He sat the last Harrison last year, and did not make it by 1%. With no vacancy to choose a specialty, José Durão decided to repeat the exam this year, going through a new study process. From the old book commonly called Harrison's (Harrison's Principles of Internal Medicine) that compiled 5 major chapters, and essentially focused on the contents of Internal Medicine, he had to study 8 different books and put together the pieces of clinical reasoning to come up with a conclusion.
Uncomplicated and pragmatic, he knows how to assess his own situation very well, but regretting that this year of pressure in which the Exam is studied and taken will lead some to such pressure as to cause exhaustion.
In his view, there are no gloomy futures, one has to look at them, find ways and not be afraid to make decisions.
That's what this former year 6 student from FMUL did.
What do you feel when you look at a results table and realize that you do not enter for scant tenths after a full year of study?
José Durão: Well, it is worth mentioning that I am not really part of the group of my colleagues who tried bravely to get a good result on the test more than once. I cannot consider it like that, since when I first studied for the last Harrison, I was not really dedicated to the test. In 2018 I was part of the Board of the National Association of Medical Students (ANEM) and, although I accompanied my study group, read the whole subject at least twice and tried to combine the two aspects as best as possible, I was mostly dedicated to the ANEM and even before exam day I was convinced that I would repeat it test the following year. I dropped out of the competition even before the grades came out, because I felt I wouldn't get enough marks to pick a specialty, and it turned out to be almost tragicomic that the last student to have a place had 57%, and I had 56%. Still, I can imagine the feeling of uselessness of a year and the frustration of those who were truly engaged in their study and could not achieve the result they wanted, in many cases not even the minimum result to be able to choose a specialty. It can be a tricky situation to overcome, mentally speaking. In an ideal world - or an ideal NHS - this would not happen. We are many and there is no room for everyone, it is a fact. It is not our fault and it is not something that comforts those who are left out of the competition, so I think that easily, in the face of failure, existential questions arise: Why do I have to be one of those who have no vacancy? Why don't they let me be a doctor? I can also be a good professional, I just want to get into a specialty, why don't you open more places? And so on… No wonder more and more recent graduates decide to emigrate. Not only there are better working and living conditions in many places out there, but the prospect of experiencing uncertainty, insecurity and possible failure in the entrance exam to the specialty is simply too black to face. After all, it is a process that may well be destructive to one's mental health. I don't judge anyone who, having other options, doesn't want to go through it, let alone more than once.
Still, you spent two straight years studying. What are the methods? Are there better techniques or routines?
José Durão: The first year was not entirely an intensive study. Still, I was always trying to follow up, so it was practically two years studying. While in 2018 I just read the book and followed up some courses, this year I tried to create a stronger study structure. As I decided not to start General Training in 2019, the main challenge was managing my free time. Setting a pace and study plan from the start is essential to avoid being overwhelmed by the amount of material. There is not exactly an optimal method or technique, I think the best advice is that one continues to study as he/she has always studied throughout the Faculty and rely on the chosen method. The bibliography is plenty, there are question books, there are courses, there are digital platforms, there are flashcards, the list is huge... One can’t use it all and there is not a magical number of "twists and turns" that should be given, so it is a matter of choosing what suits one best, planning, setting goals and meeting them as well as possible, while ignoring what the people around you are doing. It is choosing what is most comfortable and safe for each one. And to continue, as far as possible, to live life, to do things beyond study that allow some degree of normality to be maintained. Nobody particularly likes this year of study and it's good to remember that it's just another exam. It is an important exam, yes, but it does not define or should not minimally define anyone. It is an important notion to keep in mind, especially for those who "fail" after a long time of study.
In the long process of preparation, there are many silences and possibly "loneliness" most of the time. Can you tell me what's going on in a person's head when going through this year (s) of preparation?
José Durão: Above all, I think it is uncertainty, the constant question of not knowing how the exam will be, what should be given more importance in the study, how many vacancies there will be, how many people will want the same specialty, etc. There are many issues throughout the process, sometimes too many and beginning to affect the stability of the study. It takes some mental strength to be able to separate the waters, ignore these small insecurity voices, and continue to study, believing that it is worth studying. Access to the specialty gained a competitiveness that did not exist when I started the degree and the nervousness grows from year to year. In my case, I think that having a more or less constant study group throughout the year was probably one of the most important positive factors. The study can become very lonely and it is easier to give in to doubts when in isolation. I have never had the habit of studying alone at home, I suppose for some it is natural. I believe there is a time for study when anyone feels the need to vent concerns and having a good emotional support around can make a difference. Over the years, we have become aware of colleagues who need anxiolytics, sedatives, psychotherapy, stimulants, to the point of mental exhaustion that simply makes them lose their north. Fortunately, there are few cases but the truth is that none of this should be necessary, none of this is supposed to happen because it underlines the unusual mental pressure this exam places on candidates. I think it has a lot to do with competitiveness and the lack of places, since the exam can even be done easily without any of that. The access conditions are simply not the most favourable. In fact, they are less and less favourable.
Which specialty would you like to pursue?
José Durão: A bit the result of my associative history, more linked to intervention projects and personal interest for impact at a global level, and also due to the fact that I have never identified particularly with any clinical specialty, my goal is to pursue Public Health, whether here or abroad. At the moment, it is a little dependent on the grade of this new exam but it is a specialty that enables the mobility to move about, combined with a taste for the so-called global health. As I say: I can appreciate medicine but what I really like is Health. It is not yet a specialty much sought after by most of my colleagues at all, which also gave me some more peace of mind about access to public health. Right now, I’m waiting for the result of the 18 November exam and then I will plan what to do about the specialty and career. One thing is certain: nothing is over with this exam and there are many paths that can be followed in a health career.