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Views And Reviews Soundings

Is this your first time too?

BMJ 1998; 316 doi: (Published 11 April 1998) Cite this as: BMJ 1998;316:1174
  1. Colin Douglas
  1. novelist and author, Edinburgh

    A long time ago I sat the exam. Only once. Perhaps that was a mistake. Passing first time, I now realise, deprived me of much that would have been useful today. My colleagues seem infinitely more relaxed. I am compelled to put that down to their greater experience. Presumably they sat the exam as often as was allowable, got to know its moods and nuances, encountered a whole range of cases and examiners, and emerged not just with the membership of the Royal College of Physicians but with a deep understanding of the process by which it is awarded. Lucky them.

    Of course, it is also possible that they have examined before. I have not, and worry that it shows. The royal and ancient college on whose behalf we examine today takes some account of that, and issues comprehensive instructions telling us not only what to look for in those set before us, but how to score them in the various sections, and even—most helpfully—how to add up and average the scores when we've finished.

    Peter is put in charge of me. He is kindly and supportive, with the confident air of a man who can probably remember, without having to check, that average scores of marginal candidates should be rounded down rather than up. We go through the programme together. Coffee seems a long way off. The first candidate is very nervous. As we introduce ourselves I have to stop myself asking if it's her first time too. Under questioning she settles quickly, transformed into a confident young middle grader more than capable of coping with anything remotely medical that might turn up in the ward or the accident and emergency department. It is an odd moment: one at which I find myself already having decided she's passed this bit.

    Shining morning faces come and go: a man who rattles off lists when what we are really looking for is not lists but judgment; another whose knowledge and opinions have to be dragged from him by patient moral force but who nevertheless succeeds in getting almost everything right; and a very worried woman, but the closer we look the clearer it is that she has little to worry about. From orals to coffee. From coffee to long cases. From long cases to lunch. By the end of the morning I am beginning to feel that my arithmetic is approaching membership standard, but there is also a nagging, growing doubt. Peter and I have not yet failed anyone. Can we truly be said to have earned our examiners' lunch?

    In the afternoon there is scope to put that right. Short cases are a harsher ordeal: rapid fire shooting gallery stuff. Hit them or miss them; miss too many and down you go. By the time we settle round the table for tea, biscuits, and final reckoning I am just another grey suit, keeping by the rules, trying to be fair—neither dove nor hawk—in the duty to candidates, college, and public alike. But as I drive home I worry about something one of Edinburgh's great clinical teachers said to me all those years ago when I got through: “Passed, did you? Ah well—standards are falling all the time.”

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