Intended for healthcare professionals

Career Focus

The job and the exam

BMJ 1999; 318 doi: (Published 10 April 1999) Cite this as: BMJ 1999;318:S2-7189
  1. Sudipta Paul
  1. Department of Obstetrics and Gynaecology, Arrowe Park Hospital, Upton, Wirral

    In an ideal world there would be no tension between the needs of the service and the needs of the trainee. Sudipta Paul presents solutions to the conflicts that can often arise in real life

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    There is continual conflict between the demands of the job - whether it is a senior house officer or a specialist registrar post - with the commitment to pass examinations. Both are required to progress in your career; ideally, they should complement each other, the training enabling you to pass examinations and the knowledge acquired to pass examinations improving clinical management. Although trainee posts ought to provide adequate training to pass the necessary examinations, in reality this is not the case. Trainees are expected to prepare for examinations on their own with minimal help from the system. There are fixed teaching sessions in most hospitals which should be adequate to teach trainees to pass examinations. Unfortunately, most of these sessions are not organised properly to fit the needs of the examinees. They are often poorly attended because of service commitments. The duty hours are quite long (64-72 hours a week in most places, 56 hours a week in a few), leaving little personal time for trainees. Prospective cover can make things still more intense. Left with limited personal time, trainees have got two options - to work part time or to manage their time very effectively. Working part time may be acceptable to some, but the drawbacks are less pay and delay in completion of training and consequent progress in career. To most trainees, it is not an acceptable option. Therefore, they have to manage their own learning time out of the system.

    Preparing for an examination

    Once you have decided to take the examination, you need to plan your preparation. An hour of planning can save two of misdirected work. It is an illusion that there is not enough time: the reality is that the available time is mismanaged. It is not necessarily true that the harder you work, the more you will get done: instead, the more effectively you work, the more you will get done.

    Time management

    Keep a log of your weekly timetable and mark the times you will be able to spend for studying. Calculate the total time available for study each week. Try to avoid wasting time in socialising, telephone calls, unnecessary travelling, etc. Organise your work in the job and fix time for routine work. Effective delegation of work may save a lot of time. Carry a book of multiple choice questions (MCQs) or a short note book and go through it whenever you get some free time at work. Make a list of topics important for the examination and try to get them included in the teaching sessions. Try to get as much information as possible about the management of the patients you are involved in from a senior colleague. It may save a lot of reading time outside work. Before you go to bed, check what you have done that day and mark the time wasters. Try to avoid those activities in future.

    Mental preparation

    Be sure that you are mentally as well as academically prepared for your examination. You must be confident in yourself, as this is the most important factor for success. If you are not confident about passing the examination, how can you expect the examiner to pass you? So, be confident and determined before you embark on the examination.

    Learn about the examination

    Inquire about the standard required for and the style of the examination from the examining body, as this greatly influence your method of preparation. Ask people who have taken the examination for advice about how to approach it. Analyse their opinions (which will vary) and make your own way of approach.

    There has been a tendency to repeat examination questions or topics. Collect previous questions from the examining body (if available) or from previous candidates. This will give you a clear idea about the standard and style of the questions.

    Make a list of topics

    Once you have all the necessary information, it is time to plan your method of preparation and study timetable. Make a list of topics relevant to the examination according to their importance. Write down a routine for study on a daily basis, including the time and exact topics to cover. Keep it on your study table. Assess your progress daily and modify your plan accordingly. Divide the available days before the examination into six parts. Keep the first three parts to go through all the syllabus and to make notes on the topics. This may save you from disaster if you get a very uncommon question in the examination. Go through your notes during the next two parts and make necessary amendments in the notes. In the final sixth part go through your notes in reverse order of your list so that you will read the most important topics just before the examination. As these topics are the most likely to be asked about, they should be freshest in your memory.

    Making a list of topics has got several advantages:

    • The actual workload will be known

    • The most important topics will be clear

    • As you go through the list you can judge your progress and modify your plan accordingly

    • Once you have completed the list you can feel confident that you have not missed any topic in the syllabus

    • It is easier to recall information that is fed in a systematic order to the brain.


    These are useful to get some idea about the examination and how to approach it. It would be wise to attend a course well ahead of the examination to allow adequate time for preparation. Plan early to book your place in a good course and apply for study leave in time.

    Preparation and examination techniques

    The postgraduate examinations (part 1 and 2) usually consist of theory paper(s), oral and clinical, in different combinations depending on the specialty. The theory paper(s) may contain MCQs and long and short essays. The oral and clinical examination may be an objective structured clinical examination (OSCE) or of conventional style with long and short cases.

    The MCQ paper

    • Collect examination MCQs from previous examinees, as these are likely to be repeated. Check the answers in textbooks or other literature and memorise them

    • Know the facts and figures, common symptoms and signs,complications and management of all common problems and the review articles published in peer reviewed journals within the past two years

    • Practise MCQ papers in examination settings

    • Answer the question at its face value - do not try to find hidden meaning

    • In the first round quickly answer the MCQs that you are sure about without wasting time thinking about less easy questions

    • Answer the less familiar but more or less certain MCQs in the second round, leaving the rest for a third, and possibly fourth, round

    • If there is negative marking (penalisation of wrong answers) do not blindly guess answers but only answer those MCQs that you are sure about

    • If there is no negative marking you must answer all the questions as you have nothing to lose

    • When guessing, always follow your first impression as it is more likely to be correct

    • To save time, mark the answers on the question paper as you go along and transfer them to the answer sheet later. This avoids the distraction of marking the answer sheet for each question, but remember to keep sufficient time to transfer the answers: it is safer to transfer the answers after each round

    • Make a note of the number of questions you answered in each round to assess your performance. It will help you to plan for future MCQ examinations.

    The long essay

    • It includes an introduction, body, and conclusion

    • The introduction is the foundation of the essay on which the rest is built: it should provide a clear picture of the topic under discussion, including the definition, incidence, and importance of the topic in clinical practice

    • The body should elaborate the subject with expanded discussion; postgraduate candidates are expected to provide some critical discussion based on evidence

    • The conclusion is the finishing touch to the essay: it should summarise the important points, leaving some message

    • A plan may be included at the beginning, which facilitates writing without missing important points

    • Appearance is important: legible and clear presentation always carries extra marks

    • The essay should be compact with continuity in providing information

    • Always read through your essay, and revise if necessary, before you leave

    • The important topics are those problems faced commonly in clinical practice, topical controversial issues, review articles in peer reviewed journals published in the past two years, etc

    • Practise writing essays in an examination setting and get them assessed by a senior colleague.

    The short essay

    • It expects a compact precise answer on more focused topics

    • A formal introduction and conclusion are not required, but they should be included informally to give a compact professional look

    • Note the key points in the question and answer them: try to include as many relevant points as possible, as marks are awarded according to the number of points mentioned that match the points in the model answer

    • Leave a clear message and check your work before you leave.

    Oral examination

    • Dress well and introduce yourself; first impressions matter

    • Be at ease, look confident, and make eye contact with the examiner(s)

    • Consider the examiner(s) as your supervising consultant and act as though you were discussing a case with him or her

    • Be prepared to answer questions on all common problems,particularly emergencies, and topical controversial issues

    • Often you will be expected to give your own opinion and be ready to justify it

    • Try not to argue with the examiner(s), but do not change your views illogically just because an examiner does not agree with you: he or she is testing your confidence

    • Be practical in your answer: say how you would manage the problem usually, and be ready to justify it

    • After you finish, thank the examiner(s)

    • Practise on your colleagues in examination setting and make firm logical views on common problems and controversial issues.

    Clinical examination

    • All the general factors for oral examination are relevant here

    • Introduce yourself to the patient

    • Take a comprehensive history and perform an adequate examination to reach to some provisional diagnosis

    • Present a clear history highlighting important points to indicate a particular provisional diagnosis

    • Always be practical in managing the patient in the examination

    • Practise presenting cases to your senior colleagues and ask for feedback.

    It is hard to combine academic study with a busy hospital trainee post. It should not be made harder by mismanagement of time and lack of planning. Planning and its implementation are the keys to any success, and passing an examination is no exception. A properly planned and organised personal study programme, with its appropriate implementation in the examination, will enable any committed candidate to sail through.

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