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While you struggle to cope with all these unwanted feelings that failure brings, a cascade of judgement is inevitably thrown by the surrounding world. You obviously did not measure up to the expectations of your family and friends, further worsening that self-worth anxiety. Sounds familiar? Well, you may find some comfort in knowing that you are not the only one experiencing this. Damn, I’ve myself been there for many more times than I’d like to admit. And I’m not talking about failing in small things, I’ve been through failures that altered the entire landscape of my life. Each time I failed, I felt bent and broken; but only to acquire a better shape, and to learn the most important lesson that failure is not an outcome, it’s a symptom. Failure shouts out loud at us that something somewhere is not just right, and identifying that ‘not just right’ element is the key to future success. This is the reason why instead of nursing the bruises of my unsuccessful students, I always encourage them to identify that ‘not just right’ factor. Here at mrcog part 2, we call it a debriefing.

Debriefing: In our debriefing meetings, I encourage students to be vulnerable and talk freely in a non-threatening and supportive environment. If you are not a part of BeMRCOG family, you can help yourself by understanding the process. Debriefing is nothing but a critical reflection on your own performance – self-analysis. Reflection is the best practice to bridge the gap between present and desired outcome. It is an exercise that helps you identify what needs to be done differently to achieve different results. This can be done by adapting one of many approaches. I personally do a systematic reflection on my own performance following the fish bone model that I have explained in detail in my blog post ‘The man on top of mountain did not fall there’.

Risks of debriefing: But before you embark on self-analysis, let me warn you of the potential risks associated with this process. Critical reflection is not as easy as it sounds, it is an emotional process. All the reactions that I explained in the opening of this blog are rooted to our ego and self-esteem; telling us how incapable we are as compared to those who succeeded. If your first reaction to the failure was, ‘I don’t know what went wrong, I did quite well’, then trust me you are coming from a point of ego. Evidence proves that an ego-centred self-analysis is unlikely to change the outcome. I believe that failure should be treated like bereavement and therefore, I allow a good few weeks before conducting the debrief. This allows the emotions to settle down, denial to convert into acceptance and most of the times I find students ready to move on and look forward. It still remains an optional and voluntary meeting, because another risk of debriefing is student disengagement with the mentor and peers. Essentially, any such disengagement is an emotional reaction which is oftentimes not very helpful. I have faced all sorts of emotional reactions in a debrief, including violence against the mentor (myself) on a rare occasion.

So, before you proceed further to a self-analysis, it is imperative that you shift your focus from ego to task-oriented. This means that instead of thinking ‘the exam is tough’, shift your thoughts to ‘What can I do to improve?’. Unless you develop this mindset, you will not be able to be productive enough and move on.

Aims of debriefing: Improved future performance is the only aim of debriefing and this can be achieved only once you have shifted your focus from ego to task. The more task oriented you become, the better you communicate with the teacher, this consequently helps them to shape their teaching to your needs. Shared commitment towards learning process is the rule of thumb. No coaching, mentoring, courses or groups can be ideal, perfect and complete, because your learning is your individual process and is unique to you. This is precisely why I keep myself personally available to my students at any time of need so the gaps they might find within my course can be filled up with one-to-one interaction. Knowledge is not a fixed entity, it evolves and increments with experience and increased engagement with mentor and peers. And debriefing is an excellent opportunity to rebuild motivation and construct new knowledge.

Common Causes: The most common reasons that students highlight are listed below although this list can be exhaustive: – Inadequate preparation – Lack of revision/practice – Poor time management – Inadequate planning – Unawareness of UK systems

But did you know that under the surface of these apparently simple and obvious reasons, the actual problem is sometimes of a serious nature. This is more specifically true if the failure is recurrent. So just identifying this case will not solve the problem, you will need to consider the root cause to bring a better result.

Root Cause Analysis: All the reasons listed above have much deeper roots. I am elaborating just a few below to avoid a very lengthy post.

1. Superficial learning: This is the number one culprit for failure and a direct result of lack of understanding exam requirements leading to sub-optimal preparation. Most higher education exams are specifically designed to test your critical thinking and problem solving skills. This is next to impossible to pass this exam easily with superficial learning behaviour. Obvious indicators of this behaviour are what I call ‘red flag questions’ from the students. ‘What is the right answer?’ ‘Which books do you recommend to read?’ ‘What questions can come in the exam?’ ‘Can you provide me notes?’

The attitude behind this behaviour is seeking easy and quick fix, as well as dependence. None of this ever allows a critical thinking to develop.

2. Confidence issues: Both over and under confidence are silent killers. Confidence levels directly affect exam day performance, so no matter how well prepared you are and how good your critical thinking is, you can very easily make silly mistakes. The story doesn’t end here. What happens after exams is that those who were under confident further lose their confidence, and those who were over confident usually cannot identify the gaps they must bridge.

3. Social circumstances: This is unfortunately one factor we have least control on. The list is long but some of common ones are financial restrains, relationship problems, domestic abuse, work-place bullying, loss of a loved one etc. etc. One useful strategy is not to push yourself through, and plan the exam at a time when you feel is convenient. There is no need to be hard on yourself and as a matter of fact, this exam is never a top priority when compared with social factors. A practical and realistic approach is mandatory in these circumstances.

4. Mental health issues: Well, I can see some rolling eyes here. Unfortunately, doctors are most vulnerable but least open to accept this factor. it’s not surprising to develop circumstantial/temporary depression, anxiety, mania, phobia etc. with such a highly stressful job. And if these problems are not addressed in a timely manner, they can develop into chronic conditions. It’s important to understand that mental health is equally important like physical health, and just like we know physical exercise is beneficial even in the absence of physical illness, similarly a few counselling sessions now and then are very beneficial in mental strength.

5. Personality disorders: Once again these are much common among doctors than you can think of, but the problem with anyone with a personality disorder is that they are themselves completely unaware of this. A typical differentiating feature between mood and personality disorder is that people with mood disorders are aware of their problems and do accept help if available. As you can clearly see from the root causes mentioned above, faulty study is just one factor resulting in failure. So, focusing only on the study factor may not reveal other areas that require your attention. In my courses, I address the study factor by using a variety of teaching strategies.

As mentioned earlier, it’s almost impossible to cover every learning objective in one course. Therefore, I try to bridge the gaps and address individual needs by one-to-one sessions, non-academic support by offering to be your talk buddy, moral support and motivational chats. I also try to cover areas not covered by any other courses like systems in the UK, Clinical Governance, communication skills, statistics etc. in live online events. In my e-courses, my focus remains to facilitate you to build up your foundation knowledge and develop critical thinking by not offering any ready-made notes, encouraging brainstorming and promoting self-directed learning (I know I am a pain, but it’s a short term pain for a long term gain).

I feel to be privileged that the Almighty has given me an opportunity to help my colleagues and students beyond their study by having this platform BeMRCOG. The support we offer you here is extended to help you address non-academic challenges you might be facing. ‘Doctors in difficulty’ is a service where our dedicated and highly skilled professionals are available to help you through confidence issues, prioritising skills, mental health issues and even just for a routine counselling. The added beauty is that you can avail all of this in a private and confidential atmosphere, right from the comfort of your room. However, any help can only be offered to someone who seeks it.

Can you see now why is it so important to be honest to yourselves and take failure as a symptom rather than an outcome. Go through a thorough self-analysis, (you may wish to use the tool explained in my blog, The Man on the top of mountain did not fall there) and devise a practical plan of action for future. It is important to understand that experience is not the key to learning, it is the reflection on that experience that opens the doors to success.

Dr Asma Naqi MMEd,MRCOG, MBBS, BSc Academic Lead, Mentor and Supervisor

Source — BeMRCOG Ltd

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