As I penned this article in the midst of Phase Two (Heightened Alert) COVID-19 restrictions, I could not help but look back on the previous year with a mixture of relief and gratitude. When the COVID-19 pandemic struck the world suddenly in early 2020, I was preparing for Part 1 of the Master of Medicine (MMed) Family Medicine examination, a multiple choice question (MCQ) format scheduled in early July. When my batchmates and I attended the teachings at the College of Family Physicians Singapore (CFPS) at the start of the year, little did we know that it would be the last time we would see each other physically until many months later near the end of the year (of course, with masks on and safe-distancing measures strictly in place).
Learning through Zoom
In view of the introduction of circuit breaker measures in April 2020 to battle the pandemic, our programme directors swiftly put in place Zoom teaching sessions and temporarily suspended in-person clinical training. That meant that we could no longer practise the pure physical examination (PE) stations and the consultation stations of the Objective Structured Clinical Examination with our tutors and trainers.
There was apprehension about whether our examinations would continue and deep in my heart, I was praying hard that they would. Juggling work and studies while battling the COVID-19 pandemic on the ground was indeed a mind-boggling experience. The toll it takes on every candidate, regardless of specialty, is simply onerous.
It became a routine to meet our trainers on Zoom at least once a week to go through didactic lectures, MCQ questions, case write-ups, vivas and mock consults. On such days, I would rush home from work to get a quick bite and seat myself in front of my laptop in anticipation for the training sessions. From amateurs in using Zoom, our class quickly became proficient as it was used so frequently and widely at work and in training.
I found it amusing that my life revolved so much around Zoom sessions that I was almost continuously zipping from one Zoom meeting to another both in and outside work. It was only then that it dawned upon me how much I missed the in-person social interactions in my day-to-day life.
Grappling with changes
Near the mid-year mark, we knew that our MCQ examination would still proceed albeit with safe-distancing measures in place. With the measures, candidates were scheduled to take the examination on either one of the days to avoid overcrowding. On each day, we were further split into smaller batches with candidates sitting more than one metre apart from each other. The most interesting thing was that we had to sit through the examination with our masks on at all times. Besides mental and eye fatigue, we had to grapple with the discomfort of wearing a mask, and yet we all did it knowing how necessary it was for the sake of everyone's health.
After getting our Part I results, we were informed that we could proceed to apply for Part II of the examination. It was already September by then and we scrambled to brush up on our PE skills. It was one big area which we had no choice but to neglect when no face-to-face training could take place earlier.
While trying to practise PE skills with my batchmates (safe-distancing measures were more relaxed by that time), we received news that the examination committee had kindly agreed to take out the two pure PE stations and replace them with consultation stations (hence going from ten to 12 stations). I was thankful that the committee considered the fact that there was a lack of in-person PE training for my batch due to the pandemic and decided to scrap them. However, not having pure PE stations did not mean that we could forget about PE skills. In fact, in each of the 15-minute stations, we were assessed on how we performed targeted and relevant PE on our patients.
The challenge was hence about the ability to incorporate various skillsets and complete each station within the stipulated time. As some of my seniors put it, consultation stations can be harder as the topics tested are wide ranging and one can fail the station if one did not grasp the pertinent points of each station. In contrast, for pure PE stations, as long as a candidate practised sufficiently, one could secure the score for these stations which could help pull up the overall score.
Nevertheless, my batchmates and I took the changes in our stride and started training hard for the consultation stations. Because family medicine covers such a wide spectrum of care across different disciplines, we were practising all kinds of mock consultations at CFPS, the workplace and over Zoom. Over Zoom, we would have to verbalise what we wanted to examine instead of physically examining a patient. As time passed, we realised that verbalising was simply not realistic enough and we started getting up to do the physical examination on pillows/dolls/anything that we could lay our hands on to demonstrate PE skills in front of the video camera.
Even then, it was a really very different experience examining a doll on Zoom versus physically doing the consultation with a live person (our trainer) in front of you. I was grateful that CFPS gave us lots of in-person consultation training nearer to the examinations, allowing us to hone our consult skills and simulate the real examination scenarios as closely as possible. All the anxiety and nervousness that manifested in our little verbal and non-verbal habits were amplified relentlessly during in-person training. These would otherwise be well concealed and not picked up in a Zoom training session.
Passing the big hurdle
With the immense help from CFPS' training and colleagues, and a good stroke of luck, I heaved a sigh of relief when I passed the examination. Overall, despite all the challenges, the examination committee did a great job in organising and running the examination so smoothly and well. I would like to thank the examination committee, the examiners and patients for helping us with the process. I also want to say a big thank you to our programme directors, tutors and trainers at CFPS, and senior colleagues for their dedication in training and teaching us. Lastly, not forgetting to thank my batchmates who have trained with me intensely over Zoom and in person. I could not have done this without all of their unwavering support, encouragement and help.
As the saying goes, "Life is so unpredictable. Be grateful for every moment." Let's pray that the pandemic will come to a swift end, and keep our spirits up and continue to soldier on in spite of the current challenges!
Preparation tips