The run up to exams: surviving and scheming

Sabina Dosani has good tips for all medics

Yes, you are going to be a doctor. Feeling doubtful? Read on. As a first year senior house officer, I am not too long in the tooth to have forgotten those nail biting weeks in the run up to the final examinations. "The examiners want to pass you." Everyone, from last year's finalists to professors of medicine, glibly passes this on. But how do you survive until then?

Extreme swings of mood ranging from enthusiastic euphoria to morbid melancholia are normal during revision. You are not going mad. Countrywide, medical students alternate between having fantasies of passing and nightmares of failure - often occurring in the same hour. Your extremes of mood only become problematic if they prevent, rather than accompany, revision.

Find friends of similar academic ability

Group revision has many advantages: you can share textbooks, notes, examination techniques, meals, tears, and frustration. Someone in the group will be able to illuminate topics that baffle you. Group sessions with multiple choice questions are faster and more informative than struggles in silence and solitude.

Avoid smart alecks

You know who the smart alecks are: people using impossibly long words, scoring 96% in mock exams, whose only problem appears to be killing time in these tedious weeks while you get down to the business of revising for exams they could have sat while still in utero. Tell yourself they are projecting their own fear of failure on to you. It may not be true, but you will feel better.

Learn across subject boundaries

Instead of thinking in terms of medicine, surgery, or gynaecology, consider, for example, a patient with abdominal pain. Have a brainstorming session and write down all the causes you can think of. What would this patient tell you? What would he or she look like? What is the underlying pathology? How would you treat it? What possible side effects would there be? This prevents you from missing out a subject that doesn't turn you on, as well as making you a better doctor.

Clinical examinations are anxiety provoking

There are ways of minimising anxiety about clinical examinations. Examine each other. This facilitates perfection of slick routines, undisturbed by the arrival of meals, medication or ward sister. Take it in turns to role play patients with various syndromes and then the examiner. This gives you valuable insights into examiners' thoughts and questions. When you are confident - for me it was when I had finally learnt to wield a patellar hammer while retaining a semblance of professionalism - examine as many patients as you can. The worst piece of advice given to finalists is to "present to anyone who will listen." Present only to those who will give you constructive criticism and boost your confidence. House officers are usually brilliant at this, especially if you take a few blood samples for them and buy them a pint when you pass.

Stick up an affirming notice

At the risk of sounding like a woolly shrink, this works. I wrote, "You are going to be a doctor soon" on a sticky note and stuck it to my mirror. This gave me a sense of perspective on days when I wanted to give it all up and a hint of reality when I did believe I would fail.

Watch television

Either watch television as escapism or incorporate it into your revision plan. Casualty was a highlight of my revision timetable. Passionately criticising on-screen doctors' mistakes in the presence of non-medical friends resulted in me sounding and feeling like a "proper" doctor. You might even learn something. This was the rationale I used to count medi-soap watching as a revision hour.

Exercise

Walking to the kettle does not count. Anything from a long run to a few angry lengths of your college pool will energise and invigorate you. It will also improve your sleep.

Eat healthy balanced meals

To most medical students healthy eating is a new concept. You will not revise effectively on a diet of nicotine and black coffee. Some people find cooking relaxing. Others combine cooking and revision: I remember a friend of mine chopping mushrooms while chanting the side effects of amiodarone.

Go to the pub No, not to drown your sorrows. My friends and I found that going for a drink at last orders was not only something to look forward to after a day of intensive revision, but also a good opportunity to wind down. Racing minds lead to insomnia and a nightcap is invariably kinder than prescription sedatives.

If you are in difficulty, ask for help early

Your clinical tutor or dean can take catastrophic personal circumstances into account. Examiners prefer to know early if a candidate is in trouble, rather than failing a good candidate who has been overwhelmed by personal circumstances. If your perceived pitfalls are academic, talk to a senior clinical tutor. It is unlikely that you would have got this far without anyone noticing that there is something amiss and alerting you. What appear to be gaping holes in your knowledge may simply be small spaces, easily filled by a few extra tutorials from friendly consultants.

"What is the point of all this?" you will cry, many times. As an aspiring psychiatrist I often questioned the value of memorising stages of labour and anatomical relations of the inguinal canal. With hindsight I realise I learned how to organise information. You will acquire skills of separating what is important from that which is superfluous. You will be able to perform under extreme stress. From a social perspective, exams tested my friendships more than drinking, dancing, and cavorting ever did. The people who saw me through are friends for life. Preparing for exams is often difficult, sometimes painful, but ultimately endurable. Exams are not designed to transform intelligent, enthusiastic extroverts into chain smoking, caffeine toxic, celibate recluses who answer in true-false mode. You have crammed for and passed end of term exams. You have passed anatomy vivas on body parts you did not dissect. You have strong medical school survival instinct. Find it. Develop it. Use it.

Sabina Dosani, senior house officer


studentBMJ 2000;08:347-394 October ISSN 0966-6494