Dr. BK (fictional name), when still a MBBS student, appeared for
his first surgery ward posting clinical exam in 3rd semester in
AIIMS, New Delhi. In the 3rd semester posting, it is expected that
the student should know the basic clinical history taking and general physical
examination.
Everyone was amazed when Dr. BK got 80% marks when the class
average marks were in the range of 55 to 65%.
On enquiring it was found that Dr. BK was asked about the signs
of chronic liver failure in exam, which he answered brilliantly. This one
answer was enough for him to top the exam.
On further inquiry it was found that in the night before exam
Dr. BK has specifically prepared the answer to the question, ‘what are the
signs of chronic liver failure?’
So, how did Dr. BK knew before hand that he will be asked about
the signs of chronic liver failure in exam and prepared accordingly.
Did he enter in a deal with the senior residents allotting the
case to get a case of liver failure allotted to him? On enquiring it was found
that the case allotted to him was not having liver failure and was randomly
allotted to him?
Did he entered in some kind of deal with the examiner so that he
will ask him about the signs of liver failure, no matter what the patient was
suffering from and prepared accordingly? This was not the case as the examiner
was quite fair and strict examiner.
Did Dr. BK consulted some psychic to tell him the question which
will be asked in the exam the next day? No, nothing like this.
So what was the answer to this mystery of preparing a specific
answer in exam to get topper level marks?
On deeper investigation into the matter the mystery behind Dr.
BK’s success revealed some interesting facts.
In the exam viva, when his turn came, Dr. BK presented the clinical
history of the patient and answered the examiner’s question regarding it,
similar to other students.
When it was the time for presenting general physical examination
findings, Dr. BK also presented his findings of the patient's vital signs such
as pulse rate, respiration rate, blood pressure and temperature similar to
other students.
Now he came presenting the general signs of health regarding anaemia,
jaundice, chest and heart, etc.
Normally, the students say, there is no pallor (for anaemia), no
cyanosis (for breathing and heart failure), no raised JVP (for heart condition),
no icterus (for jaundice, usually due to liver failure), etc.
Dr. BK, after saying, there is no pallor, no cyanosis, no raised
JVP, no icterus, added, with a slight cockiness in his voice, “Sir, there are
no signs of chronic liver failure in this patient’’. This was expected as there was no liver
illness in the patient allotted to Dr. BK.
The examiner was piqued by his confident statement, that “there
are no signs of chronic liver’’. Usually in 3rd semester, students
do not comprehensively know the signs of chronic liver failure, which can
literally effect from head to toe.
With an aim to take Dr. BK a peg or two down, he asked, “And,
what are the signs of chronic liver failure which you looked for in this
patient?”
Dr. BK, replied, “Sir, starting from head, there is no loss or
discoloration of hairs, no icterus, no loss of axillary (armpit) hairs, no
gynecomastia (enlargement of breast in males)”… and so on till “no white, brittle
toe-nails.”
The examiner was amazed at the depth and thoroughness of his
knowledge and gave him 80% marks, while most students in his batch got 55 to
65% marks only.
Dr. BK knew before hand that, in the surgery exam he will be
asked about anaemia, jaundice, etc. which he studied same as other students. In
addition, in the night before exam, he had specifically prepared in great
detail, the signs of chronic liver failure.
Usually examiner asks the details related to the patient’s
illness and condition.
Even though, the patient was not having any liver illness, while
presenting the general physical finding, his cockiness and confident statement,
‘that there are no signs of chronic liver failure in this patient’ was akin to waving
a red flag in front of a bull.
The examiner could not avoid cross-examining his statement,
which he replied with his thoroughly prepared answer.
This technique is forcing or leading the examiner to ask you
some question which you are well-prepared.
It requires you to prepare in great details and beyond your
expected level of knowledge, answer to some question, you will be likely to be
asked in exam.
The question should be related to some point which you are going
to be asked routinely, so that you can link the question to it. In this case,
all routinely say, jaundice in not present, to which he linked, signs of
chronic liver failure.
Make generalized statement, for which the examiner will demand
details, to see if your statement is justified.
While making this generalized statement, there should be
confidence and even a bit of cockiness in your voice and body language, so that
the examiner take it as a challenge and ask you to justify your statement. Look
the examiner in the eye when making your generalized statement.
Don’t give details until specifically asked for. For e.g. Dr.
BK, could have told the details of signs of chronic liver failure without being
asked, but he reserved it for next question.
So, with a little before-hand preparation, you will be able to
force the examiner to ask you favourable questions, creating a good impression
for you.
But beware, overconfidence and cockiness in general should be
avoided in exams and interviews, to avoid antagonizing (angering) the examiner.
This is a high risk to high reward game, and not all will be able to pull it
off brilliantly.
— ND
© Author. All rights reserved.
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm.
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