The second diet of the MRCP(UK) PACES examination is just around the corner. Google Analytics showed a recent surge of traffic on Nocturnale.com with many visitors perusing articles pertaining to PACES. I reckoned since so many of you out there are hungry for information, I thought I could share a little more tips on this subject. Ergo, this article on how you can squeeze out the maximum benefit from attending a PACES course, something that most prospective examinees would want to do to attune themselves to the killer clinical examination. 

1. You Must Come Prepared

I cannot stress this enough. Perhaps the most important prerequisite to profiting from a PACES course is good decent preparation. You may not necessarily have seen a wide variety of cases, but your clinical approach and physical examination techniques must be flawless. Only by arming yourself with this impeccable routine of examination will you be able to concentrate your attention in toto on eliciting and interpreting signs.

2. Don’t Gloat. Learn from their Mistakes

If you have previously attended a PACES course, you will know there are usually four to five candidates to a group. One of you will examine the case and the rest will scrutinize the ‘victim’ with all their critical attention. More often than not, the candidate being examined makes a fool of herself and the others revel in their thoughts, ” Wow, she is worse than a medical student.” Don’t ever ever do this. If you are one of the spectators, instead of picking holes on the poor chap, try and tell yourself what are the things that you would have done differently, actively work out in the mind what other aspects in the examination that you would want to have accomplished and how you would present the case to the examiner. In other words, be an industrious participant, not a wimpy gadfly. 

3. Don’t be Shy

You know you have invested not a small amount of money in course fees. The worst that you can do is becoming a passive, withdrawn candidate in the PACES course. Volunteer yourself to examine the patient in a particular station. By revealing yourself to the scrutiny of the tutor and your fellow candidates, you will be able to train yourself to perform under stressful conditions which is exactly what you will be doing in the real examination.

4. Ask Questions

One of things I value most is the interaction with the course tutors who are experienced clinicians, having ‘been there, done that’. I always take the opportunity to clarify issues like the finer points of presentation, examination, bedside etiquette etc. PACES courses bring together a group of senior clinicians who are there to help. So use them to the fullest! 

5. Take Notes

My memory has a peculiar way of defying me. Which is why I never fail to bring along my Moleskine whenever I attend PACES courses. I keep tab of the cases I have seen and examined by logging them onto the notebook so that I may look it up after the course. Looking back, I am grateful that I jotted down all the pearls, tips and tricks I learnt from past tutors. You will be surprised how refreshingly enlightened you may become reading back your notes a few months after the course.

I hope these tips are helpful. So good luck in your exam!

I was pushed to the extreme of lividity yesterday when one of the junior medical officer shirked her duty by failing to turn up for (on-call) work. It is apparent her fecklessness and penchant for averting responsibility knows no bounds. From the outset, she has been showing very sinister attitudes towards her work and a devotee to the cause of AWOL. The deplorable thing about it is that no serious action has been taken against her with the chiefs and directors whitewashing or worse turning a blind eye in order to safeguard their petty interest in the hierarchy. 

I brood in anger knowing there will never be real justice served given the inept management of this country’s pathetic health care administration. Good-for-nothing, worthless medical officers or house officers roam rampantly in the ranks rotting the already wobbly scaffolds of medical integrity and excellence. The bad apples all but wallow in the shelter of relative impunity and continue their acts of insolence, leaving the few good men and women to crusade with flaming torches, to deliver quality clinical care with an unflinching rectitude. 

I am furious also because things are likely to remain unchanged for many decades to come. The whole health care delivery poised to be dispensed by a gang of slothful dimwits. Is this what Malaysian medicine has come to represent? A depravity to which we all sink?

Finally after years of dedicated hard-work, you won over the examiners and earned the prestigious right to be a MRCP(UK). Simple 6-letter postnomial but one which confers infinite pride and gratification to the bearer. Next came the invitation letter to attend the College admission ceremony for new members in the United Kingdom.

You have waited for this moment for eternity and you imagine walking down the aisle under the approving eyes of your fellow MRCPians, the Fellows before you all but ready to shake your hands, to receive the scroll from the President of the Royal College. You feel like a victor in a war you have fought tooth and nail. You have after all become a part of what is perhaps the oldest and most influential medical institution in the world. You deserve this.

But… being a native Asian and living outside the UK, you sighed. “Travelling to the UK is so expensive! Why can’t the College arrange the ceremony locally?”

While I agree that the experience of making the pilgrimage to the UK is priceless, the outlay may seem insufficiently justified. Having poured so much money on the examination itself, many candidates from Malaysia, Singapore, or Hong Kong would have been rendered impecunious, which effectively rules out any possibility of availing themselves for the UK ceremony. A shame, no doubt because obtaining the MRCP(UK) is as big an achievement as any milestones in a young Physician’s career. The admission ceremony is a tangible and rewarding culmination of all those years of mind-numbing hard-work.

If a proceeding as intricate and toilsome as organizing Part 1/2/PACES exams outside of the UK can be undertaken with precision, I don’t see why a simple but meaningful ceremony cannot be ‘outsourced’ too. Not only will the College be able to spread her eminent reputation further offshore and in so doing making the MRCP(UK) more distinguished, but perhaps more importantly MRCPians will get to experience what may be the only memorable moment in their working life where they are proud to say they have made it!

I broached this matter with an affable FRCP whom I am lucky to have crossed path with in Singapore a while back. Thankfully, he agreed with my sentiment. “Yeah, I agree with you. This could be done. I don’t see a problem there.” He promised he will feed in the suggestion to the Royal College when he returns to the UK.

Fingers crossed.

Very evidently, time flies. The little toddler I wrote about from time to time on this blog has turned one-year-old. From a wailing infant to a now loquacious babbling menace, she has brought with her an interminable flow of joy to our household.

I think back the past 365 days and it disconcerts me knowing how fast she has grown and how giddy a speed she acquires new skills and tricks.

We love you dearly. Happy birthday to you, Baby Kate!