APPROACH TO MBBS EXAMS.

APPROACH TO MBBS  EXAMS

BY

DR. AHMADU MUHAMMAD  SANI. B.Sc., M.B.B.S., F.M.C.R.

DEPARTMENT OF RADIOLOGY, UMTH MAIDUGURI, NIGERIA.

 ASSALAMU-ALAIKUM WARAHMATULLAHI TA’ALA WA BARAKATUHU

Many medical students approach exams as deadly serious affairs, but this is a mistake. Medical exams are like a game and, as with all games, you get the most out of them by first learning the “RULES”. Unfortunately, the “rules” of medical exams are unwritten; as a result, all too many candidates end up learning the rules only when it’s too late (a costly approach indeed!!!). The following presentation is meant to serve as a guide to passing through the MBBS Exams. This presentation may also be of importance to students in other fields of learning.

BEFORE THE EXAMS, THE STUDENT MUST HAVE FULLY PARTICIPATED IN THE FOLLOWING

>  Lectures
>  Ward rounds/Clinics/Bedsides/Tutorials
>  Self-directed learning
>  Group discussions/Past Question papers
>  Prayers, Patience, Perseverance (The 3Ps)

KNOW THE COLLEGE “HURDLES”: The following are the courses expected of Medical students.

1.        MICROBIOLOGY
2.        PHARMACOLOGY
3.        PAEDIATRICS
4.        OBSTETRICS and GYNAECOLOGY
5.        PATHOLOGY (Histopathology, Haematology, Chemical Pathology)
6.        MEDICINE
7.        COMMUNITY MEDICINE
8.        SURGERY

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).

It is important to note that PRE-EXAMS ATTENDANCE FOR all CANDIDATES is FROM 80%. Be warned that THERE IS NO MAGIC RECIPE FOR PASSING EXAMS, APART FROM STUDYING VERY HARD AND PRAYING.

THE EXAMS ANALYZED

>  WRITTEN: MCQ and ESSAY (Long and Short)
>  PRACTICALS/CLINICALS
>  ORALS/INSTRUMENTATIONS

Reasons (among other reasons) for the different parts of the exams include the following

>  MCQ: Tests your broad (wide reading) knowledge of the “syllabus”.
>  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)
                - Dressing/Appearance
                - Approach to Patient
                - Attitudes towards the Examiners
-  Confidence
-  Composure
-  Reasoning/Decision making process

MY ADVICE: The following are some of my advice regarding the MBBS exams to Medical Students.

Long before the EXAMS the candidate should have been praying for success, punctual and hardworking in the:

- Classroom
- Ward
- Clinics
- Laboratory
- Field work
- Etc

The candidate must have been patience and able to persevere all that may face him/her during the course of study. He/she must have committed everything to ALLAH (SWA) and assured him/herself that they prepared well for the exams & that by ALLAH’S grace they will make it. It is expected that the candidate has convince him/herself that others have made it before; that they can also make it; may be even better. Stick up a notice in your wardrobe or wallet that “I’M GOING TO BE A DOCTOR VERY SOON.”

Focus your mind & energy to the common exams cases & don’t be a SPANOPHILIAC or a HIGH-FALUTER. If you are in difficulty regarding Exams in the Medical School; ask for help early. MNEMONICS are indispensable in your studies especially if you know how they were formed. More of your “Close-To-Exams” nights should be devoted to Qiyamul Lail rather than TDB (Till Day Break) because all you need now is more of Spiritual Back-up. Try and avoid all obscene things e.g. Seeing, Eating, Smelling, Touching HARAM. Shun Backbiting, Slandering…Infact, avoid ALL that is HARAM. Talk less and pray more. Try as much as possible to ask your Parents, Relatives, Friends, etc to put you in all their daily prayers.

During the Exams: Keep on praying for success; maintain your confidence and composure. You should be hopeful with regards to the success from ALLAH (SWA).

After the Exams: The candidate should keep on praying for the much needed success in this temporal life and the Hereafter. He/she should accept the exams results in good faith and aspire for more success, praising The Almighty ALLAH (SWA) for everything. He/she shouldn’t believe much of the “RUMOURS” during the exams & just before the results are released.

BEFORE YOU GET INTO THE HALL: Get a good night’s sleep and try as much as possible not do “TDB” (Till Day Break) a day to the exams, or else your brain will be fatigued. Keep a positive attitude, focusing on what you know instead of worrying about what you don’t know. Get to the exams hall at least 30 minutes before the commencement of the exams. Have ALL your writing materials ready. Don’t panic. Go into the exams hall with the believe that ALLAH (SWA) is with you to give you SUCCESS all through.

MCQs: WHAT ABOUT MCQs?

>  Say your PRAYERS before starting the MCQ session and read ALL the instructions before starting to answer.
>  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.

ESSAY (LONG & SHORT)

THE LONG ESSAY: Do not forget to pray to ALLAH (SWA) to grant you success.

>  Read ALL the Instructions before starting. Allocate TIME to each question and begin with the questions you know best. You should have an OUTLINE of how you intend to attempt the chosen questions.
>  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).
      -  List/Name/Enumerate
      -  Describe/Write the Details of…
      -  Outline
      -  Compare and Contrast
      -  Define
      -  What is meant by…?
      -  Explain

Don’t panic. If you draw blank or don’t know the answer to a question, move to the next question but try and attempt ALL questions.

TEMPLATE OF THE LONG & SHORT ESSAYS

THE LONG ESSAY

In Microbiology: For any organism, discuss your answers based on:

-  Type/Class of organism
-  Epidemiology of the dx caused by the organism
-  Life Cycle (esp. in Parasites)
-  Mode of Transmission
-  Pathogenesis
-  Cultural Characteristics (esp. in Bacteria)
-  Clinical Features
-  Diagnosis
-  Treatment/Control/Prevention
-  Complications/Sequelae

In Pharmacology: For any drug, outline your answers as follows

-  Chemical group/Type of the drug
-  Actions/Uses
-  Mech. of Action/Effects (Pharmacodynamics)
-  Pharmacokinetics (ADME)
-  Toxicity/Side effects/Adverse effects
-  Summary

In Paediatrics, O&G, Pathology, Medicine, and Surgery long essay question:

>  Introduction/Definition/Epidemiology
>  Classification/Aetiology/Causes (Congenital & Acquired). I used the following MNEMONICS for causes of diseases when I was in the medical school: TIMBED DIIID CANE...

TIMBED DI³D CANE

-  Traumatic
-  Idiopathic
-  Metabolic/Nutritional
-  Blood/Haematogenous
-  Endocrine
-  Doctors/Iatrogenic
-  Degenerative
-  Infective (Bacterial, Viral, Parasitic, etc)
-  Inflammatory
-  Inherited/Genetic
-  Drugs
-  Congenital
-  Autoimmune/Allergy
-  Neoplastic (Benign & Malignant)
-  Environmental/Cultural

>  Pathophysiology
>  Differential Diagnosis.
>  Management.
                                - History
                                - Physical Exams (General & Systemic)
                                - Investigations (General & Specific)
                                - Tx-Medical/Surgical/Radiotherapy
>  Complications (from the dx &/or Tx).
>  Staging & Prognosis esp. in Malignancies.
>  Conclusion/Summary.

THE SHORT ESSAY: Write the summary of all the facts regarding the question.

1.        Definition
2.        Causes
3.        Classification
4.        Clinical Features (Signs & Symptoms)
5.        Differential Diagnosis
6.        Management

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.

PRACTICALS

>  Prayers! Prayers!! Prayers!!!
>  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)

CLINICALS: THE LONG & SHORT CASES (The Real Litmus)

THE LONG CASE

>  You don’t need a Beta-Blocker in order to boost your confidence. All you need are prayers and not drugs
>  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”.

THE SHORT CASE

>  Greet your new set of examiners and try as much as possible to forget all that has happened (good/bad) at the long case session. Understand what the examiner wants you to do, e.g.:
                - Examine the…
                - Elicit…
                - Demonstrate…
                - Check for…
                - Look for…
                - Feel for…
>  Be systematic and thorough in your examinations and findings.
>  Be courteous to the patient.

ORALS/INSTRUMENTATIONS

>  Do not forget to pray for success. Try and remember most of the Management of Emergency Clinical Cases, the Current Trends and Topical Issues in the Medical World.
>  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?
                - Types/Modifications.
                - 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.

THE MBBS EXAMS USUALLY END WITH THE ORAL EXAMINATIONS…AND FINALLY, IT’S ALL OVER…THE SIX HARD YEARS OF MEDICAL SCHOOL ARE OVER…SO, CONGRATULATIONS…YOU HAVE BEEN APPROVED TO BE ADMITTED INTO THE EXCLUSIVE CLUB CURRENTLY PATRONIZED BY YOUR EXAMINERS.

A GLIMPSE OF THE CLINICAL EXAMINATIONS SCORE SHEET

LONG CASE

LONG CASE	UNSATISFACTORY	BORDERLINE	GOOD
History Taking
Physical Findings
Investigations
Diagnosis/Management
Conclusions

 SHORT CASE

SHORT CASE	UNSATISFACTORY	BORDERLINE	GOOD
Candidate’s Approach To the Patient
Was the Exam Systematic & Thorough?
Accuracy of Findings
Interpretation of Findings
Was the Exam Technically Smooth?

OVERALL ASSESSMENT FOR THE FINAL UNDERGRADUATE MBBS EXAMINATIONS

Examiner’s Remarks	True (Pass)	False (Fail)
This Candidate is Clinically Safe To Work Under Supervision

FINALLY…WHATEVER THE OUTCOME OF THE EXAMINATIONS:
>  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.

 WISHING ALL OF US SUCCESSFUL EXAMS HERE & HEREAFTER.  AMEEN.

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.