BDI Resourcing had the pleasure of interviewing Dr Maitrayee Roy, owner of the Pathology e learning platform for FRCPath.
What do you do?
I'm a Histopathologist in India! I have finished FRCPath and have had no British Training. I currently run a diagnostic lab along with my Husband, Dr. Akshay Bali, which is called Maitri Diagnostic Lab in Haryana, India. In addition, I also work as an Assistant Professor in a Medical College.
So, you've fully completed both FRCPath exams?
Yes. I completed Part 2 in 2018, the Autumn exam.
Why did you take the FRCPath exams?
It was mostly for myself. Personally, moving to the UK wasn't a priority of mine because I'm very well set in my own business venture here in India. I took the exams mostly to see how I am in terms of national standards of Histopathology. I did not actually think I would get through it and I went in with a very open mind. I didn't pressure myself.
Are the FRCPath exams recognized in India?
They’re not recognised in terms of the government sector but in the private sector, yes FRCPath carries a weighting.
Why did you become Histopathologist?
In my mind, it was very clear right from the start after I completed my undergraduate degree that I wanted to go into a diagnostic branch. The choice was either between Radiology or Pathology. In our country, we must give an entrance exam at every step, a competitive exam (unlike FRCPath). The training in India, is very different to what happens in the UK. Pathology here, is not just Histopathology. Histopathology is just a part of Pathology. In our 3 years here, we're required to have a sound working knowledge of all aspects of Pathology and a brief overview of Bloodbank too. Then when I went for my senior residency, which I did at the All India institute of Medical Sciences New Delhi, the Pathology was entirely Histopathology and Cytology. So that's where my interest first started. The training was incredible and exhaustive and it saw me through so many exams.
You run a mentorship programme for FRCPath candidates. When you took the FRCPath exams, this kind of program wasn’t available. So, how did you revise for FRCPath?
Honestly speaking, I didn't prepare much for FRCPath 1 because of my incredible residency at my college. I downloaded some papers and got some books that were available online through Amazon. I was fresh out of residency when I took the FRCPath 1, so luckily I just sailed through.
Now the FRCPath 2, was a totally different ball game. I had known a couple of people that had unsuccessful attempts, some of them had had 2 or 3 unsuccessful attempts. I had spoken to them and it was obviously a difficult exam. The pass rate is somewhere between 30%-50%. A couple of people that I knew that were successful in their 2nd or 3rd attempt had actually gone to the UK to take some sort of observership programme and things really did look difficult. There is a website, called Leeds Pathology website, which parts of past papers (not the entire paper) are uploaded. So, that website was good and gave me an insight into what it is that they expect from their candidates in the UK.
Why did you start Pathology e-learning Platform for FRCPath?
Even in the test Centre I met a few candidates from India and from Pakistan who were giving their second or third attempts and they had done observerships probably for 2/3 months! What was frustrating and even is now, there is not an official course or even an official book for either of the exams to guide candidates.
From the moment I passed, I spoke to my friends, my juniors, my colleagues, my students and a lot of people were interested in the FRCPath exams but just like me, they had no clue where to begin! So, I thought okay, since I have gone through that and I have crossed that bridge, maybe I can help them out. So, during Lockdown, when all of the labs were shut over here, we had a lot of time on our hands. Our online help page just started as a simple thing and then more and more people joined and asked for guidance.
Now, we have 3 courses that we run. One is for those who are doing their residency in India, so they are just budding Pathologists. They need a lot of handholding because their training is still ongoing. They want to attend the FRCPath exams along with the residency exams in India, which is commendable because when I was doing medicine I had no clue about FRCPath. So those are the kind of candidates, which my husband Dr Akshay Bali is mentoring. Then I have candidates, who are Consultants in India, who are already post MD 10 years or maybe 20 years but now they want to give FRCPath or move to work within the NHS. Some just want to give it to upgrade their knowledge. Those are the candidates I have with me for Part 1 and some will clear their Part 1 and are preparing for Part 2. So, we have 3 courses. 2 for Part 1 and 1 for Part 2.
Are they all online courses?
Yes, everything’s online.
What does your course look like?
We have a very detailed course map which is shared with all of our course candidates at the outset. We have weekly sessions, every Saturday. The course lasts for almost 5 months and that's a total of 20-22 sessions. After every 3 or 4 sessions, a mock is provided to them. We have Q&A's and informative discussions about the answers. Just before the actual exam, we also have a grand mock test. It's designed exactly like FRCPath 1, which shows the candidates exactly what they need to work on prior to sitting the real thing.
The Part 2 Courses are around 4 months or 4.5 months. People are free to contact us even when the course is over for help though. Not everyone takes the exams right away. We've kind of become an online community really, where we digitize interesting cases and share findings.
How long did you wait between passing the Part 1 and taking the FRCPath 2?
1 year. For 6/7 of those months I lightly revised between working at the lab and then for a further 4 months I thoroughly revised a lot.
A common question that we get asked at BDI Resourcing is 'What should I be reading or revising?'
As previously mentioned, there is no official exam revision book or course. It's really hard to answer that question, because for overseas candidates who have never had any UK Training, there's literally no guidance.
So, that's what we try and offer. Pathology is such a vast subject. It's one of the core branches of medicine where we deal with things from head to toe. My advise is when you go for any exam, whilst it's important to have knowledge of the subject it's also equally important to know what you should not waste your time on. When I went for my part 2 exam, I found that I had wasted a lot of time reading over topics which I had presumed would come up in the paper but didn’t. For example, transplantology is a huge subspecialty in itself but in the Part 2 exam, they don't ask anything about this because that is a subspecialty. So, people who already have FRCPath and probably doing a subspecialisation, they are the ones doing the Transplant work - but I did not know this! So, I had wasted a fair amount of time revising this topic without knowing at all that this is a subject that just wouldn't come up.
I think it's so important for candidates to know how much to restrict themselves when revising. Every exam needs a strategy! Once you have got your strategy, half of your work is already done.
So, anytime we get a new batch for the FRCPath 2, I always start with what's NOT included! Because that is something that I didn't know and I would've saved so much of my own time on. There's no point devoting your time to subjects that won’t be asked. Whilst British Candidates may have more of an idea, there's no one to tell overseas candidates about the detail of what is included and what is not. There is no way anyone would know, without someone telling you.
What should Doctors expect from the FRCPath 2 exam?
Okay, so the 2nd part is a two-day exam. It's an exhaustive exam but at the same time, it's very fair. There's no point in the exam that being an overseas candidate you are at any disadvantage. You're not. If you have the required knowledge and if you can express yourself both in terms of verbal as well as written, then it doesn't matter whether you are an overseas or British candidate.
It has 7 subsections; Cytopathology, Surgical Histology, Macroscopic Pathology, Long Cases, Frozen Sections, OSPE 1 and OSPE 2. This is extremely exhaustive and they evaluate you as if you are prepared to do an independent reporting session at a district level hospital.
It was a really different experience altogether for me. Here in my country, it doesn't really matter what we write in an exam, it's mostly how we interact with the examiners. In part 2, the interaction is actually very minimal. Out of the 7 subsections, you only interact with examiners in around 3 - Macroscopic, OSPE 1 and Frozen. The remaining subsections you just write down your descriptions, findings and diagnosis and those answer sheets they then go to the Royal College and are marked there without the examiner knowing us. That's called a centralised marking system. So, that's the reason why it's very fair. The markers don't know who they're evaluating and we don't know who is evaluating us. For me, it was quite a revelation when I realised! So, that's something that you need to prepare for.
There is also no way that a candidate can go in thinking that they’re 'strong here and not so strong there'. It doesn't work that way. You have to pass each section independently. Even out of 7, if you don't pass 1, you will have to retake the entire test. Even if you did well in 6, you'd still need to redo the entire exam. Nothing spills over.
Additionally, it's not a competitive exam. It's a screening exam. All you need to do is pass, that's it. There's no rank, which is nice. Everyone's equal.
What did you find most difficult?
The hardest part, I think most overseas candidates would agree with, is the Cytopathology section. Out of the 7 sections, Cytology is the first in the exam. That's actually the most difficult part because Cytology training in my country (and others) is very different from what is given in the exam. There are very few people in our country that are lucky enough to get the kind of Cytology training that you would be required to get to sail through FRCPath. Most candidates that come from state medical college don't get such exhaustive training, particularly fluid cytology. That's the biggest stumbling block. The unsuccessful candidates that I have come across, most of them have been unsuccessful in the Cytology section and this is why they had to retake the exam.
So, again the whole idea of running the learning platform online, is to tell people what is expected out of them - specifically in sections like Cytology, where people tend to struggle.
What is your best advice for someone that is thinking about taking the FRCPath exams?
These are expensive exams. You have to travel to the UK, spend about 3-4 days in the UK, as well as the actual examination fees. So, prepare for this. Just because you’re paying money and attending courses, this does not mean you will pass. Of course, I'd advise having mentorship, whether it's through us or another mentorship course, it will set you on the right track. Get a strategy and interact with your peers.
For us, we have whattsapp groups so students can interact with each other. Sort of a group study. This is hugely beneficial. Doing it alone, is not everybody's cup of tea. Sometimes, when you have others, you can learn off others and teach others also; it motivates you.
The best advice would be to take the exam once, without fearing that you might fail. Providing you have that money. No amount of membership program or attending an observership in the UK, is going to make you feel fully prepared, unless you have been through the process once. If you're not successful, you can learn from it and see what areas you are required to work on. That was always my plan.
It's important to remember that you can take the exams up to 4 times over a period of 7 years.