Demystifying PACES - IMG Candidate Perspective (12 June 2024)

SPEAKER_00 0:00

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SPEAKER_03 0:30

Hello and welcome to this PESIS Wodcampus run by the Royal College of Physicians, Edinburgh Trainees, and Members Committee. In this podcast today, we're going to discuss and reflect on a candidate's perspective, not going through the exam experience. The aim of this podcast is really to share somebody's experience through the preparation for the exam, the exam day, and waiting for the results. We're going to talk a little bit about the PACES 23 changes, but really the aim of this is to give you an idea of what a candidate experiences during the exam. I'm delighted to welcome my co-host, Dr. Aparna Potloro, who's an IMT1 doctor working in the southeast of Scotland and aiming to do a future career in dermatology. Aparna is at her PECIS exam just at the end of 2023, so it'll be lovely to hear a bit about her experience as well. Our guests in today's episode is Dr. Joseph Zhao, who's an IMT2 trainee working in south east of Scotland. Dr. Zhao graduated from medical school in China back in 2008, and initially he trained to do neurosurgery and then moved to the UK, where he gained academic experience and also moved from a surgical career to a medical career, returning for a different clinical job. Dr. Zhao sat his PACES exam recently, and today we're going to find out a bit more about his PACES 23 experience. So thank you both for joining, and I'm looking forward to hearing your experience. Joseph, I would like to start with kind of an open question. Just tell us what does completing the PACES 23 exam mean to you?

SPEAKER_01 2:07

For me, it's more like in my stage of training, I need to apply for um ST3, or if not this year, it will be next year. So I do need to pass and get through MRCP diploma for my future career progression. So I think that's the main importance or significance for me taking the exam, the PACES.

SPEAKER_03 2:26

And was there a specific thought particularly given to kind of the timing when you start your examination? So you're currently in the middle of your IMT training. Was it particularly that you wanted to do at this stage? What do you think about it?

SPEAKER_01 2:39

For me is because I think I passed MRCP2 last year, around June. So my hope was to displace this as soon as possible. But I think I missed applying for the last dial in last year. So I have to just make it do it first dial this year. And for me, basically, I want to push for it because I try to apply for ST3. So if I manage to get any ST3 process, I can skip my ST3 and progress directly to specialty training. So yeah, timing is basically as soon as possible, that was my principle. But to be fair, I really need to get past at this dial because if not, then I will lose my ST3 applications and I will basically have to reapply some dialectic ST4.

SPEAKER_03 3:19

So really for you was important in terms of the timing of the progression. I didn't ask you previously, but what specialty are you applying for as a group two specialty?

SPEAKER_01 3:29

I applied for oncology and intensive care this year, both ST3.

SPEAKER_03 3:34

So we're going to move on and ask you a bit more details and just get to the nitty-gritty about the exam itself and how you prepared yourself.

SPEAKER_02 3:42

Parna, do you want to take on? Yeah, so I'm going to ask you a few questions about your preparation for the exam. What was your experience of applying for the sitting? Are there any pitfalls to avoid in particular?

SPEAKER_01 3:55

I think from my personal experience, the most tricky part is that you know the open term. So we just like apply during that time, but you don't really know whether you can get a place within that uh I know they keep saying that they will prioritize Chinese. You'd like it to get a place, but you never know. And you also don't know which day your exam will be if you get given a slot. So it's a bit difficult for me to plan my revision. I think that's how I feel at the very beginning. And in my case, it was like I think applied in November, and then I was waiting until maybe like mid-December, then we'd suddenly get a day in early February, which I was panicking because I thought that I probably want to spend like two, three months of time preparing. And by the time that I know, and I probably only have like a little bit more than two months. So it it was a big panicky. So I think that the best thing to try is that when you apply, you probably need to have, you know, have the preparation. What if they just skip you the first day of that time period, you probably want to walk towards that. And if you already decide to apply, even if you might not get a snow, I think it's better to start planning your time revising reading, study materials, uh watching videos, which I do, and walk towards that. Because once you get the day, you need, I mean, I spent quite a time doing like 10th practicing with the person that I partner with. And so yeah, I think that's how I think is important.

SPEAKER_02 5:15

Yeah, I completely resonate with that what you said about there being a short window for preparation because I applied in July and heard in August that my exam was in October, and then you know, the panic and the crowding retarded. So, you know, I completely hear what you're saying. And in terms of the timing of the exam, did you have any on-call ships? Did you have to swap any ships to accommodate your exam, or were you quite lucky with the timing of it?

SPEAKER_01 5:38

I think it was lucky that my placement was in intensive care during this blog. So they actually have, and I was based in the Western General, which they are quite good. They have like a lot of trainees, uh, not just medical and they got like ACCS trainees and stuff. So a lot of times they got more doctor to patient ratio. And for me, uh, once I got the day, I emailed the I think the clinical supervisor on my blog and the rotor master. And I easily so basically they already granted me like exam day for studying me, and they give me five days before that just to prepare. So I think it is it's lucky that I was in this setting. I know for sure that it was, for example, like in my first book in Vasculity or in Gemma, the intensity of the rotor will it would be really difficult for me to actually get exact thing, the time of the eyelid.

SPEAKER_02 6:26

So yeah, that's some really good kind of advice about you know getting your leave sorted and telling your educational supervisor to support you there.

SPEAKER_01 6:33

And when about to de start your revision for PACES, so it is actually a little bit of the uh downfall that I actually started a bit late because I already plan for Christmas. I got family coming to visit. So, but I I started to watch like exam videos by the time that I know that I think about mid December, that's when I know that my exam day will be on the 8th of February. I spend about like two weeks just like watching a lot of videos to make sure that how I understand like exactly how the section is going to be run, what kind of like uh format or what kind of expectation that they would have for us. And after that, I think I spend at least a full month doing intense practice with the person that I partner with and just to do the exam. And also I was quite lucky when I was in Western general, they do have a PACE school, which they organize. They will organize all the people at the starting of the block. So, okay, uh, all of us are sitting the places at this block. And uh, do you guys want to pair up or do we already have a pair up person? And once we do, then basically that they will organize like teachings and they also have more section with the consultant. I think those are the most helpful ones because I mean you're actually doing exactly what Excel is doing with the consultant who some of them are actually like pace examiners. So I think those are really helpful. And I think I do weekly practices with the person that pair it, about minimum one section per week that we find at least like two to three hours, just like go through the basis and practice on patients. And I think I joined those mock sections, like I joined five mock sections before because it's also quite competitive. A lot of people sign up for it, so I only only managed to get five. I think all those are really helpful, uh contributing to the overall experience I have when I actually attend Excel.

SPEAKER_02 8:15

So you mentioned quite a lot of good, you know, study methods there with your PCS partner and also with the PCS study group and you know the videos you were watching as well. What would be your top practice tips? And do you have any particular pitfalls which you would want to avoid?

SPEAKER_01 8:29

The pitfall will be I think the things that probably want to try to avoid is being too robotic. Because the I remember is I at the beginning, you know, I basically I read briefly about the instruction of how the exam format is, what the station is about, and I watch video, I take notes on how everything is done, I try not to miss anything. And then I think at least for some time become overly focusing on not to miss certain things. And I think that overall it makes me feel like really nervous. And every time that, you know, when I do practicing, once I walk out of the room, I said, oh god, I forgot about this, forgot about that. But thinking that it's good to make a really simple note with bulletin points about so, for example, the respiratory station, what are the wings that we need to take off, but really briefly, and try to follow one single kind of rhythm. You do everything repeatedly, repeatedly the same and the same. But I think at the same time also try not to be too focusing on certain orders or certain especially examination signs. I think sometimes I spend a lot of time focusing, trying to dig out all those, but it's not necessary and also just make me overall nervous. And I think the tip is really just that you know, at the beginning, you basically start to make bulletin points of each station. How I mean, just like if I just come into it for the first time, I'd have no idea what this patient is. So, what would I do as a basis? So it's like a routine kind of thing that you just keep practicing, practicing over and over again with the pair of person I have. And I think in the end of it, I think a lot of stations basically I just go in and I just start doing my things without thinking too much. And I do miss like certain examination points, it's just like really minor points. And I think the important thing, try to keep your confidence, keep going. But basically, you will find I think 85% of the positive clinical science and findings, and you report it with confidence and more than they want from you.

SPEAKER_02 10:22

Yeah, I know I completely understand what you're saying. I was like very stressed with you know, trying to pick out everything and trying to get all the details to the point at the very start. However, you know, as I developed and started revising and I started speaking to consultants who examine for bases, they're just looking for a safe potential med. You know, a safe pair of your hands, you can run, you know, a DJ H overnight is the kind of vibe they're looking for. And remaining calm, doing most things, you know, good and safely is what they're looking for. So as I went by, you know, examinations and everything, just speaking muscle memory, and I think having that kind of composure just really helps in the long run. Um, in terms of culturally, did you find that there was any UK-centric behaviors or cultural differences which you might find important to highlight, you know, as somebody who graduated from abroad, it would be good to get your perspective so that, you know, other people in your position might know how to navigate this if they were in this position in the UK.

SPEAKER_01 11:22

Yes, I I do think that it is really like UK culture based the whole PCS exam because the examiner who look at you are basically UK consultant and the patient are UK patients, and what they expect from you is like average UK doctor. I mean, I work in NHS for five years. I think before I start taking on my IMT training. So I do develop like what I should do and what I shouldn't do as a UK doctor. But if Tung Batam, say when I just freshly finished my trainings in China when I first moved here, I think so many things are different. So for example, addressing concerns. This is something that as an international uh medical graduate that we don't really at least we do, but at least we don't do it to the point that PACES will or how the UK will require us to, for example, if to just say that you don't routinely ask the person, is there anything else you might be concerned of? Because I mean, when I practice in China, it's more like that, they come for me, they got referred to me for this reason, I address this. That's it, whatever other reason, that somebody else will address it. But in here is we address their condition and also we ask them, is there any other concern, any social concern at home? I think this is something that we would have highlighted if we had been working for UK for so long, because that's how we do it every day, um, like working as a marriage. So I think this is something that something that I would think that being an IMG would be a big weak of. And is there any way to get over it? Um I think it's quite hard because it is not just one aspect, if you think about it. There's like many things. So, for example, we in China, even till now, the routine practice will not have like therapy MDT input. The so-called MDT they have would be a bunch of like uh specialty doctors or surgeons basically come together, discuss the plan. And also, does the patient's perspective important to them? Probably not, because all they talk about is guidelines and prognosis, what's best for them, and they they tend not to take or have any emphasis on would this treatment strategy impact on the patient, their family's life a lot. When here, as we witness that how we do things, is like we get MVT with therapies, we consider a lot of people's function, and if we propose treatment, we have impact on the patient's life or they like the family. So I think there's quite a lot in that area, in just like day-to-day practices and how we respond and how we treat patients here is so different elsewhere. And I do felt that if any life freshly graduating IMGs or if they just recently come to UK and start working, it would be good if they spend at least a couple months like doing like clinical observer or shadowing and at least observe how the culture is, how people do things here before they attend places. Because otherwise, a lot of things that I mean for us, we probably like we spend a lot of time doing it, and for us it's like a routine kind of thing. But as an IG that firstly comes from a board or had limited experience with NHS, it would be quite challenging to catch all those bones, I think.

SPEAKER_02 14:14

Yeah, that's a really good perspective. And thank you so much for like talking about your experiences with that. I think having gone through med school in Edinburgh, you're asking about patient concerns, was you know, taught from literally year one of medical school. We got always told to ask about ideas, concerns, and expectations, and you know, in every OSCE assessment we had, we were expected to always ask about those. So when, you know, having sat paces, that wasn't in like a new thing to have to do. So I can imagine it must have been like hard to learn new things and incorporate it into PACES examination. Did you find that working in the UK, you were able to kind of develop that, or did you have to actually practice a bit more and do a bit more reading around, you know, the kind of communication skill side of things and the kind of MDT side of things as well?

SPEAKER_01 15:05

Or I think definitely needs more than just working in the UK because I mean, going through my my my years of working in NHS and it at the beginning it was quite a struggle because I I mean they were titled that I have like calling feedback or patient feedback says that the doctor is too honest. I mean, that's just a light space of phrases. Some of them just say that uh the doctor is too blunt. And I I think it's just how the way medicines were practiced here and elsewhere. And also I think in here we emphasize a lot on individualism for the patient. So whatever we propose or we recommend for them also need to fit their life agenda or or how they're gonna, how the family and the patient are gonna take this forward. So I mean for me, it definitely takes more than just like participating in MDT. And I to be fair, when I was in London, I was in like communication courses, which is recommended to me by my consultants. And yeah, I went to a few of those. So basically, over time, you slowly to pick up, just sometimes just have to phrase things in a different way. I think in here, what they expect is like we need to deliver a message in a way that is acceptable to the patient and the family. But we are not allowed to like withhold information or give less information. We have to deliver the exact same information, but in a way that is acceptable to them. And sometimes just need to walk around with many different kinds of expressions just to take in the message. But that's the only way to do it. We can't just come in and say, oh, you have cancer. Usually, I think over the years I learned that so basically we start to actively listen to them so you have a scan and have anybody tell you the result, and you know, leading to what do you think that it might be something like that? Slowly basically guide them into realizing the issue themselves. I think a lot of times that's what I've been doing when I'm doing like patient conversation in actual clinical practice. But yeah, it definitely takes more than just participating. I do go to a few courses for communication before as well.

SPEAKER_02 16:59

That's really useful advice which you've given there. And I also wanted to ask: did you use any resources to prepare for pieces? You mentioned your study group and some videos you watched. Would you be able to mention what you found in particular useful and you know the kind of financial support available to be able to fund those and things?

SPEAKER_01 17:17

I use past tests for all the videos I watch. And I think they're not like the best, but they're quite good because basically they they would tell you the extermination stations from top to toe. They were like demonstration and then they have like different conditions and how what kind of question might be asked. So if you watch all the videos and which I did, I felt that I do have a quite good understanding of how the setting will be and what to expect and what they expect me to do. So that's one of the resources that I've recommended. The other thing is that I use ISI 10 focus places neurology course in Glasgow. It's actually not expensive, it's about 140 pounds. And I get it from my study budget. And it's really good because I think a lot of people will agree that neurostation is quite scary. Because you just don't know what to expect. Because I mean, it might be easy to just get a parking substation, or if you actually get one of those really bizarre, like have multiple signs, which you cannot even summarize, like inheritance ataxia, that kind of thing. It can be quite panicky. I mean, but obviously I don't think that they put like really complex and difficult patients in a PACE exam. But I think that the course did provide like a series of five different patients with really complex neurology. Because I was trained to be a neurosurgeon, so I think my neuro examination technique and knowledge is actually okay. That's how I felt. And I also worked a year in London as a neurology reg. And so I thought they're actually going to be okay. But I think when when I actually stepped putting their courses, when I actually examine patients in there, they got like so many signs in one single person. And I actually find it hard to express, to present. So basically, they would guide you to summarize all this. So, for example, if somebody had this and that, I mean multiple diplopia in all direction and gapitosis. I mean, I think that's how how I feel when I attend the course initially about, oh, what should I say about this? I would just keep sticking to uh my senior grade base, but what they told me that you can easily summarize is a really complex obemplegia. I mean, which okay, by the time that they guide me there, I find it it's instantly I realized there's a lot of things you can summarize with syndromes and stuff, which will help a lot when you're actually going to a place exam if you do see really complex patients like that. But I think luckily for in my case, I I only got my like the simple Parkinson patients, so I did not actually need to use that. But it definitely helped with confidence and also it helps me to feel like more at ease if I actually come across somebody that contests. It's more in clinical setting, you're fine because you can just like write a long sentence and then you talk to your consultant, you get a plan. But in the exam setting, you always be so scary that oh, did I actually say everything out? Especially you've got so many signs, and how should I summarize it and how should I defension it? I think that they would give you like a really systematic kind of approach to how to how to go for those really complex patients.

SPEAKER_02 20:05

And um, were there any podcasts or any other books which you used to prepare for the program at all?

SPEAKER_01 20:10

I did, I think Paces Cases, which is quite a small volume book, and I slipped through most of it. I did listen to a few different podcasts, but I because I never actually you know go through the whole thing. So, you know, um people recommend this. I I go in out and listen to one or two episodes and somebody recommend something else. But I think it did all really helpful because it feels like in the end of the day, you you're listening to the same experience over and over again. And the focus basic on what you mentioned, that you just keep practicing this routine until you become your muscle memory, and that's how you be confident in your exams. But I think the other bit that is important is about how to make your defensials, how to address concerns, that kind of thing probably just had to come from your knowledge base and your experience.

SPEAKER_02 20:54

So, you know, I agree, and I don't think it's compulsory that you have to do a course, and obviously there's they are quite expensive, and in a lot of deeperies, the study budget doesn't actually cover the cost of these courses. Just you know, going around with the study buddy and you know examining patients is enough, and going through the official resources and you know, some books and things is enough, like if you structure it in the correct kind of manner. And I just wanted to also plug in the RCPE podcast, which we have on demystifying pieces and evening medical updates, which also covers a lot of the kind of content which is covered in pieces.

SPEAKER_01 21:30

I did take a few RCPE evening updates, those are really like really specifying topics. So that I mean there were endocrines, there were it's just defensive interest. I do go into a few, that's really helpful because for those it helps you to form your systematic kind of diagnosis and differentials. So if you get in that soon, it's also gonna order your knowledge base and make you more confident in presenting and making differentials and making like treatment plans. So, yeah, that is helpful, and I did use that.

SPEAKER_03 22:00

Thank you so much, Joseph. These are just really great insights. I was listening to your conversation with Aparna and really brings back some memories, but the top tips are so very relevant to all trainees. I'm going to straight take you through the next section of this podcast, if that's alright. And really what I'm interested to talk about is the immediate period prior to the exam and the exam day so the experience of that. Tell me a little bit about the week prior to the exam. How do you find what to really focus on? Because it can be quite nerve-wracking knowing that you probably have to do everything many times, grow go for all the station. How did you approach that just in the last week, knowing that this is it? It's time limiting.

SPEAKER_01 22:42

I think for me, my personal experience is that when it gets to that point and um you just your inner nervousness is just built up higher and higher. But also that I think that I just do what I did usually because my my parent person asked, Do you want to do an intense practicing? Because I mean we do have a few days off before that study leave. And then I did practice with him twice in that week. Uh normally we do once, but sometimes we do like once or twice a week. Then we we practice twice and we go through all the station basically in each practice. But that's it. He did ask me, do you want to do more? And then I I think I was just at the point to just feel that would it make any difference because we've been practicing for weeks. And to be fair, by the time you get to that stage, I mean, like we mentioned earlier, a lot of those examinations and the and those response become like muscle memory. You just start to do things once you enter, and as you're picking up positive sign, you your head is already formulating what's the most likely diagnosis. And by the time you had that, when you present it, you already like basically uh spread out with that uh as a center and all the differentials and all the things. So I mean I I think it was a bit nerve-wracking, and I I mean I try to stay calm, but I think that I forced myself to watch all the video from beginning to the end in the in that week, which takes a few days. And also it helps because I just stay home and not do anything else and go through my notes. And I think by the guess the day before the exams, I just tell myself to just try and relax a little bit because no matter what you do, it's not gonna make any difference at this point. And I've done my preparation and that's all I would have for now. And I I was a bit like paranoid as well, because my exam is not in Edinburgh, it's somewhere around, I think, in the Newcastle. I traveled there the day before, you know, stay in a hotel because I was so scared that you know sometimes there will be like unexpected delays on the whales. You you don't want to really just like miss the train, or the train got delayed for three hours. It's nothing you can do. I think that's quite painful for me. So that's why I did the night before.

SPEAKER_03 24:49

So that leads us nicely into the next kind of question. So as you said, you you traveled a bit earlier, a day early, just to put your mind as kind of ease that you are there. Yes, you're not late, you'll be there on time, you know where you're going and where your center is. And that was quite important because again, that has the potential to decrease the anxiety prime on that exam date. Tell me a little bit just on these practical aspects. So you travel the day before. What about the day of the exam? So you get up, you know where you need to go to the exam center. Is there anything specific that they ask you to take in the exam or half for the exam?

SPEAKER_01 25:26

So practically what they say on the instructions that you don't need to bring anything. They would provide anything. But all the people who sit sit the same dial with me on the same day, everybody brought everything. So you will have your saboscope, you have your torchlight, you got your tender, you got everything in your backpack. But I think after we go in, um it's actually not I think the tension build up was what was the highest before you enter the exam scenario. Once you enter, you got people come smiling at you just come in, sit down. And they'd give you paper. You just need to color, you know, color the sheets. So and then they they'll basically tell how you I mean you can use your own set of skill, and if you don't want to use yours, you can use the one we provide. And uh most of them will be provided. I mean, I mean, obviously, I mean they want you to bring in as minimum as possible. They will just mention it to you, they're not gonna be obligated. So, for example, the the thing that actually brings inside to all the examin rooms is my set of scope, torchlight, and a pen. That's it. Because I I mean, I I was struggling. Do I want to bring my own tandem helper? Because I mean they're all the same anyway. And also feels like carrying it, you know, it's just pointing out of your pocket and it just makes you feel more nervous, you know. Yeah, you don't know like where it is, yeah, your position and stuff. So that's all that we actually need to bring in. And they do have everything if they need to. And also there's there's time that they put things there, and when you try to use them, they will tell you you don't have to, which is a great relief because uh somebody with a GCA that I try to do for philosophy, which I hate, I really hate. And they just when I try to do this, you don't have this, so yeah.

SPEAKER_03 27:04

Saving grace, yeah. Okay. And then form of identification, I seem to remember that, but you get clear instructions about what to present, doesn't it?

SPEAKER_01 27:14

Yeah, whether it's driving license or passport or I I mean as yeah, as IMGs always just bring up passport. I mean, not that many of us drive, I suppose.

SPEAKER_03 27:23

So we talked about kind of getting there the night before on that day, making sure you're on time, leaving two buses earlier if you needed just to be there on time or walking earlier. Yep. Getting to that exam room, you know, like I seem to have memories of this room where everybody, the the candidates that are there for that sitting, will wait for a few moments before they start and then they do all the checks. How how is the atmosphere in that room? Any tips to keep up your um kind of state of well-being whilst you're waiting there?

SPEAKER_01 27:56

I'm not sure. How did you feel though? For me, it's like my tendress is a hideo before I enter the place because they will be uh I think it's like is it five? Yeah, I think it's five of us just waiting outside, waiting to be called in. And then we just like are so nervous. I mean, some of them is still trying to read and know. But once we get in, we know that's it. There's no point in trying to read or anything. So they would they really tell you that relax, put your back in the place, and then they delete your room with a with like a circling of desks, and they it should give you a pass. And you just do color all the numbers, and and and and uh as you do it, there was some that I think that there'll be one or two of those uh examiners would come in and just say they I mean they're quite not actually come in and say that that just relax, just like just do what you normally do at work, that's it.

SPEAKER_03 28:39

Yeah, I think you're right. I think they do make that they try and make uh atmosphere more relaxed. Mind you, that treat this as a as a day at work and and do your best and uh yeah as you do the day-to-day at work, uh, but it can be very kind of tense atmosphere. I guess everybody's different. What did I do? I'm not very chatty, I must say, in these situations. I'm still learning to do that. I do admire people who can chat and socialize, but everybody's got their own approach. I don't know how did you find that atmosphere? What did you do?

SPEAKER_01 29:11

I mean, uh everybody just colouring the the sheets, and I mean somewhat I think at least one or two of them looks particularly nervous. And I think, like I said, my tensions start to like fall once I enter the room. And I think maybe because of my brain just saying that that's it, that is definitely it, no matter what you do will make a difference at all.

SPEAKER_03 29:31

You're still coming out and walking into your exam station.

SPEAKER_01 29:34

This is before I mean before you enter the room that okay, should I just take another look at my node kind of thing? But once you enter that room, okay, that's probably really not gonna do much difference. And I think I was trying to crack this drill with the person sitting next to me and say, Well, that's this it's not gonna make any difference anymore. We're just gonna Yes.

SPEAKER_03 29:53

I mean, to be fair, I think that's the aim of that, to give you those five or ten minutes or fifteen minutes of just taking a deep breath and taking a pause from overthinking things and walking in and doing your best. What about you, Aparna? How did you find that?

SPEAKER_02 30:08

So the day before my exam, I think my anxiety was through the roof. Um, I wear uh like a sports watch where I can monitor my heart rate, and it was honestly going up to like 160. Like I felt terrible. And like yourself, I stayed in a hotel and my husband, he was very nice and drove me to my exam center because it was away up in Aberdeen and things. So he came along with me and I slept well kind of the night before the exam. And then the day of the exam, I felt weirdly quite calm, which was a good place to be. But I just I don't know, I just felt quite calm randomly. But then my husband, he was super duper nervous, and he really wanted me to pass and I didn't need to practice on him anymore. And I think the exam room, like when we were waiting there, it was quite calm. Like, you know, they were giving you pep talks before, and you know, the colouring in of the sheet with your candidate number and things, it was like oddly quite therapeutic. And my center was, you know, they were very well organized and things. So I think that all helped, but I don't know. I think I kind of got all the nervousness out the way out of my system the day before. It was a bit random, but like I I was I felt okay on the day exam. Interesting.

SPEAKER_03 31:19

Everybody has their own you know mechanisms of coping with this stress and alleviating it. Well, they then passed the stress to my husband, who was then like, you know, of rock of anxiety. Yeah. Very interesting. So we talked about dealing with these nervous moments and the peak of your uh, I guess, anxiety before it. Joseph, tell us a little bit about your thoughts on the organization of the exam on the day, the stations, the examiner's approach. Was it what you expected and when you what you saw in previous examples, what you were told, or did you have any big surprise?

SPEAKER_01 31:54

I think I honest experienced they were good examiner, they were bad examiners. Depends on their mood. It's yeah, I think sometimes just luck. And I I think I was relatively lucky. I think like most of my examiners are quite good, and they're in a relatively good mood, I would say. So a lot of times I would actually feel like that as I presenting, as I making differentials, the question they ask is guide me to basically keep the answer they want. You you can fail it because I mean that they'll be asking what about this, or have you considered this? So basically they will need you to maybe just try to focus on a slightly different differentials, or or maybe there's a management approach that you have not actually taken into consideration, that kind of thing. Um so most of them are quite good, but one of them is actually a little bit aggressive, not in a mean way, but they I think he's trying to hammer something out of me. And also I panic. So, you know, I told you one of my stations is a consultation station. I think it's just gigantic writers. The history, the findings, everything is basically all consistent with that. But I think they just want to know what else could that be. Um they're pushing you to see what the limits are, where where you're I think that's the only one in all the stations that I feel like that they try to push me to get more differential than I already made. And it's like sometimes it's just hard to think of things, some anything else if you already think that it's almost like 100% or 95% of the GC, fitting like it's like fitting typical presenting symptoms examination and the lab test result. I mean, what else could could it be? It just somehow they but they I mean, uh under okay, what else could go to these headaches? Okay, uh hyper pressure, but the blood pressure wasn't high, and also it's could it be a subacroid bleed? I mean, but it's unlikely, there's no photoproas.

SPEAKER_03 33:44

So this was a challenging point for you. May may I ask you what's um at what point during the exam did you do the station? Was it at the beginning, towards the end or middle?

SPEAKER_01 33:54

It's actually right in the middle, actually, right in the middle, and it clearly affects me because I I mean after when I look at my score sheet, the I mean they did not actually give me a really low score, or they did they give me like an okay score or so. So it's not even too bad. I think probably like a 15 out of 20, so it's not even that bad, but the station after they all take a beat. So I I can I can tell that my my my emotion was affected by I.

SPEAKER_03 34:18

Yeah, which is completely natural. And this is what happens, you know, a lot of the time, doesn't it? And you know, what you discussed, we just all discussed about the those narratives at the beginning. That's what I was asking, because usually some of the first stations can be very stressful, and then it depends on how you deal with the stress from those while the rest of the exam goes. You clearly were affected by it, but what you're saying, but you manage to bounce back. How did you do that? How did you move on?

SPEAKER_01 34:47

I try to basically, you know, the the moment you leave the room, you should forget about everything because they basically come one after another, you don't really have that much time, and before you know it, the whole thing's finished. So that's how intense it is. And I try basically, once I get out of the room, forget completely about it. If there's a next station, it's a scenario, I start reading the scenario, there's no scenario, just to just be basically trying to think to try and go through that. Okay, it's a cardio or is it a neural and what what will be my routine? Just try to run it through my brain. I try to basically jump through it. Still, I mean, I I think that I mean it's not that easy. Uh, I mean, if you do fell, if you if you like like you felt in person that one station you you felt that you're not doing too good, it really just worries you even uh as you move on. Uh I think that you can you only do your best to try to forget about it completely. If there's less than there's a reading thing, read it and try and do highlight it on that because you do have a piece of paper to write things on. Try to highlight that. That will help. And see if you can shift your attention and focus like quick enough. If you do that, it will help. But uh I I think for me, I try my best. I still take it deep in the next two stations.

SPEAKER_03 35:58

From my uh international medical graduate perspective, we discussed some of the nuances of where you felt. Perhaps you needed to pay a little bit more attention to the preparation side of things. But that's also been kind of highlighted and developed through your training so far. Any other specific uh challenges faced um that you had during during the exam? So thinking also about kind of ethical scenarios particularly or other common challenging aspects?

SPEAKER_01 36:26

I think just like what I mentioned before, uh they are expecting you to give them what they want. So they expect you to perform to a stand up a UK doctor. So obviously the ethic will be different. How you address people will be different. You need to respect their cultural difference as well. And I really don't think there's an easy way of getting all of this extra information in as an IMG if you just graduate like and just move here. It really has to build up over time, certainly. And the main thing is that I I think it's quite important if you at least do a few months of like shadowing or clinical observing in HS thinking or just all work in the GP practice to see how the GP talked to patients. I think that I think that's quite important.

SPEAKER_03 37:11

So thank you for that. Great. I guess you talked to us about the challenges and some of the specifics. So you've come to the end of the exam, you can take a double breath, you can think about it. What do they help you, or what's your practice towards the end of the exam? Do you find that debriefing, discussing with a colleagues, for example, your partner with whom you prepared for pieces, does that help, or what's your approach of kind of finalizing that on the day? I mean, it's or do you just want to go get back to your work the next day?

SPEAKER_01 37:46

I mean, to be fair, once we finish the exams, that is actually I forgot everything. You know, when I was in there, whatever whatever station I don't feel I do too good about it, I was affected. But once I got off it, I just like, okay, that's it. I'm not gonna think about it, I'm not gonna talk about it. To be fair, I actually hop a ride home. One of my one of the persons that that we also work in Western general, he's also also sitting aside, can I hop your ride instead of taking the trains? Okay. In that ride, I mean, he still can't resist asking about something. Um but but then it it's not really useful because we realize even in the same round, the same block, in the same station, there were different patients. So they already prepare like two, three different patients for one station in the same day on the same time slot. So even if we sit the same round, it's not gonna be the same patient. So I I mean he asked a few questions, I answered it, and he realized, hey, how come it's so different? Is that there's different patients I saw them, because there's actually a room with different people going in and out. So I thought those are the reservoirs.

SPEAKER_03 38:49

Yeah, I guess there's different approaches to this, isn't it? As you said, and my preference is also to not overthink at the time because there is that risk of going into too many thoughts and details about what went wrong all most of the time and right as well. But we're clearly discussing with it now, and you've been able to elaborate details. So I don't know how you find it, but I find it that once a bit of time has passed, um, it's probably you know okay and probably good to go back through your experience and reflect on what uh went good and what didn't. What was your approach, uh Parna?

SPEAKER_02 39:25

So on the actual day of the exam, I did talk through it with my partner and then you know my study body, and I talked through, you know, what kind of happened and my experience as they had, you know, their exam a couple of days after mine at a different centre. And then I just forgot about it for a bit. I try not to like overthink it and things because I did know that from previous experiences in exam, I just really can't predict. It just doesn't correlate like my feeling of how it went with how I actually did. I I'm not very good at kind of actually judging how I did on the day. So and you know, that actually ends up being true for the actual exam because a couple of stations which I thought I did horribly and like I actually did all right. And so it's best not to like overthink it and overstress yourself too much and just you know move on. But debriefing is obviously like you know, quite good in the moment, just so you can get you know some heat off and things. Thank you. And far now, do you want to take on and talk about results day and results expectations? Yeah, so um what was your experience of results day? You know, how did you prepare for receiving your results?

SPEAKER_01 40:38

I actually because it was a bit funny. They they keep postponing the result day. So initially it's a three weeks, and then they said that it was going to be six weeks, and then it's gonna be after the uh was that 8th of April or something like that. But with Harley, you know, I was checking like I think the 8th of April should be on Monday. I was checking on a Thursday, the status suddenly changed from like an application accepted to without being processed. Okay, it's changed. I start to messaging my appearance. I teach no. And then I mean, because I think for some time just routinely lock on it and check it. Uh I think I become a routine. So and then I think on Friday and I just log in and suddenly it changed. It was before they announced resulting, and basically it's already have to be startled. Like, I did not expect to see, but I see. So, okay, okay, that's it. Thank God, that's it. And then some messaging people is like, have you guys checked if the result is out? And then people start checking, and I I did not hear much back from other people. Nobody talked to me about their result.

SPEAKER_02 41:43

I had a similar experience as well, where um, you know, ours was the kind of first sitting of the PSOS 2023 exam. So I did um already know that you know it would be kind of like you know, early December, like end of November, by the time I heard back, which would have been quite a number of weeks. Like I think they wanted to uh have everybody sit their exam so they had an idea of how the new exam was progressing before they released the results and things. So I knew there was going to be a big delay, but they actually hadn't confirmed an actual date of when we would get our exams. And then I heard from somebody that the status had changed on the portal from you know sat having sat the exam to processing. So from then on, it was genuine kind of terror anxiety where I was checking the website, you know, checking online forums, like asking my friends if the status had changed from processing to the results. I mean the status had changed on it was either a Thursday or a Friday, and um obviously they didn't release it then, you know, they kept it I waited wait till the weekend, so this anxiety was ongoing. And then it was on the Monday that I heard that the results had come out, and I was in work at the time and I was trying to log on to you know the website from work, and you know, everybody was obviously trying to go onto the website, so it kept on freezing due to high volume. It was such a nerve-wracking experience, genuinely. It was um when I was speaking to my mum afterwards on the phone, she was going, You sound exhausted, like you say. It was yeah, it was quite an experience.

SPEAKER_03 43:16

Yeah, we've been there, we've we've done it, we've opened the results, and then this big relief comes with the you know, the next stages of our training, what things need to be done, but uh ultimately with a lot of learning and a lot of training, and I do feel that the preparation for the exam, the exam itself probably prepares you for that kind of next stage. Uh and and overall, looking back, my feeling is that it was something good to do at the time, and it it definitely enhanced my skills and my knowledge. So we're probably coming to a close. It's been very interesting, uh particularly brought back some memories from six years ago for me. Shall we do some top tips for those who are current currently thinking about pieces, going through the preparation or or the sitting? And what what do you think?

SPEAKER_01 44:09

I think preparation time is important, plan it better. I mean, if I could do it, if I need to do it again, I I would definitely set like three months at least for preparation. And yeah, you need to go through a mixture of like uh video materials and reading materials, and then you need to have at least a month and a half to two months just doing enhanced practicing and having a pair-up person definitely have because you you really need to to be challenged and and basically do the things under observation. I mean, I just before I actually try it, when I first started to have a pairing person watching me do examination, I never felt I would feel so uneasy when people are watching me do the examination because I just do it like all the time when you're like on call or on your take. But having somebody just stand there to watch you without even saying anything, just panic. So that takes a lot of time to get through. And yeah, I think yeah, having a panic person, and if you are in any of the major hospitals, they have like organized pace studying, teaching, or practicing, always go to those because having the consultant section helped me a lot. It's practice like a mock and keep going through the mockings, and you can see how yourself improves as well. From the beginning, just feels like you you you don't know what you're doing till the end. Basically, you have like a practice routine and you have like a muscle memory of basically whatever you say out, how to present, what to say, and it helps with confidence as well. So I think those will be the top tips then for me.

SPEAKER_03 45:45

Yeah, I completely agree with you. I think preparation is key. I remember something perhaps I was a bit reluctant to do at the time, but really helped me. And I remember a quality gave me the step whereby or the station where you present things, your communication skills, presentation skills. Watch yourself in the mirror doing that. Again, it's very unnatural because you're not used to doing that to yourself. But if you can pass that barrier and you're happy with how you do it and you're confident in the mirror, then that helps a lot. And I guess for the exam day, it's what what you said, both of you said before, is about learning how to control your emotions and to leave some of them behind and go in just behaving as yourself on a day-to-day work and you know doing your best because that's who you are really and you're there to show what good of a doctor you are. Well, thank you very much. It was great to to chat amongst the three of us. Uh, thank you for your time, Joseph, and for sharing your very recent experience and being able to go for relieve those and go through those. And thanks very much a Parama for your time as well. It was lovely to chat during this episode. Please join us in our episodes on domestifying pieces and hope you enjoy and you find some helpful tips and good luck to you all for setting the exams.