Thoughts on my failure in Stage 5 of MBBS

The final exams for Stage 5 of my MBBS course at NUMed consist of WriSkE, SBA and End of Stage MOSLER. To pass Stage 5, students need to pass all three assessments. On 13 June 2019, the final results for Stage 5 was released. I passed the WriSkE and SBA, but unfortunately, I failed the End of Stage MOSLER, which meant that I had failed Stage 5 of MBBS.

The MOSLER is a clinical assessment where we have to see real patients. The MOSLER has 6 domains of assessment which are Information Gathering, Technical & Procedural Skills, Communication Skills, Clinical & Diagnostic Reasoning, Management, and Professional Behaviour. There are in-course MOSLER's throughout Stage 3 and Stage 5 as well as an End of Stage MOSLER at the end of Stage 5.

Here, I would like to share my thoughts on my failure in Stage 5 of MBBS.

To be honest, before I entered Stage 5, I wasn't confident of being able to pass it in my first attempt. My greatest worry was failing the MOSLER's. Back in Stage 3, I faced great difficulties with the in-course MOSLER's, failing the Clinical & Diagnostic Reasoning domain twice, and disastrously failing all domains of the Women's Health MOSLER.

Although I then passed Stage 4 without significant difficulties, that was because there are no MOSLER's in Stage 4. I knew my underlying weakness with the MOSLER's was still there, and that it would be a problem for me during Stage 5. With the addition of the Management domain, the MOSLER's in Stage 5 would be even more difficult than in Stage 3.

However, after I got into Stage 5, I realised that it is actually not as difficult as what I had expected. Stage 5 is basically a revision of the Stage 3 curriculum, plus some new things. I still remembered what I learnt in Stage 3 fairly well, and I felt that I actually understand everything much better when learning them a second time.

Therefore, I soon became quite confident of passing Stage 5. As it turned out, I didn't face much difficulties with the in-course MOSLER's in Stage 5. I managed to pass all domains of the Women's Health MOSLER this time, and the lecturer was impressed with my improvement. Although I still didn't get a perfect result in all in-course MOSLER's, I never failed any domain more than once.

After completing the final exams, I was very sure that I had passed Stage 5, and I wasn't quite worried about the release of the results. Therefore, it definitely came as a shock to me when I found out that I failed the End of Stage MOSLER. After all the confidence I had throughout Stage 5, it turns out that the worries I had before entering Stage 5 actually materialised.

I initially planned to appeal my MOSLER results. However, after reading the feedback written by the examiners, I realised there is no grounds for an appeal, as the feedback clearly corresponds to the marks I got for each station. Besides, there has never been a case in NUMed where an appeal of exam results is successful. Therefore, I gave up on the appeal.

The issue about failing Stage 5 is that we must repeat the entire year and take all assessments again, as NUMed doesn't allow us to just resit the failed assessments in August like for Stage 1, 2 and 4. Most students don't like the idea of having to spend another year studying for the MBBS degree and they prefer to be given the opportunity to resit in August.

But for me, while I think repeating the year isn't ideal, I actually prefer it over resitting the MOSLER in August. This is because repeating the year gives a substantially higher chance of passing compared to resitting in August. It is definitely important to maximise the chance of passing as failing a second time will result in dropping out of MBBS.

If we resit in August, we have only about 2 months to revise everything and also improve on our weakness, which is definitely very challenging and risky. Meanwhile by repeating Stage 5, we have an entire year's time, and we are taught everything again. It isn't uncommon for students to fail again after resitting in August, while most students improve a lot after repeating the year.

As I have mentioned in my previous post, the main cause of my failure is my method of studying. Other possible causes are overconfidence and lack of clinical skills practice. I had some relationship issues in the months leading up to the final exams, which also contributed to my failure in the MOSLER.

I never looked forward to graduation. I have been together with my friends in NUMed for so long. As an emotional person, having to separate with them after graduating definitely makes me feel very sad. Now that I failed Stage 5, I am not graduating this year, but it doesn't make much of a difference, as I still have to separate with most of my friends.

This is the first time where I failed a year in the MBBS course. I definitely consider Stage 5 to be the most difficult year. Despite that, the course content of Stage 5 have been very interesting. For the repeat year of Stage 5, I hope I will have a much better experience. I won't hate NUMed for failing me, and I will never regret my decision to study MBBS at NUMed.

My weakness in the MOSLER assessment

At the end of Stage 5 of my MBBS course at NUMed, there are SBA and MOSLER assessments. The SBA is a multiple-choice written examination, while the MOSLER is a clinical assessment with 8 stations where we have to see a patient in each station.

The MOSLER has 6 domains of assessment which are Information Gathering, Technical & Procedural Skills, Communication Skills, Clinical & Diagnostic Reasoning, Management, and Professional Behaviour. For the MOSLER which I took in June 2019, I failed the Management domain and I only scored the bare minimum required to pass the Clinical & Diagnostic Reasoning domain.

What went wrong actually? After reading the feedback written by the examiners in the MOSLER, I think I have figured out that the main problem lies with my method of studying. Basically, I place a lot of emphasis on the BREADTH of knowledge, but not on the DEPTH of knowledge.

Focusing on the breadth means that I always try to study as many diseases as possible in the books. I usually give every disease equal consideration, regardless of how common each disease is. With a few exceptions, I will not leave out any disease in my revision.

However, I do not study each disease deeply. Usually, after revising the signs and symptoms as well as the basic investigation and management plans of a disease, I consider myself done with that disease and I will not explore it further. My thought is that any further knowledge is not important for undergraduates.

My favourite specialty is primary care (general practice). Being the first point of contact for patients, general practitioners need to know a very broad range of diseases, but they do not need to know each disease as deeply as compared to other specialists. My interest in this speciality has a certain influence on my method of studying.

Having the breadth of knowledge is important for the SBA examination as the questions test on many different types of diseases, including very rare ones. My method of studying that emphasises on the breadth of knowledge enables me to perform quite well in the SBA.

But for the MOSLER, the depth of knowledge is important. This is because the examiners usually do not just ask general questions like "How would you manage this patient?". Rather, they would focus on a particular area and ask detailed questions about that. Without the depth of knowledge, it will not be possible to answer many of those questions.

One of my stations in the MOSLER was hypothyroidism. The examiner asked me about the investigations for Hashimoto's thyroiditis, a cause of hypothyroidism. I gave thyroid function test as the answer, but the correct answer should also include autoantibodies test which I did not know because I did not study Hashimoto's thyroiditis detailed enough.

Next, the examiner asked me how I would adjust the dose of thyroxine that the patient was on. I could not answer that question at all, as the only thing I studied about the management of hypothyroidism is giving thyroxine. In the end, I got a score of 0 for both the Clinical & Diagnostic Reasoning and Management domains of that station.

There was a MOSLER station where a patient with COPD came for a follow-up. I knew the bronchodilators and steroids used to treat COPD, but the patient already was on all those drugs. The examiner instead asked me about the prophylaxis against acute exacerbations of COPD. I did not study that at all, so I was unable to answer that question.

In one MOSLER station, the patient had just recently underwent a coronary artery bypass graft (CABG) surgery for MI. The examiner asked me which vessel is used for CABG. As I did not study the details of CABG, I only knew that the vessel is located in the legs but not the name of the vessel which is long saphenous vein.

In the acute care simulation station of the MOSLER, the patient had pneumothorax. After performing ABCDE, the examiner asked about the further management and I answered chest drain which was correct. However, when the examiner asked how should the chest drain be inserted, I could not answer it at all. Again, this is because I never bothered to study chest drain in detail.

Many students who failed Stage 5 of MBBS actually passed the MOSLER but failed the SBA instead. I believe their situation is the opposite of mine, where they have the depth of knowledge but lack the breadth of knowledge. From my observation, many students tend to focus on the more common diseases and study them deeply, while neglecting the less common diseases.

So, in order to pass all Stage 5 assessments, we need to have both the breadth of knowledge and depth of knowledge. In the future, I need to change my method of studying so that in addition to revising a wide range of diseases, I also go deeply when revising each disease.

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