Post 6 First steps on my medical journey

I was facing the hurdle which would decide whether the five long

years I’d spent as a medical student were finally coming to an end. I was tackling the MB ChB examination - Bachelor of Medicine, Bachelor of Surgery.   Succeed and I became a doctor – fail and I faced a further 6 months of swotting and the trauma of re-examination. A great deal was at stake.

I guess I’m a fairly quiet, perhaps slightly introspective sort of person. I’d quite enjoyed my time at Medical School but it hadn’t matched the ‘Doctor in the House’ portrayal of medical students, drunkenly chasing nurses and causing untold mischief with practical jokes and irresponsible behaviour.  Five years had been a long impecunious time to spend as a student and I envied my old school pals who had been out in the big wide world working and earning money. Some were already married, had set up home and started a family!  I was ready to move on;  eager to be qualified and practice medicine.

A few days before we had taken the written papers.  These had already been marked though the results were not known to us.  In the three hours allowed to answer the essay type questions, there had been ample time for nerves to settle and a chance to dig some relevant facts from the recesses of my brain.

 Chatting to fellow students afterwards, I realised that though many of my answers were far from perfect, (I’d forgotten numerous details that might usefully have been included), I didn’t think I'd omitted anything of over-riding importance.  All-in-all I felt that my efforts had probably reached the standard required – at least I hoped that they had!   But the written papers were only part of the hurdle we had to overcome.

Whereas our knowledge of psychiatry, public health, paediatrics, obstetrics and gynaecology were assessed purely on the written papers, for medicine and surgery we had to demonstrate our clinical competence at the bedside.   We had to take a history from a patient, examine him or her and arrive at a diagnosis, hopefully the correct one!  We would then be quizzed by senior consultants who were known to derive a malevolent pleasure from interrogating us! From the attitude that many of them displayed, it was clear they performed this task under sufferance; most would have preferred to be hacking a ball round the nearest golf course or chatting with their pals in the local pub.

We had all heard the scare stories, told with relish by those who had passed this way before, of patients who were unable to give a clear account of their symptoms, or worse, deliberately invented additional symptoms to confuse and confound.  There were also tales of examiners eager to belittle candidates with sarcastic comments such as;

 ‘When I saw you standing there wearing a white coat, I assumed you were seeking to become a member of the medical profession, but if you’re a decorator come to paint the walls you’re in the wrong room!’

or:-

‘When I asked you why this patient was limping, I really didn’t expect you to suggest that  he had a stone in his shoe!’

This was not simply a test of clinical competence - but a test of a student’s mettle, their ability to cope under pressure. Doctors are not supposed to crack when the going gets tough - though regrettably a few do!

So - two oral examinations, two giant hurdles and both to be overcome if I were to qualify as a doctor.  Little wonder that I was nervous and had I known what fate had in store for me I should have been more than nervous, I should have been terrified – but that will be the subject of a future Blog.

                                    

A couple of days ago, I looked at some of the papers I'd faced during my student days and which had been gathering dust in a cupboard ever since. It's frightening to realise just how much I knew then and how little I remember now.

 One question was Draw a stereochemical diagram of the compound which is the reference standard for the assignment of absolute configuration!!  Today, I don’t even know what the compound is, let alone draw a diagram of it!

Another question was Describe the development of the pharyngotympanic tube. Now I do still remember that this is the passage that connects the ear to the nasopharynx (otherwise known as the eustachian tube) but I couldn’t even start to suggest how it is developed and in any case why would I want to know?

And what about the lifecycle of the worm that causes schistosomiasis – I must have known all about that at one time in my life.

But the question I ask is; did I really have to know all this stuff?  How many doctors in their working life need this information? Wouldn’t it be better to shorten the course and teach it on a ‘need to know’ basis for those subsequently going into the relevant specialty?  What are your views?

Thought for the day

Instruction to examination candidates;   Do not on any account attempt to write on both sides of the paper at once.                                                            W C Sellar 1898-1957

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Extract from a Doctors letter!  The patient has not committed suicide before.
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