The Anti-Climax

Gah. It's done. After close to two months of doing pretty much nothing besides work and study, the CCFP exams are over. To those of you not in the know, the CCFP exams are the set of exams that family medicine residents in Canada are required to pass before hanging out a shingle. So, unlike the LMCC-II exams that I sat back in the fall, these ones actually mean something.

The first step was the written exams. They started off in the morning with some questions that were much easier that the practice exams that had been circulating around for the past month. I think it was intended to lull us into a false sense of security. As the day went on the questions got harder, and more obscure. By the end of the day we were well into "guess what I'm thinking" territory. Bah. Honestly, I'm not sure what two medical conditions preclude immigration into Canada, and I'm not entirely convinced that information should be taking up valuable brain space. But whatever. I'm just looking to pass.

The SOO's (Structured Office Orals) were kind of fun. If stress can be fun. Each situation has a patient that puts a problem on the table immediately, but you often have to uncover a second 'hidden' problem. Sometimes these problems border on the ridiculous, but generally they are pretty representative of what can walk into a family practice. You have 15 minutes to cover a staggering amount of information-- some related to the problem, some not so much. The problem with the SOO's is that the formula that you have to follow in order to pass bears no resemblance whatsoever to an actual patient encounter.

For example:

- I don't ever tell patients to 'come back for a physical exam'. In a 10-15 minute appointment in real life, we do both a history and physical.
- I would be thrilled if my patients only came in with two problems. I'm still trying to figure out an assertive way of limiting the patient who comes in for their 10 minute appointment with a list of 6 things they've been 'saving' for their appointment.
- I don't routinely ask what my patients do for a living unless it is somehow related to the reason they've come in. In the SOO's, you have to explore the impact that their complaint has had on their function. Gah.
- In the SOO's, after about 10 minutes you are expected to make an 'integrative statement'. This should sound something like "So as I understand it, this hangnail that you've been experiencing for the past month has been causing you a lot of distress, and is clearly interfering with both your relationship with your gay lover and your job as a basketweaver. Does that sound right?" I am quite safe in saying that I have never, in two years of practicing medicine, made a statement like this in the middle of a patient interview. But it is integral to the SOO.
- In the SOO's patients never wait until they are one foot out the door to tell you why they REALLY came. "Oh... I almost forgot. Thanks doc, for looking at that mole on my arm but I forgot to mention this crushing chest pain that I've had on and off for the past two days..."

But enough with the bitching. They're done, and I can get my life back. And now I have a month of geriatrics to get through. It's odd to go back to work after such a feeling of finality, but I still have two months to slog through before I move out of this town to start my PGY-3 emergency medicine year. Which is already looking to be full of interesting twists. But more on that later.