How to prepare for your clinical exams

You may well make an excellent doctor but this does not always mean you perform brilliantly in exams. Unfortunately, clinical exams are a necessary and inevitable part of becoming a doctor – knowing how to prepare for them is key.

Getting started

You may well make an excellent doctor but this does not always mean you perform brilliantly in exams. Perhaps you get very anxious before the exam, perhaps you spend too long revising topics in too much detail, or perhaps your exam technique is the problem.

Unfortunately, it is a simple matter of fact that in order to become a foundation year 1 doctor you have to satisfy the medical schools’ requirements by passing clinical exams. In simple terms, you have to demonstrate that you will be safe and competent when you start working as a doctor. You don’t need to know how to perform a total hip replacement, but you do need to know how to recognise and initially manage both common and serious conditions.

Before you even start revising you need to know the basic details about the exam(s).

  • Where and when is the exam?
  • What do I need to revise and what depth of knowledge is required?
  • What is the pass mark and how is this calculated?
  • How do I achieve honours/distinction?
  • What do I have to do in order to fail the exam – ie if I fail the basic life support (BLS) station will I fail the whole exam?
  • What happens if I do fail the exam? Will I have to re-take it?

Then you need some details on the actual exam(s) in question.

  • What is the format of the exam / Objective Structured Clinical Examination (OSCE)?
  • How long do I get between, and at, each station?
  • What are the examiners looking for at each station?
  • Is there a checklist I need to satisfy in order to pass?
  • What equipment can I bring into the exam?
  • Will I be provided with a stethoscope or ophthalmoscope if I need one?

Past exam questions and topics

Some medical schools may publish past exam topics or past questions. Use these not only to test your knowledge, but to gauge the depth, level and breadth of knowledge that is required.

Several major companies have online banks of questions available for a subscription free. They are typically most useful for multiple choice questions (MCQ) / extended matching questions (EMQ) / best of five (BOF) type questions, although they sometimes also have long answer questions, as well as radiology or clinical image ‘spotter’ type questions. The level of difficulty can be highly variable and the format may be different to your medical school exams. Even so, they are usually fun to do and you will be sure to pick up some (possibly random) knowledge along the way.

Revision courses

There are also numerous commercial and not-for-profit companies offering finals revision courses. These can be expensive, and remember – the content is unlikely to be solely directed towards your medical school exam.

However, these can give you a good grounding of the basics, highlighting need-to-know information that is pivotal before foundation year 1, and can give you a welcome confidence boost if you find you already know most of the knowledge. Do not go over the top on courses; one medical course and one surgical course is certainly satisfactory.

OSCE exams

All OSCEs will have ‘patients’. These might be acting fellow medical students (who you recognise!), professionals acting as simulated patients, or, most common for finals, real patients. Don’t be put off! Simulated patients (and medical students) may be very good at acting, and just because they are not ‘real’ patients it does not mean they won’t have had medical conditions or operations. For example, keep a look out for appendicectomy scars, C-section scars, crepitus in knee examinations, or wheezy chests in asthma, to name just a few.

Some people like to revise by themselves, some with other people. Working with friends not only allows you to share knowledge, ideas and exam tips, but it is also an enjoyable way to split up the day. Examining each other also allows you to see how other candidates present themselves in an exam situation.

Getting some good clinical exposure prior to clinical exams is a must. You must be familiar with the common (chronic/stable) conditions which you are likely to see in clinical exams – COPD or heart murmurs for example. If you are friendly, the large majority of patients in hospital are more than happy to talk and be examined by medical students. Acute medical/surgical units are a very good place to do this.

Do your history, examination and management plan, then compare this with what the admitting doctor wrote. Morning, evening or weekends are probably the best times to do this, when visitors and family are not around.

Before the exam

It’s natural to feel nervous before a big exam, however, you can be sure you are not the only one feeling the pressure. If you feel exam nerves are affecting your performance, go and speak to your dean or supervisor.

Don’t overload yourself with complex information either the night before or on the day of the exam – it’s impossible to revise the whole of medicine, and this is only going to make you more anxious.

On the day, make sure you leave plenty of time to get to the exam and have a back up plan if the car/train/bus breaks down.

If you remain calm and confident, have done your revision and know the basics and common topics, you will be sure to perform well. You might even come away feeling as though you quite enjoyed the exam! After all, a typical OSCE with a mixed bag of histories, examinations, skills and communication skills is not so different from a typical session in A&E.

Dr James Goodman BSc (Hons.)

MBChB, foundation year 2 doctor 

Acronyms

  • OSCEs – Objective Structured Clinical Examination
  • BLS – Basic life support
  • MCQ – Multiple choice question
  • EMQ – Extended matching questions
  • BOF – Best of five question format