Preparing for practical exams and developing practical exam skills
Do you want to know the surefire way to stay anxious? Don’t do the thing that makes you nervous! (Larina Kase, psychologist)
Taking practical exams can be nerve-racking and you may experience symptoms such as ‘butterflies’ in your stomach, fast heart rate, sweating, and other feelings of anxiety and panic. While a certain amount of nervousness can enhance your exam performance, being overly anxious can lead to a loss of concentration and confidence and result in under-performing. It is therefore important that you make time for preparing for practical exams and develop the skills that will help build your confidence and ensure that you gain the marks that you are capable of. Practical exams are very different to written exams and demand skills in a variety of areas that you may not have much experience in (e.g. oral presentation, problem solving, responding to questions ‘on the spot’).
Like any skill, developing practical exam skills takes time and a lot of practice so leaving things to the last minute is not recommended. For many of you, preparation for practical exams will begin in class. Without you necessarily realising it, class activities are designed around you acquiring the necessary skills for practical exams over the duration of the module. Engaging enthusiastically with your class tutor and following their advice and being prepared is a good start. However, to improve your performance further, especially if you find practical exams extremely daunting, there are many things you can do to strengthen the process that has begun in class. This information sheet has been put together to give you some guidance on what YOU can do to prepare for practical exams. Please note that the information sheet has been put together for students on a range of programmes. Therefore, depending on the format of your practical exams, some of the following tips will be relevant while others may not.
Top tips on preparing for practical exams:
Preparation when studying:
Be smart - make sure you know how marks will be broken down and tailor your preparation accordingly. For example, look at previous examination papers and if most of your marks are going to come from demonstrating practice skills and applying theory to the case presented, make sure that you are well prepared in these areas. Look at the module learning outcomes in the module handbook. These are statements about what the student should be able to do at the end of the module, so reading these will help you know what the module is trying to achieve and will also help you to prepare. There is often other relevant information about assessment in the module handbook so make sure you keep it handy and refer to it as you progress through the module.
Work on problem-solving skills - one of the major skills that you are being tested on in practical exams is your ability to apply your knowledge of theory to the case presented. This is a problem-solving task that will require practice for you to master. When studying, think about how the learning materials relate to practice situations and try to come up with problem-solving type questions and scenarios. For example, if you are learning about a common injury or disease, in addition to learning “textbook” pathology/theory, think about how different presentations of pain, swelling etc might impact on how you would conduct your examination and how these relate to your diagnosis of the problem. You could then work outhow different scenarios will alter the short and long-term treatment plans.
Eg:
- How might medication that the patient is taking affect your decisions?
- How might the reporting of a dull intermittent pain as opposed to a constant burning pain affect your examination and suggested management of the patient?
- What structures lie beside the site of the problem?
- How might injury to a specific muscle/ligament affect specific movement and general function of a body part?
Be fully prepared for typical conditionsthat could be presented by thepatient/examinerand make sure that you are fully prepared for them (e.g. common foot deformities such as hallux abductovalgus and hallux limitus, osteoarthritis of the hip, rotator cuff injuries, fractures of the tibia)
Make up a prompt sheet to prevent ‘mind-blanking’ in oral exams-If your practical exam includes a presentation, devise a prompt sheet and use it on the day if you are allowed (if not, memorise it). This will help you to develop a routine which will make you feel confident in your ability to stay on track and remember what you need to include in your presentation. Similar prompts can be devised for practical skills e.g. manual muscle/ligament testing, so if you get asked a question that ‘throws’ you, you will have a prompt sheet to remind you of where you were. These prompts ought to be devised as early as possible during the module so you can apply them during class and gain confidence early on.
Create a file of scenarios that you can use to test yourself with - When treatingpatients/practising with models under non-exam conditions, keep a note of the issues that they present you with and write them out on index cardsor on a self-reflection sheet so that you have a ‘bank’ of possible scenarios that you could be presented with in a practical exam. When preparing, select a scenario at random and think through how you would deal with it and what questions you might get asked. It is a good idea to discuss these scenarios in a small group to gain a broader perception of how others would manage the same situation.
Practise using technical language as much as possible (say it out loud to yourself if you have to). This will help difficult terms become part of your vocabulary and come easily to you when you are in an exam situation. Use this technical language in class with the class tutor who will then correct you at an early stage when there is an expectation that mistakes are likely. Making mistakes like this as a more mature student is more noticeable and liable to make you more self-conscious.
Practise scenarios in small groups - take turns with classmates to play the role of patient and practitioner. Give each other constructive feedback on the diagnosis, treatment plan and inter-personal and handling skills. Alternatively, meet up with some of your classmates and discuss how you would deal with certain scenarios (e.g. patients with diabetes, arthritic conditions, structural deformities). Don’t be embarrassed to use technical language – it’s a good opportunity to get used to it. Sharing ideas in this way is one of the most valuable ways to prepare as you will be able to test your knowledge in comparison to your classmates and get help and ideas from them.
Preparation in placement:
Manage every patient as you would do in a one-to-one exam – If you get into bad habits on placement, you are more likely to repeat them in an exam or in front of a clinical educator, so as far as possible, treat all patient contact in placement as if you were being examined. This will ensure that you have rehearsed all the important steps and techniques that you will be assessed on and make it easy for you to switch into exam modewhen required. For example:
- Practise correct techniques (e.g. scalpel use, Ultrasound set-up, muscle stretching)
- Practise correct safety procedures (e.g. make sure that you and your patient are positioned correctly (bed heights/brakes etc), that you are presented appropriately (e.g. hair tied back, short nails), and that you always remember to wash your hands when appropriate)
- Take patient notes as you would in an exam (using a copy of the same help sheet). This will help you get the hang of taking notes and using key words that you can then use as prompts when talking to the examiners/clinical educators.
Take every opportunity to practise exam skills in placement. For example, many students who are given the opportunity to give a quick presentation to their placement tutor after treating a patient choose not to. This is because they are afraid that they will do a bad job and so they would rather avoid it. This is a missed opportunity as your tutor will be able to give you valuable feedback and tips that you can then use in the real thing. Also, practice is the best way to overcome nerves so if you tend to get overly-anxious, get as much practice in placement as you possibly can.
Be positive
Think rationally -If you know your stuff and you’ve been practising all the correct techniques in placement, why should you get it wrong on the day? At the very least you ought to be able to justify what you do, even if it is wrong. For those of you that have exams with patients,a large proportion of your marks will come from demonstrating these skills so if you demonstrate them as you have in placement, there is less pressure on you in the oral part of the exam than you might think.
View questions from examiners as an opportunity rather than threat - Most students worry about being asked questions posed by the examiners. It is important to realise that it is not necessarily a bad thing if you are asked lots of questions – the examiners are trying to get a feel for the depth of your knowledge and are not trying to catch you out – they want you to pass and sometimes their questions are meant to help you by giving you some clues! In general, the more clear your own thoughts are, the more clearly you will express these under exam conditions. Of course clear thoughts come from the activities suggested in this handout. Remember, the sooner you start these, the sooner you will develop these skills.
Don’t let nervousness put you off - Remember that some feelings of nervousness can enhance your performance by making you feel energised and focused on the task at hand, so try to welcome symptoms of anxiety rather than let them get the better of you.
If your nerves get really bad…
If you are prone to extreme anxiety, you might need to develop some anxiety management techniques. Please make an appointment with Jane to work on this.