The slam of coffee bean grains being beaten from the barista’s portafilter, pounded its way through the muddle of chatter and laughter that filled our University canteen. My fellow trainees and I had gathered here while we waited to be called into the exam hall for our first exam.
The day had come.
The two months following Christmas that built to this moment, seemed now to have passed in a flash. Hours had been dedicated to writing and sketching study notes for each system of the body. Hundreds of flash cards were written with sample exam questions to diligently test myself with over the long evenings spent preparing. All in preparation for this first exam.
As I looked around the canteen I mentally filed each trainee into the different categories one might expect to see in the moments before an exam:
- the relaxed ones who had resigned themselves to their fate and casually discussed gossip and other unrelated topics;
- the ones who felt the time for reviewing their study notes had passed but still only wanted to discuss the exam ahead, seeking reassurance from others that all equalled them in their level of preparation;
- and those who hadn’t gathered here to chat, but instead were bent over their study notes, their faces flushed with the mental effort of recalling back all that their eyes poured over.
To be clear, I sat in the latter category. And the time I took to look around and make this observation was but a momentary reprieve before I returned to my efforts. After a few minutes, my eyes flashed to the time displayed on my phone. The exam would begin soon and no one had called us in… so they probably were not going to. I saw one group of trainees had started to gather up their things and drink down the last dregs of their coffee. As they began to walk out of the canteen, I quickly sprang up and packed away my things. Prompting the group on the table next to me to do the same. Soon inciting all present to mimic our movements.
We all filed out into the foyer area and from there, as a group, ascended the main stairway in search of the exam hall. After wandering the corridor above, I spied one of our lecturers dart through a door that marked the entrance to another staircase.
“I guess we follow,” I said. So we did.
At the top of the stairs was a small landing with enough room to stand two or three people, and beyond that was a locked door.
“Not time to go in yet?” one of my cohort asked.
“It would appear not,” a couple of us said.
So we waited. Due to the tightly enclosed space, the majority of my cohort were forced to stand in a line that travelled down the stairs.
A nervous silence fell.
“It’s like we’re standing in an airport terminal, waiting to board a plane,” I chuckled. No one laughed. A few smiled.
Yep, the nerves had now set in.
Finally one of the lecturers emerged from beyond the locked door, apologised for the delay and set out our instructions as to where we should place our things, what items we required for the exam and where to sit.
The exam hall consisted of neatly laid out tables and chairs in rows across the room. At the front hung a large white board, on which the revised start time had been scrawled in large characters. If trying to picture this scene, I suggest you cast your mind back to the exam halls you may have sat in when at school. Not university. No – this room was more akin to the dusty old gym halls that populated our secondary schools. And this, to me, was a foreboding sign.
When the exam finished, and we were asked to put down our pencils, I glanced around at the others. Some very bright eyes and stoically pale faces looked back at me (or right through me). Once the exam papers were gathered up, we stood and made our way out to the back of the hall. Our movements were slow. Our body language conveyed a state of shock. Very few spoke.
And that, dear readers, marked the beginning of a three month exam period for me.
Before I begin to detail these months of my life, let me reassure you now that I passed all my exams. These events never as bad as they seemed at the time.
Over the next few months, I acquired expert skills in graphical IT design – borne from the hours spent designing the pictures for my pathophysiology poster; I bored my team at work with a 30 minute presentation of said poster (it should have only taken 10 minutes); I perfected my bartering skills when negotiating time to perform my last three assessed clinical examinations; and I became fluent in the sensitivity and specificity levels of different biochemical tests and imaging techniques in order to support essay discussions of clinical cases – to name but a few of the activities that occupied my time.
Skipping ahead to the week of the clinical examinations (OSCEs), I started my morning as I usually did; sitting with my team to discuss the list of inpatient parenteral nutrition scripts for the day, voicing any additions, changes or questions based on the current clinical picture.
I glanced down at my phone.
We’ve found a room to practice in, the message read.
On my way, I responded.
My team knew that I was in the clutch of a long and arduous exam period, so had been very understanding whenever I had asked to slip away to prepare.
For the past week, the critical care trainees (tACCPs) and I had been huddling together in various empty rooms at the back of the critical care unit to practice for our OSCEs. We would be expected to complete six OSCEs with 3 clinical scenario questions in under 10 minutes for each: MSK (spinal or knee); cardiovascular; respiratory; abdominal; mental health; and neurological (cranial nerves, upper limb or lower limb).
As we practised, the others would watch and point out if anything was missed, give tips on how to improve our technique or quiz us with potential OSCE questions.
“Maria, grip me a lot tighter when you do that. Really get your hands in and around my ribcage. See how you can see your thumbs move in and out as I breathe?”
“Physically demonstrate that you’re inspecting their nails and palms. Run your fingers over as you look.”
“To get a nice percussion note, just place your finger flat against the intercostal space like this and loosen the wrist of your other hand – see?”
“What manoeuvres would you do to amplify a diastolic murmur?”
At any given moment, if anyone walked into that room, they would likely have stepped into a scene of one lad with his top off while someone palpated along his spine, another laying supine on a bed while someone held their leg straight in the air, and another person stood watching advising, “Don’t forget to ask if this reproduces their pain.”
These were strange times.
On the day of my OSCEs, I sat in my living room, waiting in front of my laptop for my allotted time to perform an online examination. Through the walls, I could hear my neighbour shouting loudly down the phone at someone and, from outside, a dog barked in the distance.
My lecturer popped onto the screen.
“Hi Maria. How are you feeling?” he jovially asked.
“Nervous,” I replied.
“There’s nothing to be nervous about,” he reassured me. “This will be a 10 minute mental health examination. You will be given 1 minute to read the scenario and then you will be asked to start the assessment. For the purpose of this examination, I will act as the patient you are performing the assessment on,” he explained. “Is that all okay?”
“Yes, thank you”.
“Okay, when you’re ready, we’ll begin.”
And that was it, I switched into professional mode. My lecturer pulled off a convincing performance of someone struggling with mental health issues and I did my best to sensitively extract as much relevant information as was possible in 8 minutes. After which I had 1 minute to present my summary of the scenario and briefly detail what my plan of action would be.
Then it was over. My lecturer clicked off the screen and I had about one hour to gather my things and head to the university campus to undertake my next 5 OSCEs.
For these OSCEs, we were all assigned our own room, in which sat a student from the year above who had volunteered to be our model. We had about a minute to settle, before the first 2 lecturers walked in and waited for the dong that marked the beginning of the 10 minutes.
“Please now perform a respiratory examination,” the lecturer instructed.
For this first exam, I was incredibly nervous but easily followed through the steps of all I had rehearsed, finishing in under 7 minutes. One of the lecturers then stood before me, holding a tablet in front of her and from this she read out the exam questions.
“Name 3 causes of dullness to percussion on respiratory examination.”
“How do you differentiate consolidation and pleural effusion clinically?”
And so on.
When the dong toned to signify the end of the first exam, the lecturers left the room and I turned to my model.
“Was that okay? Did I miss anything? Did I answer the questions correctly?”
This is generally how it played out over the next few exams. All the while, I grew more comfortable and confident in my surroundings. So by the time of my final exam (neuro), I was chatting amicably with the lecturer before, after and even during it (as I finished in well under the 10 minutes).
As I walked out, the other trainees and I gravitated towards one another to dissect our performances. The mood felt very different after this exam. We all laughed at our struggle to find a word to “describe normal bowel sounds” (the answer is “gurgling” in case you’re wondering) and some trainees honestly relayed that they hadn’t answered all the questions within the time but seemed content enough that this meant they would to need repeat that OSCE. As we made our way to the building’s exit, we wished each other luck in the upcoming essay deadlines and VIVA assessment that would occur over the next month.
The VIVA marked the last exam. This too was an online assessment, where I presented one of my clinical cases and subsequently defended my rationale for my clinical diagnosis and treatment plan.
When I signed out of this chat room, I breathed an exhausted sigh of relief. I had reached the end of the exam period.
And after a week of sleep, I emerged from my study cocoon – reborn as a confident and competent trainee ACP. I was looking forward to the next three months now where I would focus on developing my bespoke skills and contextualise my role as an Intestinal Failure Specialist ACP.