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I am Nervous

November 11, 2013

I am nervous.

So I have been told. Six years at medical school, flying high enough, and suddenly everybody is lining up to tell me I’m nervous. I’ve changed since coming to university, of course, I’ve changed. The chunky, gawky, awkward teenager that arrived here has metamorphosed into the athletic, confident young adult sat here typing this now. Well, I thought I was confident, had become confident.

 Back in July, fifth year exams. PACES, or practical assessment of clinical examination skills in longhand. In brief, they shuffle you around a series of rooms, asking you to talk to (and occasionally examine) a patient, followed by a minor grilling from a consultant. Then the bell rings and you change places once again. I completed this curious form of torture and then I went to the pub to debrief.

 The funny thing was that I enjoyed PACES. I am of that masochistic bent that I enjoyed the opportunity to be quizzed and grilled. I know I am not in the majority when I say this. I saw some of my friends leave the outpatients department in a fragile state and, outside the hospital, the façade would shatter and they would collapse in tears.

 But I wasn’t one of them. I enjoyed PACES and thought with some confidence that I had done alright. The results, a fortnight later, confirmed this.

 Fast-forward to this month. A scheduled appointment with one of the great and the good of medical school for PACES feedback. Everyone had such an appointment. I was not unduly worried. As far as I was concerned, I didn’t have anything to be unduly worried about.

 The meeting was very pleasant. The consultant was quite genial and apologised for running late. He complimented, congratulated me on my high written marks – and then he skimmed through the examination sheets from my PACES.

 “You’re quite anxious, aren’t you.” He said.

 I admitted that, yes, this probably was true but doesn’t everyone have a frisson of terror on the stage? Not as much as me apparently and he was unconvinced. One of the talents of a pastoral role, I imagine, is the ability to read people quickly and thoroughly. Or maybe it comes from many years doctorin’. Either way, he quickly saw that I’m not an anxious person. I’m not shy, skittish or withdrawn – I used to be, I’m sure, but university has dragged me kicking and screaming out of that shell.

 The result of that meeting is that I will have private tutorials, presenting patients while staring the tutor down. This is to tackle my “stage fright.” I’m grateful but also a bit confused that this is happening with only months left of medical school.

 Then last week, at the end of my Cardiology attachment, the consultant ran his own Mock PACES. One by one, the students on his firm examined a patient and presented them to him. I performed the examination skilfully. My presentation, however, got a little tangled as I tried to decode the murmur I heard. When it came for him to give us feedback, he turned to me and said:

 “You are nervous.”

 “Yes.” I said, since this was no longer news to me. Also, he said it as a statement of fact and not of opinion. When I asked him about my examination, he could find nothing to fault.

 I have to wonder where this anxiety of mine has come from, and why now, so late in the med student game? It’s not a Thing to be worried about but I am curious. Reflecting, I think it might have something to do with how I have been examined.

 In third year, we had OSCEs. The purpose of these was to show you could perform an examination, take a history, to see if you actually knew what a patient looked like. You didn’t lose marks if you didn’t hear the murmur or if you didn’t get the correct diagnosis. Looking back, that was a remarkably low stakes exam. It was all muscle memory.

 In PACES, you have to show you can work it out. You have to find clinical findings, put them all together and distil out a diagnosis. Suddenly, it’s actually worth knowing the right answer. This is might have something to do with my new-found fretting.

 Like most medical students, I am a perfectionist. I care about being right about everything. Actually being right a high percentage of the time only increases the pressure. This pressure is multiplied exponentially when I have to be right

  • About medicine,
  • In front of a consultant,
  • In an exam.

 This is probably an off-shoot of something even more elemental about me. I enjoy writing so very much. One reason for this, I feel, is my belief that for every situation, there is a perfect set of words, to be arranged in a perfect rhythm and sequence. That’s fine when I have all week to languidly grasp for the phrases of an article. But I can’t present the way I write.

 The thing is, I know that I have the skills necessary for these exams, and I know that I have the knowledge. But in those two hours of my life that are dictated by bells and whistles and impassive consultants with pencils in their hands, my confidence takes a sharp exit through the trap door.

 I think. I think, I worry so much about proving that I know everything, I come across as if I know nothing.

 I think. I think I need to have the confidence to be wrong. Then I’ll have the confidence to be right.

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