What I learnt this week: The seed of doubt #WILTW

This is the 94th #WILTW

I have been examining medical students this week. They are high stake exams which may alter the student’s progression through the course and do have an impact on the allocation to a Foundation School (initial placements or internships).

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Being observed by someone who is openly judging you is an uncomfortable experience. Becoming nervous can make the most simple of tasks almost impossible. While talking to the volunteer patient who was assisting with the exam station I was assigned to I was reminded of a piece I wrote on exam technique a while ago. It refers to the Paediatric membership exam which is needed to progress to the later stages of training. While the exam is obviously harder than medical school finals the impact of nervousness is exactly the same.

“There is something distinctly unusual about having your every word and movement monitored. Just this act of observation can reduce good paediatricians to the level of a newly qualified doctor. The only other time you are observed in this way, with so much pressure riding on the result, is your driving test. I am no longer ashamed to say that I passed my driving test on my seventh, yes seventh, attempt. At the time I was the laughing stock of my peers. A seemingly intelligent, motivated and able sixth form student cracking under the pressure of a three point turn. In hindsight there were a few reasons why this occurred. I failed my first test with a D (dangerous driving!) as a result of just not being ready for the exam. I was practically much improved on the second attempt but I had this nagging doubt in my mind. Most of my peers passed first time, or at the worst second time round. What would happen if I failed? With that small seed planted I spent most of the test paranoid that every little mistake I made was being held against me. At one stage I thought I had pulled out in front of someone and glimpsed the examiner placing a cross on his sheet. I was furious, stopped concentrating and then made a string of small but costly errors. In fact I had not failed for my initial mistake and had I not got so distracted by this I probably would have passed. Unfortunately my obsession with what the examiner was doing resulted in failures in tests 3,4,5 and 6 as well. There are numerous lessons to be learnt here:

  1. Don’t let me drive you anywhere
  2. Do not sit the exam until you are ready. You must seek an honest opinion from a senior colleague who knows you well and has seen you examine patients. You are doing yourself no favours by failing badly on your first attempt. It will damage your confidence and you lose the benefit of having taken the exam early to speed up your time through the system
  3. You must learn to stop thinking about the examiner and concentrate on the patient. Be truly interested in diagnosing the condition the child has. This sounds cheesy but unless you are focusing all your efforts on the child then you are wasting the knowledge and time you have spent getting to the exam.
  4. You have not failed until the college sends you a letter telling you, “You’ve failed!.” I realise this is flippant but there is no point spending months revising to give up after two stations because you feel it is all over.
  5. Although it is unusual to be allowed to take the exam seven times in a row; if you truly believe in yourself you stand a much better chance of passing. I have seen candidates go into the exam with that seed of doubt already planted; it will sprout very quickly in the heat of the exam circuit.”

Being nervous about being observed is not something that goes away. However experience delivers confidence and perhaps the belief  it doesn’t really matter what others think as you believe you are doing something the right way. Losing insight at this level of expertise is clearly a real danger and why peer feedback is so important. Would I mind being re-examined on clinical skills and procedures I believe I am expert in? Would I be nervous about it? I hope I wouldn’t as there no longer is a seed of doubt but there is still a willingness to learn.

What you have you learnt this week? #WILTW

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