ASSALAMU-ALAIKUM WARAHMATULLAHI TA’ALA WA BARAKATUHU
> Ward rounds/Clinics/Bedsides/Tutorials
> Self-directed learning
> Group discussions/Past Question papers
> Prayers, Patience, Perseverance (The 3Ps)
4. OBSTETRICS and GYNAECOLOGY
5. PATHOLOGY (Histopathology, Haematology, Chemical Pathology)
7. COMMUNITY MEDICINE
After passing all the above mentioned “hurdles” most medical students ponder and ask themselves, “so, I’m finally a dacta (doctor)?…perhaps with disbelief that it’s over.” so, what next…? Attestation?! Whatever your questions might be you must be thankful to ALLAH (SWA) for the change in your social status...Praise HIM (SWT) profusely for making you achieve your dream. Know that it is not your wit or knowledge that passed you through but ALLAH, The Almighty. If you think the contrary, then CHALLENGE THE COLLEGE TO GIVE YOU FRESH SETS OF THE MBBS EXAMS…AND SEE IF IT WILL STILL BE THE SAME RESULT. You must believe that your passing the exams was an act of ALLAH (SWA).
> ESSAY: Challenges your critical & analytic clinical skills & judgment.
> ORALS: Test your communication skills.
> CLINICALS/PRACTICALS: Test of all of the above…PLUS YOUR…
- Personality (Showmanship)
- Approach to Patient
- Attitudes towards the Examiners
- Reasoning/Decision making process
MY ADVICE: The following are some of my advice regarding the MBBS exams to Medical Students.
- Field work
> Beware of TIME and carefully READ and understand ALL the stem of the question before deciding on which is T/F.
> Pay attention to QUALIFYING words like ALWAYS, NEVER, USUALLY, ONLY, ALL OF THE ABOVE, NONE OF THE ABOVE, EXCEPT… etc.
> Use your BROAD KNOWLEDGE of the course to think about where in your note, text, ward, clinic, tutorials, etc, that MCQ was drawn from. Do not RUSH into answering an MCQ because you’ve once come across it in your revision…the examiners may have deliberately changed some wordings.
> If you don’t know an answer put a question mark by its side and go to the next without wasting much of your time and then revisit those MCQs you skipped…the answer might have crossed your mind then and some MCQs may be answers to other MCQs.
> Change an answer ONLY if you can logically justify the change and don’t pick an answer just because it seems to make sense. You have to be sure about it.
> Don’t dismiss an alternative because it seems too obvious and simple an answer.
> Don’t just shade/circle T/F every time you are unsure of the answer.
> Don’t copy someone else's answer. The candidate you are copying from could be WRONG in his/her answers. And you could be caught in the act. It is Islamically and morally wrong to cheat in Exams.
> Don’t indulge in “INTELLIGENT GUESSING” if you are unsure of the answers.
> Go over your answers if there is still time…But REMEMBER, DON’T change an answer except if you can logically justify the change.
> Be TIDY in shading/circling your answers.
> Say your CLOSING PRAYERS for the MCQs Session.
> Write ALL you know about the question in details and draw diagrams to earn more marks.
> Write LEGIBLY and use ONLY universally accepted abbreviations.
Carefully read each question and understand what is expected of you from it. E.g., (Check your dictionaries for the meaning of each of the following commonly used question tags).
- Describe/Write the Details of…
- Compare and Contrast
- What is meant by…?
- Epidemiology of the dx caused by the organism
- Life Cycle (esp. in Parasites)
- Mode of Transmission
- Cultural Characteristics (esp. in Bacteria)
- Clinical Features
- Mech. of Action/Effects (Pharmacodynamics)
- Pharmacokinetics (ADME)
- Toxicity/Side effects/Adverse effects
> Classification/Aetiology/Causes (Congenital & Acquired). I used the following MNEMONICS for causes of diseases when I was in the medical school: TIMBED DIIID CANE...
- Infective (Bacterial, Viral, Parasitic, etc)
- Neoplastic (Benign & Malignant)
> Differential Diagnosis.
- Physical Exams (General & Systemic)
- Investigations (General & Specific)
> Complications (from the dx &/or Tx).
> Staging & Prognosis esp. in Malignancies.
4. Clinical Features (Signs & Symptoms)
5. Differential Diagnosis
DON’T FORGET TO REVIEW ALL YOUR ANSWERS BEFORE HANDING OVER YOUR ANSWER SCRIPT. ONCE YOU’VE LEFT THE EXAMS HALL, TRY NOT TO RUSH TO CHECK YOUR ANSWERS & WORRY ABOUT ALL THE BITS YOU MISSED OUT. YOU STILL HAVE OTHER PARTS OF THE SAME EXAMS TO MAKE UP.
> Don’t waste time on any specimen/equipment/Slide.
> Critically read the Short Clinical Question attached to the specimen/slide; it usually gives a clue to the/how to answer.
> The following is an example of a pattern:
- Identify the specimen/Procedure
- Report the salient macro/micro features
- Give uses (if it’s an apparatus/equipment)
- Give Provisional Diagnosis
- Conclusion (where necessary)
> Appear at the Ward at least 45 minutes before time.
> Carry all the basic instruments you will use for the clinicals. However, no amount of instruments will compensate for lack of skill in using them.
> Be composed as you will be confronted ONLY by the common cases you always see on the wards. So, prime your mind for any one of them.
> You must have developed and mastered a clerking pattern for each disease/case even before the exams.
> Greet the patient given to you and EXPLAIN to him/her why you are there, and that you will need the entire corporation he/she will render to you. Try as much as possible to be systematic and organized in your:
- History Taking
- Physical Examination (Follow IPPA)
> Divide your time (30 minutes) for the long case well.
-10 minutes for History Taking
-10 minutes for Physical Examination
-10 minutes for Writing up your line of Management; and in reviewing your clerking, praying, and composing yourself. Remember that each part of the clerking is important in reaching a diagnosis.
> The Chaperones are there to assist you in case of any difficulty with your patient and when they come to alert you that you should get ready… your examiners are here, DON’T PANIC but greet your examiners calmly. Believe that they are all there to pass you.
> Present your patient confidently and audibly and speak like you are already a doctor (of which you are).
> Be organized & systematic in your presentation of the patient.
> It’s alright to make “mild” mistakes but never sound dangerous; and NEVER argue with an Examiner.
> Never say what you haven't asked/done - Never lie to the examiners.
> Keep talking unless if the examiner asks you to stop and if you are asked to examine the patient, do so “SHOWMANSHIPLY”.
> Understand what the examiner wants you to do before you venture into it and if the examiner asks you “Are you sure?” he/she is giving you a chance to correct yourself rather than trying to trick you.
> Try as much as possible to ‘impress” your examiners with the right “STUFFS” and HIT THE NAIL ON THE HEAD.
> Use the appropriate Professional Jargons.
> Be courteous with the patient and don’t forget to thank your patient at the end of the “Hot Seat Encounter”.
- Examine the…
- Check for…
- Look for…
- Feel for…
> Be systematic and thorough in your examinations and findings.
> Be courteous to the patient.
> Greet your examiners and wait for them to ask you to sit down. Appear calm and confident; and understand the examiners’ questions before answering them. Say all that you know about the question systematically.
> When you pick/are given an instrument:
- Identify it.
- What are its uses?
- Any complications associated with its use?
> If it’s a Radiograph/USS/CT/MRI.
- Identify it i.e. this is a CXR/Abdominal XR (KUB).
- Belonging to – mention the name of the patient.
- Date taken/X-ray number.
- Showing… begin with the obvious pathology on the radiograph.
- Give differential diagnosis.
- Possible Complications of one of your Differential Diagnosis.
Candidate’s Approach To the Patient
Was the Exam Systematic & Thorough?
Accuracy of Findings
Interpretation of Findings
Was the Exam Technically Smooth?
This Candidate is Clinically Safe To Work Under Supervision
> Give all Thanks and Praises to ALLAH (SWA), The Almighty, for keeping you Alive and in good health to witness and participate in the Exams.
> Work Harder for the next Exams in case you have resit(s).
> Keep Praying for Success in this Life and The Hereafter.
> Continue with the good works that you’ve been doing before & during the Exams.
I first presented this topic sometimes in 2005 to a group of medical students at the College of Medical Sciences, University of Maiduguri, Nigeria, and subsequently to several sets of medical students of the same University.
I sincerely acknowledge all materials consulted in writing this article, especially MEDICINE FOR EXAMINATIONS (3rd ed) by RJ Epstein. Published by Churchill Livingstone, 1996. New York, USA.