Free Intern Pharmacist Oral Exam Guide

The Pharmacy intern exam can be daunting and nerve wrecking for all prospective pharmacists. However, you should feel adequately prepared if you have been actively engaged in your internship placements, as the exam is meant to test potential situations that can arise in the pharmacy setting (particularly the community setting). I'll give some tips on tackling each stations and the approach to keep calm and excel on exam day.

Station A (OTC/Primary Healthcare)

• This station will involve a patient presenting with symptoms, which will ALWAYS require you to recommend a S2 or S3 product

Tip 1: Develop a Good History Taking Process

• I find this tip self-explanatory as you would have developed this skill over your internship placements. If you are lacking in experience or don't feel confident, I suggest developing one.
• The history taking process will always involve the standard questions that you ask ALL patients, but I also recommend developing patient-population-specific and condition-specific questions to make sure that you have the correct diagnosis.
  • For example, some potential questions to pinpoint whether it is Tinea Pedis (Fungal Foot Infection) could include: 
    • Where are the affected areas? 
    • Which areas did it start from? 
    • I hope you don’t mind me asking but what do you do for a living? (e.g. construction workers who work all day in the sun and sweat a lot in their boots may have increased risk of athlete’s foot)
    • Are you able to see any soggy white skin?
• This also helps in Station C, although Station C is open-book which allows you to access your resources.

Tip 2: Address the Patient's Presenting/Core Problem

• Although I have yet to hear about “tricky” exam cases, it is important to identify what the patient wants. Whilst you can absolutely provide more than 1 product recommendation (e.g. for example a patient presenting with allergies, where they have runny nose and watery/itchy eyes),it is important to find out what they want to address. This is what you would do in practice anyway (for example, the patient's itchy/watery eyes may not be bothering them enough, and they rather just have something that is systemic, thus antihistamines would be appropriate. It could be the other way around where the itchy/watery eyes from allergies is the main issue, and thus topical antihistamines/eye drops would be a more appropriate recommendation)

Tip 3: Be confident but don't be overconfident

• Like the saying “less is more and more is less”, it is important to just provide sufficient information/justification for your choices. If you feel unsure about something, do not say it. Trying to show off your knowledge also doesn't win you extra points either. At the end of the day, it is whether you pass or fail, and the main aim is to make you sure you are competent and you are able to provide safe and appropriate care to patients.

Tip 4: Know your products inside and out

• The PBA doesn't explicitly state this, but if you heard from your preceptors or your fellow seniors, you would know that the examiners will ask some questions after the roleplay. These questions are usually asked to address areas where they may have felt that you were lacking. It is meant to be a time to prove that you are competent even though you may have missed asking a few questions. They will still ask questions even if your roleplay was perfect, because they want to test your knowledge, which is why I mentioned that you shouldn't provide more information than needed during the roleplay. 
• Some common questions could involve asking about:
  • Other product recommendations
  • Why you chose to recommend a specific product rather than other products
  • Red flags for referral and who to refer to
  • Risk Factors for Condition

Station B (Legal & Ethical Practice)

• This station will involve a clinical situation where you are usually faced with an legal and ethical dilemma. The examiner will provide you with a piece of paper with the case and some prompts/questions to help you to respond. This is probably the easiest station because you are bound to have encountered these situations during your internship.

Tip 1: Practice with a Developed Process

• I found it helpful to develop a basic structure for responding to this station. It was helpful during OSCEs during uni, useful during practice and useful on exam day. 
• First, state that there are legal and ethical issues in this situation, and then state what the legal and ethical issue(s) are.
• Secondly, state the options that can be taken and the outcomes/consequences of these options. I recommend just giving them 2 options (due to time constraints) - one good and one bad option
• Thirdly, state the option taken and why it is the best option legally and ethically
• Lastly, state preventative measures that can be taken for similar situations in the future. These measures should address the “person at fault” and other potential stakeholders that could have had the potential to find themselves in the same situation.

Tip 2: Sensible Study Strategy

• Do not study every legal and ethical aspect of pharmacy. It is not practical nor is it logical. The situations posed in these exam situations are common situations that ALL interns and pharmacists will have encountered in a community pharmacy setting. Whilst this may prove to be difficult for hospital pharmacists as they lack common interactions tested in the exam, this station is still relatively easy if they understand the main laws and ethical guidelines
• Important laws would involve the SUSMP/poisons standards, state-specific medicine laws (there is a lot of overlap so they will test the laws that all states have in common - e.g. monitored drugs),privacy principles (just a basic understanding is sufficient, but most of it is relatively common sense),AHPRA specific laws (mandatory notification)  to name a few.
• Important ethical guidelines would involve the code of ethics.

Station C (Problem Solving & Communication)

• This station is the typical station where the patient presents with a script, and you go through the history taking process to identify what the issue is. You then communicate the issue to the doctor, provide recommendations, and then depending on the situation, counsel the patient if it is a new medication.

Tip 1: Utilise your Resources and Prepare Before the Exam

• Know how to use the physical AMH and flag the important parts. This is particularly useful for the written exam as well, so this approach is basically killing two birds with one stone. Please do not over-flag the AMH (I have seen students with over-flagged AMH that make it look like porcupines) because there is no way for you to effectively use the AMH. I personally flagged the high-yield pages for medications (e.g. warfarin, digoxin, amiodarone) and condition-specific medications (e.g. table for antibiotics, medications that can cause QT prolongation, antidepressants main page). I also wrote down some numbers on the side of the AMH (e.g. 5, 10, 15) so I can effectively refer to specific systems (I didn't write down every individual number as there is no point).
• Bring a tablet for the eMIMS app (7 day free trial). The only purpose (for me at least) is to use it as a safety net to make sure that there are no drug interactions. I activated my free 7 day trial close to my exam day so that I know where to access the "drug interactions" function.
• I didn't utilise the APF during this station, but bring it in just in case.

Tip 2: Understand common potential issues

• Drug interactions, drug toxicity and inappropriate drug/dose are common issues.
• Knowing medications that can commonly cause issues will help you excel in this situation. Every intern should have this skill because it would have been developed naturally over the course of your internship. If you have not, I suggest a lot of practice.

I hope that this free basic guide has been helpful in developing a foundation for the oral exam preparation. For a more extensive guide with practice exams, please enroll in the Australian Pharmacy Intern Oral Exam Preparation Course that I have developed and carefully curated from my own experiences with the exam and with insights from past exam takers. If you have any questions, please fill in the contact form in the Contact Us page.