Since sitting the written exam in Feb 2021 it has been quite the rollercoaster of emotions getting to the point of completing the clinical examinations and a great deal of personal evolution has occurred since then.
Have I enjoyed the process of clinical preparation? Not particularly.
Do I think it’s necessary to progress as a physician? Absolutely.
You may be told by some that the clinical exam period is fun or more enjoyable than written prep. I did not find this to be the case myself. Clinical prep is just a different set of challenges in comparison to the written and a completely different style of learning with a very different focus. I think what is true is that the things you learn are more lasting and build deeper into your muscles and memory.
From a teaching and support perspective I couldn't have asked for more, the resources and sessions provided were extremely comprehensive and there was a level of knowing compassion from the staff who have gone through it!
My roster of objectives with teaching sessions was quite intensive and overwhelming at first, especially if you are on a work intensive term, which let’s face it, most are. In addition to this you are going from a position of feeling relatively comfortable in your role to feeling like a first year medical student when presenting a long or performing a short case!
Embrace being rubbish, no one expects you to be remotely good for the first several weeks. Just aim to be slightly less rubbish each day.
So why is this necessary? After learning the method and approach to performing a long case you will have “learnt the rules” from which you can adequately perform in the clinic setting for a first appointment with a patient and then write a thorough and accurate letter for other health professionals to read. In addition, you will be able to communicate your findings to the consultant without them wanting to pull their ears off.
Once you have learnt these rules as a BPT you can then modify them when you start as an Advanced Trainee. That is essentially what the game is - Deliver information to prove you are sensible and holistic.
Equally why bother with short cases now we have echo’s and CT? Short cases are the icing on the cake of BPT where all that written knowledge combines with clinical skills to give you a greater insight into the common conditions that you encounter and how they interplay between various systems and specialties. I personally learnt a great deal of new information that I will take with me hopefully forever through my career.
The worst part of the whole process is really just that the stakes are so high which makes the pressure very tough at times.
Particularly as we as a cohort had a very dragged out process due to covid.
Top tips:
I refused to learn any clinical stuff until written results were out. I wouldn’t necessarily recommend this, I was quite superstitious and you may not have time to do that next year.
Re-prepare loved ones – late evenings, many weekend mornings at work, high stress. Let them know.
Get your briefcase ASAP – you need to know your way around this like a soldier with an M16 because seconds count. And get a big tendon hammer.
Create a game-plan for yourself early. An excel spreadsheet, as always in life, is a great tool to notarise all upcoming appointments with consultants/ATs/mentors. Detail which specialties you’ll focus on each week and to note when you are collecting cases for Saturdays or being examined on Saturdays.
For short cases hand-write each of the main clinical examinations for yourself. Copy someone else’s or copy off the videos but actually physically write them out. I used a notebook and broke it into specialties.
Find the list of “most frequent shortcases” and prepare a speech (spiel) for the top 3-5 for each specialty. Even if you are rubbish at the clinical exam itself this may save you in the first few weeks. In addition, prepare cliff-notes for each disease so that you can rattle off the relevant information.
SCORPIOS – Do not miss these or Saturday sessions. Prepare for scorpios intensively from a spiel and exam flow perspective – you know mostly what will come up, prepare accordingly. There will be weird things too!
Get a good group that you are happy to practice with outside of work hours and at each others homes with a mix of men and women. Practice the normal exams over and over. Mix up who you practice with.
Judge no-one and be honest but respectful with your feedback, it’s really confronting.
The practice timetable is daunting and you may not be able to keep every appointment. Don’t stress yourself out but really try and see at least one consultant a week. Develop a good relationship with your consultant and AT mentor.
Be honest with them if you need a break for a week as it can all get a bit much.
Find a method for completing your manila folders for long cases in week 1. The sooner you have a method the better. Practice drawing your boxes and folding your folder like 20 times on blank paper until it is second nature. This includes the Issues/plan section at the end – have a predictable structure to discuss the issues. Ask an AT if unsure.
Never be rude to a patient whilst doing a long case. Time is precious and stick to it as much as possible but common decency comes first.
Do not worry about being crap in front of people at the start. Seek people out to watch you being crap and get used to the feeling. Obviously try your best but you will probably suck for quite a while, forget signs, say stupid things in long cases and forget the most basic of questions. It’s ok. Even if you were considered a good BPT up until now you will, most likely, not be great at the start of clinprep!
1 long case a week (2 if you’re feeling hot), 3 short cases a week with as many supervised as possible otherwise you will reinforce bad habits if it’s just you Bobby BPT marking each other.
Long cases are so exhausting. 1 hour 10 to complete, allow 40 minutes to present and feedback and then going through it after and all the waiting around and anticipation. Each one can eat 3 hours of time.
Resources
Tally and O’connor. Not personally my style of learning. Maybe use it to write out the steps for each exam and maybe for things like causes of splenomegaly. The examiners read it the night before the exam though so it’s a “must have”.
Short and long case pdf books “Short case cards” – These will be floating around amongst your seniors. These are the real gold. Print these out, get copies off mentors, anything you can do. They have condensed versions of clinical exam checklists, discussion points, detailed long case notes (but very digestible).
Review old recorded lectures from your hospital.
HETI masterclass cases online - password protected...
RPA neurology videos are great on youtube if you can access them
MRCP paces is the best textbook of the bunch by miles in my opinion.
Write out the salient information for all the basic conditions, diabetes, HTN, cholesterol, diet, exercise, alcohol, smoking, long term steroid use, other immunosuppression osteoporosis, cancer screening. Things that you notice coming up frequently as you can recycle main points and mould them to your individual patient.
With this basic knowledge plus detailed transplant knowledge you will find that you already ‘know’ most of the things you need to talk about for the long cases and most study will be for the short cases. But do read around things that stump you in a long case!
Final words
Legend has it that this is one of the hardest medical qualifications in the world and you are nearly there. Tell your mates when you’re struggling, be nice to each other when you’re having bad days of prep and treat yourselves to some time off every now and then. It is a really physically, mentally and emotionally draining period of time but it will soon be over and you can move on.
If it doesn’t go your way it is not to do with who you are as a doctor or a person, it is just a merciless process that can catch anyone on a bad day and can be really unfair, just give it your all.
“I hated every minute of training, but I said, 'Don't quit. Suffer now and live the rest of your life as a champion'.” ― Muhammad Ali
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