Expectations/Hopes vs Training

We don’t rise to the level of our expectations/hopes, we fall to the level of our training. – Archilochus

I came across this quote a few days ago, and it really resonated with me, so I thought I’d write this. I tend to come across quotes/cliches like this quite frequently, and given that “the secrets to life are hidden behind the word cliche” (another of my favourite quotes), I plan to do a brief write-up expanding on quotes that have particular meaning to me. So here goes.

This quote by Archilochus makes a lot of sense, and like most good quotes/life advice, seems quite intuitive. Some might even scoff at its simplicity – those same people would also probably scoff at most ‘cliched’ ‘life advice’, so this post isn’t for them 😃

Anyway, the quote reminded me of my Fourth Year OSCE exams. For the uninitiated, OSCEs are Objective Structured Clinical Examinations, a type of medical school (and beyond) exam in which students have multiple ‘stations’ to get through, each of which has a different task. For example, one station might be to break bad news to a patient (an actor), another might be to ‘perform a cardiovascular examination on this patient’ (read: listen to their heart), and a third might be to interpret some X-rays with the examiner.

Given that this year’s OSCE was 4 days after the written exam paper, lots of students (including me) decided to focus on the written exam, and then in the 4 day interim, do intensive preparation for the OSCE. That worked for a lot of people, but I wasn’t overjoyed by my own OSCE performance, and I think the quote goes some way towards explaining why.

In essence, I didn’t practice the OSCE stuff much throughout the year, only really doing token amounts of work towards it, and instead focusing almost single-mindedly on the written paper. This was a mistake – the OSCE accounts for 50% of our overall grade (the written paper making up the other 50%), and OSCE-related skills (history-taking, clinical examinations, clinical communication skills etc) make up an enormous chunk of a doctor’s workload.

I can remember thinking in those 4 days of intensive OSCE preparation that (a) I wish I’d done more of this stuff throughout the year, and (b) hopefully in the exam, everything will go according to plan. In the exam, everything did not go according to plan, and while I performed reasonably, there was a lot of room for improvement.

It’s very easy, while practising a skill that we haven’t fully mastered, to think through the steps in our heads and assume/hope that they’ll translate into practice if we carried them out in real life. But as we were told at the start of the year, there’s no substitute for sustained practice over a long period of time (“a patient a day keeps failure away”), and that’s what I’ll be keeping in the back of my mind for the next 2 years of medical school.

We don’t rise to the level of our expectations/hopes, we fall to the level of our training. – Archilochus