Diplomate Struggle

“Sir, I have come back.” My lecturer had been on leave for a couple of days. “How was your exam?” I asked. He had gone to appear for the National Board exam. “It was OK” he said. “I had a bit of a problem on the ward round session.” “Huh?” I said. Our patient load and our evidence based approach to patient management were such that any one who had worked at our institute would always do well in patient management sessions. “The examiners were upset when I said a patient who undergoes a cesarean section has a Foley’s catheter in the urinary bladder.” “What do they do?” I asked. “They put a simple rubber catheter preoperatively, and remove it before starting the operation.” I was surprised. Some people do follow this method. But to criticize an alternative method was not very good. That was a couple of weeks ago. He called me yesterday. “Sir, I passed that exam” he said. “That is wonderful” I said. It was indeed wonderful. I hear the examiners are instructed to pass only 5% candidates. My lecturer must have done very well. That discussion did bring up old thoughts. The National Board invited people to be examiners without any qualifying criteria. So the usual people who are examiners for MD or MS examinations end up being examiners for this exam too. They end up asking the same questions as in the MD and MS exams. They have the same whims and fancies they have when they conduct either exam. Because they have to fail so many candidates, they end up failing those who do not fit their ideas. Years ago, one of our lecturers had gone for this exam. They failed him because he showed them the correct method of holding an episiotomy scissors, with the angle facing outwards. The examiner was quite angry. He said the scissors should always be held with the angle towards the patient. I wonder if that examiner ever makes an episiotomy, because I tried to visualize and failed how he would do it with the handles digging into the patient’s buttock. He went on to criticize the institute where this practice was learned. This candidate went on to be a professor at our institute, and a fine one too. I don’t know what happened to that examiner. I also thought of our professor who was asked to conduct this exam in our college. She got slides of endometrium for showing in the exam. She got the senior scientific officer to label them as proliferative and secretory so that she would know which one was which during the examination. She also got a list of patients kept for the examination from the Registrar, with their clinical findings and diagnosis written against their names. She failed a good candidate because the candidate said the uterus was 16 weeks’ size, while the Registrar had written it was bulky. Had she bothered to just palpate the patient’s abdomen, she would have realized her mistake. I do not know what the National Board achieves by appointing such persons as examiners. When my residents and lecturers want to appear for that exam after their MD/MS qualification, I wish them luck, but ask them why they want to appear for that exam when the examiner could be such a person and fail them. Failing for all the wrong reasons is something quite difficult to live with. In fact, it is insulting to be examined by failed by a person who is wrong and you are right. They still appear for that exam, probably because by that time they have already paid the fee. Most of them learn the hard way what I want them to learn from history and my advice. Well, that is life!