Ask any cyclist what their ‘routine’ is in the run up to a race and you’ll likely be there a while as they carefully recount the day-by-day, minute-to-minute strategy to ensure they’re set up for the best possible performance on the day. Nothing gets forgotten, be it training, food, sleep, clothing – you name it, a cyclist has tweaked it to beyond-neurotic perfection. While they don’t usually require figure-hugging lycra and obnoxiously fluoro sock choices, I strongly believe that a lot of the same principles seen in bike racing can be applied to examinations, as they are essentially the equivalent of a bike race for your brain. So here is my 6 part breakdown on how to prepare for that all important event, and get the most out of that spongy brain-muscle between your studious ears…
Train how you race
There’s no point doing lots of long, gentle mountain riding if the race involves a short, high intensity blast around a velodrome; you have to ensure you’re training your body for the physical requirements on the day. Likewise, if your examination is going to be a series of multiple choice questions, you should practice doing questions rather than just reading through blocks of material in prose format. Of course you’ll need to read and learn the relevant information, but if you use MCQs as a reference, you’ll see the sort of patterns that pop up, and learn to process the information in a way that anticipates the questions that might be asked of you on the day. If your exam is an essay paper, practice writing essays under timed conditions, in the same format, with the same pen, long in advance of the exam. You’ll be surprised how tired your hands get if you’ve not written a complete essay all year and suddenly you try and do three in an hour on the day.
Don’t overdo it
My guess would be that almost every cyclist at some point has fallen into the trap of overtraining. The sport is enjoyable, addictive and it’s very easy to assume that more training means more improvement. However the gains in your performance happen when you’re resting, allowing your muscles to rebuild and strengthen. Ideally you’d be sleeping all the time you’re not riding or eating…
The same principles apply to revision. Your brain uses its down time, particularly when asleep, to subconsciously sift through the material covered during the day and consolidate the useful information into its long term memory. To make your revision worthwhile, you’ll need to ensure you’re getting enough sleep to reap what you sow, so it may be a good idea to put the pen down a little earlier and get some well earned kip. This is doubly important if you’re doing exercise as well, which you should be!
Get your food right
If you put sludge in your car, it’s not going to run very well. If you try and win a bike race on KFC and doughnuts you’ll be sorely disappointed, and probably rather ill at the end of it. Equally, if you try and work your brain overtime in the weeks before the big day, and don’t give it good fuel to use, it will burn out very quickly. Having a tub of chocolate mini-bites next to you while you work may give you a little ‘lift’ every time you have one, but it is doing your concentration, memory and general health no favours in the long run. Fill up on good quality veg, oily fats and really complex carbohydrates and your concentration, endurance and performance will all speak for themselves. You may feel that you don’t have time to cook a ‘proper’ meal, but I promise you – you do. Not only will the break from revising give you a motivation boost, but concentrating on your food will make you feel fuller and stop you snacking between meals.
Coffee – this was almost worth a post in its own right. Caffeine has proven to be a powerful performance enhancer both physically and mentally, and is thought to have numerous health benefits that I won’t delve into here. Essentially, the best thing to do is work out just how much is right for you; be it none, a little or a lot, and keep it there. Don’t go overboard in exam term. If you think you’re over-tired and the coffee is no longer enough, it means you need more sleep, not more caffeine. On the day, have the same amount as normal – it’s what your brain is used to, and the smell of the coffee will trigger memories on a subconscious level too (Google ‘state dependent learning’ for more info).
In the weeks running up to a big event, different cyclists will do their own things, but in general the weeks immediately prior involve a lower volume of training to allow the body to be as fresh as possible on the day when it matters. That definitely doesn’t mean doing nothing at all in the week before, rather just doing enough to tick things over and stop them going stale. The same goes for revision – you don’t want to be cramming until five in the morning and then turning up to sit the paper exhausted and demoralised. I usually work fairly solidly up until two days to go, then on the day before I take it easy. I’ll do some solid exercise, and a bit of light reading, but generally let my brain rest before the event. I’m always tempted to sit and cram, especially when I see other students working, but when I’m sat in the exam room, I’m always more grateful for the rest than the extra information on the day before.
It’s hard to stay motivated when revising, especially for medical exams with their seemingly endless quantities of information and undefined syllabus. But keeping up your motivation is key to productive work – you will process the information more effectively and it’ll stick in your memory for longer. When I feel my own motivation slipping, I like to write down as many reasons why I’m sitting that exam as I can think of. Usually it’s enough to get me back on track and keen to work, but if it doesn’t, there are always fantastic motivational videos on YouTube to get you in a productive mood!
On the day
It’s show time. Exam day routine is a personal affair that everyone does differently. Some rise at the crack of dawn to cram last minute information that may be of use into their short term memory, while others saunter into the exam room at the last minute having just woken up. Find what works for you, and commit to it. Personally I don’t like to do any extra work on exam day, to leave my brain as fresh as possible for the task ahead. I have a big breakfast, a couple of coffees and then try to relax as much as possible before the inevitable onslaught begins. After the exam, forget about it, if you can. It’s easier said than done, but it doesn’t help anyone to sit there dissecting what happens; partly because it serves only to stress people out, but also because you’re likely to misremember questions or answers that you gave, even if only slightly, that can lead you to thinking you got things wrong when you didn’t. So chill out, and enjoy a well-deserved rest!
The dreaded ward round began at 08.30. You were buzzing, coffee swilling warmly through your veins, notebook and pen at the ready; a diligent student of a glorious vocation ready to learn. It’s now 09.15 and you’re stealing guilty glances at the clock, your weary eyes sliding down to your crumpled patient list to see how much more of this ordeal you must endure. A mortifyingly audible rumble emanates from your midriff as the consultant falls silent to listen to another wheezing chest. A whiff of barrier cream tickles your nostrils and you feel that all-too familiar wave of disappointment wash over you as you realise the round is less than a third of the way through, complemented by a trickle of frustration at the dogged determination of the patient that just won’t stop asking questions about their management. You watch in awe at the junior doctors relentlessly scribbling away in the notes, rifling through drug charts like finely-honed machines, occasionally handing you snippets of useful information and asking ego-destroying questions like ‘can you name the 27 causes of clubbing…?’
How do they survive these things? How are they not starving? Are they even human?
A Game of Endurance
Ward rounds are like marathons. They can last anything between two and seven hours depending on how quick you are, they require uncomfortable amounts of time on your feet, a large proportion of which is spent wondering why anyone would do this out of choice. They also both require training; you need to allow your body and mind to build up the endurance required to survive, and hopefully succeed. Over the last three years I have found a few things that really helped me get to grips with ward rounds, making them more interesting and less soul-destroying, so I thought I’d share:
Get your food right
This was probably the most important change I made to my routine. A friend of mine used to down an espresso and a pain au chocolat each morning before turning up to ward rounds. Her fifty shades of beige frenzy of sugar and quick-access caffeine ensured she was a veritable Goddess of concentration for approximately thirty-eight minutes, before the inevitable crash came and she joined the rest of the zombies trailing the age-defying consultant who seemed to have it all impossibly together. Sugar is cheap, feels good, tastes good, and certainly boosts cognitive and physical performance in the short (very short) term. But it provides very little useful nutrition, and certainly isn’t going to last long enough for a full ward round before you’ll need a top up. I found that by having a much bigger breakfast with a lot less carbohydrate, I was able to concentrate for longer, felt less groggy at 11.00am and didn’t need to eat again until at least 2pm.
- My pre-ward round breakfast:
- 6 Eggs
- 1/2 punnet Mushrooms
- 2 Veggie sausages
- 1 piece of toast
- 1 Big Coffee with milk (the fat in the milk absorbs the caffeine, giving you a slower infusion, rather than a kick)
- My pre-ward round breakfast:
Set yourself specific goals
Try not to just turn up to ‘do the ward round’ because you’ll end up bored, demoralised and probably won’t learn a whole lot. Set yourself a specific thing to do, and ask the consultant if it’s alright beforehand, and you’ll take away so much more from the experience. Having a specific job to do should keep you interested and will also let you be a useful part of the team. Ideas include:
- Ask to see one of the patients later in the ward round, and be the one to present to the consultant when they get to that patient
- Write in the notes for two or three of the patients (just make sure you get them countersigned)
- Be the ‘drug chart checker’ for that round (look for kidney busters and blood pressure tankers…)
- Check that every patient has got VTE prophylaxis
- Listen to at least one bubbly chest
- Check every patient’s catheter
Don’t stay for all of it
I’ll caveat this with the following: there is the occasional consultant that expects all of his medical students to attend all of his ward rounds all day of every day. There isn’t much you can do about this except upgrading your breakfast and hoping for the best. Most consultants nowadays however have a more relaxed attitude towards quantity of round attendance as long as it’s good quality, and you’re not just doing nothing the rest of the time. If you ask beforehand “May I join for the first half of the round, and then read up about the topics?” there is a good chance they’ll agree. They may even give you specific patients whose conditions would be good to read about. You can then concentrate hard for the first few cases, knowing that the end is near…
- This is especially useful in third year, when many of the topics are completely new and quite daunting. See two or three patients, and then go read about their conditions, using them as your ‘model patient’ for that condition.
- As time goes by and you become more experienced, the rounds will become easier as you get used to their ebb and flow. Checking observations and drug charts becomes routine, and you start understanding why the consultant is asking the specific questions that they do.
- It’s good to see the same patients on consecutive days or a few days apart, to see how they progress and how their management changes. It’s a very different experience when the patient recognises you and smiles.
Ask the consultant to grill you
This one is strictly optional. I’m one of those people who likes being put on the spot in front of the ward round and grilled for a response to questions I could have never have hoped to answer. “…Er…why?…” – because in that moment, when the adrenaline is scouring the lining off the inside of your arteries and your shirt becomes eerily moist, your brain goes into survival mode, slowing down time and remembering everything. I find it’s the most efficient way to learn – get grilled on a topic once, and not know the answer, and you’ll never forget it again! Just remember to breathe afterwards.
Hopefully these are of some use, they were certainly my main strategies for surviving the rounds. I’ll add more as I think of them, but if you have any top tips for fellow med students out there, please comment!
Fail to prepare, prepare to fail. Preparation is key in a lot of situations, and Medicine as a whole is one of those situations. Having a solid plan, thinking it through and making sure you have everything ready beforehand will save you a lot of trouble. A good way to do this is through visualisation of the procedure. When I get kit ready for cannulating, I picture myself applying the tourniquet, finding the vein, cleaning with the swab, putting some gauze just distal to where I’m going, inserting the cannula (with or without taking bloods from it), removing the tourniquet, applying the flush and then sticking it down with a dressing. While doing this, grab the equipment for each bit as you think of it, and always take a spare cannula!
You only ever forget a flush once…
Like it or not, as a medical practitioner people are going to take what you say seriously. They will look to you for advice and reassurance during their most vulnerable moments, and will often follow exactly what you say to the letter. This means you have to be careful about what you say, and how.
Advice must be grounded in evidence, explained in understandable terms, with an idea of where to find further information should they forget what you’ve said later on. At home the patient is their own medical practitioner, so just as you’d hand over to a fellow clinician, they must be absolutely clear on the management plan. Your tone should be kind, non-judgemental and should demonstrate that you genuinely care about the person’s question. Instructions should be clear and complete – assume the person receiving the information knows absolutely nothing – and include a safety net for ‘if it gets worse’
(if it doesn’t go away in 3-5 days, see your GP is a fairly good one…)
Reassurance should be given where appropriate. There is always the desire to provide relief for parents and relatives from the anxiety of not knowing what is wrong, especially when a simple ‘It will all be fine‘ would instantly make everyone in the room feel better, however raising expectations in the face of a poor prognosis is going to hurt everyone a lot more down the line, so don’t jump straight in with grand reassurances unless you know they’re warranted.
Having said that, patients and relatives will often worry about things that you wouldn’t think of, so asking them if there is anything that needs explaining is always a good idea. I recently saw a paediatric patient being intubated for refractory seizures. She was completely stable on the ventilator, comfortably asleep, with reassuring vital signs and a promisingly normal CT scan. However her parents, who were NEWSing higher than their baby daughter, understandably interpreted ‘medically induced coma with a machine to help her breathe‘ as a bad sign.
As soon as the anaesthetist asked their concerns, and explained that they could wake her up at any time – this was just to keep her comfortable and free from seizures while they figured out what was going on – they immediately relaxed,
“Oh, well that’s not so bad…”
There was no false reassurance, no optimistic guesses at what the diagnosis might be; just a simple explanation of what was going on, that she wasn’t in pain, that the beeping alarms were just a reminder the infusion was nearly done, made a huge difference to that family’s experience.