beyond Dip Level, but if you’re doing the exam I’m sure you’ll find them useful.

I’ve put together two documents with SBAs below. The first file is the questions and the second is the MCQs with answers and detailed explanations. Alternatively you can use the embedded question sheet.

I did these as it helps me to think about what the examiners may be able to ask about, but I thought they were worth sharing. The usual caveats apply, but they seemed to be of a similar standard to those in the actual exam.

The lovely Haney Mallemat has done these excellent Youtube videos. The ones on End Tidal CO2 traces may be especially useful.

Make sure you are familiar with all the contents of the “Sandpiper Kit Bag” you’ll have in each station. You’ll have a chance to familiarise yourself with this before the exam itself. You’ll need to know how to apply devices such as the “Kendrick Traction Device“, Pelvic Binders (SAM splint or TPOD), Combat Application Tourniquets (CAT) and the use of Celox Gauze. Again Youtube is your friend. My children also enjoyed practising and being practised upon for the splints (and can now put a KTD on in under two minutes!). Just be mindful to double check current guidance alongside the videos (The Faculty statement says to place a CAT as distally as possible, whereas the video from the manufacturer states to place it “2-3 inches above the wound”).

It almost goes without saying that you will need to know all of the Resuscitation algorithms (including Newborn Resuscitation!). Find a helpful Resuscitation Officer at work and ask them to go through them with you.

There are also some interesting bits and pieces in this twitter thread.

And one last tip – practise at the start of every station saying “Is it safe to approach, I’d put on PPE and call for P1 back up”.

Good Luck!

All best,

Iain