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dinesh

Advice for the next diet

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Dear Friends,

I wonder if we can start a thread to gather some tips on how to prepare better for the next CASC exam. I failed the exam last time but passed this time.

To be honest, I was not sure if I would pass this time, but I know I did some things differently and I could see some of the mistakes I had made in the first attempt.

I would like people to join in and add on. People who have passed the exam and also people who have passed certain aspects of the exam.

I personally feel:

1. Knowledge does count. I read more and in detail this time. I beg to differ from those who believe this is only an exam of communication skills. Knowledge gave me confidence.

2. Language skills are important. But the difficult part is, how to develop it in a short span. The solution I feel is to communicate as much as possible with patients. Not just as doctors but general chit chat as well. It is really rewarding. And before you know, you will develop language skills, and ‘empathy’ skills will become second nature.

Note: there is a risk to the 2nd point. Too much local language and you risk losing out on professionalism which I feel became my weakness in the first attempt.

3. I was also helped by some of the members from this forum who kindly took time out and replied to my personal messages. Thankyou empathy and intangible.

4. Practice with as many people as you can especially SpR’s and Consultants who sit in the exam.

5. I personally also attempted to be self critical looking at the college feedback to improve myself. It is difficult at times (especially when you are upset) but it can be helpful to try and look for one’s own weaknesses.

Please feel free to add or even PM me if you need any advice.

Finally congratulations to all those who passed and I do not have words for those who couldn’t. I feel immensely for them since I was heartbroken when I failed the first time. I know it is difficult to face failures time and again especially when you have tried the best you can. All the best for next time.

Dinesh

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Thanks for your kind message. I think we need to understand what we could have done better, knowing that reduces our anxiety (at least my anxiety).

One of my friends who passed this time also emphasised on the knowledge bit. He advised me to read more in details about common topics, their prognosis, diagnosis, and treatment.i.e.I may rememeber 4 prognostic factors of bulimia but not all of it.

hope we get it right next time.

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Thanks Dinesh

I agree to what you say.

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Here is a list of all exam stations in the last diet.

1st Day stations March 31st 2009

paired stations

============

1

elderly man brought to a+e by wife after found exposin self to neighbour. neighbour wont press charges if pt agrees to see doctor

task: hx and focus on aetiological factors. not risk assmnt

link: spk to wife and address concerns and take collateral hx. do not discuss mgt.

2

16yr boy referred by gp who suspects psychosis. take hx and assess him. not full development hx. due to give gcse's

link: talk to consultant and discuss mgt

3

man in a+e brought by wife, past hx of assault on previous partner - after that in hospital and on meds for last 3 yrs. take hx and assess risk

link: have discussed with consultant who advised admission under mha if needed. discuss mgt with partner and assume pt has given consent

4

40yr old man, depressed, 20mg fluoxetine for 6wks, partial improvement but wants to stop meds. cpn wants u to see for sexual side effects.

link: talk to wife, address concerns, discuss mgt.

single stations

===========

1

lady mid-20's, with hx depression for 5 years, was on fluoxetine 20mg which was inc to 40 but no improvement and changed to venla 150. reports signif wt gain. discuss mgt options but bear in mind wt gain / side effects.

2

24yr old woman, works at horse race stable, referred by gp, was previously seeing a therapist privately but found it unhelpful. take hx to assess for bullimia and prognostic factors.

3

25yr old male, scz, adm under mha, for past 5wks, now wants to go on escorted leave with sister. assess suicidal risk.

4

elderly man 65 yrs old, dx depression, treated with 2 different antidep - no response. cons suggest ect, task is to explain ect and get consent.

5

young woman, stressed at work, gp referred. assess for ocd

6

young man in A+e, brought by police after he 'handed himself over to them' bcos 'he was sick and tired of hiding from them'. assess for psyhopathology

7

elderly man brought to hospital by daughter for confusion. has had a stroke in past resulting in loss of vision and one sided paralysis. do cognitive assessment. mmse

8

talk to mother of 21yr old male with scz. has had 2 episodes in last 3 yrs. responded to olanzapine. discuss with mother and explain scz and medication and address concerns.

===relapse due to non-compliance

2nd day stations 1st April 2009-05-10

Paired stations

1. Sexual S/E

&nbsp:lol:iscuss with wife

2. Erotomanic man towards nurse.

Discuss with nurse.

3. Post natal depression. Psychopathology.

Discuss with husband.

4. Dementia risk history from daughter.

&nbsp:lol:iscuss with Consultant.

Single Stations

1. paedophilia assess risk to child

2. Hx of drug misuse from polysubstance misuser

3. Frontal lobe examination

4. Explain ECT to obtain consent 65 yr old man tried 2 antidepressants.

5. Ward asked you to asess a patient with schizophrenia who is very distressed. Assess the cause for his distress.

6. Horse racing girl hx for Bulimia and prognostic factors.

7.Bipolar Patient on Lithium for 4 yrs, GP monitoring.Has written a letter. Read the letter explain waht it says to the patient, explain possible mangement and do thyroid examination(sic)

8. Self inflicted injury in A&E do risk assessment.

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3rd day 2nd April 2009

Paired Stations

1 Postnatal psychotic depression - 10/52 pregnant and 7/12 baby - known scenario

1b talk to her husband - he wants to take her home

2 sport teacher after MI - depressed - take hx to clarify why

2b talk to the consultant

3 - tricky - elderly man confused and disoriented with wisual and olfactory hallucinations

3b talk to the consultant about differential diagnoses

4 morbid jealousy like first day

4b talk to his partner – same

Single Stations

1 outpatient schizophrenic - mental state examination

2 dead lady building a fire in her garden - elicit symptoms

3 confused elderly gentleman - mini mental

4 ocd - elicit hx to confirm diagnosis

5 mother of a schizo on olanzapine - talk to her

6 paralysed young woman - hx to show conversion disorder

7 depressed inpatient on amitryptiline - explain lithium

8 ! cardiovascular examination

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Last Day stations 3rd April 2009

Paired

1. 15 year old girl in the A&E following an overdose of 40 tablets of paracetamol due to bullying at school. Her mother has past history of depression and had been on Lithium. The girl is now medically fit.

Task:Assess risk.

Link- Talk to your consultant re: management of the above girl

The girl had symptoms consistent with a depressive illness and some others say that she even had symptoms of PTSD! She did not want me to share information with her mother re: the bullying.

Link: The consultant wanted to know what steps you will adopt to specifically stop the bullying. The examiner who marked the station was not the consultant!

2. Talk to the carer in a nursing home re: an elderly man who is wandering and has also hit a fellow resident to find out the causal factors for this behaviour.

Task: Elicit the probable causes for his change in behaviour.

Link- Talk to son who is very angry that you have started his father on olanzapine and also talk to him to address his concerns.

The carer said the man already has Dementia for 5 years and has been in the care home for 1 year whereas these symptoms started in the last 3 months. The man had been medically examined by his GP and no problems found.

Link: The son wanted to know alternatives to medication for his father.

3. 34 year old man came to the A&E and wanted to speak to a particular nurse. When the receptionist refused to allow him he waved a knife at her and the police want you to speak to the man.

Task: Assess his dangerousness.

Link- The man had been apprehended by the police but had escaped after a doctor who talked to him let him off.. He is at large. Talk to anxious nurse regarding your management of risks.

The man was clutching his bag and said he had a knife for cutting apple and a pair of hand-cuffs for BDSM. He denied any harm to the girl and denied any forensic history.

Link: The nurse seemed to be aware of the risks. She kept probing what I was going to do to the man.

4. Man had been referred to neurologist by his GP as the former had headaches and thought he had a brain tumour.

Task:Take a past medical history to arrive at the diagnosis.

Link- Talk to Girl friend regarding management, the impact on her relationship and address her concerns

The man had watched a TV programme showing brain surgery to a person who had headaches. His mother kept referring him to the doctor for various health concerns. His uncle had died of brain tumour a year ago.

Link: His girlfriend confirmed about his mother and said he was a worrier. She was also planning to break up with him.

Single stations

1. Assess an old lady to ascertain her beliefs as she feels guilty of having committed a crime several years back.

Delusional guilt in an elderly lady with no past psychiatric history with depressive features.

2. Talk to 53 year old daughter who is a school teacher about antidementia medication as her mother has been diagnosed with with Alzheimers disease. Talk about their benefits and side-effects.

The lady had trawled the internet and was worried about the liver problems in anti-dementia drugs.

3. Assess a man who wants to look at his medical notes- He is late for his appointment and wants to leave soon. He had been depressed in the past.

Task: Assess his thoughts.

Hypomanic patient.

4. 65 year old man presenting with restlessness, change in behaiour and wandering.

Task: Do a cognitive assessment on the man with a focus on frontal lobe pathology.

The man was clearly programmed to do poorly in all frontal lobe tests.

5. A lady on the ward diagnosed with Schizophrenia. She has been worried that her thoughts are being interfered with.

Task: Assess the cause of her distress.

Exploring first rank symptoms.

6. A 47 year old man who presented to the A&E with an overdose. He is medically fit for discharge.

Task: Assess the risk to see if he can be detained.

The man had a depressive illness and did not want to come in to the hospital.

7. A 24 year old lady diagnosed with Agoraphobia.

Task: Talk to her about desensitisation and answer her questions.

The lady had agoraphobia with panic attacks with special reference to shopping in supermarkets and had a great difficulty coming for the appointment.

8. You are seeing a 27 year old lady who has seen her doctor complaining that her eyes are wide apart.

Task: Assess her to clarify her diagnosis.

The lady with Body dysmorphic disorder had been bullied by her classmates as 'fish face' has developed this pre-occupation after several of her boyfriends had left her.

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Dear Friends,

[highlight]1. Knowledge does count. I read more and in detail this time. I beg to differ from those who believe this is only an exam of communication skills. Knowledge gave me confidence.[/highlight]

[highlight]3. I was also helped by some of the members from this forum who kindly took time out and replied to my personal messages. Thankyou empathy and intangible.[/highlight]

I completely agree with you on these two accounts. I know of a colleague who used to read in the library until late at night although he practised in the group only occasionally, he passed in the first attempt. I think confidence is really important and it shows in your body language. And SEC is really a rock of support in various ways.

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we should start discussing as soon as possible.

First we should start from station of the last exam, looking to feed back and think what went wrong.

My understandings that CASc needs more knowledge,they expect you to perform very well.

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Dinesh, I totally agree with you.

I also request those who passed the CASC could participate in this discussion their help will be much appreciated.

Dear Friends,

I wonder if we can start a thread to gather some tips on how to prepare better for the next CASC exam. I failed the exam last time but passed this time.

To be honest, I was not sure if I would pass this time, but I know I did some things differently and I could see some of the mistakes I had made in the first attempt.

I would like people to join in and add on. People who have passed the exam and also people who have passed certain aspects of the exam.

I personally feel:

1. Knowledge does count. I read more and in detail this time. I beg to differ from those who believe this is only an exam of communication skills. Knowledge gave me confidence.

2. Language skills are important. But the difficult part is, how to develop it in a short span. The solution I feel is to communicate as much as possible with patients. Not just as doctors but general chit chat as well. It is really rewarding. And before you know, you will develop language skills, and ‘empathy’ skills will become second nature.

Note: there is a risk to the 2nd point. Too much local language and you risk losing out on professionalism which I feel became my weakness in the first attempt.

3. I was also helped by some of the members from this forum who kindly took time out and replied to my personal messages. Thankyou empathy and intangible.

4. Practice with as many people as you can especially SpR’s and Consultants who sit in the exam.

5. I personally also attempted to be self critical looking at the college feedback to improve myself. It is difficult at times (especially when you are upset) but it can be helpful to try and look for one’s own weaknesses.

Please feel free to add or even PM me if you need any advice.

Finally congratulations to all those who passed and I do not have words for those who couldn’t. I feel immensely for them since I was heartbroken when I failed the first time. I know it is difficult to face failures time and again especially when you have tried the best you can. All the best for next time.

Dinesh

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thanks Danesh, its so kind of you to think about us at this stage.

We hope this thread will continue.

Rehman

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it would be great if people who appeared for the exam whether they passed overall or not could mention how they performed and what areas they covered in the stations that they passed.eg someone who passed cvs examn mentioning what all things they looked for.thanks :)

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it would be great if people who appeared for the exam whether they passed overall or not could mention how they performed and what areas they covered in the stations that they passed.eg[highlight] someone who passed cvs examn mentioning what all things they looked for.thanks
[/highlight]

Yes, i will really be interested in the CVS exam because it really beats me how i managed to fail it with flying colours :D

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Excellent work. Any advice on appropriate opening lines to use for the 16 yr old boy with suspected psychosis referred by GP - he wasn't forthcoming.

Also, I'm looking for a study partner to practice with - Reading / Oxford areas. Interested, anyone?

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i am glad someone started this thread. Its very positive as compare to all the negative things going around casc. I really do not want to comment on if casc is good/bad or objective/subjective, what college wants, racism in exams and all that as i think these talks are waste of our time and would not give any thing positive and would not change anything.

The truth is that to pass casc you have to

1. pass 12 stations out of 16 &

2. be among those 38 percent not expecting percntage of more people passing next diet or college should increase the pass ercentage etc

I am not a genius or anything, all i want to do is share about my experiece of MRCPsych exams as this is the purpose of this thread in my opinion

I passed all my exams in first attempt, paper 1,2,3 and recent CASC exam

1. I donot like to be with people who are negative and will talk all sorts of negative things about exams/college/examiner and would avoid them

2. I always started my studies for exams atleast 3-4 months before actual exam (could not do the same for casc as gap b/w paper 3-casc was not much)

3. I strongly believe in group discussions and would always do the discussion with someone who is positively critical, i m sure there are many

4. I utilised my time at work quite well esp with spr and consultants

5.-for CASC-

1. as i said i did lots of group discussion (group of 3, all passed fortunately) all asians (i do not think you need a local grad to improve anything)

2.I contacted sprs in gen adult, ld, camhs, old age and forensic and did the relevant stations (it sound difficult but its not) you must plan for this immidiately after paper 3 and believe me its very very helpful esp for risk assessments, OD assess, cognitive assessment, camhs-od and eating disorder stations etc

3. a senior spr/consultant will pick up all the basic mistakes which we make, then write them down on all the visits, work on it during group discussions

4. make a list of all the stations.stations will be more or less same, its all about how good we do them

5.last 2 weeks-revise all the stations atleast 3-4 times (6-8hrs study daily)

6. most imp- if you have someone who is non medico (my wife in my case) i did all stations of explanations of various conditions such as schizophrenia, bipolar, pnd, AN, BN, explaing medication such as anti dementia drugs, explaing autism, adhd etc, believe me it helps alot as my wife would ask me again and again if she does not understand anything and that will surely help to tell you things in layman language for carers/patients

7. to read all the royal college leaflets atleast 5 times, very helpful

8. courses- i always believe that a good course always help (individual)

I did cambridge course and oxford course, both are very good courses.

Cambridge is certainly the best among these two, not sure about any other courses as had no experience/ please do not expect that courses will feed you everything, prepare well and then attend courses to improve skills, if required

9. i managed to pass 15/16 stations and this is what i did.

10. i do think luck is imp but luck do come with hard work in right direction, now what is the right direction for anyone noone knows, i can only tell what i did and i know that i m not special, another asian sho so anyone can do it.

11. I find it hard to believe that one will fail more than 4 stations due to racisms/examines problems etc, this may happen in any exam but wont make you fail in 5 stations for a fail result

GOOD LUCK TO ALL THOSE APPEARING CASC IN OCT 09

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This racism thing baffles me- i am white uk but just passed on my third attempt- so surely lots or IMGS passed when I didnt.

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I would not say that it is racism on part of examiners or the Royal College, but I do believe that British doctors will definitely have the home ground advantage eg Sachin Tendulkar playing at Wankhede Stadium or Saurav playing at Eden Gardens.

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Excellent post Blue Heaven. Congratulations on passing this and the other exams the first time.

I agree with a lot of points that you have said in your post. While reading it, I felt I did a lot of things similar to what you did.

I too will second some of your views:

1. IMG's can practice amongst themselves and pass. I must say I practiced with 2 groups, both had IMG's. In one group all of us passed. Unfortunately in the other group my colleagues could not make it. But this is not due to us being an IMG.

2. I failed both stations in LD the first time around and I realised that was my weak point. So I requested an LD consultant and attended a clinic with her. Honestly it was an eye opener. For those who feel any specialty is their weakness, I strongly recommend contacting relevant Consultant(s) and observing assessments in Clinics, inpatients, ward rounds, whatever you can get your hands on.

3. Royal college leaflets were very helpful and so were notes from various courses. I experimented with my assessment style while practicing and got feedbacks. This was so that I could fine tune myself to do better in the next diet.

4. I must add and I feel this is more important than all that I have said: failing an exam does strike right on the core of our confidence. The biggest mistake you can do is to attempt the exam with lowered confidence levels. I know it is easier said than done but do not let your confidence down. There will be times especially during practice sessions that the ghost of failure will haunt, make conscious efforts to buck yourself up.

5. I agree with you Blue heaven that luck is important and like you I also think that luck favours those who have prepared better.

I hope people will continue to add in their experiences and help others crack the exam.

Dinesh

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its racism in biarre sense..

i feel better when its a white examiner than when its a asian one..

same when working with ... whites are fairer than asian ones..

more so who have straight from subcontinent as consultants..

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i am glad someone started this thread. Its very positive as compare to all the negative things going around casc. I really do not want to comment on if casc is good/bad or objective/subjective, what college wants, racism in exams and all that as i think these talks are waste of our time and would not give any thing positive and would not change anything.

The truth is that to pass casc you have to

1. pass 12 stations out of 16 &

2. be among those 38 percent not expecting percntage of more people passing next diet or college should increase the pass ercentage etc

I am not a genius or anything, all i want to do is share about my experiece of MRCPsych exams as this is the purpose of this thread in my opinion

I passed all my exams in first attempt, paper 1,2,3 and recent CASC exam

1. I donot like to be with people who are negative and will talk all sorts of negative things about exams/college/examiner and would avoid them

2. I always started my studies for exams atleast 3-4 months before actual exam (could not do the same for casc as gap b/w paper 3-casc was not much)

3. I strongly believe in group discussions and would always do the discussion with someone who is positively critical, i m sure there are many

4. I utilised my time at work quite well esp with spr and consultants

5.-for CASC-

1. as i said i did lots of group discussion (group of 3, all passed fortunately) all asians (i do not think you need a local grad to improve anything)

2.I contacted sprs in gen adult, ld, camhs, old age and forensic and did the relevant stations (it sound difficult but its not) you must plan for this immidiately after paper 3 and believe me its very very helpful esp for risk assessments, OD assess, cognitive assessment, camhs-od and eating disorder stations etc

3. a senior spr/consultant will pick up all the basic mistakes which we make, then write them down on all the visits, work on it during group discussions

4. make a list of all the stations.stations will be more or less same, its all about how good we do them

5.last 2 weeks-revise all the stations atleast 3-4 times (6-8hrs study daily)

6. most imp- if you have someone who is non medico (my wife in my case) i did all stations of explanations of various conditions such as schizophrenia, bipolar, pnd, AN, BN, explaing medication such as anti dementia drugs, explaing autism, adhd etc, believe me it helps alot as my wife would ask me again and again if she does not understand anything and that will surely help to tell you things in layman language for carers/patients

7. to read all the royal college leaflets atleast 5 times, very helpful

8. courses- i always believe that a good course always help (individual)

I did cambridge course and oxford course, both are very good courses.

Cambridge is certainly the best among these two, not sure about any other courses as had no experience/ please do not expect that courses will feed you everything, prepare well and then attend courses to improve skills, if required

9. i managed to pass 15/16 stations and this is what i did.

10. i do think luck is imp but luck do come with hard work in right direction, now what is the right direction for anyone noone knows, i can only tell what i did and i know that i m not special, another asian sho so anyone can do it.

11. I find it hard to believe that one will fail more than 4 stations due to racisms/examines problems etc, this may happen in any exam but wont make you fail in 5 stations for a fail result

GOOD LUCK TO ALL THOSE APPEARING CASC IN OCT 09

Blue heaven, your comments are based on your experiences which have been very positive and please accept my congratulations. I had not failed an exam until the CASC in my entire life and I too had passed PLAB1, PLAB2, Part 1 written, Part1 OSCE and Paper 3 in the first attempt until I fell at the final hurdle. Just think Blue heaven 60% people failed so there may be at least some people there who have worked as hard as you but still failed. I know you mean well but what do you expect, it is natural to feel happy when you pass and sad when you fail, if it were the other way round we would be ocupying some psychiatric beds ourselves. It is very good that you have shared these strategies with us and I will certainly try to use them to my advantage but I know of atleast 2 people have used these same methods but have still been disappointed. So dont dismiss us please as negative. I know I am only a profile here but I feel too devastated to talk to my friends in person and am not even answering their calls.

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Eeyore,

Apologies for butting in, but I think I can say this on behalf of Blue Heaven. His intentions are noble and he is not dismissing anyone as negative.

As your list of passing goes, I share exactly the same pattern- passed PLAB1,2, Part 1, Paper 3 single attempt and 'fell at the last hurdle'. You managed to pass these the first time. This shows that you clearly have it what it needs to pass the exams. Its just one off and trust me, it is just a matter of time. You will be there the next time around. Dont let yourself down.

Easy for me to say I know, and terribly difficult to follow. I have walked that painful path. Just hang on.

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thanks blueheaven and dinesh for your fantastic contributions :)

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Paedophilia Assess Risk to child,

I started by asking was he aware of the allegation, then demographic details including age, occupation,relationships and family, children, then what had actually happened(his version), was this the first time this had happened with this child, how he knew the child and how long, about the child's parents, any other children involved. Then about any previous allegations of similar nature, was it a male or female child, related or unrelated. By this time, the 1 min bell rang and then I only had time to ask about about sexual preference. If I had more time, I would have asked about sexual fantasies, possession of child pornography, access to internet, friends with such interests etc, previous involvement with police ,violent offences, convictions, mental health issues, drug and alcohol etc etc.

Any one did any differently or any suggestions to do things differently?

(I failed this staion, areas of concern being

1. Questioning style including use of appropriate mix of open and closed questions

2.Fluency of interview

3.Appropriate choice of avenues of enquiry

4.Range and depth of history explored

5.range of risk explored

6.Depth of enquiry into risk)

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So many views about racism etc in CASC section. I thought I will add mine!

While preparing for the exam one of my colleagues got 3rd day as the exam day, I told her there were most casualties on day 3. She replied- there is no point worrying about something that is not in your hand. By the way- she passed and passed at the first attempt.

Extrapolating that view onto racism. There are 2 possibilities- 1. Some examiners are racists and 2. None of the examiners are racist. For the 2nd possibility- I am sure nobody has to worry. For possibility number 1- the big important question is- what can you do in the next 6 months to filter them and get them out or change their mindset. You cant. So my suggestion (which is what I did)- forget about racist examiners- just focus on hardwork- studying, practicing, fine tuning your skills, learning from colleagues, SpR’s, consultants. There is a lot to do.

Another thing that I did: From my last feedback from the Royal college- I made a list of areas of concern for both single and linked stations and counted which were the more frequent areas of concerns. It was a bit difficult to shun my defence of denial and accept I had failed! If there are 2 or more examiners ‘concerned’ in a particular area- think why, is there really something that needs done, get feedback from colleagues, SpR’s, Consultants. That’s what I did.

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