This is a post that absolutely no one asked for, but I’ve found myself with an absolutely mindblowing amount of free time ever since MBBS ended, so I’m taking the chance to write about my experience in the exam while it’s still fresh in my memories (totally not having wartime flashbacks 🌚) for my juniors. If you’re not from NUS, this post won’t be of much use to you cos our MBBS is very different and much more intense.
Let me start off by saying that the NUS MBBS is a crazy exam and it kinda sucks when you’re going through it. It’s 1 month of non-stop exams, endless revision, low-grade anxiety, and wondering if it’ll ever really end. But y’all will make it through, and hopefully pass on your first try!
In this post, I’ll be going into greater detail about:
- General life/exam prep advice
- What resources I used to study/prep
- Pass/fail criteria & Assessment Points
- How to allocate time in the theory papers
- Tips for the practical exams
- My MBBS experience
To give you a feel for the onslaught of exams you have to prepare for, this was my MBBS exam schedule:
|OSSE (1h4min) & MEQ (1h20min)||16th Feb|
|EMQ (30min) & MCQ (2h)||17th Feb|
|OSCE & Ortho Case Analysis (1h10min)||19th Feb|
|OSCE (50min)||20th Feb|
|Surg Case Analysis||23-26th Feb (1 of 4 days)|
|OSCE & Focused Task (1h)||7th Mar|
|MEQ (1h30min)||9th Mar|
|MCQ (2h15min)||10th Mar|
|Short Case (40min)||13th Mar|
|Case Analysis (37min)||14th Mar|
|Results Day||1st April, cos the school knows we are clowns|
(from a chill/non-viva med student’s POV)
The NUS MBBS has a pass rate of ~95-97%, which is lower than NTU’s 100%… 😦 It can be scary to think about being the 12-ish students who fail either the Medicine or Surgery track every year (usually due to fierce/anal examiners rather than lack of knowledge!!), and pretty much all of us have been worried about failing, but don’t let the statistics scare you. Most examiners are trying very hard to pass you for the practical stations, so don’t worry!!
I remember a paediatric professor reassuring my friend and I that the MBBS is just a ‘quality control’ to ensure we would be safe House Officers, and that everyone starts off with a pass in the MBBS practical exams until they prove themselves to be dangerous or morally dodgy. According to this prof, any doctor who fails a student for a practical station will have to physically go down and meet the Board of Examiners to justify why they failed the candidate on a separate day, which is a huge hassle (and hence why the students who fail tend to be from the same circuit, under the same few notoriously strict examiners…just pray for kind examiners and y’all will be fine).
I know it’s extremely clichéd to say that ‘MBBS is a marathon, not a sprint’, but it’s honestly true. You can’t hope to slack off all year and cram all the content in the month leading up to the exams (I suppose you could, but you might lose sleep & your sanity), because there’s honestly way too much stuff. So here’s some advice:
- Study consistently – Even a small amount of work each day is better than cramming last-minute. If you see a case/condition in the wards, just quickly look it up on UpToDate/Amboss or seniors’ notes as a quick refresher. Make your own notes if it works for you, or just commit to one set of seniors’ notes for each subject/wtv suits you best, don’t bother with textbooks or using a diff set of notes just cos your friends are using them.
- Breadth > depth – Anything and everything under the sun can and will be tested, so don’t get too obsessed with details for less common conditions. Just give those marks away, there are always enough basic questions to help you pass. Don’t bother memorising dosages except for emergency conditions (stuff that will make you a dangerous HO, eg. hyperK/STEMI/seizures) and common things like H.Pylori therapy.
- Know your approaches and core conditions well – Joke’s on my batch, who studied cancer for our Surg long cases as per the past year trends, only for us to be trolled with an acute/approach-based long case. Our Med long case was approach-based as well. I’ll recommend some resources for studying approaches down below!
- Practice a bit, see some cases in the wards, but don’t be excessive – This really depends on your CG/your preferences, but my CG was extremely chill and didn’t really go out of our way to see cases (we just examined whichever patients our seniors recommended to us, we didn’t scout for cases the way other CGs did) or practice as a group. Just focus on perfecting your physical examination steps, see some patients with good signs, and you should pass.
- Don’t try to read all the years of seniors’ accounts for the practical papers – I know you might feel FOMO when your friends start discussing the crazy cases or questions that came out in past year practicals, but it’s really not worth the time reading through the 4-5 years worth of accounts on your batch Dropbox. Just read the most recent 1-2 years at the very most, and skip duplicate accounts/vaguely similar cases. It’s just to give you a rough feel of either how well or how badly a practical can go, but don’t let it shake your confidence.
Life/Mental health Tips
There were so many things that we hadn’t managed to study properly even when we went into the exam, so most of us were just praying hard that our ‘black holes’ in knowledge wouldn’t get brutally exposed.
Imposter syndrome is very real, especially once you realise you’re ~3 months away from becoming a full-fledged doctor; combined with pre-exam anxiety, you can feel overwhelmed at times and wonder why you even joined med school.
- Don’t be too hard on yourself – 1) You can’t know everything 2) You will forget things, even if it’s something very common or easy 3) exam nerves will make you forget even more things or say dumb stuff, but don’t beat yourself up over small things.
- Don’t overwork yourself – It’s not that difficult to pass, as long as you can prove that you’re safe, empathetic and patient-centred. Make sure you have enough time for self-care/things that make you happy + get enough sleep (I was still getting ~7h, cos I can’t function on any less LOL), so that you’ll be in a good state when taking the exams.
- Don’t let a screw up in one practical station ruin subsequent stations – Pretend to be a goldfish with short-term memory loss. If you get wrecked in one station, just tell yourself to forget that it happened, and use it as an incentive to do even better in the next station!
Resources I used
I’m obviously on the more laidback spectrum of students, and would not touch a textbook in a million years (yes, I can imagine surgeons & the top students cursing my name as I type this cos they really love textbooks). I passed using seniors’ notes + Google, and you can too!
So these were the resources I used for MBBS prep throughout M5:
- Nigel’s long/short cases for med & surg – they are excellent and cover a sufficient breadth of core conditions
- Nigel’s communication notes, 50 OSCEs for MBBS (on Dropbox)
- Macleod’s Clinical Diagnosis – good for approaches, ddxes, workup of various presenting complaints. I didn’t buy Nigel’s approaches book, although many of my friends did.
- GS – Medbear
- Ortho – Siying’s Ortho
- IM – Amboss, UpToDate (tq NUS for the free subscriptions)
- Paediatrics – Ching Hui & Hamid’s, Grace Huang’s Long Cases
Somehow it looks really skimpy after typing it out, but I relied on all of these for exam prep and they served their purpose!
Pass/Fail Criteria + Assessment Points
Assessment points (APs) are an additional scoring criteria used in the practical examination (short/long cases & OSCEs), and are awarded by your examiner after each station. In general, you’ll automatically get the APs once you exceed the pass mark for each station, and get 0 APs if you fail, but don’t quote me on that.
Most people supposedly fail because of insufficient Assessment Points, rather than not having a high enough score to meet the 50% pass mark. So here’s the breakdown of AP requirements:
- Surgery – minimum of 10/15 APs to pass
- OSCE – 8 x 1 AP
- Ortho long case – 2 APs
- GS – 5 APs (3 awarded by passive examiner, 2 from active examiner)
- Medicine – minimum of 16/24 APs to pass
- OSCE – 6 x 2 APs
- Short cases – 4 x 2 APs
- Long case – 4 APs
My junior asked me why OSSE and MEQ were 2 separate papers, and I honestly have no idea. Maybe the school just enjoys subjecting us to even more hours of torture? (that would not be out of character)
- 64 mins, 16 questions x 4 parts each, which roughly translates to 1 minute per qn. Time is veryyyyy tight.
- It’s basically a hit and run kind of paper, just type the first answer that comes to mind when you see the slide/picture/question, or flag the qns you’re not sure of and hope you have enough time to come back to it afterwards (but you probably won’t). The answers are often just short phrases, don’t waste time typing too much.
- 1h 20min, 4 cases (1 combined GS+ortho, 1 ortho, 2 GS), multiple parts. The timing is reasonable and not as rushed as the OSSE paper.
- Unlike the OSSE, there’s no backward navigation in this paper, since subsequent questions build on the answers & storyline of the previous parts. This means that you’ll roughly be able to see if you answered the previous part correctly once you click to the next question. It can be lowkey demoralising especially if you changed the right answer to the wrong one (like I did oops), but just keep ploughing on.
- 30min, 5 sets of questions x 6 parts each, ~1 min per qn
- In the EMQ (extended matching questions), you’ll be given 6 short scenarios/question stems that you have to match against 10 possible answers. You can only use each answer once, so if you pick the wrong answer that’s supposed to be the answer for another question, you could lose a lot of marks.
- But don’t worry, the EMQ is generally quite easy and they tend to test similar topics every year – bone tumours, post-op complications, cancer treatment, etc.
- 2h, 120 questions, 1 minute per MCQ (80 GS, 40 Ortho)
- Surg MCQs are far easier than Med MCQs as they’re based on factual recall. Just study Medbear thoroughly and you’ll do fine. It’s tiring to have to read long question stems, radiographs and lab values non-stop for 2h, but the timing is reasonable and you should be able to finish the full paper. 🙂
OSCE & Ortho Case Analysis/Long Case
For my batch, we had 2 days of OSCEs: Day 1 was a 70-minute circuit of 3 OSCEs + 1 Ortho long case + 1 rest station, Day 2 was a 50 minute-circuit of 5 OSCEs.
Surg OSCEs are a mix of 8 short cases, communication and procedure stations. They’re generally manageable and quite standard, so don’t worry too much about failing or losing APs here! 🙂
- Each station is 8 minutes long, excluding a 2-min reading time outside each station.
- We had 2 fairly straightforward procedure stations – 1 toilet & suturing, 1 chest tube removal
- 2 communication stations – 1 angry family member, 1 counselling for a below knee amputation.
- 4 OSCEs with real patients – as far as I know, everyone got very standard cases/PEs taken right out of Nigel Fong’s short case book. Most examiners aren’t out to kill you and just want to pass you, so the Q&A usually comprises simple things like differentials, investigations & management.
- Even if 1 station goes badly, just pretend you’re a goldfish with short-term memory loss, and don’t let it affect your performance in subsequent stations. Losing 1 AP isn’t the end of the world!
The Ortho long case is generally manageable (100% muggable from Nigel’s long case notes), but your experience may vary depending on your examiner. For a vast majority of us, we got chill/nice examiners (who we bantered with after finishing the station early LOL), while an unlucky 1-2 circuits got some infamous examiners who are known to be nasty towards students and fail them (I won’t drop names, but you’ll know once you read the seniors’ accounts).
GS Case Analysis/Long Case
- There are 2 examiners – the active and passive. The passive is responsible for observing and awarding 3 APs, the active is in charge of asking questions & giving 2 APs.
- If you bomb the long case and lose too many APs here, your chances of failing the Surg track increase significantly.
- 40 minutes
- 15 min history taking, observed by the passive
- 2 min to organise your thoughts, alone in the room
- 8 min to present your history and do a PE, observed by both examiners
- 15 min Q&A, usually led by the active
I was very blessed to get Prof Alfred Kow (passive) and Prof Lomanto (active) from NUH. We had simulated patients, so I had more than enough time for history taking. For our year, it was an ‘approach/acute diagnosis’ case rather than a cancer/chronic case.
I took a bit too long to present my history, so my PE ate into my Q&A time. Mercifully, Prof Kow was really fast at shooting questions, so I still managed to reach/complete his questions on management before the bell rang (he was technically my passive examiner, but he asked all the questions instead of my active examiner LOL).
Prof Sir Lomanto (my CG mate reminded me that Prof/Sir Lomanto attained knighthood) was really supportive and friendly, which really helped ease my nerves!
- 1h 30min, 6 IM + 2 Paeds questions x 7-8 parts each, 20 marks per question
- I’d recommend spending no more than 8-10 minutes on each IM question, and leaving 15 mins for the Paeds questions which are at the end of the paper.
- There’s no backward navigation, so you can feel a pang of instant regret when you click to the next question and realise you answered wrongly.
- The 6 IM questions are purely MCQs, with some costing as much as 4 marks, an insanely painful weightage for 1 wrong answer…there’s no real way of spotting what can come out, so just try your best and don’t beat yourself up
- The Paeds questions are open-ended, and each answer is usually only worth 0.5 marks, so you have to write a lot and think fast.
- 2h 15min, 120 questions (80 IM, 40 Paeds)
- It’s even more tiring than the Surg MCQ, with a ridiculous number of lab values to interpret in almost every IM question, as well as a heavy dose of pharmacology (in my batch’s paper at least). The Paeds MCQs are much easier to score in, so just aim to do those well and scrape a pass in the IM MCQs.
OSCE & Focused Task
This is the iffiest part of the whole MBBS, because the exact pass/fail criteria for each station is unknown. It’s a 60 min circuit with 6 stations, each one lasting 8 minutes (excluding 2 min reading time).
- The OSCEs are communication stations that invariably include scenarios with angry patients, medication counselling/explaining results, breaking bad news or admitting fault.
- Just come up with a generic script for common topics, and use the seniors’ OSCE notes to practice saying these things out. Your OSCE scripts may sound contrite, and in real life, situations rarely flow as nicely as the OSCEs (and simulated patients are too nice), but it’s good practice for when you’re getting yelled at irl as a House Officer LOL.
- The Focused Task puts you in the shoes of a GP, where you’re given a presenting complaint or preexisting medical condition in the question stem, and have to: take an abbreviated history from the SP + verbal PE (examiner will offer findings) + explain your diagnosis and management to the SP directly.
You’ll end up panicking a bit after discussing some of the stations with your friends and realising that maybe you missed out a point or misread the task, but it usually turns out fine since you can afford to lose up to 8 APs in the Medicine track (you can bomb 4 stations, or 2 stations + 1 long case).
All those hours spent in the wards looking for short cases and examining patients culminate in just 40 minutes of 4 short stations (3 IM + 1 Paeds) and 8 APs…
There’s no reading time in between stations, so when the bell rings, you just rush out of the room and straight to the next station. 8 mins are for PE, and the remaining 2 mins are for discussion. Always remember to wash your hands before and after PE, cos if you don’t you lose 2 marks instantly!
There’s no real way of preparing for this, except just being confident of your PE steps, praying that you’ll be able to pick up the signs on that day, and knowing some broad investigation & management principles. It’s largely examiner dependent, with most being fairly helpful & providing guidance, while a minority won’t prompt you even if you’ve picked up the wrong findings.
Some circuits had very standard diagnoses such as Developmental assessment, obvious murmurs, ILD, RA, gout, HSM, but my circuit ‘lucked out’ and ended up with a less conventional set: we had patients with spastic diplegic CP, an equivocal MR, a v small splenomegaly and Graves’ disease status post thyroidectomy (our qn stem was ‘examine a patient with diplopia’ so we did a full CN + thyroid PE + Q&A in 10mins LOL). Thankfully, almost all of us still managed to get the correct diagnoses.
In general, you’ll pass the station as long as you’re able to pick up the signs (with/without prompting), don’t fabricate signs, and show that you’re professional and take care of your patient/have good bedside manners. The patients are honestly saints for letting so many of us inexperienced students examine them for hours on end. :’)
Case Analysis/Long Case
The med long case is worth 4 APs, and 2 examiners will be present throughout, so there’s no active or passive like in GS. And in every circuit of 5 students, 1 person will get a Paeds long case. Spoiler alert, that person was me.
- 37 minutes
- 15 min history taking
- 10 min to present your history and do PE
- 2 min to organise your thoughts, alone in the room
- 10 min Q&A
Thankfully, the Paeds long case was approach-based/an acute case, so I didn’t have to take a chronic history (which takes longer) from the ‘mum’/a simulated patient. It’s already a blessing to have simulated patients, since they answer a lot faster and more accurately than real patients lol.
For the PE, since there was no child, I was required to verbalise the full PE, including requesting for vitals and elaborating on what I was specifically looking out for in each PE step. For my friends in the IM long cases, some had to do the PE for real, while others had chill examiners who let them just verbalise it. The Q&A was pretty standard and uneventful, and my examiners casually let me off once the bell rang.
And with that, the MBBS was over. And our results day is on 1st April, because YLLSoM obviously has a twisted sense of humour. :’)
Just work hard and work consistently throughout M5, do your SIP/ward work dutifully (go home when your HOs tell you to!), and you should be fine. Quite a lot of the exam is out of your control (it’s examiner and patient-dependent), so just try your very best and don’t worry too much about the outcome – you’re statistically likely to pass!
Take care of yourself & your mental health, look out for your friends, and help each other across the finishing line. 🙂
To all those who’ve been following this blog over the years, thanks for accompanying me on this arduous journey, and hope these posts have been of some use to y’all. 🙂 Hope to see some of you in the wards someday!
I’ll be writing about my life as a House Officer (junior doctor) in my upcoming year-long series, The House Elf/Officer Chronicles, so be sure to follow my Insta or Facebook page to stay up to date with my latest posts and life updates!
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If you’re interested in exploring my blog, click here for an index of all the posts I’ve ever written (travel, musings, doctoring), or check out my most read series below:
- the Chasing Dreams series: a multi-part series chronicling my thoughts, dreams & changing ideals over the years (since 2018), including burnout, quitting the rat race, migration and trying to find my path in life
- the (not-so-definitive) guide to doctoring: Getting into Med School & FAQs | Surviving your Clinical Years | MBBS Tips | Life as a M1 // M2 // M3 // M4 // M5 during COVID // Life as a Doctor (monthly series) | Chasing Careers series