Professional Exam: Is All About Mind Game!

Yes, sitting for professional exam/ pro exam is all about mind game! Why do I say so? It's because of the experience that I had 6 months ago (wow, how time flies, I'm now in the 6th month of unemployment..)

Knowledge wise, should not be a big problem at all when you are in the final leg of medical school, as the numerous exams/tests that you have taken prior to that have filled your brain up with a certain level of knowledge. Not to mention the knowledge gained from writing case write-ups (without plagiarism of course), covering beds and attending teaching sessions. Hence, the doctors in my school have always repeatedly told batches of batches of final year students that, 'You will definitely pass unless proven otherwise' (only applicable for undergraduates though haha, as it is the other way round for master students). 

Besides, there is ample time given before pro exam to refresh our memories (3 weeks in my medical school)! So it would be a lie if you keep on telling yourself that your brain is empty. 

The reason why I say pro exam is all about mind game is because psychological preparation is as equally important as knowledge preparation. Pro exam, is, after all, the final hurdle that all of us have to go through in order to graduate. So, the pre-exam & in-exam anxieties are definitely no joke. I still could remember how I would wake up with palpitations and awaken in the middle of night by scary dreams like I couldn't answer this & that throughout the study weeks (& my batch was fortunate/unfortunate to have 1 week extra due to raya holidays). There were times that I would wish that tomorrow would be the start of the exams to prevent me from getting arrhythmia or heart failure. Lol. 

Anxiety can really be a hindrance to your progress, as it affects your processing ability. In mild cases, it causes slow response, poor memory recall, while in severe case, thought block is the end result. The latter is definitely a huge liability during exams, especially in OSCEs, short & long cases. 

OSCE came in first in the list during my pro exam, & I definitely was not mentally well prepared at that time. I could not identify a simple AF ECG which I usually could, & mistook that as heart block instead. As you know, for OSCE stations, once the diagnosis is wrong, the answers following that would be all incorrect too, so zero mark it is for that station. 

Another pretty good example of grave mistake caused by anxiety was during my surgery theory paper, my eyes failed me again by turning right hypochondrium into left instead. ==" the worst part was I only realized that when I heard others discussing about that question, even though I had checked my answers + questions for a couple of times.  

The time that I truly experienced thought block (albeit a brief moment) was the last day of pro exam, during my ENT short case. Xerostomia, was the term that I could not recall no matter how hard I think at the near end of my short case when examiner asked for another complication for parotidectomy. I could only recall it after the exam instead. 

There were a lot more of mistakes that I had done due to anxiety, but those mentioned above are the notable ones that could cause a huge loss in marks, and hence, to wave goodbyes to Distinction/ Honours. Yes, we should really aim higher, especially in this day & age when job security is no longer guaranteed for doctors. Of course, performance during housemanship is much more important, but your resume will look good with honours under your belt during interviews. 

Tips for overcoming exam anxieties:

1. Never think yourself as a failure! 

Definitely a No to keep on having the thought that you're going to fail in the exam just because you have experienced failure before/ you are not on par with the pace of your fellow colleagues, as that will only bring unnecessary stress to yourself, which will wear yourself off. Nobody is born to be a failure, as long as you are working on the right path, nothing can go wrong, unless you yourself have given up. Regarding not being up to the standard of your colleagues, not to fret, but learn to analyze what exactly that you lacked of. If it is because of some hi fi knowlegde on rare condition, then it's okay not to know much on that. However, if it's related to common cases seen in the wards, then, that's the time that you should start worrying, BUT, keep in mind that, there are still time for you to improve yourself! 

2. Stay away from the rumours regarding exams & examiners.

When exam is near, anyhow somebody will start the rumours on the difficulty of the exam, which 'killer examiner' is expected to come during clinical exams etc. Like in my year, there were people who insisted that even Master students could not answer our professional exam questions. Hmm, logically thinking, that should be grouped under false/exaggerated rumours. It's true that there will always be a small percentage of difficult/tricky questions,  but definitely not all lah. We are not trained to be specialists, We are trained to be safe doctors who know their basics well! In the case of examiners, only God can decide on the examiners that you will be facing during clinical exams. Nothing will go too wrong if you have your knowledge and supporting facts. Besides, there will be 2 examiners during long case, one from the particular specialty that is related to your case, and another from different specialty. Marks are given by both of them. So basically you are in the safe zone if you know how to manage the patient from A to Z at the level of the specialist from the other field. 

3. Eat, pray & sleep properly during study weeks & exams!

It is super important to maintain euglycemic before and during exams, at least for me lol. Glucose is the ultimate fuel of our body; Adequate sleep can keep us sane and fresh; Praying can keep our mind calm. So for you to be able to read & think, you will need a functioning brain, which could be easily achieved by those three mentioned earlier. The lack of any one of the components can make you fall into the vicious cycle of anxiety->stress->brain dead-> anxiety-> stress. 

4. Make an effort in attempting past year questions. 

This is to prevent you from experiencing 'Cultural Shock' during the actual professional exam haha. Without a doubt, the quality of the pro exam questions (theory) is a step higher than any of the end of the semester final exam questions. Attempting the questions and clarifying your doubts with doctors are pretty useful in honing up your skill in answering one best answer (OBA) questions. The most dreaded question (from my POV) is nonetheless, 'what is your next step of management'. O.O too tricky till there will be disagreement among doctors on the exact correct answer. Getting to know the cases that was seen during long & short cases of previous years are of great help too, as most of the time, similar cases will be repeated year by year. While the set of questions following case presentation is always concerning your history, physical examination (may need to perform again in front of examiner) investigations+reasons, principles of management with some reasoning, complications. Some will also get imaging interpretation (mostly Xrays & Brain CT, abdominal CT is possible too but not that common as compared to others). Oh ya, get to know the exam format for clinical exams in particular, so that you can train yourself to be able to finish your task within the allocated time. In my medical school, there is only 1 hour allocated for long case, 45 minutes for clerking + PE, 15 minutes for case presentation preparation. 1 hour sound so long right, but during exam, 1 hour will be gone in just a blink of eye, and you might not be able to fully clerk/PE patients with multiple comorbids. So learn to be wise & fast. 

5. Study consistently at the state that you are comfortable with. 

This should be a practice since Day 1 in medical school post-orientation. Study diligently, ask whenever in doubt even if it sounded stupid, because you are a medical student, not a doctor yet! One thing I regretted deeply during my 5 years in medical school was not being proactive, I just kept quiet even if I have millions of questions in head, that was so wrong of me.. Being quiet will not bring you to anywhere you know. Anyway, not to lose touch with the world too while you are busy studying. It's good to spend time with your family & friends, or on things that you enjoyed (eg movies) from time to time. That's the way to keep you going forward with a sane mind. 😊

Although scoring in exam is important as a student, never forget the fact that, you will soon become a doctor, and all you have in mind will be turned into practice, hence, always bear in mind that, becoming a safe doctor is the ultimate mission rather than passing exams. This is what doctors in my medical school have always emphasized on.