Basic Physician Training Survival Guide
BPT is a challenging time for trainees, but there are ways of making it easier on yourself and there is an end in sight. A consultant reflects on this period of her life and offers four points of advice to those about to begin or currently in training.
At the outset I want to make it clear that I did BPT in 2015-2016, well before the covid pandemic. I have no doubt that there are greater pressures on basic trainees going through the process now. I also sat the paper written examination, which, I understand, can be a different experience to that of the computerised exams. Finally, I admit that I am privileged, managing to get through BPT without personal illnesses or pressures from other spheres of my life. I did my BPT years in a supportive, though new, BPT network. Thus, while I did not have the best lectures series, I did have excellent peers and a supportive Department of Medicine. I am aware that many do not have these advantages. With these caveats in mind, what follows is the best advice I can give for doctors about to start BPT.
Your seniors have an obligation to support and teach you
Once, at a stroke call, I told a consultant about a patient without even mentioning the timing of the onset of the patient’s symptoms. Frequently, I jumped to my conclusion about a patient, mentioning to the consultant one or two examination findings, without even introducing who the particular patient was. Luckily my first term was in the geriatrics department and the consultants there were very patient.
When I first started basic training I felt uncertain about every patient I examined. I questioned every impression and was wracked by nerves as I spoke to my senior registrars and consultants about my assessments. This is normal. I used to worry frequently about doing or saying things that would make me look stupid, or that I lacked flair and initiative, and I would get tongue tied as a result. I’ve learned since that it was not my responsibility to make decisions and treat patients on my own.
Now, as a consultant, I know that consultants will always prefer a registrar who asks questions, asks for help and communicates. The “bad” registrars are the ones who are over confident and unaware of their limitations, who make decisions without communicating. After about 6 months as a registrar, I noticed I felt a great deal more comfortable and more confident doing basic things and anticipating decisions on my own. It is a stressful transition, but ultimately worth it as you find yourself becoming a better and more confident doctor.
Studying for the basic training exams is nothing like medical school, where, if you are diligent enough - after all, there are many demands on your time in these years too - you are able to study every single thing on the curriculum. And each person does things their own way.
I have friends who got through without study groups and one who tells me he only started studying three months prior to the written exam. If you are a regular person like me, not a genius, then I would suggest making a clear study plan from the start of BPT, borrowing resources from previous candidates, and working with a study group, pooling notes (you will struggle to write all your notes yourself). At the same time, work to your strengths and keep in mind that your best learning style may be different to that of others. Some of my friends learn by listening and find reading and writing difficult.
My listening skills are hopeless and, to remember anything, I need to write and to look at pictures and diagrams. I would study high value materials only. Closer to the exam, for example, I mainly studied from the “study course” notes, as these were much more compact and manageable than the reams of poorly collated lecture, short course and study group notes I had collected.
Practice multiple choice
I did not realise how poor my multiple choice technique was until I started practicing, using two methods: first, my study group and I went through past questions, and second, I utilised question banks online, such as the fracpractice page. When it is not possible to know everything that may be asked (and it isn’t possible even for geniuses) MCQ technique can easily be the difference between passing and failing. I know for me it made a huge difference, with my rate of success on practice questions jumping drastically over time regardless of my knowledge base.
Look after yourself
I think as doctors we like to be goal directed and we have always got where we wanted to by “pushing hard enough”, but life is short and as registrars we preside over so much death and grief that it is especially important that we remember to look after ourselves. During written examination preparation, for instance, I took one evening per week to do a sewing class, to at least take a break from medicine. Eating meals can be difficult on the wards, but I always made sure I had something available to eat and enough water to drink. I find a good reminder that helps me to set appropriate boundaries is the question, ‘If I were to live my life over, would I want it to go the exact same way?’
Of course, to get through BPT and take that step closer to becoming the doctor you want to be, sacrifices need to be made, but these exams are not worth sacrificing your mental wellbeing. Remember, although the written and clinical examinations are technical requirements of the training, they are not definitive measures of your skill or value as a doctor.
These exams are “high stakes”, they have an impact on your career trajectory and your life, but at the same time, all my friends who have not continued BPT have found other paths they are happy on and those that failed exams the first time, who took a break or who took longer to get through for various reasons are content with where they have ended up.
As registrars, we deal with many distractions and difficulties - from workplace politics to the inevitable friction that occurs when people are overworked, stressed and exhausted. As a new consultant, however, I can tell you that finishing training is liberating - you are no longer subject to what can seem, and often are, the whims and flaws of sometimes mercurial supervisors, and though you still, from time to time, find yourself in difficult situations, you have more freedom to stand up and leave a particular situation if you decide it’s not benefiting you.
BPT is stressful but it is transient. You will work hard, but you will see your knowledge and skills advancing rapidly as a result and, I believe, you, like me, will find that the effort is ultimately worth it. Your group of fellow BPTs often become some of your closest friends for life. It may not always feel like it, but by stepping up from resident to registrar, you get to take a more active role in helping the patients you see. You will get to lead the conversations and have a direct role in choosing the tests and treatments. Getting on top of the evidence and finding yourself informing consultants of the latest studies can be exhilarating and rewarding. In the end, you will have an excellent grounding in general medicine which will equip you for the next step on the journey as an advanced trainee. If I see you around, I will shout you coffee. We can sit and reminisce about what will most likely be a distant memory.
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