On failing MRCP PACES

It wasn’t until I was 28 years old that I first really felt failure.

It stopped me dead in my tracks, like a deer in headlights.

It was a horrible feeling. It felt like the worst thing imaginable at the time. But in hindsight, it was one of the most formative experiences of my career so far.

I was mid ward round when a notification flashed up on my phone, from noreply@MRCPUK.org

Results available

I excused myself from the mammoth haematology ward round, which had already been going on for a couple of hours, under the guise of going to the loo. I logged into the MRCP website.

It was then that I saw it. I can still see those words so vividly, as though they are still ingrained on my retina. They were printed in all-caps in Arial font on the bottom right hand side of the PDF file I’d just downloaded

FAIL

The emotions I felt after reading those words were profound. I’d never experienced anything quite like it.

Embarrassment;
guilt;
incompetence;
fear;
insignificance.

Immediately, I felt that all the money I’d spent on expensive courses, energy fighting to get study leave approved, and time spent coming into the hospital during evenings and weekends on signs safaris, amounted to nothing.

I looked at myself in the mirror. I cried. Realising I’d been gone from the ward for just a bit too long for the team to think it was just a coffee-induced wee, I managed to compose myself sufficiently to rejoin them.

When I returned to the ward round, the consultant emerged from a side room, took one look at me, and instantly knew something was up.

“What’s wrong?” he asked.

“Oh, nothing” I said.

“Are you sure? You seem…upset”.

In that moment I thought I was alright, but the observation that I seemed upset really set me off. Tears started rolling down my cheeks again, with the swiftness of a new doctor running to arrest call. Oh gosh. Not only was I crying, but I was doing so in front of the entire team.

I was being watched by not only the consultant, but also the registrar, nurse specialist and Foundation doctor. They were trying to make it seem like they weren’t looking at me – by flicking through the patient’s notes in their hand, or trying to tear off an apron in preparation for entering the next side room. But I knew that out of the corner of their eyes they were looking at me intently, eagerly anticipating my response.

“I just found out…I failed PACES”, I eventually replied, with a sheepish, downward gaze.

“Oh that is bad news. I’m really sorry”.

“That is really bad news” he said again.

He then raised his arm and placed his hand on my shoulder.

In my moment of self pity, I grabbed his hand.

“…by two marks!” I said.

“The important thing is not to worry. I’m sure you realise that the purpose of these exams is to pay the rent on their inner city offices, and not to produce competent doctors…”

I thanked him, the registrar handed me the notes from the patient they’d just seen, and they continued the ward round. As I was taking the notes back to the trolley I turned to the most recent entry in order to catch up on the plan and jobs I had missed.

  1. Chase bloods
  2. Update next of kin
  3. Palliative care review

I looked further up the page and read the rest of the entry, which read:

Dr Zografos explained that the bone marrow biopsy shows disease relapse, and that it is an aggressive form with no suitable curative treatment options. Explained that we would shift the focus in care to ensuring symptoms controlled as much as possible.”

There I was bawling my eyes out in front of the boss because I hadn’t passed an exam. He’d just had to tell a patient that their disease was incurable. Despite this, without batting an eyelid, he paused the ward round and took the time to reassure and console me.

This gave me an instant sense of perspective which I desperately needed.

In time, I realised that for too long I had allowed my happiness to be defined by my professional success. I didn’t see it at the time, but I had been slowly falling down a slippery slope of allowing my academic successes – such as getting merits at medical school, passing exams and having abstracts accepted for presentations – to become inextricably linked to my feelings of self worth.

We should not let exam success define our happiness. This could even be applied to securing training posts or research fellowships. For for a long time I defined my value as a function of my professional achievements, or rather what we are led to believe define success.

Failing MRCP allowed me to break this cycle, and it’s one of the things I’m most grateful to have happened.

Failing exams sucks. It really does.

Especially those which demand a great deal of time, expense and energy. Such as high stakes postgraduate training exams like MRCP or FRCA. 

We are doing ourselves a disservice when we let such factors that are so outwith our control be the definition of our happiness and mental and physical well-being.

Although they are meant to be standardised, there is so much that is outside our control. This is by no means an exhaustive list, but some fo the things we cannot control in postgraduate medical exams include:

  • The questions that are asked
  • The patients that are brought in
  • The examiners that are signed up on the day
  • Whether the examiners have had enough coffee that day
  • The relative preparedness of other candidates on the circuit
  • Whether the thermostat is working properly in the Travelodge you’re staying in the night before

Having reflected on this a lot, I think a person’s historic experiences of failure play a huge role in determining whether or how much a person is affected by the news of exam failure. I hadn’t really experienced failure before and that’s probably why it affected me so much.

We should make more of an effort to put ourselves in uncomfortable situations, and especially those where we are likely to fail. For example, by learning a new hobby, joining a five-a-side team, entering a competition, or investing in bitcoin*. The more opportunities we give ourselves to fail, the more likely we are to feel failure. This will allow us to feel it safely and in situations that are less high-stakes then postgraduate exams. This is especially important for those who may not have had much experience of failure in the past.

If we do this, when the time comes for us to fail professionally, which it will do at some point, we will have the approaches, mechanisms and resilience (or ‘toolkit’) to manage these emotions that result. We will be able to bounce back quicker and stronger, realise perspective more effectively, and ultimately have a more fulfilled training journey.

Failing MRCP is one of the most important and most formative experiences that I’ve had.

*not financial advice

Names have been changed to preserve anonymity

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