As a senior house officer who had worked only at district general hospitals, I made my first attempt at the MRCP clinical examination at a prestigious London teaching hospital in a state of nervous dread. The “short cases”—when you are taken by two examiners and a nurse to a succession of patients—are seen as the most challenging part of the exam. Half way through my short cases, I was taken to see a frail elderly man and asked to examine his chest. Unlike the other patients I had examined, he was fully dressed. After introducing myself, I helped him remove his shirt and vest, examined his respiratory system under the watchful eyes of the examiners, described my clinical findings, and gave my diagnosis. Impassively, they turned around and disappeared through the closed curtains surrounding the bed, accompanied by the nurse.
As I began to follow them, I heard a plaintive voice say, “Isn't anyone going to help me dress again?” This was an important exam for me, and the advice of my seniors was to see and diagnose as many short cases as possible in the given time. On the other hand, you don't normally walk away from a patient you have undressed without first helping him or her to dress again. Notwithstanding a strong urge to pretend I hadn't heard, I decided, MRCP or not, the examiners would have to wait. I turned back and began to help him dress. It wasn't long before the now perplexed examiners and nurse reappeared to find their candidate. Their irritation disappeared when, as I asked the nurse to finish dressing the man, they realised what had occurred, and the exam continued.
A few months later I received a letter from the Royal College of Physicians saying I had passed. To this day I wonder if the “dressing challenge” tipped the balance in favour of a successful result.
Footnotes
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