This checklist is for a doctor preparing for the Diploma in Tropical Medicine & Hygiene (DTM&H) who has done a stack of questions and wants to know whether they can honestly say they have covered the exam. The answer is not a study timetable; it is a set of things you must be able to evidence. The principal limitation to name at the outset is that "just do more questions" is not a coverage strategy for DTM&H, because dedicated commercial DTM&H banks are scarce and the exam tests skills that no single-best-answer bank rehearses. Coverage here means blueprint spread, image and public-health practice, source currency and calibration — not a raw completion count.
Start with the honest coverage finding
If you searched for a large, dedicated DTM&H question bank the way UWorld or Pastest exists for bigger exams, the most useful thing this article can tell you is that the market is thin. There is no canonical, high-volume commercial DTM&H bank; what exists is a small set of resources — the approved teaching courses' own materials, a handful of textbook question sets, iatroX's UK-clinical bank with tropical content, and self-made cards. That scarcity changes how you should think about "enough". When one bank supplies most of your practice, exhausting it tells you that you have seen its items, not that you have covered the syllabus. Every coverage claim therefore has to be built deliberately against the awarding body's blueprint, because no vendor's item count can stand in for it.
The Society of Apothecaries publishes the authoritative blueprint in the Guide to the Diploma in Tropical Medicine & Hygiene (incorporating the Regulations and Syllabus). Treat that document, not any bank, as the map you are checking your coverage against. There is no large official practice-question set; the Guide and your approved course are your primary calibration references, which makes disciplined self-audit more important here than for exams with generous official materials.
The exam you are checking against
Before you can decide whether a gap exists, characterise the target. The DTM&H is delivered as four online papers taken under live remote invigilation (Society of Apothecaries Guide, last checked 21 July 2026). The two multiple-choice papers use a best-of-five format with no negative marking; two further papers test written and image-based skills that a standard MCQ bank does not.
| Paper | Format | Questions | Duration | Marks |
|---|---|---|---|---|
| Paper 1 | Best-of-five MCQ | 50 | 1h30m | 250 (2.5 each) |
| Paper 2 | Best-of-five MCQ | 50 | 1h30m | 250 (2.5 each) |
| Paper 3 | Preventive-medicine short structured questions (SSQ) | 5 | 1h | 100 (20 each) |
| Paper 4 | Parasitology/entomology image short-answer (SAQ) | 50 images | 1h30m | 150 (3 each) |
Pass marks are set by the Angoff method, and the two MCQ papers are combined with the SSQ and SAQ papers into the overall standard; candidates must reach the combined pass without falling too far below on any single component (verify the current compensation rule in the Guide on the day). The published syllabus weights the content roughly as clinical/communicable infectious disease around 60%, non-communicable disease around 15%, and preventive medicine and international public health around 25% (Society of Apothecaries, awarding-body-reported, last checked 21 July 2026). Eligibility requires an approved course in tropical medicine and hygiene or global health and humanitarian medicine. iatroX covers the knowledge and unseen-MCQ layer that feeds Papers 1 and 2 and supports the recall behind Papers 3 and 4; it is not an image-diagnosis station or a marked public-health-essay tool, and no bank should be treated as if it were.
Build a blueprint coverage table
A completion percentage tells you nothing about spread. Replace it with a table that forces you to evidence coverage domain by domain. Copy the columns below and fill one row per syllabus area; the point is to expose the domains you have quietly avoided.
| Syllabus domain | Official weight (approx) | Questions attempted | First-attempt accuracy | Last reviewed | Confidence (1–5) |
|---|---|---|---|---|---|
| Malaria (diagnosis, treatment, prevention) | High | ||||
| Other protozoa (leishmaniasis, trypanosomiasis, amoebiasis) | High | ||||
| Helminths (schistosomiasis, filariasis, STH, strongyloides) | High | ||||
| Bacterial/mycobacterial (TB, enteric fever, leptospirosis) | High | ||||
| Viral (dengue, arboviruses, VHF, HIV in the tropics) | High | ||||
| Non-communicable disease in LMIC settings | ~15% | ||||
| Nutrition and environmental health | Medium | ||||
| Preventive medicine and outbreak control | ~25% (P3) | ||||
| Vaccination, travel and migrant health | Medium | ||||
| Parasitology/entomology identification | P4 |
Two columns do the real work. First-attempt accuracy ignores the questions you have already seen and re-answered, because on a scarce bank your repeat score inflates fast; only your unseen first pass approximates readiness. Last reviewed dates each domain so you can see which areas you have not touched in weeks — the ones most likely to have decayed. A domain with a high completion count but a stale review date and a middling first-attempt accuracy is a gap wearing a disguise.
Ten domain-level blind spots self-selected practice tends to hide
Left to our own devices, we practise what we already half-know. These ten areas are the ones DTM&H candidates most often under-sample, and each should be reviewed by a clinician with tropical-medicine experience before you sign it off as covered — self-marking is where blind spots survive.
- Species-level malaria detail — distinguishing P. falciparum, vivax, ovale, malariae and knowlesi on film and by management, not just "malaria".
- Non-falciparum relapse and radical cure — G6PD testing before primaquine/tafenoquine and the reasoning behind it.
- Schistosomiasis by species and syndrome — intestinal versus urinary disease, Katayama fever, and neuroschistosomiasis.
- Leishmaniasis forms — cutaneous, mucocutaneous and visceral, with the geography that drives the differential.
- Enteric fever and antimicrobial resistance — including XDR typhoid and how resistance patterns change first-line choices.
- Viral haemorrhagic fever triage and infection control — the isolation and notification steps, not only the virology.
- Snakebite and envenoming — syndromic assessment and antivenom principles, an under-drilled but examinable area.
- Tuberculosis in high-burden and HIV settings — extrapulmonary disease, drug resistance and co-infection.
- Outbreak epidemiology and control — case definitions, attack rates, and the practical steps of a field response (Paper 3 territory).
- Migrant and returned-traveller screening — asymptomatic infection, eosinophilia work-up and latent-disease pathways.
If you cannot point to recent, unseen practice and a knowledgeable review in each of these, you have not covered the blueprint, however high your bank percentage.
Format checklist: the two papers a question bank cannot fully rehearse
Papers 3 and 4 are where MCQ-only candidates are most exposed. Verify deliberate practice, not incidental exposure, for each.
- Parasite and vector identification (Paper 4). Can you name a parasite or arthropod from an image and answer the linked short questions under time? Practise from atlas-quality plates and film photomicrographs — Plasmodium stages, microfilariae, ova, trypanosomes, Leishmania amastigotes, and the arthropod vectors — writing a short structured answer, not choosing from options.
- Maps and image reasoning. Can you use a distribution map or a clinical image to narrow a differential (geography of a rash, a distribution map for a vector-borne disease)? Rehearse turning a visual into a reasoned answer.
- Global-health and public-health practice (Paper 3). Can you write a concise, structured answer on outbreak control, a vaccination programme, or a water-and-sanitation intervention? This is a writing skill with a rubric, and it needs timed, marked practice against the syllabus, not passive reading.
Interpretation checklist
Tropical medicine leans heavily on interpreting data under time. Confirm you have practised each of the following where the syllabus makes it relevant, and note that none of these is fully rehearsed by picking a best-of-five option:
- Images: thick and thin blood films (parasitaemia and speciation), stool ova-and-parasite preparations, skin and mucosal lesions, and vector morphology.
- Radiographs and imaging: cavitating TB, hydatid cysts, and tropical splenomegaly patterns.
- ECGs: where systemic tropical disease affects the heart (for example Chagas cardiomyopathy) or where electrolyte disturbance from severe illness matters.
- Laboratory trends: rising or falling parasitaemia, eosinophilia work-up, and the biochemistry of severe malaria or dehydration.
- Calculations: paediatric and adult fluid and drug dosing, and epidemiological measures — attack rate, case-fatality ratio, sensitivity and specificity of a field test.
- Ethics and statistics: research and public-health ethics in low-resource settings, and the basic statistics behind screening and outbreak decisions.
For any medicines detail — dosing, cautions, interactions — use the SmPC/eMC as your UK reference, and use current WHO treatment guidance for the tropical-disease specifics; note explicitly which source and which date you relied on.
Recency checklist
Tropical medicine is guidance-sensitive, and an out-of-date fact is a wrong answer. Flag every guidance-driven topic and record the date and jurisdiction of the source you learned it from. High-churn areas to check include: WHO malaria treatment and chemoprevention recommendations; artemisinin partial-resistance and its geographic spread; cholera and dengue vaccine policy; mpox classification and control; snakebite antivenom guidance; and mass drug administration for neglected tropical diseases. A note that reads "WHO malaria guidelines, 2024" is auditable; "I'm pretty sure it's artemether–lumefantrine" is not. Where UK practice diverges from WHO or destination-country practice, record which jurisdiction the question is testing.
Performance checklist
Coverage is necessary but not sufficient; you also have to demonstrate that the knowledge performs under exam conditions. Before you stop doing new questions, confirm:
- Unseen, timed, mixed blocks. Your recent accuracy is measured on questions you had not seen, done to time, with topics mixed — not one comfortable topic at a time.
- Speed. You are completing best-of-five items at roughly the paper's pace (about 1.8 minutes each) without leaving blanks — there is no negative marking, so a guess always beats an omission.
- High-confidence errors. You are tracking the questions you were sure of and got wrong; these misconceptions are your highest-yield fixes and the most dangerous to leave.
- Retention. Domains you "finished" weeks ago still test well now, on fresh items — coverage that has decayed is not coverage.
- Official-material calibration. You have sat any official sample material and your approved-course assessments once, unseen, and treated the result as a calibration reading rather than a score to farm. Because your bank percentage is not your exam score, this calibration matters more than any single number (why your Q-bank percentage is not your exam score).
Stop or continue: a decision tree based on the measured gap
Use the audit, not your mood, to choose the next activity.
- Continue new questions if the coverage table still has domains with low first-attempt accuracy or few attempts. You are not finished; you have unmet coverage.
- Consolidate if coverage is broad and accuracy is solid but your high-confidence-error log is still generating fixes. Stop adding volume and work your error log and spaced review instead.
- Simulate if knowledge is strong but you have never rehearsed Paper 3 under time or named parasites from images to a standard — switch to format-specific practice.
- Seek teaching if the same domain keeps failing after review; a clinician or your course tutor will unpick a misconception faster than another twenty questions will.
- Rest if accuracy is high, coverage is even, retention holds and the error log has gone quiet. More questions now buys fatigue, not marks.
A one-page checklist you can copy
| Check | Evidence required | Done? |
|---|---|---|
| Blueprint spread | Every syllabus domain has attempts + a first-attempt accuracy figure | |
| Ten blind spots | Recent unseen practice + clinician review in each | |
| Paper 4 images | Timed parasite/vector identification to a written-answer standard | |
| Paper 3 public health | Timed, marked short-structured answers against the syllabus | |
| Interpretation | Films, imaging, ECGs, labs, calculations practised, not just read | |
| Recency | Guidance-sensitive topics dated and jurisdiction-tagged | |
| Unseen performance | Timed mixed blocks; pace ~1.8 min/item; no blanks | |
| High-confidence errors | Logged and being actively closed | |
| Retention | Old domains still test well on fresh items | |
| Calibration | Official/course material sat once, unseen, as a reading |
A worked example (invented data)
Priya, a returning humanitarian doctor, has "done" about 900 questions on her single bank and sits at 78% overall. Encouraged, she nearly stops. Her coverage table tells a different story. Malaria and enteric fever show 200+ attempts at 84% first-attempt accuracy, reviewed this week — genuinely covered. But leishmaniasis shows 22 attempts at 55%, last reviewed six weeks ago; snakebite shows nine attempts; and she has never once done a timed Paper 3 short-structured answer or named a parasite from an image to a written standard. Her 78% is real but hollow: it is the average of a few over-practised strengths and several untouched domains. The decision tree sends her to continue (leishmaniasis, snakebite, VHF) and simulate (one timed Paper 3 answer and a 20-image identification drill each week), not to rest. Two weeks later her first-attempt accuracy in the weak domains has moved from the 50s to the high 60s, and she has a marked public-health answer to calibrate against — a truer readiness signal than her headline percentage ever gave her.
Bottom line
Stopping new questions is a decision you should be able to defend with evidence, not a feeling that you have "done loads". For DTM&H, that evidence is blueprint spread with honest first-attempt accuracy, deliberate practice of the image and public-health papers that MCQs cannot rehearse, dated and jurisdiction-tagged sources for the guidance-sensitive topics, and calibration against the scarce official material. Because the commercial bank market is thin, the discipline has to come from you: build the coverage table, close the blind spots, and let the measured gap — not the completion bar — tell you when to stop.
Frequently asked questions
How do I know whether I have covered the full DTM&H blueprint? You know it when you can produce a coverage table with a row for every syllabus domain, each showing a meaningful number of unseen attempts, a first-attempt accuracy figure, a recent review date, and a confidence rating — and when the image and public-health papers each have their own deliberate-practice evidence. Coverage is a documented map against the Society of Apothecaries syllabus, not a completion percentage on one bank. If any domain is blank, stale, or evidenced only by repeated questions you have memorised, that domain is not yet covered, regardless of your overall score.
Can one question bank be enough for DTM&H? For breadth of recall, a single strong bank can carry most of the multiple-choice preparation, and because dedicated DTM&H banks are scarce you may reasonably lean on one for volume. But one bank cannot be enough on its own, because two of the four papers — the preventive-medicine short-structured paper and the parasitology/entomology image paper — test written and image-diagnosis skills that best-of-five items do not rehearse. Enough means one bank for volume plus deliberate image practice, timed public-health writing, and calibration against official and course material; the two-Q-bank principle and the completion-is-not-coverage method both apply here.
What should I measure instead of my overall Q-bank percentage for DTM&H? Measure first-attempt accuracy on unseen, timed, mixed blocks broken down by syllabus domain; your high-confidence error rate; your retention on domains you finished weeks ago; and your pace against the paper's roughly 1.8-minutes-per-item target. Your overall percentage blends over-practised strengths with untouched weaknesses and inflates every time you re-answer a familiar item, which on a scarce bank happens quickly. A domain-level, unseen, first-attempt figure is a readiness signal; a headline percentage is a comfort blanket.
When should I stop doing new DTM&H questions? Stop when your coverage table is even across domains, your first-attempt accuracy on unseen blocks is stable and adequate, your high-confidence error log has gone quiet, your retention holds on fresh items, and you have rehearsed the image and public-health papers to a written standard. At that point additional questions mostly generate fatigue rather than learning, and your time is better spent on spaced review of your error log and calibration against official material. If any of those conditions is unmet, you are not finished — the gap, not the calendar, decides.
Which DTM&H resource should I use for my weakest component? Match the resource to the deficit rather than reaching for more MCQs by default. For image and parasitology weakness, use atlas-quality plates and film photomicrographs with timed identification practice; for public-health and outbreak-control weakness, practise timed short-structured answers against the syllabus and have them marked; for recall gaps across clinical infection, use unseen MCQ volume such as iatroX; and for underlying knowledge, return to your approved-course materials and current WHO guidance. The decision-tree article in this cluster walks through choosing between these by learner profile, time and budget.
Editorial notes and references
Written by Dr Kolawole Tytler, NHS GP and founder of iatroX. Last checked 21 July 2026. Exam figures are drawn from the Society of Apothecaries' published Guide and Syllabus and are subject to change; treat any vendor figure as vendor-reported and verify the current format, fees and regulations on the awarding body's site before you rely on them. Disclosure: iatroX operates a question bank that competes with other revision products; this article confines iatroX to the knowledge and unseen-MCQ layer behind Papers 1 and 2 and makes no claim that it substitutes for the image or public-health papers, an approved course, or clinician review. No proprietary-algorithm claims are made. Corrections are welcome via the feedback route on iatrox.com.
References: Society of Apothecaries — Diploma in Tropical Medicine & Hygiene, and the Guide to the Diploma in Tropical Medicine & Hygiene (Regulations and Syllabus). World Health Organization treatment and control guidance for the relevant tropical diseases. UK medicines detail via the SmPC/eMC. Internal: Your Q-Bank Percentage Is Not Your Exam Score; Question-bank completion is not coverage; the iatroX comparison hub; and the iatroX quiz landing page.