In which Ellie starts working in hospital

Today was my second day in hospital. I was going to write yesterday about my first day but unfortunately I came home, put on a video to refresh my physical exam knowledge, and instantly fell asleep. So far my hospital experience can be summed up in two words: getting underfoot. Don’t get me wrong, it’s been brilliant. Even when you’re not doing anything it’s still a million times better than sitting in a claustrophobically hot lecture theatre wondering if anything you’re getting taught is relevant, but at the same time I am spending a lot of time feeling like I’m loitering, lurking, or simply getting in the way. Here’s a brief over view of my first 2 days.

Day 1

I turned up 10 minutes early to meet my consultant, an extremely nice man who specialises in Diabetes and Endocrinology. Another student whose consultant is away this week joined me and to be honest I was extremely glad of the moral support. We sat through a multidisciplinary meeting regarding the patients on our ward which summarised thier problems, investigations and, most importantly, tried to figure out when they could go home. We then spent a few hours visiting the patients and updating their notes. This took up most of the morning and involved me standing awkwardly around a selection of beds, trapped somewhere between the trolly and the curtain, trying and failing to look like I should be there. We then broke for an extremely long lunch. The second half of the day was significantly less productive (if you could by any stretch call the morning productive). My consultant had suggested that I come to a clinic on erectile dysfunction that he was covering for another doctor so I dutifully turned up on time only to find the office door locked and the corridor deserted. A liver disease clinic was labelled, but nothing to do with erectile dysfunction. I managed to track down the reception desk where I was told that they knew nothing about any such clinic, and had never even heard of my consultant. Not a good start. I instantly began to panic. Was I in the wrong place? Should I wait? I awkwardly hovered for about 15 minutes before giving up and going back to the ward where I stalked a junior doctor for the rest of the day. I haven’t seen or heard from my consultant since.

Day 2

Today was less nerve wracking but equally unproductive. I turned up just about on time (my natural tendency to play fast and loose with time management is already coming through) and sat through another pre ward round meeting, however as soon as we started to go around the ward it became obvious that our presence was more a hinderance than a help. In addition to the consultant there were 2 junior doctors, 2 nurses, and a physiotherapist. The consultant actually had his own medical student in tow so together with myself and the student from yesterday we made up a rather intimidating group. We did the maths and quickly decided to make ourselves scarce, however this did lead to us spending the rest of the morning sitting in the seminar room half heartedly trying to fill in our General Medicine workbooks and testing each other on the causes of heart failure.

In the afternoon we had a 2 hour long Rheumatology seminar after which most of the other medical students disappeared back to their respective homes. I on the other hand had made a deal with myself not to leave until I had completed at least one clinical skill so I headed back up to the ward. This roll of the dice bought me nothing more than another hour of following the junior doctor around, asking stupid questions and saying things like “what are you doing? Can I do it? Can I please take blood from someone?” Eventually I was persuaded to go away and leave him alone when he made it very clear that he wasn’t going to be doing anything I could join in any time soon.

So those were my first two days. They were certainly very interesting in terms of seeing how things work on the wards, how people share responsibilities and the different kind of factors doctors actually consider when treating patients, but I wouldn’t say I’ve learned anything so far. Still, I have only been there two days. I’ll write again after my first week and hopefully have something a bit more interesting to say.

Best moment so far: being told by the junior doctor that I’ll make a good doctor because it occurred to me to ask why a patient who was clearly incapable of eating hadn’t yet been started on an NG tube.

Worst moment so far: failing to find my way to the erectile dysfunction clinic and the lingering fear it generated that my consultant now hates me.

Most interesting patient: a man with a massive pituitary adenoma which had haemorrhaged causing vision loss. This patient was incredibly interesting because he also had Type 1 diabetes which had only developed a few weeks ago – an extremely unusual presentation that made the consultant question whether the adenoma was actually secondary to a metastatic cancer which was also affecting his pancreas. I’ll try and follow up on this patient and report back as much as confidentiality allows.

Until next time!

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In which Ellie gets ready to start Phase 2

Sadly the luxurious 6 week post exam break is over (4 weeks if you don’t count the 2 weeks I spent studying for resits just in case) and the time has come to drag myself back to the medical school. My amazing 10 day adventure in India already seems like a distant dream, and with what little tan I managed to get already fading in the bitter Leicestershire winds, there is little left for me to do but tell you about the ridiculously unhelpful induction week we have just received, and complain about the tremendous anxiety I feel towards actually setting foot in a hospital. Let’s begin.

Induction week

What do you want from an induction week preparing you for the transition from theory to practise? Top of my list would be some understanding of where we actually had to go and what we would be expected to do when we got there, preferably with ample time factored in for tedious but necessary administrative fodder. Sadly what we actually received was 2 days of teaching on a subject that was actually examined 7 weeks ago, an afternoon long “team building” exercise which basically involved us playing pretend lorry driver (complete with pretend wooden block medicine which had to be packed into our pretend ice cream tub lorry following a health and safety video on how to use scissors so we could wrap the wooden blocks in coloured paper) and yet more labouring on the importance of reflective writing. Topping the week off was a day of training in order to get a smart card, which I gather is needed to do basically everything in hospital. This training, mandatory for all 200 students, took around half an hour per person and could only be accomplished on 6 computers, meaning that long angry queues soon developed. The smart cards will be ready for collection during the following week at and only at those times already scheduled for yet more induction training. As a result I have no idea how or when we will ever get hold of these smart cards. Now those of you who are regulars to this blog will probably have noticed that I have a fairly low tolerance for inefficiency and incompetence – add to that my profound jet lag and wicked sinus infection and you can probably guess how I felt about this induction week. As far as I’ve been able to tell the only useful part of the week was that it gave me a chance to get over both of the above before next weeks important induction training.

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General Medicine

My first block is in General Medicine. From what I can gather this is basically a rag bag of topics that don’t really fit into any other category, such as endocrinology, nephrology, and gastroenterology. I suppose it’s normal to feel apprehensive before venturing into totally new territory, but since the beginning I’ve had a lingering feeling that I’m somehow tricking people into thinking that I’m competent and that now I actually have to be active on the wards rather than just hiding behind text books someone is going to find me out. I have a recurring nightmare about the consultant asking me a question in front of a group of medical students, most of whom are significantly younger than me, and just staring at him with my mouth open until he concludes I must have escaped from the mental health ward and has my place at medical school revoked. I think that it’s the uncertainty that’s getting to me the most. Probably after a week on the wards I’ll feel much better. Until then though I’m tortured by images of getting lost in the hospital, accidentally letting lose a massive infection, and somehow prescribing poison to a patient. It doesn’t help that in a comedy of errors style stream of events I’ve managed to land myself without a clinical partner. This means that I have no real outlet for my crippling social and professional anxiety, no one with whom to double check the time or the place of our meetings, and no one to smack me over the back of the head and tell me to stop being silly when my catastrophizing starts to spin out of control.

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Well that’s it for now. I’ll write again when I have a slightly clearer idea of what I’m actually supposed to be doing on my first placement. In the mean time I’m going to distract myself by sleeping off my jet lag, mentally adding alcohol to my alcohol free beer, and composing an obnoxious post about how wonderful my trip to Kerala was (complete, of course, with stylised pictures of glistening sunsets). Finally I’d like to apologise if this post fails in eloquence, intelligibility, or basic grammatical correctness as I’m absolutely exhausted and can currently only breath out of my ears. Until next time!

In which Ellie runs a free clinic for Yahoo Answers

With the exams far behind me and little to fill my days I have found my normally tolerable insomnia spiralling out of control. If any of you have ever had insomnia you will know how much it sucks – it’s stressful, it’s confusing, but most of all it’s boring. When it’s 2 am and you know in your heart you won’t be asleep before 6 the worst part is often finding stuff to fill the next 4 hours with besides lying silently in the dark wondering why your brain won’t shut up. It was at this point last night that I discovered Yahoo Answers. Yahoo Answers is basically the Jeremy Kyle of internet forums, where people come to ask important questions such as “Did NASA invent thunderstorms?”, “Are Mermaids real?”, and “Is it true that Obama’s suits are made of cheese?” It didn’t take much searching to find a few hilarious medical questions, and being the kind and generous soul that I am I thought I would offer some much needed advice. I therefore present to you my Yahoo Answers free clinic.

1.  Q: “If a woman has a yeast infection, does her vagina rise?”

A: Anyone who’s seen American Pie will know that vaginas are anatomically extremely similar to bakery items, however like bread they will only rise when kept overnight in a warm dry location. Too hot and the yeast will die, too cold and it won’t be activated. This is why the majority of vaginas do not rise when a woman gets a yeast infection.

2. Q: “I was bitten by a turtle when I was younger, can I still drink orange juice?”

A: As with all patient-doctor consultations we can’t force you to take our advice, however drinking orange after a turtle bite is generally considered to be at the more dangerous end of the health related behaviour spectrum. Just one glass of orange juice could be enough to produce symptoms such as thick callouses on your back, bradykinesia, and premature skin ageing. After 4 glasses you should notice that your height has markedly decreased and that you are experiencing weird food cravings. By 10 glasses most medical professionals agree that you will have become a turtle completely.

3. “Does that make me a Moron?”

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A: Fortunately for you there is only a 20 – 25% chance of becoming pregnant on any given cycle, and even then you must have sex at the correct point in your cycle for it coincide with ovulation. Because of this the chances of your unborn daughter being pregnant are quite slim. As to your next question your friend is absolutely wrong to suggest that you should baptise your child as a Moron – I am also of the Vegetarian Faith and can confirm that it is the only true way to salvation.

5. “Am I turning into Taylor Swift? I’ve noticed that over the summer my hair has gotten lighter. I also find myself singing along to country songs and have developed an attraction to the Jonas brothers. Am I turning into Taylor Swift? (note: I’m a 30 year old Indian man).”

A: Yes, it’s very likely. Between 2006 and 2014 there were more than 30 reported cases of people turning into Taylor Swift, 85% of which were Indian men in their 20s and 30s. Listening to classic rock for approximately 2 hours a day can help to control the condition, but at present there is no definitive cure. I strongly encourage you to see if your regular doctor will prescribe you tickets to Download, as they’ve just confirmed that Kiss will be headlining.

6. Q: “My son doesn’t like bacon, should I be concerned? I fried some thick cut bacon today but when I gave some to my son he didn’t seem to like it at all (he’s a little over a year old). Will he still go through a normal puberty like other kids in the future? Is it possible he’s gay?

A: As a member of the Vegetarian Faith the holy scriptures teach us that it is forbidden to eat bacon, and that all who do will be condemned to spend an eternity eating nothing but really disappointing side salads covered in too much dressing. The fact that your son is refusing bacon at such a young age makes me suspect that he may be a prophet of the faith. For the low price of £69.95 I can test your son to confirm if he really has divine powers.

…he may also be gay.

Thank you for reading. I hope you found these answers to be useful and informative. The next Yahoo Answers free clinic will be back in town soon.

Disclaimer: in case you’re one of the people who wrote those questions, no, those are not the correct answers. Go back to school. Unless you’re the man who think he’s turning into Taylor Swift, in which case you should definitely try and get Download tickets on the NHS.

In which Ellie fails to diagnose lung cancer

This is actually kind of a retrospective post. The event in question happened a few months ago but I got too swept up in exam mayhem to remember to write about it. Anyway, since I am shortly to be beginning clinical teaching it seems like a relevant thing to discuss. Basically what happened is the powers that be decided we should spend half a day in a simulated clinical environment. This involved about half our graduate cohort (25-30 people) turning up to the training rooms of the local hospital where a variety of “bays” had been set up, each purporting to represent a different time of day. Milling around were people playing nurses and consultants (some of whom I think actually were nurses and consultants), and each bed contained either an “patient” or a mannequin with an accompanying “relative”. We were separated into groups of about 10 and given an hour and a half to tend to the “patients” using whatever division of labour seemed most appropriate. Right away the group polarised into those who were happy or eager to take charge (not me) and those who were happy to be manoeuvred into position (definitely me). I must say that I had reservations before the day began regarding how realistic the scenario would be, and since this kind of enforced role playing sits fairly ill with me at the best of times I contended myself by selecting a partner and letting the (extremely nice) ex paramedic of the group take care of the details. It was decided that in pairs we would each assess a patient and then reconvene to make sure we all knew what was going on. This was our first mistake. Not because it wasn’t a good idea, but because it was never going to happen. As soon as we got anywhere near the beds the fake patients and their families started barking overly rehearsed demands at us and all thoughts of a secondary pow-wow were well and truly lost. My partner and I approached the bed cautiously and upon realising that we’d been stuck with a mannequin began addressing our concerns to the “wife”. Now, it is still unclear to me whether this woman had been primed to be the most objectionable person on the planet or whether that was her natural state, but for the purposes of the simulation it didn’t really matter. Nervously we began to take a history.

“Can you tell us a little about why your husband has come to the hospital?” we asked in our best reassuring-yet-competent voices.

“Well he’s been having some pain in his stomach” replied the wife, wringing her hands and rolling her eyes, “he needs to get some pain killers and to go home”.

Excellent, we thought. Stomach pain – a straight forward how, when and what. This is how little we understood of the hell we were entering.

“So” we rejoined, “when did the pain first beg…”

“PAIN KILLERS!”

We stopped, blinking into the red face of the formally docile actress, now fixing us with a stare that would put the wind up Vinnie Jones.

“Um, yes” we said, unsure what to do next, “well, we’ll get him some pain killers as soon as we can, we just need to ask a few more ques…”

“Well fine, why don’t you just get on with it then?” shrieked the banshee.

A few falteringly asked and curtly answered questions later the wife lapsed back into her original chant of screaming the word pain killers again and again, and my friend and I timidly scuttled off to find someone capable of prescribing fake drugs to a fake human being pretending to be a fake patient. After queuing for an unendurably long time we finally got our turn with the consultant.

“Um, we have a patient.. he um, needs painkillers?”

The consultant fixed us with an upraising stare.

“Are you asking me or telling me?”

“Um, telling you?”

“Presenting history?”

We did our best. It wasn’t good enough. Eventually the consultant sent us back to the wife to take a more complete history. On the way back my partner astutely suggested that maybe the patient had cancer which had metastasised. We asked a few more pointed questions and managed to elicit that the patient had had a cough for a while. OK, lung cancer could fit, but not on the strength of a cough alone. We asked as many questions as we could think of but couldn’t find a single other indication of lung cancer. As if she’d read our minds the nurse (“nurse”?) came over with our patient’s notes and there on the very first page were the words “biopsy completed, no lung cancer found”. At that point we unanimously (and I think appropriately) decided to rule out lung cancer. This was our second mistake.

Finally we managed to extract ourselves once more and returned to the consultant with the most comprehensive history anyone has ever taken. He listened, nodded, and occasionally interrupted with questions, the answers to which often began with the phrase “his wife told us…”.

“Hang on a second” he interjected, “Why is his wife doing all the talking? Why can’t the patient talk for himself?”

Silence.

“Because…  because he’s made out of plastic?”

Wrong answer. Back we had to go once again to ask the wife why her imaginary mannequin husband wasn’t answering our questions. Now, I may not be the sharpest nail in the graduate cohort tool box but I flatter myself that even I, if presented with a living patient who refused or was unable to speak for himself, would probably think to ask why. Anyway, disbelief now fully suspended I began to perform a GI physical exam on the mannequin. This involved me palpating his hard plastic stomach while his wife said things like “it hurts more when you press there”. After palpating I had to confess that I hadn’t brought my stethoscope and therefore could not listen to the patient’s bowel sounds.

“Well” the wife said smugly, “it’s not like you were going to hear anything anyway, was it?”

No kidding! I wasn’t really palpating his distended bladder either though, was I? Either I’m supposed to be treating him like he’s alive or I’m not.

At this point time is running low and I’m running dangerously thin on patience. We go back to the consultant to make one last desperate plea for painkillers and to find a nurse to put a catheter in to relieve our patient’s bladder. Neither quest was fruitful. Now I’ve never worked in a hospital before, but I am fairly certain that a full diagnosis is not required in order to get a few lousy paracetamol. Still, once again we had to return to our patient and tell the, now livid, wife that we couldn’t get any painkillers. It was at this point that we made our third big mistake.

CRASH

We turned around and saw that the husband of the patient in the neighbouring bed had collapsed to the floor and was being anxiously tended to by the 3 medical students on his case and the nurse who was supposed to be placing our catheter. When we asked what was wrong the former paramedic told us that the man was diabetic and having a hypoglycaemic fit. 5 minutes and a rich tea biscuit later the man was fine and the nightmare was able to continue as before. This basically involved another few minutes of the wife yelling at us for not having given her husband painkillers, us trying to explain that painkillers actually need to be prescribed and cannot in fact just be swiped from a draw, and no, taking her husband home again without a diagnosis was probably not going to help the situation. Finally the woman in charge called time on the horror show and we were allowed to take our seats around the “bay” to get our feedback from the fake patients. It was at this point I began to suspect that our patient’s wife was not in fact just assuming a character role. Among our many failings was not managing to get any painkillers (who saw that one coming?), not going to help our fellow medical students when the other patient collapsed (because 4 competent professionals who are handling a fairly mundane situation, and who have not asked for help, will be nothing but grateful if 2 other people start trying to intervene), and the fact that we kept going off to see the consultant in pairs instead of taking it in turns to stay with her. Now, on the last point I actually agree with her, and in fact as we were doing it we both knew it wasn’t best practise, but in all honesty both she and the consultant were so intimidating that I think we needed the moral support. Then came the piece de resistance, the wife looked us dead on and said “to be honest I was very disappointed that you didn’t even figure out he had lung cancer.”

We didn’t even figure out he had lung cancer. You mean, despite him having exactly 1 symptom of lung cancer, no history of any type of cancer, and actually having the words “not lung cancer” written in his notes, we didn’t manage to figure out that he had lung cancer. That is truly astonishing.

When I voiced this objection I was greeted with the rather condescending “do you believe everything you read in the notes?”

Yes. Or to be more accurate, yes, when the notes agree with the physical evidence. For example, when the female patient of some other students had a vasectomy mentioned in her notes, those students were within their rights to question the accuracy of said notes. I’m all for a healthy dose of scepticism, but to think that it’s reasonable to question and even reorder every test mentioned in a patient’s notes, especially when the results of those tests agree with your history, is just ludicrous.

And so at length we walked that long road out of hell and came blinking once more into the light of day. How would I rate the experience?  Well, aside from being a simulation seemingly designed with my exact flavour of social anxiety in mind, it did have some valuable points to make. Patients lie, or are obnoxious, or deliberately obstructive. Nurses and other doctors cannot always deal with your requests promptly. Patience is not always easy to come by, and more often than not forcing another smile may feel like a precursor to peptic ulcer disease. These were valuable lessons, and I take them to heart. What was not valuable was mandating us to take half a day away from revision in order to rub our faces in the fact that sometimes people suck. I know that people suck. I’ve met them. I’m over it. Equally invaluable was expecting us to perform skills we’ve not yet been taught (such as the nurse asking me why I couldn’t place the catheter myself) or asking us to psychically divine true information from false in the notes. If I’m honest it felt like a day designed to make the organisers feel very pleased with themselves. I imagine them sitting around afterwards congratulating each other on having opened the eyes of the naive little medical students. Never mind that the naive little medical students are mostly in their late 20s and with more than enough exposure to human nature from their previous professions. Mostly it felt like a box ticking exercise. As soon as I heard about it I could immediately picture a funding renewal form with a big “interactive learning” box that needed to be checked.

In reliving this episode I can’t say I feel particularly inspired with confidence for our coming clinical placements. I suppose I’ll just have to hope that all the patients aren’t made out of plastic, accompanied by spouses that hate me, with medical records that were written on opposite day. But perhaps that’s just me being naive – I mean, what a fanciful world that would be.

In which Ellie gets yet more exam results

So, anyone who has read my last 3 posts will know that I was 99.9999% convinced that I’d failed. Well, it is with equal parts happiness and surprise that I can now reveal… I passed! I have literally no idea how. I was prepared to entertain the possibility of passing the resits, but I never actually considered that I would pass the original exam. A part of me still kind of wonders if they sent me the wrong results. I keep expecting to get a follow up email saying “sorry, our mistake, you failed”. I honestly wasn’t this shocked when I got my acceptance email saying I had a place at medical school. I mean, I’ve been revising for the last week and I still have yet to find any material that was actually covered in the exams!

I don’t really have much more to add, except that this officially means the most brutal part of the course is over. The relentless torrent of science that’s been fired at us for the last 18 months will finally ease off a bit, and in fact I think the formal teaching side of things is more or less over. What’s more, we finally stream in with the undergrads and our working hours become way more reasonable (in contrast to the 18 month long human rights violation we’ve just endured). Next stop is clinical rotations. My first block is Leicester based and its General Medicine, which I assume means GP. In fact, thanks to my little cat almost all of my blocks are Leicester based (apart from my mental health unit which is in Northamptom).

So what can we take from all this?

1. You really can’t ever tell how an exam has gone until you get your results

2. Even if you don’t know the answers to any of the questions, and have enough personal problems to make you doubt everything you ever held true about yourself, and have literally zero background in science, its still possible to pass the exams (somehow).

3. If I can pass Phase 1 of Graduate Medicine then absolutely anyone can do it. To those of you on the fence about your ability to handle medical school, if you’re sure it’s what you want to do then go forth and do it. I don’t know you, but if I’m smart enough to do it then you definitely are.

My final note is to anyone now faced with resitting the PPE. To those people I say this: the fact that you’re even in this position means that you were good enough to get to this point. Whether you’ve passed all the exams so far, or had to resit ESA1 and 2, you were smart enough and worked hard enough to get to the PPE. That means that you 100% have the ability to pass the resits and make it into Phase 2.

Well that’s it for now. I’m going to sleep for about a week, eat every single item of food in my fridge, and then finally plan my wonderful adventure to India. Jaldi milenge!

In which Ellie dreads the morning

Right now it is 9:22 pm. That means that in exactly 13 hours and 38 minutes we will get our exam results. Well, I say “exactly”, what I actually mean is that the university will attempt to send the results out at 11, suffer some unforeseen technical meltdown, and instead let them dribble out throughout the day as has happened with our last 2 sets of results.

I’ve been doing OK with the exam results so far. I have friends who grow physically nauseous at the thought of finding out our results, but up until this point I’ve felt like I just want to get it over with. You see, since the last exams ended I’ve fallen into a bit of a pattern: Wake up somewhere between 10 and 11, waste time on the internet until about 12, try and pre-emptively revise for the resits until about 6, rationalise that I’m still catching up on rest and resolve to do more the next day, go to bed, toss and turn until about 5am, repeat. Obviously this is not exactly a productive model to be following. But I have a theory, and my theory goes something like this: “Schroedinger exam results”. That’s right, my lack of motivation is all down to a bad case of the paradoxes.  You see logic tells me that I’ve failed, but until I get the results email and see it before me in black and white there exists the theoretical possibility that I might not have failed. And as long as you have it in the back of your mind that you might not have failed its very hard to employ those key strategies for success, like getting up before midday and engaging with your work for more than 10 minutes at a time. So I wanted to find out once and for all, to get it over with and silence all of those well meaning yet annoying people telling me “I’m sure you passed, you always pass”. Not that I don’t appreciate their faith, I absolutely do, but when you know in your heart how bad something has gone, you kind of just want someone to acknowledge it. There is a point at which reassuring someone becomes more dismissive than comforting. But that’s beside the point. The point is that once I know I’ve actually failed then this apathetic twilight I’m currently drifting in should collapse around me like a dying star, leaving only the terrifying reality that I have to work or get thrown out of medical school. Self motivation has failed – I need the fear.

This is how I’ve felt since the exams… until now. Now, when I’m actually faced with the results about to be released I find that I’m quite happy in my apathetic twilight zone. It’s nice here. It’s a wonderful safe place built out of tiredness, evasion, and huge amounts of denial. And so, in summary, I am dreading tomorrow morning. However, since dreading it won’t prevent it from coming I shall instead divide my time between eating my remaining Christmas chocolate and wondering what life would be like if I were a cat. Excellent, that’s what.

In which Ellie sits the PPE (Part 2)

So, after sleeping for about 72 straight hours, I have finally woken up enough to write this post. Wednesday was the last of our PPE exams (before the resits that is) and this paper was called the SBA – single best answer. This paper runs on the premise that given 5 correct answers, you should be able to select that answer which is most correct. Typically this is the paper I do best on because it tests you in a more passive way, simply asking you to identify a correct answer rather than to produce one yourself. I say ‘typically’ because, as with the first SAQ paper, I’m 99.9999% convinced that I did so horrifyingly badly that I wouldn’t be surprised if they skipped sending me my results and just set me an email with the words “are you kidding?”.

I’m not sure what’s gone wrong this time around. The ESA1 exams I passed. Not particularly well, but I did pass them. ESA 2 I actually failed the SAQ, but I passed the year overall because of my ESA1 and SBA marks. This was obviously a bit of a kick in the teeth but I soothed my wounded pride with the knowledge that I had such appallingly bad tonsillitis during the exams that I could hardly think. This time though I felt fairly well prepared. Yes I’ve had a really terrible term for personal reasons as even a cursory glance at my previous posts will show you, and  yes if it comes to it I think I have enough to warrant a claim of mitigating circumstances, but I worked my butt off during this revision period. I started revising about a month before the OSCE, which is plenty of time; I worked all through the holidays only taking 2 days off for Christmas and Christmas Eve; and for about 2 weeks before the exams I was working 12 hour days! I seriously fail to see what more I could have done. But when it came to it I might as well have answered the questions like this:

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Seriously, I never usually revise between papers because I just see all the mistakes I made and it upsets me, but on this occasion I did and I’m not exaggerating when I say that none of the stuff I looked at had been tested in the first exam. And yet I had revised from the lectures and the recommended secondary materials. So if I revised hard and from the correct material then why did I struggle so much with the exam? Well, I’ll have to proceed with caution from here on out because I don’t want to be accused to slandering the university, nor do I want it to look like I’m making a lame attempt to pass the buck on why I failed. I would hope that anyone who is at all familiar with my posts to this point will know that neither is my intention. Similarly I’m going to try and avoid giving any specific examples of questions as I suspect that will cross somebodies line somewhere for what counts as professional discretion (sigh). Anyway, here are my top 3 reasons why this exam was unreasonably awful.

1. Badly written questions.

My number one complaint about the exam would be how poorly written and ambiguous the questions were.   For example one question might ask for “2 important components of your treatment plan for [bacterial infection X]” – now, does that mean it wants the 2 different antibiotic treatments you could give depending on the severity of illness X, or does it want you say antibiotics and something else, like pain killers? And that’s probably one of the least ambiguous examples. Similarly on the SBA it asked “Which drug, which is the first line treatment for [autoimmune condition Y], needs enzyme levels measuring before being given?” Well there is a drug which is first line treatment for condition Y, and there is a drug given for condition Y which needs enzyme levels measuring before its given, but they’re not the same drug. So this isn’t even a case of one answer being more correct than the other – both answers are in fact mutually exclusive and yet both are equally necessitated by the phrasing of the question!

2. Badly photocopies pictures

I understand that photocopying colour pictures for 300+ students is expensive, and I’m not going to go into where exactly the £6000 a head tuition fee increase is going if not on improved resources for us, but I will say this: if your’re going to give pictures of a gram stain, they need to be in colour. And no, printing off one colour image and then taking it around and showing it to us for a few seconds each does not count.

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Similarly, if you’re going to ask us to circle or indicate features on an image in black pen, the image itself cannot also be black. And while I’m the first to admit that I’m not the best at reading radiographs, when a chest X-ray looks more like a deep sea fish than a set of lungs, it might be time to consider upping your copy budget.

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3. Excessive, non clinically relevant detail

I think I mentioned this in my last post but some of the questions just had absolutely no relationship to clinical practise. The university always makes a big deal about how the questions must have clinical relevance because they’re preceded by a clinical scenario. Let me just take a moment to illustrate how that actually works:

Lead in: A 30 year old woman present to her GP with a 6 month history of anovulation. On investigation the GP finds she has a BMI of 30. The patient has 2/3 of the symptoms suggesting Polycystic Ovary Syndrome.

Question: Write out the 6th line of the 2nd verse of Meatloaf’s 1977 classic hit, “2/3 ain’t bad”. Backwards. In Aramaic.

So there you go. If (when) I fail, those are my top 3 reasons why it wasn’t entirely my fault. Of course, to be fair, the majority of the year will probably pass despite these obstacles, but that doesn’t make them any less relevant. I knew from the beginning that I was never going to be top of the class – whether that’s because I’m less intelligent, or less dedicated, or don’t have as strong a background in science is up to you to decide – but I do think I have the ability to pass this course and (more importantly) to be a good doctor. But only if the questions I’m being asked are fair, coherent, and representative of the material we’ve actually covered. And right now that’s an extremely big ‘if’.