What’s all the fuss about?
A Dummy’s Guide for the Partner or Friend of an adult or paediatric registrar who has just been through #RACPdebacle
Your partner or friend is in tears and heartbroken because they were unable to sit the exam on Monday due to an IT malfunction. You found out on Wednesday that the resit has been organised for 10 days time. What’s the fuss all about? A resit is not the worst thing in the world and it is like a trial mock exam. Doctors seem to be doing exams all the time, why is this one any different?
When I was an intern, I thought medical registrars were amazing people – I would look up to them and everyone knew they were the smartest people in the room. If a medical registrar said something, everyone listened. They seemed eternally capable, tough, experienced, unbreakable and they were confident. Clinical medicine was a frightening world with full of deteriorating patients and in some way, those clinical attachments at medical school were not quite the same. Medical registrars were a source of calm and inspiration. They were all a bit nerdy, interested in fitness, and ranged from very stressed to mildly stressed. I knew if I was called to an arrest, a medical registrar would arrive and save the day.
Fast forward six years and now I’m a medical oncology registrar – looking back and across, I still think medical registrars are amazing people. Every registrar I know loves their job in some deep and specific way, and walks around with about thirty things they think could be done better in their profession. They work unpaid overtime, spend their weekends doing research projects, enjoy teaching their junior staff and love complaining about the college. I have enjoyed my time in specific ways and I completed my exam in 2016.
My wife is a paediatric registrar and for the last six months, I have been attempting to provide high level care for my wife as she has sacrificed time with family, her friends, her own interests in order to study for her written exam. She, along with many other trainees, sat the exam on Monday, only to find out that the exam was called off. She was disappointed like every other adult or paediatric trainee that day – the outpouring of grief and distress is evident in the Guardian, SMH, Twitter and Facebook.
Sometimes medicine can be opaque and adult and paediatric medical registrars can appear like minor demigods (or at least act like them) in hospitals so here is a rough outline as to why they might look a little bit stressed before the exam and why they are all quite stressed after the recent exam cancellation.
a) If they pass the written exam, then they become eligible to do the clinical exam which is a one day long “live” examination with real patients in another state, and being examined by multiple senior consultants on history taking, examination, synthesis and management. This is equally frightening and nerve wracking, and costs another $2000. Great candidates can fail this exam just because they have a bad day. Once again this is a sudden and expensive death situation, with the clinical exam being held only once a year.
b) If they pass the clinical examination, then they become eligible to apply for advanced training. Surely if they have survived the previous challenges then they will easily obtain an advanced training job? No. Especially in competitive fields like cardiology or gastroenterology, trainees can miss out on training positions altogether, or may have to do the first year after BPT as an unaccredited year outside of a training program.
c) Advanced training is another three year period of training in the specialty of choice and carries its own burdens of on call responsibilities, an increase in level of clinical responsibility and rural rotations as well
d) Surely at the end of advanced training, they will obtain a job as a consultant? They have just had 10 years of a series of difficult experiences. The answer is again No. At this point they will have the letters FRACP after their name, but that does not mean they will get a job. Most newly minted FRACP will likely do an overseas fellowship or a research degree and then, and maybe then, they will obtain that coveted job they have been working so hard for much of their adult lives.
If you put the above seven points together, you might come close to realising why that person you care about is going through a difficult time. This is not just another exam, this is not a simple resit – for most trainees it will be the highest stakes exam they have sat, the exam they have prepared for over a year for, and an exam that has had impacts on everyone they care about. They are on a path to becoming a specialist physician, which right now, is one of the longest and toughest paths to follow in medicine – they have jumped through so many hoops such as getting into medical school, getting through medical school, getting through internship, residency and getting a job as a junior medical registrar. And they know they have so many more hoops to jump through. To have something as simple as the opportunity to do the exam be taken away from them is deeply unsettling.
What can you do to help a trainee who has been affected by this?
My wife went through this on Monday and I was a personal witness to the months of sacrifice, preparation, anxiety, self doubt she put into this exam. It is now Thursday – the resit date has been set for March 2nd, and there has been mention of a supplementary date.
I think acknowledging the multiple and varied feelings that trainees might have is crucial
It is not as simple as “don’t be angry, move on” or “just do the resit” – if you paid attention to the flowchart, adult and basic trainees have invested far, far more than just their professional identities into their profession. This is their life and they have involved their entire support network in their decision to train to become a specialist physician. Listen to the stories, be with people and ask how you can help them.
Keeping things in perspective is important – in the acute aftermath of a traumatic incident it is almost unreasonable to ask people to maintain perspective, but in the overall scheme, finding a way through is vital.
The amount of support my wife has received from her network was excellent, and seems matched by the social media response. The loud and strong support from senior clinicians on Twitter has been astounding and I know that not all junior doctors find themselves interesting enough to open up a Twitter account so I have picked some of my favourite pieces that pave the way forward for trainees who have been through the #RACPdebacle
Chris Elliot @drcelliot Feb 18
Bethan Richards @BethanRichards3 Feb 18
Winston Liauw gives a different take on the matter and tries to find a message for trainees from an almost entirely negative experience and reflects on the consequences of poor planning in digital health and the experience of terror that trainees went through – The @TheRACP Physicians Exam Debacle as a Teachable Moment for Future Health CIOs
In short think of the BPTs around you who have been through this experience, be kind to them.
This outpouring of grief and sadness is also a good opportunity to reflect on the level of involvement that trainee doctors put into their own education, and the level of emotional commitment that junior doctors have for their training. Medicine is not a 9 to 5 job, it is a vocation, it takes over our lives at least temporarily, and each of us makes sacrifices for it. This RACP exam failure has accidentally shown everyone, albeit briefly, just how significant the sacrifices are – this outcome is not just a result of the IT failure on Monday, but also the way the examination is set up and the nature of our training. Would there have been this reaction if the exam was held four times a year? Would this have been the reaction if the examination did not cost each trainee $2000? Would this have been the same reaction if junior medical registrars had less stressful roles? We should hold on to this moment, look at it carefully and use it to advocate for positive change to make it easier for future junior doctors who will think about becoming a specialist. For now, when you see that medical registrar who has just been through this experience ask them how they are going. We are trained to show empathy to our patients but we are not trained to show empathy to each other, and this is as good a time as any to start practicing this. For the adult and paediatric trainees who have been through this experience, know that there is a significant amount of awareness about mental health issues and medical registrars, and know that there is support all around you.
Director of Physician Training
Your Advanced Trainees