What to do when they don't get through (exams...) - defining career trajectories - Dr Rebecca Stewart

Welcome to the first of our series of Medical Education Blogs.   If you'd like to contribute, please let us know!  
This blog I have actually posted before and have since presented as a session to a group of MEs with much interest - so I thought it might be worthwhile to share more broadly.

So AKT and KFP marks will be out soon and with that often comes the disappointment of an unexpected unsatisfactory result - and for MEs - the challenge of counselling the doctor.

Human beings don’t like to fail.   Doctors are terrible at it.  It’s hard, especially when that failure is linked to self-esteem, professional image, and livelihood.  But sometimes, the strong emotions that accompany failure, stop us from taking the time to consider why we may have had that outcome in the first place. Consequently, we habitually reattempt for success without reconsidering our approach – which can often lead to an unchanged outcome.  I won’t pretend that I in any way understand how those that fail GP exams feel – I’ve only ever failed one exam in my life (my practical driving test – for not putting my seat-belt on) and I was devastated.   But, I can offer some suggestions from my experience that might help them for the future.

​What do we do when a patient keeps coming back with the same unresolved symptoms?  We usually try a few alternative treatments, perhaps increase a medication dose, whilst at the same time re-enquiring as to their initial symptoms, checking for red flags, and safety-netting.   If they are still not getting better, we usually go right back to basics – retake the history again, re-examine, review the results of any investigations, perhaps read around the topic – and then reconsider what might be going wrong.   If we still can’t work it out, we ask for a colleague’s insight.  This approach works for doctors reattempting the exams as well.

I’ve been working with doctors having difficulty with exams and in GP training for a long time, including researching and publishing on the topic.   The reasons for having difficulty fall into three categories:
​
Knowledge

• Poor baseline knowledge.
• Not enough study.
• Not studying the right things.

Skills

• Superficial learning – cramming, studying using the wrong techniques, learning resources verbatim.
• Not contextualising knowledge, i.e. how to apply it to patients.

Attitudes

• Lack of commitment to General Practice as a career – this has been documented in research as a contributor.
• Personal issues affecting the capacity to study.
• Believing that the exams are ‘bad’ and ‘unfair’.
• The belief that without having an FRACGP you will not be a good doctor.

Reference
Now I know that the last point above will have some of you thinking – and that’s what I had hoped.  Gaining the FRACGP will make you a better GP, but you can still be a good doctor without it.   Many of the doctor’s that I work with, have re-attempted the exams over and over, engaging in a new course of study between each attempt, and the outcome remains the same.  They have the added burden of ‘study fatigue’ as they have been studying for many years, in addition to poor self-confidence and lack of self-belief due to constant failure.

Re-attempting assessments needs to involve structured decision-making, so here’s what I suggest:

• Give the doctor/learner (and yourself) and permission to think about the situation.  Tell them to be kind to themselves through the process.
• Consider if the doctor might have study fatigue and where their confidence is sitting – address these two things before taking any next steps.
• Use a structured decision-making process to reaffirm that their training trajectory will actually get them to the career endpoint that they seek.

• Ask them to right their decision down and the reasons that support it.   Share with a colleague or mentor.  It can be useful for them to discuss the situation with someone not involved in medicine too.   Consider if speaking with a psychologist, Medical Educator or Medical Career counsellor might be helpful.  Make sure that they have a chat to their GP  too!
• Based on their decision – make a plan with them support and mentor them - and of course regularly revise it!

                    Make sure they know that if you keep doing things the same way, you will get the same result!