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I just got back my results for the exam I just gave to enter Psychiatry training in the UK, and I am extremely whelmed.
Back when I first decided to go down the route to becoming a doctor in the UK, the competition ratio was <1, basically there were more open vacancies than people to fill them. And now, it's about 4 something, so you need to scrabble your ass off to make it. So the one thing I desperately desired got about four times harder since I began the long, tedious and expensive process for questionable payoff.
Anyway, I did well. A score, which if I did the maths right, is about 64th percentile. Why do I have to calculate this myself? Because the company contracted by the NHS, Pearson and by extension, their website, Oriel, is trash, and managed to bungle the onerous task of ranking people in a CSV file/Excel spreadsheet.
So, I am officially better than the average British doctor in the mad scramble for positions. Yay me. Unfortunately, that may or may not be good enough for a seat, given that 3500 people are fighting for maybe 400-600 of them.
The silver lining is that since this exam is the sole gatekeeper for Psychiatry, but also a requisite for other subjects like ACCS and Anaesthesiology, there are plenty of people who apply to psych and GP alongside because they have nothing to lose (other than a few hours of filling up horrid forms). If they're significantly better than me, well they're likely to match into their desired subjects and leave their nominal psychiatry slot vacant, and I might get in. This means a good fraction of the 1300/3500 either get something they desire more or would turn down a seat in psych even if they were accepted, whereas all I want is to do that one blasted subject.
Unfortunately, it seems that Manchester is unlikely to be an option given my score, and I never aspired for London in the first place. Too expensive, for one. I can only hope that I end up qualifying for a place that isn't in bumfuck nowhere, where the primary presenting complaint happens to be BAA (beastiality-associated anxiety), a significantly overlooked concern in Wales and Scotland.
For fuck's sake, I would appreciate some clarity as to whether or not I'm in or out. Now, I have to wait for an official score and then the weeks or months of preferencing, matching, reserving, upgrading, and all the other rubbish that follows. That takes long enough that I might end up studying for Round 2, in September, which I would have to anyway if it becomes clear it's a lost cause.
But it isn't clear. Not yet. Now I stew and fret, and wonder if I should consider studying for the even more abominable version that is the Indian residency exams. 4:1 competition? Nah fam, more like 40.
I did decent. About as I expected really. It ought to be a confidence booster, but I am also incredibly fed up of it all, especially the enormous amounts of time it takes. The curriculum is vague, half the exam is pure guesswork and ass pulls, I did much better in the actual Clinical Dilemmas section than the SJT (turns out advocating for Dr. Stephen Hawking MBBS to roll himself off a cliff instead of bothering me wasn't the correct answer). The study resources have only vague similarities to the actual exam, and nobody knows what the fuck is going on.
At any rate, I have to thank @Throwaway05 for bearing with me when I was badgering him in the DMs, but some gratitude is owed to everyone listening to my meandering descent into insanity.
As usual the UK is different than the US so I don't know enough about what's going on here but some things likely hold true:
-Above average for a physician, on any type of assessment or metric.....is impressive as hell. These people are study psychopaths and you have your neurodivergence etc. Good. Fucking. Work.
-Have some caution with respect to specialty trends, these can turn on a dime and if you don't have a good source of intel you can miss out on wild swings in competitiveness (for instance in the US Psych went from not competitive at all to tough as hell to average, all in the span in 3-4 years. Advisors mostly missed this and left people high and dry). Sometimes it's better to swing the bat and not worry (shit, does that also work for Cricket?*).
-Ruralness. This one I can definitely comment on(ish). There are a handful of cities in the US most Residents want to be in, and approximately 10,000 places they don't want to be. Thanks giant ass continent. Normally when I'm advising students I'll tell them to rate location higher than they think. Not wanting to shoot yourself because you have fun things to do during your limited fun time is more important than higher salary or academic prestige. However higher than you think doesn't mean it's the whole list. Training is short, career is long, and the UK is small. As long as you have flexibility after you are done then you can live with wherever they put you and then leverage yourself into a better position later.
The reason I tell people to be in a big city is that you don't have too much time during training so you want to have access to easy fun. The flip side is that if you are in a shit location you don't have a lot of time to regret being in a shit location, and when you have vacation you can just travel where've you need to go (again, uk smol).
You might be concerned about training quality in a rural area and this is real, but psych isn't surgery. You don't need physical practice doing a Whipple, you can catch up on knowledge gaps through training and studying resources pretty easily. You also likely get to avoid the truly annoying patient populations (like malingering homeless) that a big city will be flush with, and rare shit like autoimmune encephalitis is still rare enough that you wouldn't see it in London or wherever. You will need to eventually learn how to deal with bread and butter homeless malingerers and decompensated psychosis but because they are common in a city setting you'll figure it out quick when you move to one.
At least I think, for all the above there. I don't know the UK well but I imagine some of the trends are similar to how it is here for that sort of stuff.
-I meant to reply to a post but didn't, so I'll ask here....how do you deal with all the hackers in Tarkov?
*apologies for blatant stereotyping.
❤️
(It's 64th percentile for all the MSRA applicants too, not just Psych, which is heartening. These are proper lads and lasses with GMC registration)
I did study my ass off, if it wasn't obvious I was on the verge of absolute burnout haha. What makes me even more pissed is that most of that work was utterly irrelevant, you'd think the examiners were taking the piss if you saw the questions I encountered, and not just the SJT part which I've complained about enough.
For example, NICE guidelines recommend urgent referral for malignant hypertension with papilloedema to prevent further end organ damage, and in the question where I had such a patient, the options included "admit" and "refer to _ specialist".
Mf, is that supposed to be an urgent referral? Is it implied that we're going to admit them first to get the hypertension in check before bleeping someone?
So many questions like this, with vague options. The majority of questions were maybe 2 or 3 sentences long, whereas all the MCQ banks give you whopping multiple paragraph cases with little tidbits and clues inside. I would like to say that the additional difficulty and challenge helped me prepare, but as far as I can tell, it didn't, that particular question was the only one where the megabyte of guidelines I memorized was relevant, and even then the answer wasn't clear.
5 questions in a group where I'm pretty sure the answers were all bacterial vaginosis (though maybe one could be a misplaced tampon, not that I'm quite sure how you can lose one of those in there, but I opted for BV).
It all makes one despair, what on earth can I study to improve on that? And the SJT is.. I won't repeat myself.
So I fervently hope I manage to land a place this go, as I am frankly unsure how it's even possible to improve further. Maybe read more neuro, which I skimped on, but that's about it. No childhood rashes, no paediatric milestones, none of the supposedly high yield topics except gyne, and even then it was just BV.
For what it's worth, the sudden ramp up in difficulty seemed to come as a surprise to even the UK locals. I will work on the assumption it'll only get more difficult, if I am cursed to have another go. Besides, I haven't found anything else I like :(
I haven't swung a bat in ages, I find both cricket and baseball to be remarkably boring sports, at least in the former the spectators get more cardio than like all but 3 of the players.
I think both my training and my career are going to be short, for the usual reasons we discussed heh. I suppose that disagreement can only be resolved with time, not that I wouldn't be exceedingly happy if I manage to be a Real Consultant™ 7 years down the line.
That's what I suspected and it's good to have some confirmation! I'm not worried overly much about the quality of the training, just QOL in general, but psych is still supposed to be chill, and the fewer hobos going for a needle the better.
The UK is small enough that I don't have to worry particularly much about getting about, though geographic proximity would certainly help maintain the one relationship I've got going. And there's family in the bigger cities, not particularly close, but better than nothing. It's not too big a deal, I am sick enough of studying the 3 odd years since I finished my MBBS that I'll take any training post with the word psychiatry in it (though not in India).
If my USMLE woes are resolved, then I'll phone it in at work with LTFT, going from 80% hours to as low as they'll let me before they realize I'm not showing up at work at all, and if I do manage to pass it and match I'm going to firebomb the GMC building and catch the first flight out. But that's not a given, and so to that particular damp island I go, for now.
Thank you, as always, for the excellent advice, it's too early to celebrate quite yet, but if I'm being honest I think my odds of matching are >50%, and worst case it's another 6 to 8 months gone.
It may not be satisfying per se but some of the oddities of medical examinations come from a very well-defined place (well if it’s like the USMLE anyway).
-Specific pieces of data one specialty wants to convey to another. “No ortho you really do need to know this about the ‘beetus.”
-Making things harder in a way that assess actual knowledge and understanding instead of fact recall.
Those are two of the biggest. Also repeat questions are often stemming from the whole “experimental questions” aspect of the exam.
Making things vague, removing buzzwords. This means you have to actually UNDERSTAND the stuff instead of just memorize facts or guidelines. You need to know the why and what of currant jelly stool instead of just recognizing it in a stem and slamming down on the answer.
I swear to you with time and space you’ll find that some of the stuff is more reasonable than your experience of it felt like.
Except the SJT, fuck that toxic horseshit.
Put another away:
Ideally at some point you’ll be doing a boards question or some other assessment and you’ll have this experience of “I don’t know the answer to this question but my knowledge is sufficient to understand what the answer should be based off of other things I do know.” I’m not quite sure I made that come across the way I wanted to but hopefully you’ll have the ah-hah moment at some point.
Thing is, it's not like the USMLE, I attribute the oddities of this exam to incompetence rather than
maliceattempts at making questions that get at in depth understanding of medical matters. The SJT alone should be sufficient evidence to back up that claim.The questions were easy, at least in terms of diagnosis, and I understand scenarios where one has to use limited information to make a snap judgement come up regularly, and vagueness is not necessarily inaccurate to real life, it was the fact that they designed questions that ranged from "why did I even study for this" to "choose between two plausible options with insufficient information to decide between them". Admit? Admit and do what? Refer? Urgently or not? That's critical, and without it the question becomes a matter of guessing, especially when a lot of it hinges on the particulars of where you see the presentation. It matters a great deal whether your nominal location is in a GP practise, or they're showing up at the ER, and in some cases that information was both relevant and absent.
I can't say I know much about the USMLE (given that it would be an entirely academic curiosity for me, right now), but the PLAB exam was significantly better in that regard. Clear curriculum, an understanding of core competencies to cover, better written questions. I can't even say the MSRA by itself was harder, both had the typical pattern matching red currant stuff too, but this exam made me feel like I went to get a driving test and then ended up forklift certified. The difficulty comes solely from the fact it's competitive for limited seats, whereas that's far less of a factor for the PLAB. I'd rather have a hard exam where I know how to prepare than an "easy" one where I'm at just as much at a loss as anyone else.
The
missiledoctor knows what the right answer is by knowing what it isn't eh?PS: Tarkov cheaters. You learn to live with them. And don't go Labs, if you can help it. I play on Singapore and occasionally Chinese servers, so I'd imagine I have the worst of it, but avoiding Labs and Lighthouse (except for quests) will keep you mostly safe. And eventually you'll be rich enough that dying to a cheater every dozen raids or so is the cost of doing business.
Given the general state of the U.K. I am entirely amenable to the idea that the exam is just absolutely fucking retarded, but I do want emphasize that it's probably just a tinge more likely that they are doing something on purpose, potentially with a heaping dose of "I don't like this."
Sometimes it's straight up "this seems like a stupid question but it seems to correlate with exam performance so..."
I don't know if this exercise is viable for India, but one exercise I have students do towards the tail end of clinical is look back at their first year exams, you'll see clinical correlate questions mixed in with basic sciences questions and at the time they are enormously frustrating "why the fuck did they ask about that" is a common refrain, but if you come back at the end of clinical you'll see that it's common, or a necessary concept to reinforce and so on.
The SJT for instance is stupid, but it's placed there with quite a degree of deliberation, just the two of us hate it.
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Congrats on the solid score. I don't think I've ever replied to one of your posts on test prep because I don't really have anything to add, but I'm happy for you nonetheless. Good luck on the next steps!
Not as solid as I'd like, but it's still respectable, especially for a first attempt at an utterly fucked exam haha. There's a decent chance I'll get in somewhere, even if it's not perfect, and after 4 years I'll have the opportunity to sit yet more exams (depressed party horn) and then sub specialize, which could entail upward mobility. And worst case, I could still take that CCT degree and head to the Middle East for better money, if that becomes a crisis.
Thank you, it means a lot to me that there are people quietly rooting in the back.
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It seems to me that a smaller town would be a good thing for a doctor from a poor country, no?
Salary will largely be the same (or possibly even higher) and living expenses will be as low as possible. You seem like a guy that's mostly either at work or at home anyway so if you want to do something in the city you can always travel there.
It seems like a pretty good deal when you're starting out.
London sucks the life blood out of the rest of the country. The only other cities I'd call respectable would be Manchester and Edinburgh, not that I've exhaustively traveled the country.
I'm unabashedly a city boy, and not so poor that I consider the lower COL to be a driving factor. London would be tight, but I am best described as the poor son of comfortably well off parents (at least by Indian standards).
However, posts in bigger cities have advantages too. Looks good on your CV. More opportunities for locum work, which pays market rates and is thus often double to quadruple the paltry standard NHS wage.
And while I am a homebody, it's not like I don't leave the house at all, and a bigger city = more and interesting friends to drag me out of my shell.
Sadly the working conditions of NHS doctors makes taking regular trips to the big city a luxury at best, but I plan to work 80% hours if possible, which gives me a free day off during the week (to fuck about or to locum for actual money).
That might prolong the period of my training, but the salary cut is not nearly 20% because it draws from a higher tax bracket.
Not that it's the end of the world, just potentially mildly unpleasant, and you're right that I'll be too busy to really notice or care.
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Right, and large parts of provincial Britain are so poor that the town doctor is one of the richest people there, which isn’t necessarily a terrible place to be if one doesn’t care about the amenities of the big city.
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