Studying

A post for anyone sitting any exam in medicine.

I have a dear friend sitting a fellowship exam in a few months.  Said friend is brilliant – we’ve known each other since first year of medical school, and when she’s passed this exam, she’s qualified to be far richer than me.  Her specialty is so safety-critical (there are varying degrees of this depending on what field you choose), that it has an exam when you start training, and an exit-exam at the end.  And like all medical exams, they’re a curious mix of vague multiple choice exams, essay questions on things you know nothing about that you’ve never heard of in your day-to-day job, and face-to-face arrangements where you either stand in front of a bunch of serious looking guys who are all much bigger than you, answering questions on scientific obscurity, or, getting 6 minutes (in front of same bunch of guys), to examine someone and confidently make a diagnosis, usually obscure.  FUN right!

The BEST part, is that there is no real curriculum.  It’s not like university where, for the most part, if you show up to lectures and do your readings you’ll do alright, and if you’re really interested you’ll get HDs.  Or you do the easily-available past papers and your lecturers write questions based on the semester material.  There’s ‘the curriculum’ they provide you, which is really just a list of all medicine. (Hot tip; there are now over 7000 drugs you can prescribe, let alone all the diseases, genetic mutations, crazy new drugs, diagnostic procedures – I could go on!).  There’s also the part of you (especially when you’re a woman, occasionally one of your examiners might be a woman but that’s it), that just isn’t used to the idea of being a specialist doctor.  You think, ‘who, me?’  because ten minutes ago you were playing beer pong in a seedy bar in medical school thinking you were the coolest ever because you’d never been cool until that moment you played beer pong.  But specialists don’t play beer pong, they wear suits and have serious faces and Know Everything.  Their juniors are scared of them and scramble at the slightest hint they’re coming to make sure everything is ready and beat themselves up for a good week if they haven’t gotten to something, longer if the specialist gives them grief about it.  And you’re a junior for so long you don’t know what it is to be a boss.  Does anyone?

One minute you’re in medical school playing beer pong even though you don’t like beer, thinking you’re the coolest ever, hiding up the back of the lecture theatre with your friend hoping no one asks you a question while your friend does the crossword, or standing in the path lab being told about the special tubes in some machine when really you just want a nap – and suddenly you’re sitting fellowship exams?  About to become a boss??  Really?

And yet, here you are my friend.  Yes you, about to become a boss.  And here I am bursting with pride, watching you jump into that black hole of study.

Studying for these exams is like being blindfolded and tied up and straightjacketed and asked to swim in a straight line across a lake.  Nothing you do is every enough.  Everyone is better than you.  Everyone studies better than you, and magically is going to do better than you.  It is mandatory that you beat yourself up for not understanding statistical theory they offer whole degrees in.  If you’re a guy, you grow a long beard and it’s not movember, out of some strange time-marking ritual.  You can’t speak to anyone.  You don’t want to do anything but study but you can’t study because you’re exhausted from your 12 hour shifts that usually go much longer if you’re a caring doctor.  You walk outside and the light blinds your eyes and you see regular people doing regular things and they feel like aliens.  You do really badly on your practice exams.  So badly sometimes, you can’t even talk about it because if anyone found out The Truth, they would know that you don’t deserve this.  You don’t deserve to be a boss, what are you doing here?  You get 35% on a practice exam, how dare you even dream of it?  Most people would give up, surely?

Except you do deserve it.  And here you are.  Dressing up and showing up, in one way or another, at that study desk days in and days out.  Doing good some days, badly on others, not enough on some, too much on others.  Trying to find that balance that can’t be found.  Falling down that rabbit hole that has to be gone down for success.  Entertaining the idea, that subversive, dangerous idea that maybe you can.  Maybe, just maybe, all that learning and forgetting and learning and forgetting, and failing and succeeding is just exactly what you need.  On the day you’re going to see that question you failed a thousand times over and you’re going to remember the answer.  On the day you walk into that room and there are 5 guys in suits, maybe a token woman, you’re going to remember every single guy in a suit who gave you grief over the last 6 years and know that they can’t hurt you.

And because you’ve passed all of your exams with high marks so beautifully before (or maybe you didn’t but regardless, you still got here), you’ll know that you can do this because you’ve done it before.  You know that all those study sessions, the long ones, the short ones, the failed ones, the successful ones are all just coins in a bucket and you’ve filled the bucket up a thousand times over.  On the day, you’re going to walk in there and everything will just kick in, you wont be you anymore, you wont have control over what you say because your training will take over and the fancy, suit wearing specialist will take over and choose the best answers for their patient.  The safe answers, the caring answer, the non-experimental answers, the ethical answers.  And even if the roof caves in and the exam is cancelled you know you’re going to be okay and that the sun will keep rising whether you want it to or not, and all of your friends and family will be cheering on the other side, roof or no roof.

All of this is a process of shedding your skin and growing a new one.  It takes time, and it’s painful and it doesn’t necessarily go smoothly.

Here’s the best part though.  You’re not going to be that specialist.  You’re not going to be the one in the suit with the five other serious looking ones who gave you grief when you were an intern.  You’re going to be the one with the kind smile.  With the twinkle in their eye.  Who tells their intern not to sweat it if they didn’t follow up on something non-critical within 3 hours of being asked to do it.  You’re going to be the new breed, the next generation of specialist.  The dynamic, friendly and brilliant kind who are currently just sprinkled about like little oases of relief in a world of so much stress and anxiety.  That’s who you’re becoming right now.  Try it on.  You’ll probably find that it fits better than you ever imagined.

No matter where you are in medicine – first year, or pre-fellowship, this post is for you.  All the very best of luck.

Stardust.

3 months.  3 months I saw patients with varying degrees of attention and quality.  3 months I walked those corridors, struggled through them, cried in them.  I cried every. single. day.  In cupboards, to my friends, and into my lunch.  I left evening teaching early because my breasts were like rocks and leaking but I couldn’t stop breastfeeding because it’s all I felt like I had for her as a mother.  I had nothing else to give her.

3 months I froze and practiced and froze and practiced and froze and froze until I didn’t anymore.  The words started to come, not perfectly, but there they were.  A semblage of structure, something approaching sense coming out of my mouth.  I was struggling and behind right up until the last two days, two days before, it suddenly started to click.  I have lived my life to varying degrees of raw and burnt out and never before have I been so raw and burnt out.

3 months I sat in teaching, feeling like an outsider, feeling like I shouldn’t be there.  Mother’s don’t do this.  My colleagues were already in study groups, they didn’t know me nor I them and I was alone.  Mother’s on TV were doing washing and not letting their babies watch television and steaming sweet potatoes.  Mother’s don’t do this.  They don’t become mothers and sit both specialty training exams in the same year. I cried.  I can’t repeat how much I cried.

And for 3 months my husband, not without his own challenges, got the baby up and fed the baby and changed the baby and played with the baby, rinse and repeat for 12 hours a day.  That precious hour I got with her was a shadow.  I could barely look at his drawn and haggard face, the guilt nearly killed me.  3 months of the most crushing guilt and escalating burnout.

I showed up on the day, exhausted, in something resembling a suit that I’d cobbled together to fit my new odd-shaped body.  My hair has all fallen out from breastfeeding and stress and it was barely passable.  My tights felt uncomfortable.  I walked in there and did my thing.  I forgot to do so many things.  I said stupid stuff.  I ran away in the lunch break and cried some more, somehow there were still tears left.  I listened to the other candidates bang on at each other with nervous excitement.  I sat on hard plastic chairs in a 1970s hospital lunch cafeteria and ate a bad sandwich.  After lunch I did embarrassingly badly, I can hardly think about it.

Afterwards I went and sat in my hotel bar and bought myself a glass of champagne because everyone who’d sat it sent lots of messages to our group about how happy they felt that it was done.  I drank that glass and cried some more.  I didn’t feel happy.  I felt broken and defeated.  And stupid.  Really really stupid.  Only a stupid person would attempt this with a baby and no extra family support.  For the next two weeks I was so sure I’d failed.

And there it was, like stardust.

In my inbox, there it was.  For whatever reason, uncomfortable stockings, imperfect skills and hair and motherhood, I passed.  In spite of it all, I passed.

No one I worked with could ever really understand the self-doubt I felt.  From the outside I seem to have it more-or-less together except for the corridor-tears with my inner circle.  So much has happened since I started this journey in 2013.  More than I want to recount or even think about.  I’m a different person than the one who started.

The further down the rabbit-hole I go the less I feel like I know.  But I know that for what it’s worth, I did this.  I really really did this.  I got into medical school, survived it, and did the physician exams and passed them.   Whatever happened long ago, who I might have been and the things that might have happened just don’t matter anymore, because I did this.  And I can’t wait to get on with my life.

Studying for an exam with a newborn.

16102452103_67332ab89f_k I’ve been meaning to write this for ages but life is so busy right now with work, and the baby and studying for the next exam that it’s hard to gather myself to coherence.  I’m writing this because when I started studying with the baby, there was next to nothing on the Internet but a handful of forum posts debating it, lots of people saying it was too hard, lots of people saying it might be doable, and one really really good blog about a woman who studied for the American bar exam with a newborn baby – I took a lot of cues from her, although I don’t think I ever quite achieved the hours she did!

By the time I sat the exam, I was managing around 3 hours a day of study total, broken up into many fragments that varied on how long the baby slept for.  Sometimes that study was ten minutes, sometimes 45, but I got there in the end.

Here’s my thoughts on getting through an exam with a baby.

1.  Allow yourself to fail.  When I started studying for this, there was so much opinion on the Internet on how it just can’t be done so I went in with nothing to lose.  Every time I studied or procrastinated I would shrug and say ohwell, I’ve got nothing to lose, at least I tried.  Not putting pressure on myself was a huge psychological boost.

2.  You can do stuff when you’re tired, even though you’re tired.  Because of 1), it doesn’t matter how much or how little you do.  So even if your baby has kept you up for like, a week straight, just have a go.  I think I did the same lymphoma flash cards every day for a month because nothing goes in.  But it does eventually.  I would sit there at 3am breastfeeding, nodding off, and trying to answer the same card over and over.  But it didn’t matter because there was no pressure to pass or fail either way, so I just kept trying.  The hard part is learning how not to emotionally respond to being tired, or thinking “I can’t study because I’m so exhausted”.  You have to turn it into “I’m exhausted but I can have a go at studying, doesn’t matter if it doesn’t go in!”

3.  Newborns are great for studying with because they can’t move, crawl, or do anything.  They sleep and they cry.  You can’t study when they’re crying, but you have two options when they’re sleeping.  Sleep yourself, or study.  Put no expectations on the lengths of either because mine would either sleep for 20 minutes or 3 hours depending on her mood.  I had to be really really flexible.

4.  Flashcards flashcards flashcards.  Every time I did a practice MCQ, if I got it wrong (or fluked getting it right), I would read up on the condition, and then make flashcards about it.  You can do flashcards on your phone or computer any time of day.  The best type of study for an exam where you have to remember stuff is is practicing remembering stuff.  I cannot emphasise this enough.  Forget about reading and highlighting and summarising.  Just forget it.  It’s over.  I highly recommend the Anki flashcard app.  I made thousands.  No it doesn’t matter if you don’t do them all.

5.  Question banks question banks question banks.  If I got a question wrong I’d done a flashcard on, I’d redo the card if I’d covered it, and make another card if I hadn’t.

6.  Psychology.  You have to believe you can pass.  You have to accept you could fail.  For me I decided that if the baby and my husband were okay, the outcome didn’t really matter.  Yes I needed it for my career, but my family are my everything, not my work.  I saw an educational psychologist who helped me work out what techniques worked for me, and steered me through the mountanous self-doubt that inevitable follows when you do something well outside the bounds of what society tells you that you can do.

7.  You are not a cleaner.  I’m not a tidy person, I’ve never been a tidy person, and I put no pressure on myself to be one, or cook or do anything remotely domestic.  The baby is work enough, having a high stakes exam on top of that is more than enough.  So my husband I did bits here and there – in hindsight we should have got a cleaner but were to sleep deprived to get ourselves together enough.

8.  Meditate.  Your exhausted.  Hormonal.  In love.  Terrified.  Trying to study.  I used the Meditation Oasis app, although you can get the same podcasts for free from http://www.meditationoasis.com.  Just do it.  There’s no right way of doing it.  No it doesn’t matter if you fall asleep doing it.  Just do it.  Really.

 

By the end of it all I had amassed thousands of cards, and signed up to almost too many question banks (although I mostly managed to finish them.  My day would start with getting myself and the baby up, doing flashcards while breastfeeding, then playing with the baby, putting her to sleep, going back to sleep, playing with the baby, putting her down for second sleep, then doing past questions and making flashcards.  My husband would come home from work, take the baby, and if I had anything left in the tank, I’d study some more.  Over Christmas when he was home more I got some good 2 hour sessions done (our families are interstate – I highly recommend having at least one set near you!)

I failed this exam the first time I sat it without a baby.   Too much happened in one year, bad headspace, no real understanding of what multiple choice exams involve, or the psychology behind them.  I passed the exam when I sat it again.  I didn’t just pass it, I destroyed it.  I got above the average in both domains so if you’re where I was a year go, baby on the way and so depressed about giving up study – don’t be.  You can do it if your head is right, if you have support, and if you’re willing to work on your mental fortitude.