Sumitras Tips Clinical

SUMITRA’S TIPS TO PASS THE CLINICALS: The 12 (+3) step program

Tuesday, 08 July 2008

Step 1: Stop procrastinating!!! If you have all the basic training requirements out of the way, then commit yourself. You are never going to be more ready by waiting.

Step 2: Go over the college forms with a fine tooth comb and send in all the relevant bits, by courier or registered post. Get a good photo of yourself taken – this is the first thing the examiners will see, and their first impression may put you in an adverse position.

Step 3: At least 4 months out, make a plan for yourself. This should include a timetable of study, with appropriate breaks and time blocked out for essential activities (mental health days absolutely allowed). Be realistic so that you aren’t having to make a new timetable every week, and feel bad about yourself in the process.

Step 4: Take a look at all the mounds of material on the college website, the ANZAPT website and other sources and make a folderfiling cabinet/whatever. I used the Westmead Guide as a starting point, but don’t feel you have to.

Step 5: Ask all your senior trainees and consultants for tips. Take every scrap of paper you can get from them, and read it all.

Step 6: Take a good long look at yourself and figure out what you are good at and what you aren’t. I used the Twelve Mistakes That Will Sink Your Boards document as an overall guide, but really to get a proper insight you need to do some practice exams.

Step 7: Form a study group if you are able to. The advantages of these are that you are able to observe as well as do practice exams with them. Observing is as important because it puts you in the examiner’s shoes, teaches you about how boring it can be, and therefore how you have to perform to keep them on their toes. It also shows up in stark relief the annoying things we all do that irritate examiners. The second advantage is that you can practice OSCEs together. There is a wealth of practice OSCEs on the college and on the ANZAPT website.

Step 8: From all these things, figure out:

  • Your style
  • Includes interviews style, but also OCI recording format – ie folder, card, binder etc.
  • Your strong points
  • Your weak points
  • What book reading you need to do (should be minimal)

Step 9: Begin working on these bits!! You should end up with:

  • An introduction
  • A schema for your history with the variations required for “special” patients eg the elderlycognitively impaired, the garrulous, the not very talkative, the one that arouses murderous rage (or motherly affection)
  • A schema for your summary, formulation, gaps, dx
  • Don’t see work as an annoying distraction, use all the new patients you see as practice for this –put aside 20minutes in exam conditions to write the above and management plan, then try to present to a consultant or your study buddy etc.
  • A schema for your management plan
  • It can be tricky to write different management plans on the different types of patients you see as apre-prepared tool because you run the risk of sounding formulaic (this is one of the main criticisms leveled at trainees)
  • Maybe have a more broad outline from which you can pull relevant bits and tailor them to yourpatient
  • Don’t forget to include recovery and hope as a long term focus

Step 10: Do some practices – whatever number you feel is necessary. The more anxious you are, the more exposure you will likely need. I discovered that the single most helpful thing I learnt from my practices was that my anxiety level prevented me from detaching myself from the interview and having a meta-awareness of what was going on. This greatly affected my ability to formulate and therefore come up with a management plan.

Step 11: While it is important to do practice exams with specific patient types, you will not have the luxury in the exam of knowing what sort of patient you will be seeing, so go in blind for some of them.

Step 12: More important than the practice exams is you reflecting and learning from them later, sometimes rewriting the presentation. This is the only way you will pick up on patterns of errors and therefore learn from them.

Step 13: Be savvy, read through the marking guidelines to see what the examiners want. Deliver that. Being an examiner yourself helps with this. This is most important in the OSCE when what you think is a great performance doesn’t tick the boxes the examiners have, so you don’t score high marks.

Step 14: Be aware that your sense of self will crumble during this process. Being exposed to that kind of scrutiny for such a period of time cannot but do that. Make sure that you have sorted out the resilience stores – ie exercise, sleep, enjoyment, someone to talk to, so that you are able to deal with this as the learning process that it is and not a destructive force.

Step 15: GOOD LUCK!!

Sumitra Shankar