Thinking backwards to leap forwards – Filling up the tank of self belief.

Sometimes when we are faced by obstacles we can feel dwarfed and overwhelmed. In the experience of myself and many others, the final exams that test practical skills and patient care (the OSCEs) are the greatest challenge of the medical degree. Please apply what I have learned to any challenge that you face.

The fear we feel before any challenge is contributed to by many things; Our previous experiences, our baseline ability, and the duration and intensity of our preparation.

In fourth year exam, I felt like I failed. I didn’t do as well as I had hoped in any of the exam, with performances in some areas that really concerned me. I left knowing that I would be called back to have another opportunity to take the exam again. The feeling of failure was instilled in me and I hated the poisonous feeling of fear it left inside.

I carried this fear through to my final year OSCE. Yeah, I had passed MBBS4 – but if I narrowly scraped through last time, what’s to say that I’m not going to make it this year? The same feeling of fear, the poison, would sit cold inside my chest and make me feel nauseous.

To add to this, I felt that I had lost my baseline ability. After MBBS4 I decided that the opportunity to take a year away from the medicine course to study physiology was the right and timely decision. This hiatus provided many benefits, however, upon rejoining medicine I felt like I was 12 months behind my final year peers. How can I pass this exam if I’m out of practice?!

The fear we feel before any challenge is contributed to by many things; Our previous experiences, our baseline ability, and the duration and intensity of our preparation.

My previous experiences and my baseline ability provided my confidence with some serious knocks. To compensate, I amplified the duration and intensity of my preparation. In the months before my exams, I was waking up earlier and sleeping later, but I still felt awful.

I reeled. How can I get through this funk? If I turn up to my exam with these seeds of self doubt in my mind, the first challenge I face will cause them to take root and my ability will flounder. I’ll make simple mistakes, my tongue will tie and my mind will fog over!

I opened up Evernote – instead of dwelling on the negative thoughts and memories, I tried to focus on the good ones. Under a title of “OSCE WORDS” I listed all the good things that had happened over the previous months of studying, working in a general practice and hospital environments. It went something like this:

Rory –
Forget the feeling of self-doubt inside – remember the kind F1 who recognised your confidence while you examined that patient, and praised the thoroughness of your presentation and management.
Remember the great feeling when you made that diagnosis in front of the consultant and your colleagues. The bits of the puzzle came together and it all clicked.
You practiced reading ECGs and CXRs – and when it came to the test, the doctor said you ticked all the boxes.
The mock OSCE examiner was the examiner from hell, and he gave you a really tough time. He didn’t smile even once. His questions were delivered with malice. Remember, though, that he said he only asked tough questions to test the strongest students – and even though you felt awful, yours was the best he saw that day.

This note helped me find composure. I felt pretty stranded by myself, so in this note I called on the help of my friends, colleagues and teachers. This process of unwinding the previous 6 months of preparation was meditative – looking back to when I started, I was absolutely unprepared. Now I could see how far I had come. I could see a step by step improvement marked by peoples’ praise or feedback along the way.

When it comes to the final jump, self doubt will reach up from the ground and tightly restrain you in place. Take the time to consider where you have come from – when you see that these improvements happened step by step, the final jump shouldn’t feel so big.

The fear we feel before any challenge is contributed to by many things; Our previous experiences, our baseline ability, and the duration and intensity of our preparation.

I now transfer this to other bits of my life. Meditation in the morning allows me to take stock of recent events. I added a gratitude section onto my weekly to-do list; what has happened recently that was truly great? What previously unseen opportunity has appeared? What unexpected moment of kindness was gifted? When these are really great, I write these down on a bit of paper and pop them in a jar next to my desk. Just the process of acknowledging these good things is a positive one – and when situations get tougher, I know I have good things stored up as sustenance.

When you feel like your obstacle is overwhelming and you lose belief in your ability, what do you call on to get it back?


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