Confidential

A couple of weeks ago I got roped into a teaching session for the 2nd year students by my surgical team.  They were running a rotating series of 5 or 6 learning stations for about 8 students per group, and since one of the registrars was away they got me to run a station instead of him.

In the other stations the big boss surgeons sat the students down and presumably taught them surgeony things like the best bottle of red between $50 and $75, and who the best trainers for racehorses are.  My station, bizarrely, was a test.  Tough luck if you got the test first before you'd been taught anything.  Not that it really mattered because the test didn't count for anything.

It seemed to me to be a pretty pointless exercise.  Also, watching people do tests is not my idea of fun, so as each new group came into my room I would explain that they could choose between doing the test by themselves or having us all sit around and talk about the answers.  To their credit (I thought) the groups all chose a middle path and had a crack at it themselves before having a discussion afterwards.

The discussions were good. I would let them air their theories about what they thought was the right answer and why, and I made sure that everyone contributed at some stage, before I would tell them what I thought was the right answer (note the important caveat there - I was not given the answers) and why, and then we'd discuss it some more.  I got the impression they all found it kind of useful and somewhat interesting.

I was told to collect the papers but made an executive decision that the students might as well take them home instead, seeing as I pretty much told them all the answers anyway.  As a result I had this almost surreal conversation with one of the surgeons:

Indignant Surgeon

Where are all the test papers?

PTR

The students took them home.

Indignant Surgeon

How will the students know what the right answers are if we don't mark their papers?

PTR

I suppose they could always look things up.

Indignant Surgeon

But they'll pass the information on to the other students in other groups who haven't sat the test yet!

PTR

The test doesn't count for anything, right?

Indignant Surgeon

We'll have to change the test.

To recap, he was upset that students might go away and learn something, and even worse, might help other less motivated students to learn something too!  Silly me - I forgot that medical education has nothing to do with educating people.  It's actually all about making sure that people feel bad about how ignorant they are.

I was discussing this with my Smaller Half and she pointed out the additional absurdity that there is no way in hell that a surgeon is going to sit there and mark 50 exam papers that don't even count for anything.  I suggested that it would probably have been passed down to the Fellow, who would dump it on the Registrar, who would delegate it to the RMO, who would handball it to the Intern, who would sling it to me.

So not only was I able to actually teach people something, I also thwarted a stupid plan and saved myself some dull work in the process.  Win-win-win.

Serenity now

There comes a time before each exam when you must find the balance between learning and de-stressing.  For me, that time is now.  And the balance is learning 0%, de-stressing 100%.

This is particularly true of studying medicine because there seems to be no limit to what we might reasonably be expected to know, even though in actuality what we are expected to know is quite reasonable and sensible.  In fact, to put it in the words of an Esteemed Colleague, "They just want us to be sub-lethal".  Just make sure you know Plummer-Vinson (Paterson-Brown-Kelly) Syndrome back to front.  Sure, it's rookie stuff, but you'll look silly if you haven't reviewed it.

Everybody de-stresses in different ways.  Some people hit the gym.  Some people meditate.  I like to behave like an effete retired dilettante.  So here's what I do:

• Feed the birds.  Tut-tut over the crows that have been pushing the rosellas around.
• Put some string quartets by Mozart on the stereo.
• Slowly nibble some avocado and smoked salmon on whole-grain ano-bread while sipping my eco-coffee and browsing The Guardian online.  Tut-tut over government spending cuts in the UK.
• Gaze vacantly out the window at the garden, thinking about where I might plant some bulbs for the winter.
• Put some waltzes by Chopin on the stereo.
• Go to my blog and dispense some patronizing and sanctimonious advice to my long-sufferering readers.
• Do some tai-chi in the front yard where the neighbours will be sure to see me.
• Throw open all the windows in the house and stand in front of them with hands on hips breathing deeply and saying, "Aaah, it's a beautiful day!  Feel the air in your lungs!"
• Put some Bach violin sonatas on the stereo.
• Idly wonder what might be on the OSCE tomorrow.
• Hurriedly snatch up an excrutiatingly detailed textbook and attempt to memorize specific gene defects for a range of rare diseases for the best part of an hour before collapsing sobbing into a corner.
• Put some Rachmaninoff piano concertos on the stereo.
• Tell everybody on Facebook how bored I am.  Tut-tut over the young folk these days.

The next time you have a big exam looming, why not try my method?  It's never failed me!

Practise MCQs

Which of the following are good reasons that you'll pass your exams?

1. You are a genius - you mother told you so.
2. You're part of a generously funded rural education program so the university can't afford you to fail.
3. The year after you already has too many people repeating from your year so the university can't afford you to fail.
4. You have the dirt on the political heavyweights so the university can't afford you to fail.
5. All of the above.

Why is it that beft always go to the left?

1. Levorotatory motion induced by perinatal prostaglandins.
2. Differential homeobox gene expression.
3. Torsion of the sigmoid mesentery.
4. Peyronie's disease.
5. None of the above.

Medicine as a career is:

1. Overrated
2. Underrated
3. Serrated
4. Frustrated
5. Adulterated

Is it significant that FaceBook has started pushing ads for anxiety attack cures at me?

I can tell that exams are coming.  They aren't close, they won't arrive for another few months.  If this was a Western and I was a train robber, I'd be crouched down with my ear to the rails listening ... listening, while my boss chewed his terbaccy and spat in the dust.  I can't hear exams of course, but I can tell they are coming all the same, because my classic diversionary activities are really ramping up.  I have noted:

1. increased frequency of online Scrabble playing,
2. heightened interest in recreational wargaming, and most ominously of all,
3. marked propensity to cook elaborate meals.

Yesterday I cooked a ragout of Italian sausages in a chilli, sage and tomato sauce, that I served with buttery parmesany polenta, roasted garlic and pumpkin with rosemary, and sauteed asparagus.  And today I made Burmese braised pork with chilli bamboo shoots served with a boiled salted duck egg.

Deluxe.  And a whole lot better than studying.

MCQs

We had a practise exam a few days ago.  It doesn't count for anything, it was just an opportunity for us to have a go at the type of question that will hopefully turn up at the end of the year.

There was a fair bit of stuff in there that I had to guess at but I'm feeling reasonably confident that I won't crash and burn because I am a pretty good guesser.  Guessing isn't just about closing your eyes and stabbing your pen at the page (no, that's how you get IV drips in) - guessing is a game that you play against the evil genius who sets the exams.  If you know how he thinks, you can beat him.  And thus I present PTRs Incredibly Useful Guide To Doing Well In Multiple Choice Questions When You Haven't Really Bothered To Prepare Properly (tm).

The key fact to remember is this: one of the answers is right.  Another key fact is this: another one of the answers will be clearly wrong.  And finally, the other two or three answers will be there to confuse you.  My approach is to first identify the answer which is clearly wrong.  Then, one by one, eliminate the answers which confuse you.  Whatever remains, no matter how improbable it seems, is correct.

A brief example is in order.  Here is one of the questions from the practise exam that I used my photographic memory to capture:

A fifteen year-old boy presents with sudden onset severe scrotal pain.  Your best next step in managing this problem would be:

1. My first is in anaphylaxis but not in diarrhoea, my second is in Cushing and also in Parkinson, my third is in spleen but never in lymph and my last is in both E. coli and S. aureus.
2. Inject adrenaline straight into his heart. 
3. If three and a third surgeons can insult three and a third medical students in three and a third hours, how many medical students can two surgeons insult in four hours?
4. Take a detailed biopsychosocioeconomicopoliticogeometrical history.
5. Antiquis temporibus, nati tibi similes in rupibus ventosissimis exponebantur ad necem.

What do you think the answer is?  Apply my technique, figure it out and submit your answer in a comment!