The firs thing is not to blame yourself and get depressed for any prolonged period of time. If you take use as a “gold standard” a group of candidates who should/ eventually pass the exam, sitting the exam only has a sensitivity of about 75-80%. And it certainly bears no relationship to what makes you a good doctor. Why such a poor correlation?

- The exam format hasn’t been changed in a while. 20+years? Who knows? Is it about time to institute a thorough review? Probably.

- The exam format doesn’t relate to medical practice. Have you ever been in a situation when you had to urgently elicit a clinical sign under observation?

- As for long cases, again the issue is that they don’t correspond to medical practice. Having simply a patient in front of you who clearly has a long and complicated medical background without having access to any of it (no bloods tests, no radiology, no referral letter) and simply the patients memory also rarely, if ever occurs.

- As for the MCQs, the secretive nature of the questions and the colleges reluctance to reveal them on a regular basis doesn’t serve the interest of the college or the candidates. If you are trying to ensure a high standard of medical knowledge, letting the candidates know about where the “developing areas” are and the slant of past questions is clearly advantageous and the candidates will benefit by not rummaging around collating past papers despite the colleges insistence that this practice be stamped out- who are they kidding? It will also save consultants around Australasia time because medical RMOs won’t keep running up to them with a half a question asking them to choose the best alternative out of 2.5 choices. Maybe they should take a page out of the surgeons book who have released hundreds of questions from their database.

So realise that there are hundreds of candidates who have failed the exam a few times (8 of the most I heard) who have subsequently passed and been great doctors. There also has to be some examination process and selection procedure. Most people will pass if they have the will. How can the process be helped? Its no secret that moving to a large metropolitan hospital increases you chances. Practice, don’t be nervous on the day. Read widely. Chase your dreams.