How to bounce back after a bad exam (a PCMS clap back)

Our curriculum is organized into 5-7 weeks blocks/terms each focusing on a specific system (well at least from the third block). We have to complete 12 blocks throughout the duration of 3rd and 4th year, 6 blocks a year and then write a final integrated exam at the end of 4th year. However we also write two exams at the end of each block, covering the content we had just learnt (in the older system we’d also write a third exam from the previous block at the end of every second block e.g. I’d write PCMS again together with LOTS paper 1 and 2 at the end of the LOTS block – so glad they decided to do away with this in 2016).

If you’ve read Intro to SCMD3000, (almost 2 years later), then it wouldn’t be too difficult to guess that my first block didn’t go in a way that had me celebrating. PCMS paper 1 was brutal, have you ever written a paper that, actually lets leave it at that. My first exam had me feeling like maybe I just wasn’t smart enough for this medicine business, I mean how could I be with an embarrassing 43.82% as a mark.

I could have made all the excuses in the world; I had registered late, I didn’t have the prescribed textbooks, coming from a gap year I wasn’t quite used to studying again, I had lost my baby sister a week before the exam, I was working part-time to put myself through school. All very valid but unfortunately they wouldn’t change my marks, would they? One of the things I’ve learned from my almost 5 years of varsity now is the importance of reflection and knowing oneself.
All excuses aside, whenever we’ve flunked a test or exam we’ve had a general idea as to why; maybe we didn’t budget our time well (first year biology test 3), maybe we didn’t practice on past papers enough (pretty much every physiology test ever), or maybe we just didn’t understand the content (first year chemistry). In my case I didn’t really have time to mourn and be down because the second block had already started and I needed to figure out why I had struggled so much with the first one. So in my reflection, I realized; I hadn’t managed to cover all the work, couldn’t recall all those autopsy slides and pretty much anything bacteria (bloody microbiology).
I needed a plan – so into “let’s get an A+ mode I went
*Plays ‘Eye of The Tiger’ by Survivor for motivation*

 

First thing I needed to do was create more study time without expecting the day to randomly last longer than 24 hours. I looked at my timetable and started filling in the free gaps with my own study time. I didn’t have the luxury of working on my school work during the weekend because I’d have my part-time job which was quite strenuous too, so I made sure I got to campus an hour before and stayed for at least one hour after lectures everyday to study. I spent my now free Friday afternoons (💔 I know) in the PBL rooms (study rooms). I couldn’t just study harder, I needed to study smarter too.
At the risk of pointing out the obvious there for a second, studying such a heavy course content wise, it’s so easy to fall behind and not manage your time effectively. A friend of mine had suggested I kept a diary or some kind of calendar to help keep track of how much I had studied, what I still need to cover or revise on. It also allowed me to allocate a certain amount of time for past papers a few days before the exam. In a perfect world I’d stick to this schedule like white on rice but unfortunately I’m human so I had to leave room for possible unforeseen events like tornados, world war III, catch ups or random series binge watching (like re-watching Game of Thrones’ last season before the new one starts). But in all seriousness life does happens; sometimes it takes longer than expected to grasp a concept or go through a section. Sometimes you’re just too tired from the day or just not in the mood. So I can’t stress how important it is to put together a realistic timetable to study the new material and continuously revise from the previous block too. To increase my study time I’d chosen the day in the week with the least lectures and compulsory themes to stay at home and study. My now blooming social life took quite a hard knock too but it was a necessary sacrifice. I wasn’t just studying to pass I also needed to regain the confidence that I was smart enough to sit in my new class, that my acceptance into the program wasn’t a waste or that I was occupying the seat of another more deserving student. I covered the work, then recovered it again; made random mnemonics and associations to help me remember the work. Changed a few things about my study methods and try new ideas I got from the net; sticky cards, key words, podcasts (anything I could get my hands on). I seek aid from colleagues in my class and in senior years. I wasn’t too fond to the idea of a study group, because more often than none there would be more of everything else in comparison to studying. We did however agree to meet on certain days to go over a past paper and discuss answers, this often took hours because we kept going off track but it was really good to have a break and chat about series, movies or sport every now and then. There’s only so much oedema talks I can do.
If I had to summarize this entire post;
1. Accept that it does happen and give yourself a limited amount of time to mourn and reboot.
2. Reflect and try figure out what was the main reason(s) that exam went bad.
3. Stay away from excuses, have goals, make an active study plan, and try your best to stick to it.
4. Regain your confidence by going through example questions and seeking help (consulting with colleagues, tutors and/or lecturers)
5. Find a study method that works for you. Different methods work for different people and different subjects. For example I need to read out loud as if I’m teaching whoever is listening; it’s fun, makes me look crazy but it works for me.
I’m not saying this is a bullet proof plan and that it will work for everyone but it worked for me. It worked for me because of how personally tailored it was to me, it took into account that I used public transport to get to and from campus, the exhaustion from that and the fact I worked 18 hours each weekend. Sometimes I was behind in comparison to my peers but I kept at it and never allowing myself to get overwhelmed. By the time I wrote PCMS paper two, I had a lot more confidence in myself and my memory. When the marks were released I was 4% short to doubling my paper 1 mark, 83.72%. That’s a hard mark to forget plus it was also my first A in Medical school, so you can just imagine what it did for my confidence and the type of tempo it set for the rest of the year.
Thinking back I wonder what my marks would have looked like if I had stuck to this plan for longer than a block.
FIN.
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The doctors, I hope I never become (A story from other side).

This is a tale of four doctors

Earlier this year right before my reproduction block exams, I came down with a bad case of the flu. I didn’t think much of it until my upper lip started swelling up, developed quite a persistent fever and I had all kinds of pains shooting up and down my face. Because of how close it was to my exams, I decided to self medicate; I got myself some ibuprofen and paracetamol to try get through the next 3 to 4 days. However, the medication didn’t do much for me, needless to say I just couldn’t study effectively. I remember being in so much pain that I ended up walking out of my first exam about half way through, because I just couldn’t handle it anymore. I remember being pretty worried but I had to soldier on, paper two was in less than 24 hours; so more medication, a lot of water and more futile attempts at studying. Paper two ended at about 11am the next day, I had braced through the pain but at this point I knew I needed professional help. I decided to go to the hospital next door, which made sense I mean my school is a hospital. After some wondering about and asking directions from any security guard I could see, I finally reported to the walk-in/emergency department where a nice nurse instructed me to sit in what seemed to be a very bizarre and disorganized queue. I’m calm, probably a little high off the medication, first time in a public hospital so I’m also a little nervous. After about an hour in the queue, I get called in and a nurse takes my blood pressure, writes my name on a form and sends me back to the queue. Now the medications are starting to wear off, I’m starving and my battery has just hit 56% which means my phone will die at any moment now. After about another hour, the nice nurse calls, “Next to see the doctor.” It’s finally my turn, as I walked into the consultation room, Dr X was texting on his phone and without ever looking up, he asks “what’s wrong?” so I started history giving, he interrupts me by asking “did you go to the clinic?” and before I was able to answer he looks up and says “this doesn’t look too serious, let me refer you to Dr Y in area something something”. Now I’m annoyed because I didn’t get to say much apart from “my face was swollen and sore.” There was no CAJCOLD, no history taking format that resembled what I had been taught in any way.

Dr Y was upstairs, I left the consultation room feeling hopeful that my nightmare was about to come to an end, just to be met with yet another queue, by this point I’m dizzy and my stomach is doing the most. I thought about asking the brother behind me to keep my spot in the queue as I ran to grab something to eat at the cafeteria but I remembered the argument that had happened a few minutes ago between these two guys and how one had left the queue and was force to go back its end, plus he just didn’t look like the friendliest oak, so I refrained myself. Fatigue suddenly kicks in as I remember that I hadn’t slept much the previous night trying to prepare for my exam, I had also skipped breakfast because I had woken up late. My face was burning away and my phone had now died. At least another hour went on before the queue started moving, after another 40 minutes or so finally I was in Dr Y’s consultation room, at least he greeted me before again asking me what was wrong, as I started history giving again, he interrupted me a few times, answered a phonecall, spoke over me, and tried to finish off my sentences (I didn’t know we knew each other like that, this is quite intimate). He started talking about sending me to another Dr, “this is a facial-oral issue” he says “I don’t really remember that rotation”, by this point I’m fed up, I keep quiet for a few seconds then say in an almost psychotic calm tone, “I really need to get out of here, I have my reproduction exam tomorrow morning”, he paused and said “oh are you GEMP?”, I nod. He smiles nervously, throws away the form and says “let’s start again”, it went from a consultation to a quiz real quick (I didn’t even see it coming). He’s asking me about possible differentials and some OBGYN stuff too, weird but well at least he’s listening to me now. Eventually he calls Dr Z and says “I’m sending a student to you, he’s not feeling well.”

It’s now a little past 3PM, I’m hungry, tired and annoyed. I get up to a rather empty ward to meet Dr Z, whom without saying much just sends me back down to get an X-Ray, another queue (this has been an amazing day). By this point I’m grumpy and keep thinking to myself, “do I really need a doctor for this?” Took another hour and a half but I eventually got that X-Ray. It’s now 5PM, I’m starving, my arms are shackling but I’ve lost my appetite. I run back to Dr Z who’s now telling me how he’s tired and I must wait for the later shift Dr who’s coming in at 7PM. I keep my cool, because I’m thinking this *insert bad word* could be my registrar next year, so be nice. A few minutes later Dr A walks in; being the only patient in the ward, he approaches me and asks “what’s wrong? why are you here?”, I give him the X-Ray and my history form that has a big sign on top saying ‘GEMP II’ I don’t know why that’s important (no, seriously I actually don’t).
Into another consultation room we go; he palpates my face and then pokes a large needle into my upper lip but he either forgot the anesthetics or assumed I was a tough guy, so now I’m literally holding back tears because I can’t disappoint him, had it been the latter. “Oh there’s no pus in here, there’s just a lot of blood” he says, still quite unsure what this could be he prescribes everything under the sun, but at least he was nice. He gave me some NSAIDs, Antihistamine, antibiotics, even threw in mouth wash (good opportunistic health promotion, I was impressed). By the time I walked out of the hospital, it was about 6:45PM, a whole day had gone by.

I had never been on the other side, always the medical student and never the patient. This was such an humbling and yet infuriating experience. It’s so easy to call patients rude, impatient or annoying but we often forget that they have to take their entire day off work, travel far and abandon responsibilities just to spend 5 minutes with a doctor.
I experienced being a patient in a public hospital that day. 4 doctors 4 histories no one even asked my name, no CAJCOLD or vitals were taken. I had to say that I was a medical student before I was taken seriously. Why must I be a medical student before you treat me like a human being, before you don’t try rush my history and/or finish my sentences. I absolutely hate the lack of respect for the profession and for the patients we treat, just because they are the vulnerable group. We’re so quick to blame patients for poor compliance and bad health seeking behavior but we forget that we are the very same people chasing them away. All Dr X had to do was listen my history, I know I talk a lot but I had literally walked in with a possible diagnose and even threw in a couple of differentials just to be spicy. I can understand that maybe he was having a bad day, or maybe his significant other was stressing him out, or maybe he didn’t get paid for his overtime last month or that he may had lost a family member the day before, but I do not recall asking him to be a doctor or my doctor for that matter. I did not have a gun to his head as he took the Hippocratic oath. We can’t keep blaming the lack of resources and shortage of staff when we’ve gotten so comfortable with providing such a pathetic level of service. The other three doctors aren’t off the hook either.

I saw exactly the doctor I do not want be that day. When your teachers fail at being role models, where do you look to, there’s only so much I can learn from Grey’s Anatomy. I left with the genuine fear that I, too, will become desensitized to my core values and oath, and unless there’s litigation on the line, I might just become one of those doctors. I’ve recited this experience dozens of times, in the hope to never forget it, so that the next time I’m dealing with a “difficult” patient, I remember where they’re coming from or what it must be like being in their shoes.

Oh yeah before I go, one of the medication actually helped, not too sure which one. The swelling cleared out about 5 days later.

Starting to resemble medicine, maybe a little bit.


Into the second block we go, Life On The Streets (LOTS). By this point we’ve all received our stethoscopes, BP cuff and name tags – you know what this means right? Instagram posts galore. The coolest thing to happen to us since the white lab coats in first year.
The second block introduces the format of teaching for the next 2 years. The mode of teaching remains primarily through lectures and themes session but there’s also the introduction of a Weekly theme, course packs, PBL cases, Hospital day practice, clinical skills and a lot of acronym lectures (PD, PPD, CD) that are also called themes weirdly enough. The highlight of the block remains that we actually end our days at 1pm on Fridays (a moment of silence to appreciate this gift).
The second block is quite intense, each week covers different serious health and social issues, except for the last week that covered Skin infection (really?) but you get to meet the amazing Prof Dusé so it’s far from an anticlimax. I should have probably started with what we covered in the first 4 weeks;

Each week comes with a series of lectures and a course pack (Learning topics – extra information you won’t learn in class but will be tested on in exams, they usually ranges between 20 – 50 odd pages, extra reading – great).
Week 1 covers Malnutrition (We meet little Anna, a one year old baby and the most popular patient in GEMP). It’s mostly anatomy and physiology lectures, a few themes sessions and Biostatistics guy is back to tell us a tale about kings and castles, knights and sorcerers, and a babe in distress – there was a bit of role play.

Week 2 covers Genetics; albinism, Duchene, Marfan syndrome and those guys

Week 3 covers HIV; a mol med flashback: microbiology and more pharmacology. The highlight of the week remains the special guest lecture by Justice Cameron (google him)

Week 4 covers Rape; a bit on STD, some anatomy, J-88 forms, psychology, law component, stigma issues, rape survivor guest speakers and just a lot. It’s quite an emotional week.

In Week 5 there’s some big Afrikaner man who gets a splinter in his finger, I think, can’t really remember. It was quite gruesome though; a lot of skin-eating bad boys. However, we get to meet Prof Dusé, who really equals interesting talks about his dog, the whisky he had the previous night, some really cool excursion he went on to save the world, infection control and, yes more microbiology.
At this point we’re all trying to get used to the medical school environment, we all have lecturers we may like (Prof Dusé, love him) or hate (that genetics lady, sleeping pill on legs). The number of people in the lecture hall have decreased a bit, I’m assuming people want to self-study and that no one has decided to drop out. Friendships have also become a thing. We’re spending some time in the hospital too so that’s exciting (I should probably make a post about this).

Is it starting to resemble medicine now? Well I would hope so, maybe at least a little bit.