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The bigger, better version !!

So, here are few tips which can help you secure those brownie points! ūüôā

1a. Making charts and comparative tables help in remembering information. Even non comparable topics in tabular form will be easy to remember. Eg GERD, ACHLASIA CARDIA, CA ESOPHAGUS. You tend to remember the image of grouped data. Just highlight the key words. Minimum grammar. Try It!

Use keyword, association, linking and substitution techniques. Let me elaborate on that- Mark only that word which gives you maximum information. Next associate that word with something you already know. Then link all the words. Use plenty of imagination. I will give you examples-

I made a list of Autosomal dominant and Autosomal recessive diseases. Then I thought about an elderly couple known to me- a certain Mr and Mrs Gupta. Mrs Gupta was a dominant lady while her husband was a meek (or recessive) gentleman. I associated all the autosomal dominant diseases with Mrs Gupta. Like Gardner syndrome- (Imagine Mrs Gupta doing gardening in bedroom Рridiculous and weird associations), Treacher Collins syndrome- (imagine Mrs Gupta teaching couple of blue donkeys from a Collins( a brand) dictionary). Just use your imaginations- make weirdest associations!  For complex names/ drugs/ terms- substitute those technical words with nearest rhyming words you are already aware of- example- imagine an autistic child eating a large asparagus- ASPERGER SYNDROME!! (the words asparagus will remind you Asperger syndrome!)

Similarly, one of my relative had ca colon. I used to imagine him while reading about ca colon and made various weird associations. Glycine is an inhibitory neurotransmitter in the CNS. I imagine myself pouring¬†glycerine¬†on a¬†glowing brain¬†which causes a short circuit (ie a negative or inhibitory thing!! I know this sounds weired but use your own associations) Visualize! ¬†This can be applied to almost anything. Imaginative people will have an edge here! Make your own personal stories. To each his own!! ūüôā

1b. If You have donated your Anatomy and Pathology books and became a Good Samaritan to some poor soul, time to get them back!! Most of the time your viva revolves around anatomy and Patho physiology of a disease. Quickly read about surface markings of important structures.

1c. You should have a clear-cut understanding of common diseases which your hospital treats. Divide your syllabus into MUST read, SHOULD read and COULD read. Allocate time to each in that order.

2. FREQUENT REVISION IS THE KEY. Annotate your main text book with facts and information you gather from other sources (Textbooks, Teachers, and seniors) so that you just have one book to read in the end. First reading takes time however every subsequent reading takes one fourth of that time. So a topic which took you more than 3-4 days initially can be revised in less than an hour. suppose you read Endocrinology from Harrison’s and took 7 days, you will end up confused. Its Normal! During second reading of the same chapter, you will start correlating facts between various conditons. It is only during the final fast reading of the topic , which you should be able to do in couple of hours, you will get the confidence that you have correlated all the facts!

Damage control strategy– Only 2 days left for exam and more than 70% syllabus remains? DONT PANIC. Rather then planning to sleep,¬†aka depression somnolence,¬†pull yourself together and try to go through whole syllabus within 24- 48 hours of exam just by fast reading it. It can be done by the same logic discussed previously. We used to call it “lapetaa”¬†[Hindi, verb, meaning- to finish it anyhow]. Under the influence of catecholamines your mind becomes 10 times more powerful. You will be more confident after this as things will last in your immediate memory. I think I passed biochemistry exam just because of this. (I adopted this technique from my friend AMIT, who is currently an Orthopaedician in Ireland. So thank you, Amit!!)

Same holds true for Case Presentations. Frequent Mock Clinical Case Presentations among your friends will take that fear away. This is called¬†desensitization¬†– ¬†defined as the diminished emotional responsiveness to a negative or aversive stimulus after repeated exposure to it !! ūüôā

3. Dress decently. This is an exam, not Haute Couture. No fleshy cloths! No Tees with graffiti! (Imaging wearing a T shirt stating I AM AWESOME on your exam day! Your examiner may take that as a marker of disrespect and this may lead to all your awesomeness becoming a history! ).

Nails should be trimmed (It will save you from that embarrassing moment, when you are asked to demonstrate palpation!)

4. Do not try to charm your examiner during viva-voce. Do not smile unnecessarily. More often than not, it goes against you.

5. Try to speak fluently. Well articulated people have an inherent advantage. Be ready with differential diagnosis and points in favour/ against of each d/d. knowing the diagnosis of case beforehand is not gonna help you. Infact it suppress the thinking process!! Remember, you are being judged on how you arrive at a particular diagnosis, not for making the right one!

6. While presenting a case, if you can manage without reading from your answer sheet, BONUS MARKS!!!

7. Be direct and honest. Else say, I don’t know. Do not evade the question asked by examiner by answering something else which you know, thinking it will divert him. (Remember, He had tried ¬†the same in his days!!)

8. There can be more than one investigation/management protocol for certain conditions. Therefore, don’t argue with your examiner. Although I agree that sometimes examiners, especially senior ones, expects same old treatment strategies which they have been following and are against the new emerging modalities. ¬†eg Inguinal hernia- open repair or laparoscopic repair??There is no right answer to that. However, as a medical undergraduate you should be thorough with conventional management/ open classical approaches of surgical diseases and latest drugs in medicine. Ironical? ha!!

Well, remember Just because you are taught to follow a certain management protocol does not imply that your examiner will always agree to that.¬†¬†Sometimes “truth” is a function of “time”, “place” and “person”. Ask Galileo, whose truth was considered a lie because of the times he lived in!! ¬†You should know pros and cons of a particular investigation/ treatment modality. Be Humble. Be flexible in accepting his/her beliefs. (As if you have a choice!!) Acknowledge, if your examiner shares some information/ personal experience.

9. Dig some information about your examiners if you can. Try to find his/her philosophy towards treating a particular disease, his/her favourite topics, and research works he/ she is involved in etc.through peer networking/ googling etc.

10. Give a direction to your viva by dropping some KEYWORDS (topics you are thorough with) as bait, which may direct them towards the area you are most comfortable with. You may get lucky ;). I got Ca Breast as a long case and I dropped BIRADS Classification cleverly. It worked. I screwed my paediatrics viva though!!:(

11. During Viva/Interviews- usually every question you answer will be followed by 2 whys/Hows/whats! Example-

Q. Most common site of amoebic liver abscess? A. Right lobe

Why 1? Ans-  due to vascular anatomy! (You are a borderline candidate!)

Why/How 2?  Ans- Right lobe portal laminar blood flow is supplied predominantly by the superior mesenteric vein, whereas the left lobe portal blood flow is supplied by the splenic vein. (Dont worry,  You are safe by miles!)

Why/ How 3? Ans- E histolytica¬†trophozoites present in the lumen of ¬†cecum must adhere to the underlying mucosa and penetrate the mucosal layer leading to invasion of¬†E histolytica¬†into mesenteric venules. Amebae then enter the SMV circulation and travel to the liver where they typically form large abscesses. [ You are a Dude!! ūüôā ]

So in depth study/ conceptual study, helps you in the long run!!

12.¬†The Kindly Brontosaurus posture–¬†You must stand quietly and lean forward slightly, hands loosely clasped in a faintly prayerful arrangement with a subtle grin.¬†‚ÄĒbut you must keep your eyes fixed placidly on the examiner‚Äôs face at all times. Nod empathically from time to time.¬†The body language of the Kindly Brontosaurus is respectful and nonthreatening. There‚Äôs a humility, so you allow the other person to feel empowered. Since you‚Äôve made them feel like king of the jungle, they‚Äôre more receptive to you….. LOL. (Ref: Personal experiences)

13. Remember, best way to learn is to Teach. So once you grasp a particular concept, explain it to someone else.(No..Not your Doggie or Grand mom but someone from your field, of course, who can ask questions!!)

14. Remember only one thing can bring confidence- KNOWLEDGE! So read well!! ( I am yet to have that confidence, by the way!)

15. Unfortunately, the medical viva exams (MBBS, MS, MD) have not been standardized yet at most of the places. So there is always a possibility of observer bias! If you feel that you are a victim of bad luck, return with a vengeance!!

And finally- Is performance in these medical exams a marker of your professional success?? That is your “food for thought”!!


¬© anshuman kaushal‚ĄĘ 2013.

Disclaimer: Author can not be held responsible in case of any mishap! ūüėČ Please use this advice at your own discretion.