Exam Intelligence

Anything could happen in the next 24 hours, but one way or another, by this time tomorrow I will have walked out of the viva hall and be on my way to the pub for a stiff drink (although the College warn you not to be too liberal with your “social refreshment”, as the signing of the register of Fellows is a very solemn occasion etc….
Fair enough if you think you’re going to pass!

Anyway, my last tip before the exam (and more will follow, whatever the outcome) is practicing what is known as “The 60-Second Elevator Pitch”. Actually a “sales” technique for “pitching” your idea to e.g. Donald Trump or Richard Branson to get them to give you hard cash for a business when your only chance to persuade them is jumping into the lift with them on the way down from their office in whatever tall building they work in, I think it can be adapted to delivering your spiel in a viva, or at least practicing a way of being succinct in a viva.

Imagine you have one chance and one chance only to impress someone with your knowledge on a single subject. Your entire pass/fail rests on this one chance. And you only have 60 seconds. There are clearly a number of factors which will influence your passing or not as well as your knowledge.

1. Make sure you speak for 60 seconds. No longer, as that’s over time and will lose you marks, and no shorter, because even 1 second is long enough for 2-3 extra words.
2. Be confident. You want to pass. So pitch to pass.
3. Be calm and speak at the right pace. Too fast and words become garbled, too slow and you can’t get enough information in, and you won’t come across as knowledgeable or confident.
4. Breathe! You can’t (realistically) speak under pressure for one minute without running out of breath before the end.
5. Choose your words. Even if you have to take 5 seconds before you speak, choose the right words. Remember the Five Word Viva Game? It pokes its head in here as well.
6. Use intonation to emphasize, rather than raising your voice or strong gesturing. Gesturing is important, but it might be useful to practice in front of a mirror or using a camcorder (or webcam, this being 2008), just to see exactly what your body language is like. Don’t play with pens, it’s distracting….
7. Dress right. Wear a suit, don’t deceive yourself into thinking that you might be able to wear anything more casual; you are supposed to be a professional.

I wish anyone who has a viva this week the very best of luck.

One of the most disconcerting things about going to a viva is that (apart from having no clue about what you might be asked), is the possibility of coming across an examiner who is a complete, erm,…is very mean.

There are several ways you might choose to cope with this.

• Pray you don’t get one before you get to the exam.
• Like the Beautiful South, Carry on Regardless.
• Imagine them sitting naked in the chair in front of you with nothing but socks on, although this may make you feel slightly queasy (unless Jessica Alba was your examiner (substitute celebrity of choice) - Ed).
• Simply remember that you have worked very hard for the exam, know a lot (even if you think you don’t) and probably know more than the examiner what you are talking about.
• Practice before the exam with someone who you feel intimidated by, respect a great deal, or get one of your friends to be annoying and act all disinterested. Get them to interrupt, ask you “Oh really”, “Are you sure?”, “Do you want to start again?” and so on. Have them change tack rapidly and switch topics without warning.

We have been trying this technique in preparation for Monday/Wednesday. It can be quite disconcerting having a good friend turn into a “bad cop”. Sometimes though, if taken to extremes, it’s impossible not to laugh….

69 hours to go….

Do you waffle when telling stories?
Does your partner tell you to get to the point when you’re explaining about something that happened at work?
Do your family hold their heads and groan when you start off by saying “A funny thing happened the other day….”, or something similar?

Then you may be a waffler, and I’m not talking about someone who bakes light crisp battercakes in a waffle iron, rather, I mean the other type of waffler, who speaks or writes in a vague and wordy manner (The Free Dictionary).

You may not even realise you are doing it, unless some particularly harsh person in your vicinity tells you about it, or you do one of the things I will come to shortly.

To realise you waffle will take some getting used to. There will have to be acceptance on your part that you are using empty “filler” words as previously discussed, which simply waste your time, as you are not scoring points. Remember back to the SAQ. The key was to transmit as much information as possible in the most succinct, legible manner possible (A remarkable achievement you got a viva then - Ed.) Yes, thanks, I know my handwriting is terrible… Anyway, BACK TO THE POINT: in the viva, you have to do the same, but in the spoken word, so to speak (ahem).

To help you on your way out of denial, try doing one of the following:
1. Pop down to your nearest Lidl and buy yourself a £15 dictaphone with 15minute blank tape, or failing that, blow all your money on one of these dinky gadgets, and practice talking about, say, “What are the changes in physiology in a runner’s body from 30 minutes prior a marathon race, until some time after the race?”
2. Better yet, borrow a video camera and do the same.
3. Sit down with two really harsh consultants from your department and practice being viva‘d by them on the above topic, whilst recording the whole thing with one of the above devices, or just get them to feed back to you whether you waffle or not.

If it is the case that you harp on without going anywhere, then you only have a few days in which to hone your technique to eliminate waffling. Nil desperandum, as they say. It is all perfectly feasible.

The key is in practicing with yourself, in front of a mirror, with your wife/husband/boyfriend/girlfriend, with a dictaphone or video camera, or in front of pairs of consultants (or even one will do, at a pinch) in your department.

• Try using the Five Word Viva Game to cut out absolutely everything extraneous, then flesh out your answers a little bit to build up to a sensible answer.
• Don’t repeat yourself: “The main concerns are residual nerve block, excess opioid and residual narcotisation, incomplete recovery of neuromuscular function, hypoxia and metabolic/endocrine derangement, are the main concerns.”
• Try to cut out saying “Er, um, ar, ah, aer” etc. Try a pause instead.
• Elongate vowels in starts of sentences slightly “Weeelll”, “Theeeere aaaarre” and “Iiiiii wooouuullld” for example (you get the idea, I hope?).
• Be confident about your knowledge when you are sure about it, and make the examiners feel you are confident. Remember that you are not about to become a consultant (this isn’t an exit exam, as one of my consultants put it), but they are looking for someone who is a good Registrar (Specialist, Specialty or otherwise) to whom they could entrust a case in the middle of the night whilst they cosy up back to sleep, and not worry about it (unless worrying is really necessary, in which case they’ll probably come in anyway).

Keep at it: one way or another it’ll all be over bar the drinking in a 10 days time…

The statement:
“I believe this patient has rhabdomyolysis because they have raised CK, raised K+, renal failure, leg weakness”

versus:

“This is a classic case of rhabdomyolysis, with leg weakness as a result, demonstrating raised CK, raised K+ and renal failure”.

In one of my better work-avoidance moments, I was reading
that we waste a lot of our time when studying (rather than
avoiding studying, like I'm doing).

I mentioned earlier that I like to try and sit down and
decide what I intend to learn from a particular study
session. What I hadn't thought about was that I should
define a period of time I am going to spend on doing the
learning. There appear to be a couple of reasons that
make setting a goal and a time limit a good idea.

Firstly, if we decide on what it is we are intending to
learn, we avoid meandering around a lot and ending up
becoming distracted by concepts or ideas that are not
central or essential to what we want or need to learn. If
you read an article and don't understand a concept, you
can usually read to the end of the article without
understanding the concept, and grasp the central tenet of
the article anyway. If each time you didn't understand
something you went off and looked it up, several things
would happen. You would waste time looking it up, and you
would get distracted from your main theme.

Secondly, there is something called the serial position
effect.
When asked to repeat back a list of things they have just
been told, people will usually (not always) start with the
last thing they were told (called the recency effect),
then more than likely some of the first few things they
were told (the primacy effect) and then those things in
the middle are least well remembered. By working
continuously without interruption for lengthy periods of
time, we don't give ourselves beginnings and endings
(primacy and recency) to recall from, and if we don't set
ourselves a time limit or a "learning limit" or "learning
goal", we are less likely to stop work. (This appears to
me to be a special application of Parkinson's Law, where
work will simply expand to fill the time available, and by
giving ourselves an indefinite time to finish, we could
give ourselves and indefinite and infinite amount of
work).

Thirdly, there is always the "fear of the unknown".
Imaging you want to learn the contents of e.g.
Fundamentals (Pinnock et al) or Miller's Anaesthesia, or
(my favourite) Hutton. How many pages are there in each
of those books? (963, 3376 and 1072, in case you were
wondering). A lot. Imagine sitting down and starting to
read at page ONE, only to read all the way through? Every
time you stop and come back, you still have "1072 pages
less whatever I read so far" to go. Or are you a glass
half-full kind of chap/chapess and think "I've read this
many pages, fantastic"? And how long is it going to take
to read (well you could work it out, I suppose)? This
uncertainty of the amount of time it will take is almost
certainly going to be a millstone around your neck.

So what am I trying to say here?
Well, basically it boils down to: when studying, set
yourself a goal, and set yourself a (realistic) time in
which to achieve that goal. Take a break when you've got
to the end of that goal to allow primacy and recency a
chance to exert their power, and then come back to your
studying. Which is where I'm going now.