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Medical School Finals: Pumping up Brains and Expanding Waistlines

Submitted by on June 30, 2013 – 8:44 PM

coping-with-stressOne month before the holiday finished, 4 months until I knew some of my more easy going friends would start revising and 4 months after some of my more anxious friends had already begun – I began the long, arduous preparation for my medical school final year examination (aka ‘finals).


This is an extremely challenging, physically and emotionally fatiguing step forward on a medic’s career ladder.  The purpose of these daunting and to some, crippling exams is to provide assurance to colleagues and more importantly the general public that we are sufficiently equipped to deal with one of the most precious commodities that you and your loved ones possess – health. In passing these exams we declare our willingness to work into the twilight hours to ensure our patients receive the best possible care. Success in these exams will mean we can no longer shelter behind the shield of being a student, but rather must leave ourselves exposed to the consequences of our life-changing decisions.


With hard work and dedication we pursue the dream of satisfying the examiners and putting ourselves in a profession that despite its rewarding opportunities has higher depression rates and a lower than average life expectancy. According to one statistic, a doctor can be expected to get sued at least once in his life (but at the same time we must remember that 92% of all statistics (including this one) are made up). Nevertheless the prospect of transitioning from a student to a doctor is a frightening step made even more so when you know that it is based on a satisfactory performance in examinations lasting 2-3 hours.


Revision for medical finals is not one dimensional. From joining online websites to practice multiple choice questions, to working long hours into the night as to practice clinical examinations, to attending expensive seminars in order to brush up on your medical knowledge and keep up with your fellows is just something we choose to put ourselves through. All this we must remind ourselves is for an exam lasting a few hours that may be influenced by a number of other factors including illness on the day, or being asked a question about something that was on the one page you didn’t manage to read in your 2000 page textbook. Indeed, it is plausible that on the exam day you are having one of those ‘off days’ where you perform below what you’re capable of on any other given day.


In many UK medical institutions, part of the ‘finals’ exam is to perform inarguably the most nerve wrecking of all the assessments – the Objective Structured Clinical Examination or OSCEs. These consist of about 16 stations lasting around 8 minutes for each one. They are designed to test your practical skills and the application of your medical knowledge as well as your patient interaction. For example, a station in my OSCEs read, ‘this patient has come in with chest pain – examine him and present your findings to the examiner’. In this station I was expected to perform the ABCDE approach (airway, breathing, circulation, disability, exposure) and then present a list of possible differentials and my management plan to the examiner. The pressure to perform in front of consultants is not underwhelming and I was bemused but not surprised at the number of my colleagues that popped a beta-blocker before beginning their stations.


In secondary school and college, part of our assessment and final grade was determined by coursework. This was a project that we could work on throughout the year and present to our teachers who would mark us accordingly. This, in my opinion enabled a fairer assessment for those candidates who struggled to express their talents in the short space of time available in the exam room. It also prevented a total reliance on remembering and then regurgitating facts to the examiner and then forgetting all you had learnt 2 weeks later.


With the exam system as it is, do we promote the student philosophy of ‘revising 24 hours a day, 7 days a week, for 2 weeks of the year’? Is this something that medicine and its training programme need to look into? After all, a monkey can be trained to tick the right box, but can it be trained to show the empathy, versatility and commitment that are required for a healthcare professional. I presume not.


Whatever the case, my experience of the medical finals will remain etched on my overloaded brain, increasing waistline and aching hand for a little longer yet. The experience was tough and tested my dedication to what I believed I wanted to pursue. Was it worth it? Having successfully completed the exams and passed, the answer may hold more substance when I hit the wards this August. For now, I will enjoy a well earned cup of tea with my mountain of leftover biscuits and crisp packets.



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