Iraqi Board Family Medicine common mistakes
Iraqi Board Family Medicine · Understand the traps and how to avoid them.
When a question asks about screening or prevention, the candidate picks the test with the highest sensitivity or the newest test rather than the test that the local or WHO/ministry programme actually recommends for that age and risk group, and then justifies it with 'it detects more cases'.
Undergraduate teaching rewards diagnostic acumen and 'catching disease early', so candidates default to the most sensitive investigation. They have not memorised the actual screening schedule (breast, cervical, colorectal, antenatal, neonatal, growth and developmental surveillance) and do not distinguish screening from case-finding or diagnostic testing.
What to do instead
Build a one-page screening table by age, sex and risk (what, when, interval, test, cut-off, and the local programme source). For every screening question, first name the target population and the programme, then choose the test. Practise discriminating 'screening', 'diagnostic', 'confirmatory' and 'surveillance' in question stems before answering.
On a clinical vignette the candidate answers with the single 'best' diagnosis or drug in general terms and ignores the setting constraint in the stem, e.g. offering CT angiography or a specialist referral in a primary care centre with no such facility, or admitting a patient who could be managed at home.
Hospital-based training frames management at the tertiary level. Candidates read the vignette as a diagnostic puzzle and skip the sentence describing the facility, the patient's preference, cost, or travel distance, which is precisely what the exam is testing in a family medicine paper.
What to do instead
Before answering any management question, underline the setting, available resources, patient preference and follow-up capacity in the stem. Learn a two-tier answer for common problems (what can be done in primary care versus the referral threshold), and default to the safest feasible primary care option unless red flags demand referral.
The candidate treats paediatric fever, gastroenteritis, asthma and neonatal jaundice with adult-derived thresholds and doses, or forgets weight-based dosing and the different normal ranges in neonates and infants, giving an answer that is numerically plausible but wrong for the age.
Adult internal medicine dominates the candidate's daily work and revision time, so paediatric values are recalled as scaled-down adult values. Candidates also skim the age line in the stem and answer for 'a child' rather than for a 3-week-old or a 5-year-old.
What to do instead
Memorise age-banded normal values and danger signs (respiratory rate thresholds, capillary refill, dehydration signs, bilirubin treatment lines by age in hours, paracetamol and antibiotic doses in mg/kg). Re-read the age and weight every time and calculate the dose explicitly before choosing an option.
In obstetric and gynaecology items the candidate manages the condition without first dating the pregnancy or classifying its trimester, and misses red-flag triage such as bleeding in early pregnancy, reduced fetal movements, pre-eclampsia features or post-partum haemorrhage, choosing outpatient follow-up where urgent referral is required.
Antenatal care is taught as a schedule to memorise rather than as a risk-stratification exercise. Candidates do not habitually convert gestational age into a trimester and a differential, and they underestimate how often the exam tests the referral decision rather than the definitive treatment.
What to do instead
Adopt a fixed opening step for every obstetric stem: confirm gestational age, confirm viability/pain/bleeding, then classify as emergency, urgent or routine. Drill the red-flag list (bleeding, severe headache with hypertension, fever, absent movements, leaking, postpartum haemorrhage) until the referral answer becomes automatic.
When asked to interpret a study or a test result, the candidate answers from intuition about whether the finding 'seems important', confusing statistical significance with clinical importance, misreading a confidence interval that crosses the null, or mixing up sensitivity/specificity with positive and negative predictive value.
Biostatistics is often learned as formulas to pass a written paper, not as a reasoning tool. Candidates have not practised reading an abstract's result line and cannot quickly map prevalence onto predictive values, so they fall for the distractor that quotes a p-value without effect size.
What to do instead
Practise a 4-step appraisal of short abstracts: design, effect size with confidence interval, applicability to the patient, and absolute versus relative risk. Draw 2x2 tables for predictive value questions and vary prevalence to see the effect. Learn to reject 'significant but trivial' and 'non-significant therefore no effect' options on sight.
The candidate selects the most intensive or most specialist intervention for a frail older patient or a terminally ill patient, or over-investigates a patient whose goals are comfort, rather than choosing the option that matches goals of care, functional status and advance directives.
Curative, disease-oriented training makes 'do everything' feel like the safe answer. Candidates have limited exposure to structured geriatric assessment and palliative care planning, so they miss cues about frailty, polypharmacy, falls, delirium and caregiver burden embedded in the stem.
What to do instead
For any patient over about 75 or with a life-limiting illness, run a fixed checklist before answering: functional status, cognition, falls, medication burden, goals and ceiling of care, and family/carer support. Learn deprescribing principles and the palliative answer set (symptom control, advance care planning, avoiding futile transfer).
In ethics and communication items the candidate answers with what is medically optimal or legally defensive, overriding the competent patient's refusal, disclosing a diagnosis to relatives before the patient, or breaching confidentiality, instead of applying consent, capacity and confidentiality rules to the facts given.
Candidates conflate 'best interests' with 'what I think is best', and in cultures with strong family involvement they assume relatives should be told first. They also have not practised the four-principles framework or capacity assessment on realistic scenarios.
What to do instead
Learn a fixed sequence for ethics stems: assess capacity, obtain informed consent, respect refusal, maintain confidentiality, disclose only with consent or a justified exception, and document. Practise breaking bad news and shared decision-making using a recognised framework so the communication option is recognisable.
The candidate answers an acute-care question with the definitive in-hospital treatment and omits the immediate life-saving step, or fails to recognise the red flags that mandate emergency referral, such as chest pain with diaphoresis, a stiff neck with fever, or an unwell child with lethargy.
Emergency medicine is examined as knowledge of conditions rather than as a sequence of actions under time pressure. Candidates read the vignette to the end and answer the diagnostic question rather than the 'what do you do first' question that was actually asked.
What to do instead
For every acute stem, answer in the ABCDE order and choose the first action, not the best ultimate treatment. Build a red-flag list per presentation (chest pain, headache, abdominal pain, fever in children, trauma) and rehearse the 'recognise, resuscitate, refer' pathway until the first-step option is the obvious one.
The candidate misreads the question's task word, giving a diagnosis when asked for the next investigation, a mechanism when asked for management, or 'all of the following except' answers as positives, and then justifies the choice with correct but irrelevant knowledge.
Time pressure and long stems encourage pattern-matching to a familiar disease name. Candidates answer the question they expected rather than the one written, and single-best-answer formats punish this more heavily than the essays used in undergraduate exams.
What to do instead
Train a 10-second stem parse before looking at options: identify the task word (diagnose, investigate, manage, refer, mechanism, except), the population, and the setting. Cover the options, formulate your own answer, then match. Flag and revisit any question containing 'except', 'most appropriate' or 'initial'.
The candidate manages a community or outbreak scenario at the individual level, treating the presenting patient and ignoring the population intervention asked for, or answers epidemiology questions without distinguishing incidence from prevalence, crude from standardised rates, or association from causation.
Clinical training rewards one-patient reasoning, and community medicine is revised last as a list of definitions. Candidates do not practise applying measures to a described population, so they choose the clinically satisfying option instead of the public health one.
What to do instead
For community items, identify the level of intervention (individual, family, community, policy) and the measure being asked for before answering. Practise calculating and interpreting incidence, prevalence, relative and attributable risk, and standardised rates on short numerical scenarios, and learn the criteria for causation and outbreak investigation steps.