• Dr Sally Ayesa

Picking yourself up

Preparing for exams carries its own special breed of suffering, with times of relief and triumph mixed with those of despair and self doubt. It is tumultuous and humbling, and one of the most difficult things I have ever put myself through.


The exam itself requires candidates to exhibit great bravery, constantly putting themselves in front of their mentors and colleagues to be critiqued and picked apart in the name of self improvement. When you are constantly being told ways you can improve it is very easy to lose perspective of how far you have come, or how good you are. And then, when you have a bad tutorial, practice viva or actual viva it can be phenomenally hard to see past the wall of bad emotions you are feeling. Trust me, I know.


The last thing you need, however, is someone telling you to just move past it. So instead, here are some times I fell apart and how I kept going.


Mock vivas - a wake up call

I rocked into my mock viva session with a new suit and my favourite pair of heels. I looked the part and felt ready, but really was in for a shock. My first viva was abdominal imaging, and I proceeded to fumble through pages of printed multiphase CT studies, barium enemas and ultrasounds. The feedback cut me to the core. Why couldn't I immediately tell the difference between clean and dirty shadowing on ultrasound? Why didn't I immediately recognise that the pre-sacral space was too wide on the barium enema? Obviously there was a collection there - didn't I know that?


I took the pass (but really it felt borderline) and managed to push the abdo viva to the back of my mind and progress through the other stations. It was a mixed bag, but overall a good day. When all was said and done, however, the negative voices and the doubting questions started to resurface.


By this stage I had purchased a light box, so I went about printing bags of cases which highlighted my mistakes. A whole bag of barium with enemas and swallow studies so that I wouldn't miss presacral widening again. A whole bag of ultrasounds so that I could assess the biliary tree quickly and seamlessly on film. In fact, most of my teaching cases are areas which I struggled with. I perhaps tortured myself over my mistakes, which I don't think was the most healthy way to go about things. I think a happy medium would have been better - taking the mistakes on board, learning from them and moving forward.


I put this on my laptop to remind me to keep me going while I studied for RANZCR Part II exams. I have never taken it off!

The downward spiral before the upward trajectory

About a month before the final viva I was exhausted. I was working part time but dragging myself to work six days a week for work, study and tutorials, racing home on my days off to collect and care for my kids, and driving around Sydney to evening tutorials and teaching as much as I could. I drove from one side of Sydney to the other for an important evening group tutorial with a college examiner, arriving late because I was stuck in traffic. When I parked the car, I realised I couldn't get out and go in. I was embarrassed about being late, emotionally fragile and utterly exhausted. I sat in the car for about ten minutes and then decided to head home.


The next day, I travelled the hour drive from home to work for a single one hour tutorial. Already exhausted and friable I waited my turn only to find have the tutorial finish before I had presented a single case. I had literally used the last of my energy to come to a teaching session that I sat in the back of. I started walking to my car, sat down on a wall and started crying. I felt so broken that I didn't know what to do. I felt like I was never going to be good enough and that I couldn't get through the exam. I felt embarrassed that I was so exposed in front of my colleagues and bosses, and (in my own mind) constantly making mistakes.


Luckily, my friend and fellow candidate called me because he was worried enough to check. He bought me coffee and quietly listened while I tried to rationalise the wave of negative emotion I was feeling. He was kind and direct, giving me reassurance without hyperbole. I started to breathe.


That night, I rested. No cases, no study. I tried to reset my brain and think straight. I remembered some good advice I had heard some months before, about doing a session of gentle cases. A candidate before me had fallen apart in a similar way, when a kind mentor had offered her a session of gentle cases to boost her confidence and get back into the rhythm.


The first boss I contacted didn't really seem to get it. I was given a more dismissive message which didn't seem to grasp that I desperately needed help. I didn't need a 'you'll be fine', because I didn't feel fine.


Luckily, the second boss I asked was obliging and we set up a short session the following day. After a better night's sleep, I did the gentle session - talking through five mammograms without pressure or expectation - and I felt better. I managed to build back up from there over the following few days and start my run into vivas. I have tried this with a few candidates since and they have told me it helped.


The midst of it all

My abdominal viva did not go as planned. The fourth viva on day one, and I was exhausted. I missed a straightforward opening case (which was a total set piece) and felt like I was on the back foot from the outset. I struggled to read, but pushed through the cases. I got through a good amount but knew that I was not in a strong position. Fast forward an hour, I was near tears counting the cases I thought I passed and the ones I failed on my fingers. With a cocktail, in full view of the street. Not a great look.


My husband was with me and we decided to have a dinner out to try and reset my brain. We had a few glasses of wine and tried to talk about things that weren't exams. I forced myself to reset and move forward. I had no other choice. Luckily, after a bit of rest and a good meal I had my favoured subject - chest - the next morning. It was the first viva I came out of with a smile on my face.


Some final thoughts...

This shit is hard. Don't minimise what you are going through and don't be afraid to ask for help.

Just keep swimming.

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