At the peak of the COVID-19 pandemic culminating with the circuit breaker, those of us in the healthcare sector faced multiple uncertainties as we treaded unfamiliar grounds. Many doctors were deployed to different areas of service to fulfill the need for manpower in the front line or to ensure team segregation, such that each unit could still function if the other was affected.
For the final-year senior residents, an additional uncertainty that loomed over us was our residency exit examinations and career progression. As one of the candidates for the psychiatry exit examination originally scheduled in May 2020, the worries and frustrations felt during that period remain fresh in my mind.
Apart from the stresses of adapting to new work roles and the constantly changing protocols, we also worried about whether the examination would still proceed, having heard that other specialties had to cancel theirs due to the pandemic. We were thankful that Prof Chong Siow Ann, the Chief Examiner, updated and reassured us regularly, and also openly discussed the issues and obtained feedback from us. There were multiple obstacles to consider for the examination to proceed. These included the need for physical separation of the examiners and candidates, especially since psychiatry is a national programme and we were from different healthcare clusters. Other challenges included managing the technicalities and logistics of holding such a major examination over an online platform, sourcing for a venue with the necessary infrastructure and setting up the technical equipment.
Adapting to new platforms
The eventual decision by the Examination Committee (EC) and the Residency Advisory Committee (RAC) was to postpone the examination by a month to the end of June 2020, and that we were to have the examination using Zoom, a video-conferencing platform made famous by COVID-19.
We pivoted to using Zoom for our tutorials as well. Our seniors also adopted it to organise a mock exit examination, so that we could gain confidence in the new format. We started paying more attention to our body language during these Zoom sessions, including maintaining eye–contact with the camera rather than the screen and being mindful of our facial expressions as we realised that our actions and anxieties were "zoomed" in (no pun intended) on the monitor. A major concern that was brought up during these sessions was the stability of the Internet connection – any break in connectivity could seriously disrupt the proceedings of the examination, especially when each section had a time limit. We were reassured by the EC that such "lost timings" would be taken into consideration and adjusted for in a fair manner.
Tackling the examinations
The venue for the examination was set to be the Communication Suite in the Lee Kong Chian School of Medicine Building at the Novena campus. The big day came and we were all given separate reporting times based on the hospitals we worked at to prevent cross cluster contamination. It went down to minute details of taking separate lifts at different timings to maintain the stipulated safe distancing. We were then ushered to individual waiting rooms to prepare for the actual examination.
The psychiatry exit examination is a viva comprising a long vignette, journal critique and a topic discussion. We were given an hour to read the vignette and the journal article before being questioned by the panel of examiners. When the hour was up, I was directed into a nearby room with a laptop connected to Zoom with the three examiners on screen, each in a separate room. We were given the option of using our own earphones, which I did as it helped to decrease background noise. After doing a microphone check, the nerve-wracking examination proceeded. There were four images on the Zoom screen – the three examiners and myself. Having our own image on screen throughout the examination had its pros and cons. We could clearly see our body language and anxiety on screen, which could either magnify our anxiety or remind us to calm and compose ourselves.
The examination ended in a flash compared to the many months of blood, sweat and tears, both on the candidates' and organisers' parts. Fortunately, the Internet connection during the examination was smooth and there were no major issues encountered thanks to the superb planning by the EC.
Towards a new normal
Moving forward, this will likely be the new normal for examinations during these trying times, especially if they do not require direct patient contact or physical examinations. It also has the added benefit of eliminating the need to travel out of country for overseas examinations, thus saving costs and time. A batch of our psychiatry junior residents has even cleared their membership examinations via online platforms in the comfort of their homes!
Looking back, I am honoured to have had the first-hand experience of taking this major examination over Zoom during this COVID-19 period. Thank you to all in the EC and RAC, and the examiners as well as our seniors for organising the examination and taking us for tutorials. All the best to future candidates!