Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?
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Notes -
Shameless hijacking of the SSQ for a Wellness/Fun topic, because I just can't wait till the middle of the week. Forgiveness requested in advance.
Ahhhh. The exam is over. Is it over for good? I don't know. The Royal College usually takes about 5 weeks to release results, uncannily close to how long you spend waiting on a new antidepressant before you can tell anyone whether it's working.
By this point in my career, I've made peace with the fact that my anxiety and post-exam nihilism do not correlate particularly strongly with exam performance. I've done well (or at least passed) every test to date, even when the emotions actively present while I'm staring at the screen are some mixture of incredulity, frank confusion, and mild despair.
I dare say I felt less actively homicidal during this year's Paper B than its predecessor. The majority of questions seemed reasonable. There might be one or two utter stinkers in there, but unlike last time, my frank confusion is just as likely to be the product of my ignorance as it is incomplete information or bad phrasing. Progress, of a sort.
Working myself to near-meltdown did pay off, even if the last week and change was spent un-teaching myself what SPMM taught me.
When I first saw them reference NICE/SIGN guidelines from 2019/2020 many months ago, I assumed they did this because the guidance hadn't meaningfully changed since then. This was wrong. Badly wrong. About 20% of the material is out of date. The core management of psychiatry has not undergone any fundamental upheaval (haha, no), but NICE does its usual cost-benefit/utility analysis and pushes out minor updates whose effects ripple through the decision trees. I spent my last week of revision correcting these dangerous errors instead of actually being able to study. I pay these fuckers to do that for me. They haven't updated jack-shit since at least 2022.
Can you give methylphenidate to a child with ADHD and comorbid tic disorders? SPMM (quoting older NICE) says no. New papers by 2025 say: uh, actually, probably fine. No need to condemn the poor bastards to guanfacine, which doesn't help with inattentiveness. This precise question came up in my exam, and I chose methylphenidate, praying that if the College demands its trainees stay up to date, it has the courtesy to do the same.
I said I was tired. I still am. Nervous energy and the upper limits of Ritalin intake only go so far. I came out of the exam hall craving a drink. Craving two, maybe, or three and four if time allowed. Six seven? What, do I look Italian?
This means I have not bothered to sit down and do a proper post-mortem to see whether my answers were correct. I couldn't be arsed. Still can't be. Maybe tomorrow, if I haven't forgotten everything by then.
The most exciting event during the exam was the fire alarm going off, prompting a rapid evacuation of the test center. Nobody seemed to be in a position to answer reasonable questions like "is the building actually on fire?" or "can we pause our fucking tests while you figure this out?" or "what if I'm willing to fight the fire with water (coolers and actual extinguishers) if that's the price of a pass?" We spent half an hour in the rain, grumbling and despairing in equal measure.
It turned out to be a false alarm. We were allowed back to our seats, and after an interminable wait, the invigilators managed to get hold of the RCP and wrangle extra time on the test for us. I consider this an absolute personal win. I stretched my legs, drank some water, and took an ibuprofen for the mounting headache. If the exam had actually been cancelled or postponed, I was angry enough to sue, and so were most other trainees. Some intend to lodge a formal complaint anyway.
I used the extra time to revise my revision, changing a grand total of 2 questions to another, equally plausible answer. Idk, the vibes were better. I was exhausted, it had been 4 hours in there, and ibuprofen and nicotine gum only go so far.
I left with time to kill and went to the seedier, smaller parts of Glasgow. Always a good way to get a feel for the place. At a tiny pub the size of my living room, I had a pleasant time with the bartender and his geriatric buddies. I fielded multiple questions about the accent (I have a mental script handy) and explained that their guess on its provenance was as good as mine. They suggested Canadian, which is... maybe? Some of them had actually visited Toronto, so they might be onto something. I'll continue calling it a mongrel for now.
Then a haircut. Not strictly necessary, but I needed to treat myself. I treated myself to a hefty bill: £38 for a cut and shave at a Turkish barber, where my actual barber was a pleasant enough Scottish man with ADHD and depression (we had a productive discussion that changed nothing; it was idle conversation). At least it's a great haircut, done super quick. Maybe ADHD can be a superpower, if that superpower is running a trimmer at speed? Whatever. I got a nice hot towel waterboarding experience (probably billed) and coffee and nicotine gum (entirely free, thank god).
Then a sinfully delicious meal at a pub. Goan venison with rice and a whole-ass femur cracked open to let the marrow out. I could have had seconds. Instead, I settled for a helping of Vietnamese later from somewhere cheap and cheerful.
Then a train back, where I had the opportunity to debrief my parents before it got too late in India. To my pleasant surprise and bemusement, I'd received another arranged marriage proposal. Daughter of dad's medical colleague, a fully qualified dentist. I would like to claim I used to have a slight crush on her when we were kids meeting every year or so, but I could be imagining things entirely. Apparently she'd been stalking my Instagram and liked what she saw? Good for her, girl, but I live in a different country and like my teeth the way they are. If I didn't, I'd go talk to those Turkish gents. They'd hook me up.
I was also bombarded with an unusually high number of likes on dating apps, those technically-still-on-my-phone shrines desperate to remind me of their existence. I suppose my sunny disposition suits Glasgow, which lacks any solar insolation for most of the year. Certainly for as long as I was in it. Someone claimed I had a contagious smile, which is probably the better kind of very local endemic condition.
Not a bad day. Managed to take the train home uneventfully, managed to crawl into bed, and also managed to dread going back to work tomorrow. My sleep cycle is in dire need of new tyres. I'm tired. Adios.
How are you coping with the fact that they're now going to "non-prioritise" people who don't have UK degrees or strong UK links for consultant training posts? I'd be super extra double pissed off in your position, especially when they say this is to ensure "a level playing field" when it actually does the opposite and gets rid of the level playing field.
I'm not entirely sure what you mean by that, since I'm only aware of planned changes to the UK training pathway. Last time I checked (all of a week or two back), the fact that I'm already in training and will (hopefully) acquire a British degree makes me quite safe. Even if I want to go through the pain of becoming a senior registrar and then fight for a substantive consultant post. Not perfectly safe, since things are up in the air. To be specific, the number of years of NHS experience you need to be treated as on-par with British medical graduates.
Am I missing something? If yes, then the main way I cope with this is by ignoring the problem till I can't put it off. Worst case, I'll end up a perma-reg or a locum consultant, or join a private company. That's not glamorous work, but it pays the bills, and I already live well below my means. If the UK isn't an option, then I think there's a chance I have an out in the form of NZ. If my USMLE issues clear up, that opens doors I'd rush through like they lead to nirvana. In the worst case? I can leave for India, rather unhappy about everything except the increased vitamin D production. All of this was half the point of the pain and suffering, I retain some optionality, even if it's not as much as I'd like.
Ah, I was talking about this: https://www.bma.org.uk/advice-and-support/career-progression/training/what-the-new-law-means-for-uk-graduate-prioritisation
Surely you must have seen this? I'm nowhere near medicine and in my circles people have been complaining about it.
Yay. ☺️
Nay. 😒
I know about this, as I should, since my future hinges on it. But I'm not seeing anything about consultant posts, which is why I was perplexed. If they were discriminating against me on that basis, I haven't heard about it, and it's not covered by the BMA article
I'm a core psychiatry trainee. That means I'm "completing" core training. It's in the name, unless they have very serious opinions on ab workouts.
As far as I can tell, I'm safe. About 90% confident saying so. I caught the last chopper out of Saigon, or the last C-17 Globemaster out of Kabul. Sacrificing my sanity or my will to live to get there was a small price to pay. I tell new Indian doctors who want to train abroad not to waste their time aiming at the UK, and not just because of recent developments.
Yeah, the UK has issues. I tell people who want to become quants as well that they shouldn't prioritise the UK: you pay crazy tax while getting basically nothing in return + you don't even have the lower tax for X years incentive plans the European nations have to entice people like us to come over. It's like the UK believes that by virtue of being the UK it can bring high talent people over plenty of other options that only look better and better every year. That may have worked in the past, I'd be surprised if it still works 10 years down the line.
In finance there is no real QOL difference between NYC and London and even some reasons to prefer the latter. Sure, Texas is much lower tax, but finance is pretty small in Texas. Singapore and Hong Kong increasingly prioritize locals / Chinese.
All in pay for my job is maybe 30% higher in NYC. Once you factor in state and local taxes the tax burden is pretty similar. Groceries, restaurants, rent are 50-70% more expensive in NYC. Consumer goods are the same, but one can only buy so many iPhones and big TVs. High end fashion and luxury goods are subject to import and luxury taxes that make them ~30% more expensive than they are in London. Vacation time is half of what it is here. Property is about the same although NYC prices are steady while London’s are falling. The weather is a mixed bag, NYC is sunnier but London has a far better climate. A ski vacation in the Alps is half of what it is in Aspen at the same tier.
The main jobs where it seems to make sense to move to the US are in tech and medicine, although the latter is very difficult. In finance, though? Compare what $6000 rent gets you in lower Manhattan vs the pound equivalent in London. My parents’ local Italian restaurant in NYC (once you factor in taxes and tip) costs the same as Cipriani here. (Cipriani in NYC is at least double). And when you factor in much higher crime, crazy homeless psychos, far more dangerous and dirty subways, tropical swamp summers and freezing winters, worse storms etc etc it really is no contest for me - London wins, at least for now.
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