Paper 3 of the DTM&H is the SSQ (Short Structured Question) paper on preventive medicine and international public health. 10 questions are presented; you choose exactly 5 to answer. Each is worth 20 marks. Total: 100 marks in 60 minutes — 12 minutes per essay.
This paper tests a different skill from the MCQs and parasitology. It tests whether you can organise your knowledge into a coherent, evidence-informed written argument under severe time pressure. Many candidates with strong clinical knowledge underperform here because they have not practised essay writing since medical school.
The Essay Technique
Read all 10 questions before choosing. Spend 2 minutes scanning all 10. Choose the 5 where you can write the most complete, structured answers — not necessarily the 5 that look simplest. A question on a topic you know well but that requires a nuanced answer will score higher than a superficial answer to an "easy" question.
Structure every answer. With 12 minutes per question, you need a framework. Use this: opening statement (1-2 sentences defining the issue and its significance), key points (3-4 paragraphs covering the main evidence, interventions, or arguments), challenges/limitations (1 paragraph acknowledging complexity), and conclusion (1-2 sentences summarising the key message). This structure ensures you cover the mark scheme systematically rather than writing a stream-of-consciousness answer that misses key points.
Write concisely. 12 minutes is approximately 400-500 words if writing quickly. Every sentence must earn marks. Avoid lengthy introductions, repeated points, or tangential discussions.
Use evidence. Reference specific studies, WHO data, or programme examples where possible. "The WHO estimates that..." or "Evidence from the Global Burden of Disease study shows..." adds authority and demonstrates the evidence-based approach the examiners expect.
High-Yield Topic Areas
These topics appear with disproportionate frequency in the SSQ paper.
Water, sanitation, and hygiene (WASH). The burden of waterborne disease. WASH interventions and their evidence base. Point-of-use water treatment. Sanitation ladder. Handwashing promotion. WASH in emergency settings.
Malaria control. Insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), intermittent preventive treatment in pregnancy (IPTp), seasonal malaria chemoprevention (SMC), case management, and the challenges of resistance (both drug and insecticide). The malaria vaccine (RTS,S/AS01 — Mosquirix, and R21/Matrix-M).
Immunisation programmes. The Expanded Programme on Immunisation (EPI). Cold chain. Coverage targets. Barriers to uptake. New vaccines in the pipeline. COVID-19 impact on routine immunisation.
HIV/AIDS control. Prevention (PrEP, condoms, PMTCT, treatment as prevention), testing strategies, ART access, 90-90-90 / 95-95-95 targets, challenges in key populations.
Tuberculosis control. DOTS strategy. MDR-TB. TB-HIV co-infection. Active case finding. Contact tracing. BCG. New diagnostics (GeneXpert).
Maternal and child health. Maternal mortality causes and interventions. Antenatal care. Skilled birth attendance. Emergency obstetric care. Under-5 mortality. IMCI (Integrated Management of Childhood Illness). Nutrition interventions.
Non-communicable diseases in tropical settings. The double burden of disease. CVD, diabetes, cancer, and mental health in LMICs. Health system challenges in addressing NCDs alongside communicable diseases.
Health systems strengthening. WHO building blocks. Primary healthcare. Universal health coverage. Community health workers. Health financing in LMICs.
Epidemiology and disease surveillance. Outbreak investigation. Surveillance systems. Study design. Measures of disease frequency and association.
How to Prepare
Practise writing timed essays from month 3 of your course onwards. Use the iatroX DTM&H Q-Bank to build the clinical and public health knowledge that underpins strong essays. Use Ask iatroX to verify specific facts and figures before incorporating them into practice essays. Aim for 2-3 practice essays per week during the final 2 months of revision.
The SSQ paper is where disciplined preparation pays off most visibly — the candidates who practise structured essay writing score significantly higher than those who rely on unstructured knowledge recall on exam day.