Anonymous #1
#1
Report Thread starter 1 year ago
#1
Hi to all,

I had been doing rather well in firm, which is in the fourth year, but we had an in course practical assessment (history taking and exam and management).

The assessor i had was one of the consultants, who was incredibly strict, and i struggled with nerves and was given a patient who struggled with English.

I am on the same level as most of my peers, and they told me their assessors were lenient, signed them off, and let them get through.

In our actual exam, we will not need to examine for this particular speciality , we will have an actor who will facilitate the history, and speak english well. Additionally we will have more months to practise within our group of friends and get slick.

I am really worried there are unrealistic standards being set, unnecessary pressure, and this is all killing my confidence at a time when it needs to be nurtured, not thrown into the deep end without adequate support.

I have one more week to prepare again for the assessment, but i am rather nervous as i think it really is unrealistic in terms of the standard we are being asked.
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seaholme
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#2
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These things unfortunately happen. At the beginning of clinicals at medical school I was given a supervisor who was a legendary piece of work and had a bit of a nightmare experience. Some people think that throwing you in the deep end, making fun of you by mocking your ignorance and basically beasting you is actually a way of teaching. In a messed up way it does work as I can honestly say I never forgot a single teaching session that I had with my supervisor, in my opinion for the wrong reasons. You may also come across such 'teachers' as your consultants when you are working, although you'll get very little direct teaching if any and mainly feel it in the sense of ?inappropriately high standards.

The consultant who taught you the other day would probably argue that they are pushing you and that in 'real life' you will need to be able to deal with patients who don't speak english well and manage the situation. You're supposed to be there to learn how to be a doctor and so the fact something 'won't come up' in some end of year exam and 'will be an actor' makes sense from a student perspective where your end goal is passing an exam, but if you said that to the Consultant they would probably wipe the floor with you. Thing is, this kind of experience at the beginning of life in medical school IMO is counterproductive as you yourself have identified, as students are still building up their basic confidence and competences and it can leave you feeling angry and upset, and like you're doing a truly awful job.

What I would say is that you yourself say you are not struggling and feel on a level with your peers. There will always be a little bit of randomness in how you get taught as in clinical years everybody has a more unique set of experiences and teachers. The medical school know this - and honestly reports from your consultant for this sort of thing, unless you raise a red flag, are kind of irrelevant to anything so I wouldn't worry. The main thing is that you're feeling unfairly treated and that it's affecting your confidence, and the way I see it you have two choices. Either just suck it up and do the assessment with this consultant, just try to prepare for it well and be aware that you'll likely get some harsh feedback but it's possible to turn that into something positive and learn from it. Ultimately others are probably making the same errors or whatever as you are, but you for better or worse are having that flagged up to you. In a way (to do some positive spinning...) it's an extra learning opportunity.

OR email the medical school and explain that you feel like you were disadvantaged e.g. your patient didn't speak english and so it was harder for you than for others, and they should take this into consideration when reviewing the assessment. Like I said though, I suspect if your Uni is anything like mine, nobody ever reviews an assessment ever unless you fail at the end of the year or something, so this risks just causing a stink about something very minor.
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nexttime
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I don't think there is a person on the planet who doesn't feel at least a little annoyed after failing at something. Most likely some of the criticisms were not justified, but most likely some of them were too.

Perhaps the standards were too high, but it sounds like this was just a mock/not important at all. Take on the feedback, decide what you can learn from this, and come out stronger.

I don't think you need to be "nurtured" - you're an adult and future doctor, not a duckling. Within the bounds of professionalism, people need to be allowed to give you criticism where needed.
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Anonymous #1
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(Original post by seaholme)
These things unfortunately happen. At the beginning of clinicals at medical school I was given a supervisor who was a legendary piece of work and had a bit of a nightmare experience. Some people think that throwing you in the deep end, making fun of you by mocking your ignorance and basically beasting you is actually a way of teaching. In a messed up way it does work as I can honestly say I never forgot a single teaching session that I had with my supervisor, in my opinion for the wrong reasons. You may also come across such 'teachers' as your consultants when you are working, although you'll get very little direct teaching if any and mainly feel it in the sense of ?inappropriately high standards.

The consultant who taught you the other day would probably argue that they are pushing you and that in 'real life' you will need to be able to deal with patients who don't speak english well and manage the situation. You're supposed to be there to learn how to be a doctor and so the fact something 'won't come up' in some end of year exam and 'will be an actor' makes sense from a student perspective where your end goal is passing an exam, but if you said that to the Consultant they would probably wipe the floor with you. Thing is, this kind of experience at the beginning of life in medical school IMO is counterproductive as you yourself have identified, as students are still building up their basic confidence and competences and it can leave you feeling angry and upset, and like you're doing a truly awful job.

What I would say is that you yourself say you are not struggling and feel on a level with your peers. There will always be a little bit of randomness in how you get taught as in clinical years everybody has a more unique set of experiences and teachers. The medical school know this - and honestly reports from your consultant for this sort of thing, unless you raise a red flag, are kind of irrelevant to anything so I wouldn't worry. The main thing is that you're feeling unfairly treated and that it's affecting your confidence, and the way I see it you have two choices. Either just suck it up and do the assessment with this consultant, just try to prepare for it well and be aware that you'll likely get some harsh feedback but it's possible to turn that into something positive and learn from it. Ultimately others are probably making the same errors or whatever as you are, but you for better or worse are having that flagged up to you. In a way (to do some positive spinning...) it's an extra learning opportunity.

OR email the medical school and explain that you feel like you were disadvantaged e.g. your patient didn't speak english and so it was harder for you than for others, and they should take this into consideration when reviewing the assessment. Like I said though, I suspect if your Uni is anything like mine, nobody ever reviews an assessment ever unless you fail at the end of the year or something, so this risks just causing a stink about something very minor.
Everything you have said has rung so true. Thank you for the reply.

I want honest feedback, so i can learn now and now suffer later. However, giving me a patient who struggled to talk in english, mumbled, confused the history (and the consultant admitted i would not get that in the actual exam as it was confusing) really threw me off. It isn't their fault, given they were kind enough to give me their time, but it certainly isn't the way to build ones confidence and assess core skills. I will admit, i could do much better, but i just had everything against me. Now i have to redo the assessment and i'm very nervous. It's just odd to be given good marks year on year and have a style of taking a history and then told to change it and be more abrupt. Why didn't any of the other assessors pick it up? My history taking is very conversational, but with a clear focus and structure. I have asked others on different firms and my own firm , and they say they never got the diagnosis, they fumbled and they empathise with me, yet they have all been signed off.

I am starting to feel rather anxious , and in a way, whatever belief i have built up has taken a major knock.
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seaholme
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(Original post by Anonymous)
Everything you have said has rung so true. Thank you for the reply.

I want honest feedback, so i can learn now and now suffer later. However, giving me a patient who struggled to talk in english, mumbled, confused the history (and the consultant admitted i would not get that in the actual exam as it was confusing) really threw me off. It isn't their fault, given they were kind enough to give me their time, but it certainly isn't the way to build ones confidence and assess core skills. I will admit, i could do much better, but i just had everything against me. Now i have to redo the assessment and i'm very nervous. It's just odd to be given good marks year on year and have a style of taking a history and then told to change it and be more abrupt. Why didn't any of the other assessors pick it up? My history taking is very conversational, but with a clear focus and structure. I have asked others on different firms and my own firm , and they say they never got the diagnosis, they fumbled and they empathise with me, yet they have all been signed off.

I am starting to feel rather anxious , and in a way, whatever belief i have built up has taken a major knock.
Well in a way it is good experience because you may have a conversational style of history for people who can talk back to you but actually in practice you'll need to also have ways of speaking to people where there are communication issues. It depends what specialty you end up in, but in certain jobs I've done, communication has been an issue for at least half of all patients. Maybe it's language barriers, maybe it's dementia, maybe it's learning disabilities, maybe it's psychosis, maybe it's deafness (surprising number of old people come into hospital sans hearing aids and truly are deaf as a post), sometimes they're just hard to talk with because their agenda and your agenda are so far from each other! This person not signing you off is clearly an example of people in the medical school all having a different way of teaching and assessing and as I said before, that happens. I suspect they're very unlikely to give you a second 'challenging' patient. But even if they do, you've now had that experience.

My advice would be that whenever communication becomes problematic - language, whatever - the best thing to do is switch to yes/no questions. And when they answer your question to clarify with them their answer each time until you are certain you're there. For example:

"Have you had a cough?"
"Yes"
"Have you been coughing anything up?"
"No"
"So has it been a 'dry' cough or do you maybe mean you've had a sore throat?"
"Sore throat?"
"Pain in your throat, when you swallow *point to throat*"
"Yes I've had pain in my throat"
"And have you been coughing? *imitates coughing*'"
"No cough, but sore throat"

I mean that's a rubbish example but that's definitely how I deal with communication issues, just keep questioning things until you are certain they have understood. You have to find a way to take a good history where you are certain their answer is true (to help you formulate your diagnosis & plan!). Sometimes conversational histories don't work although I agree that is also my preferred style. Even within that you will have to ask some yes/no questions to figure out what is going on and exclude certain diagnoses.

Thing is you are now equipped to approach even if the next patient is also hard to talk with. Think of it like this: you have to make a diagnosis so whatever you have to do to get there, you should do. Even if it means really going back to basics with yes/no Qs and checking. Obviously most people respond better to open questions and you pick up more, but sometimes you're just not in the position to be able to do that and you still have to help that patient and get to the answer as best you can. You can if you wish at the beginning say 'ideally I would like to organise a translator if possible' :P But really you see most of these people at like 3, 4am and you'll just have to do your best.
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