The Exam

This piece is a continuation of my interest in writing things about the intersection of medicine, education and my experiences. I thought some number (likely just 1, after I forget to write more) of blog entries about the experience of preparing for speciality exams would be of interest and, failing that, would at least be cathartic for me.

Practical Advice

There is, unfortunately, no definitive method of preparation. The college syllabus is a technically relevant document but ultimately fails to be of particular use. Being told you require an “in depth knowledge” of most of everything is useful only for exacerbating your anxiety. I found some reassurance in the fact that my colleagues all shared my frustrations and that at least I wasn’t uniquely inadequate. I had previously – in medical school and my current Masters – found group study to be less efficient or productive. I’m not sure if my opinion has improved, but it certainly is therapeutic as we share our challenges. There is also a certain motivation (anxiety) in working with those who are better prepared than yourself, as it is harder to overlook (avoid) topics.

When it came to actually settling into study, the process was quite tentative as it represented the first time in many years we had seriously approached structured learning. With several months before the exam (August 9th, not that I’m counting) it will be interesting to see whether the value of group study persists. For those considering a group, make sure you have a system!

The most useful information about preparation has thus far been from word-of-mouth advice from friends and colleagues. My perspective is that:

1. Grinding through sample MCQs is the easiest approach (all the question banks I saw are essentially equivalent)
2. Comprehensive revision from a textbook is too inefficient if you’re time-poor
3. Covering the least intuitive things early (statistics…) helps with consolidating the learning
4. Some areas simply are not be worth mastering and a knowledge of the core concepts and buzzwords may suffice
5. Treatment guidelines (eg. NICE and RANZCP) are very different to common clinical practice

Bitter Ranting

I did notice that my clinical practice improved after commencing study, although I strongly suspect that this improvement will fit a curve of diminishing returns. The major topics – drug interactions, official guidelines, landmark trials – were certainly significant and useful. I felt more confident directing management discussions with those specific facts at my disposal! I think this naturally translates into better care but, as always, it can unfortunately be all too easy to lose sight of this benefit.

Unfortunately, the minutiae represents a disproportionate amount of the effort I expend. I’m sure the difference between Carl Schneider and Kurt Schneider will never be clinically relevant, but apparently I need to be ready for it. Thus far, I have consistently confused them (not a pair you want to mix up!) when answering practice questions. Very few doctors exist in a vacuum and with the widespread and easy access to resources (especially digital), it feels bizarre that the pedagogy has not taken this into account. Independent practice is not about obviating the need to review practice guidelines or check drug interactions, but about having the knowledge to recognise the need to do so in any given clinical context.

The entire process of preparing for these stupid things seems to take on a certain drama, with “the” exam taking on a defining role in our lives. Our use of the definite article (“the”) supports this unnatural importance and reinforces the fear we all share. The bizarre sense of grandiosity/prestige around the whole process only worsens the situation, giving some a weird superiority complex. The consequences of failing (opportunity cost and actual cost) make me feel there has to be a better alternative.

Hopefully I continue to write about study, even retrospectively. I think there is (sadly) an absence of useful feedback on this entire process. Please let me know what you think, or what you’d like!