GP training is challenging, and sometimes you will face obstacles in your journey to complete training. In this article, Dr Obiora Oji shares his experience of dealing with multiple challenges and how he overcame them to get his CCT.
On Your Marks
Failure to thrive. That was gradually becoming me. Six months to the end of my training and I had not passed any of the mandatory exams. Not for the lack of trying. The last bit even made it worse.
I remember sitting up at the desktop all night working out by how much my scores had increased after three successive AKT attempts. A skill I had copied from my chat exchanges with Mahibur.
That evening I had sent him a message on Facebook messenger. He dutifully asked me for my scores in each of the exam stems. I remember wondering why he was bothered about these.
We worked out by how much my third test needs to better – the penultimate one – and he advised me not to rush into another exam.
I took his suggestion, signed up to his AKT Pass Guarantee Programme as it offered a structured approach to covering the RCGP curriculum with daily guided learning.
The next task was explaining to my wife and requesting a huge favour from her. I had two very young boys under 3 years old at that point and it had been difficult coordinating exam prep with the endless demands and stresses of a young family. I bargained for time away from home – closer to my surgery- on weekdays and some weekends. Miraculously, my wife agreed. So I rented a spare room away from home for the 3 months before the exam. I worked hard and long. I stretched all my senses. Gave up my beloved Facebook, muted the chatty groups on WhatsApp and left a few other ones.
I covered the curriculum and more. I studied broadly with the hope that no matter where the questions came from, I would be prepared. And failed!
Worthy of mention is the fact that my scores had significantly improved, going from low 50s to mid 60s. Objectively, it was huge progress. Unfortunately not every step forward takes you to your destination. Very often, we need a chain of steps forward to get the task done.
Sometimes, you do all the right things and still get the wrong outcome. As demoralising as it is, one must always reflect on the positives.
After the results came out, my ES invited me to a meeting. I had barely 6 months to the end of my training with 2 outstanding exams.
As much as he wished me well, it didn’t look feasible that I would finish with my peers.
Talking about peers, my training cohort had been greatly reshuffled by the ability or inability to pass the exams. Those of us who were unsuccessful had been neatly tucked into the remedial class during half day releases. It was not the most pleasant of experiences but we were our own architects. We only had one task- pass our overdue exam.
At the meeting with my ES, he took me down memory lane. He highlighted my knowledge gap which was proving too gaping to fill and advised that I should apply early for an extension. He figured that it was better I initiated the request than wait for the deanery to evaluate and invite me. To be honest, I didn’t think it mattered. I had the feeling I would surprise him somehow and pass both exams before my original CCT date. Nevertheless, I played along.
It was at the extension request meeting that I had my life changing moment.
The HR lady had mentioned casually that training less than full time (LTFT) was an option. Up to then, I had always imagined that you needed to be pregnant or have some health related problems to qualify. I asked a few more questions and signed up. I went down a whooping 50% of hours. And changed surgeries for what was to be my GPST4.
With that drop in daily commitment to work from what I had done in the previous 3 years, my memory cells dramatically improved. I began to look forward to work days – now 2 days a week. I suddenly had more time to remember the things I used to love – the writing, the admiration of the beauty of family and watching my kids grow. I felt re-energized and ready to try again and was encouraged by a new supervisor who breathed immense confidence into me.
I stayed on with the AKT Pass Guarantee Programme – having been granted a gracious free repeat tutelage by Emedica. I also started a dedicated discussion group with 2 other doctors. We shared learning points and took turns to lead question solving sessions from all the resources available. I applied all the tricks I had learnt from my previous experiences.
Consistent dedication to the daily and weekly tasks in the Emedica pass guarantee programme. Moderate indulgence in Passmedicine. Severe indulgence in GP self test and BMJ Onexamination.
Most importantly, I stopped panicking about the exams in view. This was attempt 4. I also signed up to take RCA – submission deadline being a week after AKT.
The plan was simple. Tests during Covid were not added to the total count. At least pass RCA. Then get an extra AKT opportunity. And I gave both my best effort.
The AKT went alright. For the very first time, questions looked familiar, attemptable and for someone who had at a point considered an evaluation for dyslexia, I had finished in good enough time this time around.
What was different I have often asked myself? I relaxed better. I stopped groping between being a wonderful doctor, maintaining staff cordiality and preparing for exams.
There was however another twist in the story. The RCA result was the first of the two to be released – I had failed by 1 mark. This was my lowest point in GP training. I couldn’t understand why I was unable to pass any exams. I did a recheck of the scores and hoped and prayed that I would get another email explaining there had been a mix up. It was here I began to think of Plan B actively. What if it was not nature’s will that I become a GP?. What if I was forcing myself into a career that wasn’t my destiny to fulfil?
I paid for rechecking – officially – and sent passive aggressive emails to the chair of RCGP. How could they- in the face of the pandemic sleep at night after failing a candidate by 1 mark? When they knew how acutely short of GPs the NHS was! The rechecking was ill-fated. The rant email never got a reply.
I weighed all my options again while hoping that something will finally give. And one week later it did. An AKT pass!
That was the sign I needed – I indeed could pass something! I could pass anything at all! I dived straight into more recordings for the RCA.
One can never underestimate the power of a supportive team of clinicians, admin staff, and the fresh criticisms of friends who had recently passed the exams.
In my first submission, I had never employed the summarize gambit. The feedback from the result alluded to it as well so I improved on that and a few more areas. I reflected openly to patients as I sought their understanding of my understanding.
And it worked.
I passed my RCA with 2 months still left in my extension period. It was December 2020 and I had a conversation with my supervisor and TPD. There was no point extending training into the new year. I requested and was granted an early CCT.
It has been said before that quitters never win. I would say; quit quitting!
Whatever you have begun, you are more than capable of finishing. All you may need to do is re-pace yourself.
You can take a break, change your coach, redistribute your energy but never take your eyes off the goal.