By Iqbal Kahn
If you ask many people, “How long does it take to train as a doctor?”, the response would probably be five years. And many people joke that it takes longer to train as a vet than a medic! However the simple answer is that a doctor is always training in one form or another, and that as medical professionals, we should always be striving to be the best.
A new, common training structure brought in in 2007 sees doctors completing an arduous five to six years at medical school, before starting their careers on the wards proper. This entails a series of placements spread across two years designed to introduce them to the different fields or specialties within a medical career.
Next follows a period of up to eight years of training within their chosen specialty. During that time, doctors are faced with attaining membership of their chosen Royal College. For example, paediatricians must become members of the Royal College of Paediatrics and Child Health by completing a succession of written and practical exams. Only then do they become a consultant.
These exams are extremely challenging and test the candidate’s medical and scientific knowledge. The pass mark is set so that less than 50% of candidates sitting the exam pass and only the best prepared and the brightest ones will get through. Over the years, I have met many excellent doctors who have failed to progress into their chosen careers because they stumbled at this hurdle too many times and eventually gave up.
Each exam can cost several hundred pounds to sit, and most candidates will need to take three exams across this stage of training. Coupled with the very real chance they’ll need to resit their exams, the investment can run into several thousand pounds, on top of the debt they accrued whilst at medical school.
However you could argue that whilst these doctors are cash rich, they are definitely time poor. Alongside their studies, doctors are still juggling their 48-hours per week work commitments. Draw the short straw on your rota, and you could face an exam at 9 a.m. at the other end of the country, in the middle of a week of night shifts.
Given these challenges, it’s not uncommon for candidates to revise for up to four months in the lead up to their exams. Approaching exams in the same professional manner in which they deal with patients on the wards is critical. Everyone has a preferred learning style, but practising suturing skills with your partner may not be entirely practical! So in the lead-up to the exams, many candidates will prepare by answering hundreds, if not thousands of questions, using books and online materials.
The exams themselves are timed and long! Depending on the specialty, candidates can be expected to answer in excess of 100 questions in four hours — tough going when you need to carefully read, assimilate, and then make a clinical judgement on the information you’re presented with.
We expect our doctors to be just as competent at the ‘softer’ skills too. The patient-focused exams test candidates’ abilities to ask the right questions, give the right answers, but most importantly offer the patient a treatment and management plan that is bespoke to them. We focus a lot on ‘outcomes’ in healthcare, but we should always remember that the outcome is what the patient wants, and not necessarily what we feel best.
The UK has one of the most rigorous approaches to medical training and I’m pleased that that’s the case. We are clear in our expectations of doctors, and we do expect a lot of them, but it means that we get only the best working in the NHS.
Iqbal Khan is a Consultant Gastroenterologist and General Physician at Northampton General Hospital. He is also an Honorary Lecturer with the Universities of Leicester and Oxford. He has written two textbooks for candidates preparing towards the MRCP(UK) exam and is a Moderator for the PASSit online revision website, from Oxford University Press.
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