Dr Rukshana Latiff

You might have thought that you were done with OSCEs after passing finals but here you are, facing yet another clinical exam. The flashbacks of being examined as you interact with role players, and the nerves and palpitations you felt are all too familiar. You are not alone! The good news is that this isn’t your first rodeo, and while the stakes might feel higher, are they really? You passed finals and the MRCPCH clinical exam is not that much different. You now have the chance to learn and improve through these exams and to become a better doctor. We say, challenge accepted! Let’s ace these clinicals together!

We have compiled some tips and advice to guide you through:

1. Plan ahead 

Consider when to start revising for your exam. Earlier is not necessarily better, so start when you feel comfortable. You could begin with sporadic reading of books and steadily progress to practising daily, but there is no specific formula for success. You don’t want to start too early and burn yourself out, but equally you don’t want to run out of time.

2. Have a revision strategy

Think about how you tackle the seemingly endless list of revision – you will want to think about each type of station and plan accordingly. You might want to go about it in a system-based manner, listing down the history taking questions, the possible examination findings, the differentials, key investigations and management plan. To prepare for a video station you could watch multiple videos and practise answering questions, whereas for a development station, choose a developmental stage, memorising it, and writing it out within 3 minutes will help you focus your approach on exam day. There are loads of ways to study and prepare, just experiment a little and find one that suits you. If you find a study buddy you can prepare revision or mock stations for each other too!

3. Get yourself a study buddy

About that… have a friend who you can revise with. Even if you feel that you revise better alone, passing something like clinicals requires someone to observe you and give you honest feedback. Plus there’s the bonus of having a friend to vent to about exam stress! It is also comforting to know that someone else is going through the same thing as you are. Practice your presentation of a case and rehearse your spiel on investigations and management plan – you will learn and develop so much more when you get constructive feedback from another person.  

4. Keep your eyes and ears open

Every interaction with a patient, parent or colleague is a new opportunity to learn. Treat each encounter like an OSCE; look out for clinical signs, think about your communication and try to develop rapport. Observe your colleagues and think about the skills they have that you want to adopt or emulate (or avoid!) in your own practice. Though there are only two stations solely for communication, your soft skills are being assessed all the time! 

5. Do not compare yourself to others

That being said, we all do things differently, and it can be difficult not to compare yourself to other people negatively, particularly when revising together. Focus on your own growth and concentrate on your improvement. Being inspired by someone could motivate you to do more, but comparing yourself with someone will only add more pressure, unnecessary stress and feeling overwhelmed.

6. Consider attending a revision course

There are opinions about which is the ‘best’ course to attend for MRCPCH revision. Honestly, they all have a similar agenda; a case-based approach reviewing findings of both ‘common’ and ‘weird and wonderful’ cases. They can be quite pricey, so factor this in (and whether expenses and study leave are an option for you). However please remember there are plenty of trainees who excel in their exams without having attended the paid courses. Lots of training centres also put on local mock sessions, so ask around.

7. Book study leave early

Be aware of your local study leave booking system, and if you are planning to book days off to revise make sure to request the days off that you want well in advance. If you have a rough idea of when and how you plan to revise, this could help you optimise your leave requests. Also get your leave requests for the day of the exam in as early as you can. Exam leave is something you are entitled to but if there are lots of you on the same rotation taking the same sitting it helps your department plan ahead.

8. Be confident!

Facing and acing clinical exams is an art. It’s true that you need knowledge to get through it, but you also require a systematic structured approach. It is not always about knowing what specialist metabolic investigation needs to be done, but in knowing when to escalate and who to refer to. All the exam is testing is your ability to be a safe doctor. You have gotten this far in your career, have faith that you are aware of your limitations and know how to ask for help. In short, this means that you are already capable of passing the exam!

9. Remember to breathe!

Unless you live locally, consider travelling the day before to help prevent any unnecessary stress. Dress in smart but comfortable clothes, and don’t forget your stethoscope (I know someone who did!). Don’t worry about taking bottles of water/pencils/paper/watch with you, the centres have water and writing equipment ready and clocks in every room. Once the exam starts, read the clinical brief carefully – there might be important clues in it, and once you are in the station keep your eyes open. There might be clues lurking around the examination room that can help. There will be door knocks/bells rung to inform you of timings of the station (you will receive a briefing on the exam day) and when you finish a station, smile at those around you and to yourself and move onto the next one. Fresh eyes and mind all over again. You can do this. 

10. Keep calm and move on

Once you are done with your exams, let it go. Debriefing it with your colleagues might help, but there is no point in over-analysing everything that was said and done during the exam. Patients and role players are human too. They might report or do things differently whilst interacting with different clinicians. You are getting marked on your logical reasoning based on the information given to you whilst YOU were in the station, not based on comparing you to other candidates.

You have gotten through the examination successfully. Success is not merely determined by your score in the exam, it is the entire experience that denotes your success. Your results depict your performance at a singular point in your life, and you will continue to grow from it. We wish you all the best in your exams and future career – now go and ace it!

There are lots of resources available on the internet. Here are some of the ones the author used (in no particular order):

• Bedwani, S. J. (2016). Mrcpch Clinical: Short cases, history taking and communication skills. Pastest Ltd. 
• Casans, L. (2011). Communication scenarios for the MRCPCH and the DCH clinical exams. Radcliffe. 
• MRCPCH Clinical Exam Revision | Free revision guides, examination videos and common cases for the MRCPCH Clinical Exam. (paediatrics.co.uk)
• Paedsprep – Your MRCPCH revision partner.
• Pass MRCPCH – London Paediatrics Trainees Committee – YouTube
• Dragon Bytes Paediatric PodcastDragon Bytes Paediatric Podcast 

Author: Dr Rukshana Latiff, University Hospitals Birmingham. Edited for PaediatricFOAM by Dr Sarah Walker