As soon as you start revising for the Practical Assessment of Clinical Examination Skills (PACES), you should ask registrars and consultants to take you around to watch you examine patients, ask you questions and critique your performance. Very quickly you’ ll realise that some of these registrars and consultants are hawks and some are doves. What is a hawk? What is hawkish behaviour? Hawks are tough. They believe in tough love, they give you a hard time, they expect high standards, they knock you off your perch and they keep you honest. Hawks are negative and pessimistic. They pick up on every omission or fault in your examinations, they ask you difficult questions and they critique you harshly.
Like yin and yang, doves are the opposite. Dove-like in behaviour, they are gentle. They encourage, they flatter, they appreciate your efforts, they build your confidence and they let you fly. Doves are positive and optimistic. They praise your thorough examinations, they ask sensible questions that you can answer and they critique you fairly.
These stereotypes are not absolute, but every registrar or consultant who takes you around will either have hawkish tendencies or be dove-like. But does this matter? Who cares? Does it change anything? The answer is yes. It really matters – I’ ll explain why.
During a typical PACES revision session in the first 2– 3 weeks, you’ re learning your examinations, you’ re learning how to present and you’ re gaining in confidence, but it’ s all quite daunting. The last thing you need is a hawk to swoop down and tear you to shreds, destroying your confidence before you’ ve even started. Go for the doves, to break you in gently.
After 2– 3 weeks, your examinations become slicker, your presentations are smoother and you feel increasingly confident. You start to think you can do it, you can be good enough and you can make it. But PACES is difficult, examiners are not always nice; they can be tough. Now what you need are hawks to take you around, give you a kick up the backside, put the fear back into you and keep you honest and working hard, and not lazy or sloppy with your examinations and presentations.
Finally, the exam approaches, about a week away. The hawks and doves have worked well, building your confidence and keeping you honest. You start to peak, you’ re really good and you have every chance of passing. But the exam is daunting, you become nervous and you need a strong will and a positive mental attitude to perform on the day. The last thing you need is a hawk to tear you down before your exam, destroying you and making you think the whole PACES experience is all too much. Seek those reassuring doves again. Good luck.
Ajay M Verma