Preparing for DNB practical exam and beyond - Body language
Passing the Pediatric residency exam is a tough task especially when it comes to the practical/clinical examination and OSCE.
Unlike theory exams, practical exams do not test your knowledge in pieces, but how you can apply the collective knowledge to a given clinical scenario. The ability to role-play a doctor during your practical exam is one of the important steps to clear before starting clinical practice in the real world.
Indian system of evaluating is far from being perfect, and DNB practical exams are no exception, however, NBE is far ahead of other systems of post-graduate examination in the medical field and probably that is what makes it more difficult.
Since the pattern of exam we faced earlier is different, The DNB starts feeling even more difficult. But this is a no-outcome rant, so let’s face it and come to the point which is...
How to pass DNB practical’s?
Well, there is no simple answer to that. But soluions are always there. One things is definate its not just the knowledge that is tested in practicals, but your overall persona as a clinician.
Apart from your knowledge you gained over three years of residency, which is a key, the assessment during the practical exam also includes your mindset, attitude, your ability of decision making, and your overall personality as a doctor.
Who likes a confused, sweating, anxious doctor?
The anxiety, pressure, uncertainty, new place, new faces of examiners, new exam pattern, everything impacts the overall piece of mind and body language negatively, expressing anxiety, fear, and even anger sometimes. Even though this is not what you are, or want yourself to be perceived, unfortunately, your body language projects quite opposite.
While some examiners understand these problems, some may be strict enough for the excuses, which is understandable from their point of view, after all, they are issuing you a license to practice. Imagine a pilot getting a license to fly when he is unable to perform his best under stressful situations. Scary!
You will get several discussions, mostly focusing on the key points in academics. For a change let's try to discuss the other aspect. Before appearing for my practicals, I was a bit anxious about how should I dress, what apron to wear: Short sleeves or long? and so on.
All of this to make myself presentable, But I never thought about how my body language could impact my performance.
Practical exams are like hide and seek game. You try to hide what you don’t know from the examiner but your Body language speaks for itself and what worse sometimes, is that, even when you know the answer to a particular question, it might project as if you don’t know or you are confused just because of wrong clues projected by your body language.
Let’s try to pen down a few things on how should be your body language while appearing for the practical examination. These things are even more important while attempting the OSCE station which focuses on testing your communication skills with little kids and their caregivers. This guide can also be helpful for exams such as IELTS and OET.
Medical Viva and Body language
Consider this as one of the several tips for hacking pediatric Practical Exams.
Body language speaks a lot about our mindset. Your resilience, functionality, and capacity to respond to what you know and what you don’t know.
Eyes speak a lot about what is going on in our minds. Many students start seeing in north -south - east - west when they are thinking, recollecting, processing, or when they have no idea what the answer is ( happens).
While there is nothing to be afraid of, looking afraid is not going to score a mark on you. better to look up straight towards the examiners with natural eye movements. Also, give equal due time to all examiners sitting in front, rather than just focusing on one. Try to engage them all with your eye gestures.
Your Neck posture
Like the face, neck posture also responds to our thought process. We hold straight when we are confident to answer and we bend forward when we are not sure of the answer, we drop down when we bluff and bluff is caught. The solution is practicing a neutral response while answering. Even while saying "you don’t know the answer" you should be looking straight! because, in reality, you don't the answers and there is nothing to be ashamed of that !.
It is absolutely natural to not know the answers to all questions unless you are a book yourself. 'It is Ok!. But it is not OK to try to hide, bluff, or be ashamed.
Your face and expression
The face is the mirror of the mind and facial muscles are highly sensitive to stress, anxiety, and anger. Some students even get twitches face or neck when they are nervous or don’t know the answer.
Don't look froze up while answering. While it is natural to look anxious, clueless while you face the examiner, you can actually control these things if you keep the thing in, back of your mind and practice viva with friends. Just give it a thought that “ I will remain neutral, no matter what” and it should be fine.
Even when you know the answers, your unnecessary facial expression might project you are not confident of your answers. Better to avoid this. Overall posture- sitting or standing with neutral and symmetric posture is always better, crossed legs or arms conveys mental nervousness.
The tone of your voice speaks for itself. I would put this as the most important component of your body language. Speak in a calm and composed way. Avoid jargon. Speed, intensity, and tone clearly tell the examiner about your background knowledge of the topic.
Let us try an exercise. Speak to yourself about the dose of paracetamol vs the dose of mycophenolate mofetil and observe how your tone changes. Maybe, try to record it on mobile and have a listen. You can easily notice the change in voice quality.
You can easily master this. Try speaking with friends, while they act as an examiner and vice versa. Or perhaps if you don’t have any, speak to yourself in the mirror or keep an object in front and try to practice your viva voce.
I am sure these things take very little effort and time. If you can master a tough subject like pediatrics, these are very tiny things in comparison. In fact, just having these things at the back of your mind, make a lot of difference. Unfortunately, it is never discussed or taught during residency.
An important thing which also helps in this is clearly telling you don’t know the answers at once, you are sure you don’t have the answer. This avoids unnecessary ups and downs in voice while speaking.
The other thing is, when we know what the examiner is asking, we jump with joy like winning a lottery. Well, you need to control that, The survival tip for voice is to speak at a low pace with a uniform tone without any need of accelerating if u know the answer.
Drooping shoulders or inward shoulder might reflect your uncertainty about what you are answering. You also lose nonverbal contact with your examiner. Indirectly it declares that you don't want to go further on the topic.
Some might do this while thinking or recollecting the answer and the examiner might think otherwise that you don't know the answer.
Preferably use hands as in the natural way of communication. You can use your hand to illustrate a few things but using them on and on can be very distracting for some people and might project that you are anxious.
Don’t overuse the hand for explaining things, they are useless in the spoken narrative. You can lay your hands and arms on the table gently. Also, don't stiffen up too much if you are folding them across the chest. Don’t stiffen up or cross your hand over your chest even when you are listening to the question.
There are three kinds of people. Those that make things happen, those that watch things happen, and those that do not know what is happening around them. Your attitude decides what kind of person you are.
An attitude of giving your 100% while being prepared for all sorts of outcomes will boost your confidence level. 'Being prepared' for all sorts of outcomes does not mean giving up but being realistic. Things happen, topics are left unread, you may not know all the answers, you have been asked, sometimes you just know everything other than that one question. Someone might get sick during the examination or simply it is just not your day.
A positive attitude will not change your wrong answer to right but it will definitely boost you while giving correct answers and strengthen you while saying “ Sorry but I do not know the answer to this. ”
I have learned these things from my experiences and observations. I do not know for sure how much impact these things quantitatively affect the results or outcomes, but they definitely improve the quality of conversation during VIVA and especially during the observed OSCE sessions.
Additionally, just have a look at few videos on Body language in exams on youtube. But the best thing which cannot be emphasized more than anything is Practise, Practise, and Practise. Practice viva sessions with your friends, yourself, and almost any dead thing in your room can be made examiner. It is your choice
Watch following video. This is exactly how we behave during the examination in front of the examiner, without even noticing this is actualy happening.
That is it, for now, watch this space as there will be more posts to crack down the DNB practical exam. Meanwhile check out
Kishor L Giri | DNB Pediatric
Kishor completed his Pediatric residency at Jehangir Hospital, Pune and currently working as Pediatricican in Navi Mumbai. Majority of his articles are focus on clinical aspects and tips for the exams.