Human beings don’t like to fail.   Doctors are terrible at it.   Postgraduate exams are often the first exams Doctors have ever failed.  That’s hard, especially when that failure is linked to your self-esteem, professional image, and livelihood.  But sometimes, the strong emotions that accompany failure, stop us from taking the time to consider why we may have had that outcome in the first place. Consequently, we habitually reattempt for success without reconsidering our approach – which can often lead to an unchanged outcome.

I won’t pretend that I, in any way, understand how those of you that weren’t successful in the AKT and KFP are feeling at this moment – I’ve only ever failed one exam in my life (my practical driving test – for not putting my seat-belt on) – and I was devastated.   As a GP and Medical Education expert, I can give you some suggestions that might help for the future.

When I was looking for alternative words to replace ‘exam failure’ I found ‘false step or start’ which is an interesting descriptor – making a false start in a race doesn’t mean that you can’t win – you might just need to start in a different lane, change your technique, find a new coach, or improve your fitness.

A false start doesn’t mean that you’re not good at sport – it may just be that this race isn’t the right one for you.  But, if you keep making false starts you can unfortunately be disqualified.

What do we do when a patient keeps coming back with the same unresolved symptoms?

We try a few alternative treatments, consider other management options, whilst at the same time re-enquiring as to their initial symptoms, checking for red flags, and safety-netting.   If the patient is still not getting better, we usually go right back to basics – retake the history again, re-examine, review the results of any investigations, perhaps read around the topic – and then reconsider what might be going wrong.   If we still can’t work it out, we ask for a colleague’s insight.  This approach works for reattempting the exams as well.

Let’s answer a comment question first – should I appeal?

The simple answer is ‘no’.   It is heartbreaking to miss the mark but 0.xx% but remember this mark discrepancy  is not one incorrect answer, it represents multiple small incorrect answers over several questions.  The RACGP invests considerable time and resources into ensuring that the exam meets validity and reliability standards, and that marking and reporting of results is accurate.

The appeals criteria are strict and are explained in the RACGP Fellowship Pathways Appeals Policy.

The Appeals process has two steps:

1. Reconsideration – to be submitted within 10 office business days of results notification. The fee is $1000.00.
2. Formal Appeals Committee hearing – must be submitted within 20 office business days of notification of a Reconsideration decision. The fee is $4000.

Grounds for an appeal are:

1. The original decision was inconsistent with RACGP policies;
2. Provided information was not appropriately considered at the time of the original decision.

The Appeals Guidance document can be found here.   Essentially, unless you have clear evidence indicating that your exam result is inconsistent with RACGP policies, or examination information was not considered, then your Appeals application will likely be declined.

I don’t know why I didn’t pass?

I’ve been working with doctors having difficulty with exams and in GP training for a long time, including researching and publishing on the topic.   The reasons for having difficulty fall into three categories:

Knowledge

• Poor baseline knowledge.
• Not enough study.
• Not studying the right things.

Skills

• Superficial learning – cramming, studying using the wrong techniques, learning resources verbatim.
• Not contextualising knowledge, i.e. how to apply it to patients.

Attitudes

• Lack of commitment to General Practice as a career – this has been documented in research as a contributing factor.
• Personal issues affecting the capacity to study.  This is a big one and often underestimated.
• Believing that the exams are ‘bad’ and ‘unfair’.

Reference

There is also the belief that ‘without having an FRACGP you will not be a good doctor’.  This belief can impair how you reassess your situation and make a ‘Plan B’.

Now I know that the last sentence will have some of you thinking – and that’s what I had hoped!

Gaining the FRACGP will make you a better GP, but you can still be a good doctor without it.   Many of the doctor’s that I work with, have re-attempted the exams over and over, engaging in a new course of study between each attempt, and the outcome remains the same.  They have the added burden of ‘study fatigue’ as they have been studying for many years, in addition to poor self-confidence and lack of self-belief due to constant failure.

If you keep doing things the same way, you will get the same result!

So how to decide what to do next?

Re-attempting assessments needs to involve structured decision-making, so here’s what I suggest.

• Give yourself time and permission to think about the situation.  Be kind to yourself through the process.
• Consider if you might have study fatigue and where your confidence is sitting – address these two things before taking any next steps.

• Write your decision down and the reasons that support it.   Share with a colleague or mentor.  It can be useful to discuss the situation with someone not involved in medicine too.   Consider speaking with a psychologist, Medical Educator or Medical Career counsellor.  Having a chat to your GP is a good idea too!
• Based on your decision – MAKE A PLAN – and stick to it!

Plan A – Reattempting Assessment

If you decide to reattempt assessment, the subsequent attempts often become pivotal to life and all encompassing.   Be careful not to lose the ‘balance’.

Believe in the validity and reliability of the exam as an indicator of clinical competence – if you don’t believe in the end goal you are trying to achieve, your heart won’t be in it.  Make sure you have not skipped the basics, for example looking at the structure of the exams and how these should be approached (The RACGP Exam Support Online Modules).

Be positive – you are still a good doctor!  Learn and teach on the job – this will help you identify areas that you understand less well or have good knowledge in, but difficulty applying in context.  Approach learning deeply – problem-solve and relate facts together.

If you’ve decided to repeat the exams, persist but change your approach!   This approach can be influenced by other significant factors such as limitation of training time (for GP Registrars), AHPRA Registration, and Provider Number eligibility.   If you’d like more information on options for working and training in Australian General Practice then my recent blog explains the options.

Most importantly, make sure you have a good coach, friend, mentor, colleague, supervisor and all the above if you can, to support you through the process.  Consider the Professional Enrichment Program which is a confidence coaching course especially designed for Doctors having difficulty with the GP assessments.

Plan B – Career rethink

Many doctors have not considered a Plan B, and the fear of ‘what happens if I fail again’ can be paralysing for personal and professional planning and progress.   Difficulty in passing the exams may be a sign that you need to look at your medical career through a different lens.

There are several great Facebook groups that explore career options for doctors including Creative Careers in Medicine  and Non-Clinical Doctors Australia & NZ.  These groups can open your mind to the variety of careers available.   There may be other factors influencing your performance that you can’t change right now (e.g. health matters, family or other stressors).  GP may be the right career for you, but it may not be at this time.

Whichever plan you choose, make sure you do so through a clean lens.   You may not want to be in this environment right now, but the reality is, you are.   Allow yourself the opportunity to stop and reassess the situation – remember that it is just a ‘false start’.   Brush the dust from the glasses and give yourself some time to refocus on where you are going, how you are going, and what is the best way to get to where you’d like to be.

You’ll may be surprised at the view you see if you allow yourself the opportunity.

GP Support Services (free, 24-hour, confidential counselling services):

• Doctor’s Health Advisory Service
• RACGP GP Support Program

References:

Harry V., Bethelmy A. (2007).  Failing postgraduate exams.  BMJ: British Medical Journal, 335s:200

Panja A. (2003). Failures can be the pillars of success. BMJ: British Medical Journal, 327(7423), 1115.