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Riya

Clinician versus examinee/"in the hot seat"

7 posts in this topic

I had this interesting discussion with a collegue & then with one of my consultants, who also happens to be a Royal College part 2 examiner. Whenever I practise long cases with the latter, he keeps emphasising the fact that we need to come across as clinicains rather than as (anxious) examinees.  While we enact the role of a clinician in our day to day clincal practise quite efficiently, when it comes to exams & especially the practicals, we often/invariably take up the role of examinees with ill-desired  consequences at times.  Why do we do what we do & what could be some effective techniques to handle this immenent challenge of every trainee? Lets brainstorm. Any suggestions, however impractical they may seem is welcome. Thanks in anticipation.

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The answer to your question is in your own footnote- 'We are what we repeatedly do. Excellence then is not an act, but a habit'.

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The answer to your question is in your own footnote- 'We are what we repeatedly do. Excellence then is not an act, but a habit'.

Well spotted! Did mean to leave a little clue behind... ;)

Anything else? C'mmn guys.

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This is a good point.  The Part 2 was a real big life event for me.  I sat the Part 2 four times and kept getting stumped by the clinical.  This was the first time in my life I had failed an exam.  Written was always a walk in the park, but I really found the clinical situation, talking in front of two other clinicians in an artificial setting with  the pressure behind you was a real obstacle to me.  I had the theory, the clinical skills and had no problems communicating in the hospital setting but put me in front of two stony faced examiners and I was a quivering wreck.  

It could have been social anxiety, the stress of being 'judged' and maybe a lot of self doubt / negative cognitions and ruminations getting in the way.  Afterwards, I'd kick myself and wonder what I could have done to stop myself getting so anxious.  

What helped me in the end?  Allowing my confidence to grow, telling myself that I did deserve it, but if I failed the exam again it did not make me a bad doctor.  Seeing myself as a serious clinician and not an examinee really helped.  Speaking to the examiners as if they were my senior colleagues, visualising myself discussing a case on the ward like normal.  It takes a lot of effort especially if you're someone who's nerves get in the way.  You have to remember that you are a competent doctor.  

My good friend gave me a great tip. In the first few sentences in the PMP, give them a couple of sentences thats sums up the case, issues, risks and any striking features - let them see that you've grasped it, let them relax and carry on.  

Good luck, I wish you well.

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Examinations are stressful to both the examinees and examiners. I am sure most examiners understand that the situation is artificial and to a certain extent accept/acknowledge anxiety in the examinees. If a candidate has passed his/her part I, has completed atleast 3 and 1/2 years of Psychiatry and has passed part II theory, their knowledge should be pretty good. The examiners, I am sure, know this. It boils down to how one handles the stress, controls the anxiety and manages to present their case/discuss the PMP in a coherent and systematic way. The only option to do this well is to pratice.

Speaking of personal experience, I was very anxious before the exam. But it was all the practice that helped me in the end.

Try and present cases/discuss PMPs as often and with as many people as you can manage. Choose all those 'scary' consultants! One needs to get used to that anxiety as well. Also feedback from these 'scary' consultants can be very good and will boost one's confidence immensely.

Good luck!

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i think it's all about CONFIDENCE and the OVERALL IMPRESSION that you give. The examiners are thinking 'can this person be my registrar?' and 'if I (consultant) went on leave, could I leave this person in charge? Are they safe?'

Confidence is so important, but obviously without being arrogant. I remember my PMPs...I was clear in what I was saying...almost to the point of raising my voice and stamping my authority!! Speaking clearly and showing clarity in your approach and thinking also helps.

For the clinical having a good rapport with the patient...being nice and putting the patient at ease goes a long way. Presenting your long case with pauses and putting emphasis on key words will keep the examiners interested. It's all in the approach. Obviously you will need the background knowledge too!

I know that as psychiatrists we are pereceived as 'touchy feely, passive and a bit wet,' - well here's your oppotunity to be a bit more like a surgeon!!! Good luck. :)

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I am 'delighted' and 'thrilled' at the invaluable feedback posted re: this topic. I thoroughly agree and am going to think it over, digest it and make the best use of it all. I also hope my other collegues joining me for the final hurdle, makes the most of it too.

Thanks immensely! :)

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