Confronting Medical Exams
“All these times, we have been making choices at different levels to join ourselves with the most demanding and most prestigious Medical field. But the Medical exams are a few instances where the Medical field makes choices to incorporate us with it”.
Medical exams may well be a few of the most stressful and worrying times in our life. There are a variety of assessments, (written exam, viva voice, OSCE and spots exams) each which have their own unique way of terrorizing students. We sit there in front of what seems like an endless, soul-destroying textbook, and it just seems hopeless. We despair, some of our friends seem to know so much more than us and every time they spout things we don’t know, we feel more and more depressed.
Most people worry about failing, but what is the reality? Who really fails? The answer is, virtually no-one. You will not feel reassured by that, but let me tell you a few things that will reassure you. There are only three groups of people who can be relied upon to fail their exam:
- Unprofessional people
- People who think they can pass without doing their work
- People who are ill on the day of the exam.
There will be students who come up to you and tell you they failed because they were ‘unlucky’. Students have to believe that no-one fails because they are unlucky; as the exams are designed and marked to make sure that doesn’t happen. People who failed did so because they were in one of the three groups above.
If you consider the people in a batch, you can probably identify the unprofessional ones; they’ve possibly been warned by the doctors and nursing staff about their behavior or their attire. However, the vast majority of those who fail, are the ones in the second group. You will not pass an exam if you don’t do the preparation.
The OSCE (pre-professorial OSCE exam and OSCE component in other exams) is the exam that proves whether you have done the work, been on the wards, clerked patients, seen pathology, ward managements and followed doctors. That’s why it is a good exam. It is the great discriminator. It separates the academically gifted people, who can’t be bothered to go to the ward from those people who will be good doctors. You will not pass the OSCEs if you do not see patients. There is no book that substitutes for clinical experience. You cannot con the examiners into thinking that you have done the work when you haven’t. Basically, the people who pass have taken the exams seriously.
How to Pass
Many surveys have shown that an isolated doctor is always bad. It’s the same when you near the final year, approaching final exams. You must work with your colleagues. Get into groups ideally between two to four. Try to make sure that you all get on with one another. If you don’t have any friends, find some! Many of our consultants promote the team work of the students within their groups and there were incidents where we were taught lessons when we failed to keep up the team spirit in ward works.
Having discussions is the effective tool to acquire knowledge within a limited timeframe. If you think that you don’t know anything; join a discussion group and you may catch something there. If you think that you know something; join a discussion group and you may clarify many things! And if you think that you do know everything; join a discussion group and you may be challenged with something there. And this is how a discussion goes well with these three groups of people.
You need to learn and hunt in packs. When you hear of a patient who has a physical sign, go together. It’s not good examining patients on your own as you won’t know what mistake you are making. Take turn to examine while others watch and critique. Present to your friends as you would present to examiners.
Treat patients with the respect they deserve. If you treat them as human beings, in contrast to seeing them as ‘cases’, when you practice, you’ll treat them as human beings in your exams as well. The examiners make note of it and if you make a mess of a station, your attitude to the patient and examiners may encourage the examiners to give you a borderline pass instead of a fail. They know a gentle, polite doctor when they see one.
There are many people who can help you in the build-up to exams. Apart from the structured teaching with consultants, lecturers, X-rays and so on, there are others who can help you. Speak to seniors, demonstrators, interns, SHOs, registrars and senior registrars who spend their time to teach passionately. Do not ask randomly! There are many extremely good and knowledgeable people, but there are also few people who will waste your time and not teach you anything of value. Speak to registrars and house officers, they will help you to locate patents with good histories and signs that they pick-up on admission days. These simple things will help you more than you would believe. They also reduce the time you spend running aimlessly.
NOSCE TE IPSUM
‘Know thyself’. As you approach your exam, you will tend to stick with what you are good at and shy away from areas of weakness because you don’t want to think about them. It becomes obvious with examination skills. Is there a medical student who doesn’t tremble at the thought of having to do a cranial nerve examination in exam? It’s all about familiarity. When you clerk, you always perform a cardiovascular, respiratory and abdominal examination. Neurological examinations are few and far between as are hand examination, thyroid and breast and other examinations. Your hearts tell you to avoid these, but you must do them. You must be familiar with them. Practice on your friends when there are no patients. Practice on your roommate when there are no friends. Practice on your teddy bear when there is no roommate. Does this sound silly? Ask yourself this one question: ‘Is passing final worth it?’ Examinations such as breast and testicular examinations are bit trickier (unless you have very liberal roommate or very patient partners!) but be inventive. If you know when patients come for their monthly penicillin injection at clinics, you can do the auscultation in a hell lot of patients for cardiac mummers in a day. Likewise go through the theatre lists if you want to examine hernias. In reality, there is no need to worry much about finding patients because here at Jaffna, during the three years of clinical appointments, you will encounter plenty of patients.
How to behave in Viva Voice, OSCE and Long & Short case exams
There are some simple ways to improve your marks and performance in the exams where you represent yourself in person. These will encourage the examiners to move you from a borderline fail to borderline pass or from borderline pass to a clear pass.
There is no prescribed uniform to be worn in exams. Be smart. Make sure your clothes are ironed and clean. The good dress that you worn last time for a wedding may have the smell of vomit or cigarettes and that does not create a good impression. I hope our faculty will soon get rid of the custom of wearing school uniform for some viva voice exams.
Brown shoes and belts are not good. Sensible light color shirts are preferred. Make sure that the first button of the shirt has been put on before you wear a tie. Do not ware an outrageously colourful tie; it’ll just distract the examiners from what you are saying. Some women believe that dressing provocatively increases their chance of passing. It doesn’t, especially if you get a female examiner who will know what you are up to. Smartness is the key here.
Make sure you wear a clean and ironed white coat for the exams where you are expected to wear it, or alternatively buy a new one.
You will probably sweat profusely before and during the exam if you do not use a decent deodorant. Make sure you don’t make the patients uncomfortable and annoy the examiners. In regards to perfume or aftershave, be very careful. If you insist on wearing it, only wear a little. Patients who are being examined may have asthma and you could precipitate an acute attack. This will not directly fail you, but is not a great start!
How to Talk
Always introduce yourself to the patient, thank them at the end, cover them back up if you have exposed them and then thank the examiners. This makes a great impression even if you have not performed well in the station. Be polite, never get annoyed, shout at, or insult a patient – even if they shout at you! When you are presenting, try not to point at them. If you tend to wave your hands around when you talk, put them behind your back. If you are too nervous to look the examiners straight in the eye, try looking at the top lip (this sound silly, but they won’t notice and it makes it easier for you). Always talk to the examiner who is asking the questions.
p style=”text-align: justify;”>Do not hurt the patient. When you shake hands, don’t do it vigorously. Do not swear and avoid mumbling things under your breath, as the examiners almost certainly will hear you. Try not to cry. It usually gets you no marks and little sympathy.
I wrote this article as a collection of information which I came across through our consultants, lecturers and a few articles. Most of the time, we all know what we need to do or what is expected of us. But the secret of success and failure is what we do actually.
This article by B. Paul Bright (33rd Batch), appeared in the 4th MSU Newsletter published in November 2015.