Boycott finals revision courses

Having passed my resit and got my demotivational e-mail of where I rank in the year (350/377 since you ask, big up the tenth decile massive), I feel relieved to be able to say I’m a final year medical student without my heart sinking. My first act as final year student was to attend a small talk on the preparations for finals. Exams which seem to be disproportionately taken seriously, unless I missed a memo, these wont decide where your first jobs are, those being decided by 3rd and 5th year exams, and even failing them has less of an impact now the exam is earlier, allowing for resits before the time of jobs starting. Yet, six months before they are held, you can already smell the whiff of competitive panic, not that people are worried about how much they know, but how much others are preparing. Tutorial groups are forming, evening lecture series are being held, books bought and revision courses sold.

I’m opposed to these revision courses, in general and one more than the rest, and I speak only of my knowledge at Imperial, though no doubt the same occurs at every medical school. They come in two flavours, medicine and surgery, and are delivered by doctors and surgeons who invariably have teaching positions at the medical schools of the students they are charging for extra tuition.

The courses range in price, from some sounding fairly reasonable (£5) to others being prohibitively expensive. There is one above £200 (even with discount) and others in the mid 100 and others at the £50 mark. Some people don’t have this money to spare, especially as few of the courses cover more than one big subject (ie, medicine vs surgery) so there’s a good chance people will buy multiple courses. Some seem happy to give money for every course, to make sure they don’t miss any nugget of advice an individual might impart. I know some see it as an investment into their future career, that this amasses to less than a month’s future salary and if of use, a benefit to buy. Which is nice, the people who say this are seem lucky enough not to have rent problems (live at home or own their own house), but most people laying out £200+ for a course is not possible. If I were to go on one of these I’d probably have to ask my parents for the money, which is still a fairly privileged position to be in, and one not one open to most. This reinforces an unacceptable plutocracy that remains in medicine. While finals has relatively less impact on first job applications, if these courses are of use, they consolidate and hone knowledge within those who can afford it, at the expense of those who cannot.

In previous years, the exam results have “counted” for relatively more, I’m sure there are some prizes, merits and distinctions to play for, yet have not had these revision courses. So why the sudden urge to give people who should teach you anyway money to do so in your spare time?

Peer pressure
The myth of finals being more important than they feel, previous years and the fear that you’re going to miss out some nuggets of information, exam secrets (some are rumoured to tell attendees what’s in the exam) and everyone around you justifying the expense leads to a perfect storm of peer pressure. Most people seem aware of the massive peer pressure effect, but still feel unable to not go on them, because of the fear. Every year this seems to happen, as the courses are run by the same people year on year, and apparently always a scramble to get tickets, yet talking to junior doctors who have been on them and those who have not (who, incidently still passed) tells a worrying story.

They’re apparently shit
Previous years are even more frank about the peer pressure effect, but with the added hindsight of having attended the courses to tell people what they have experienced. I’ve yet to meet any one who has attended them and found them to be crucial to their year, some of the more expensive ones are derided for their poor teaching style and that their only use is for the handouts (available as hand me downs or for a tenth of the price) as the lecturers don’t stray from the slides or generally wax lyrical about themselves in some sort of ego masturbation to a paying audience. Some are even described as only being tangentially relevant to the finals. Considering I have a very poor link to other people in medicine, I can’t believe those paying for them haven’t heard the unanimous inditement of the courses.

Lack of incentive to teach
I’ve been taught by some of those giving these courses, some are excellent teachers. Others take time out of the lecture to explain how failing one exam is a very good predictor of failing another, to an audience with people who had recently failed exams. Styles aside, I struggle to find it acceptable to charge for extra tuition that should be there already. The myth of the courses implies to not attend is to fail, implying that the university doesn’t teach the syllabus, despite the lecturers giving the revision courses. Allowing this, I can’t help but feel that the quality of education of those unable to attend suffers. Either the revision courses are very important to final year exams, and therefore highlights a dire lack of teaching within the university such that a revision course is deemed necessary to get enough knowledge, or its totally superfluous and these doctors are taking advantage of the fear and peer effect for financial gain, which is also unacceptable. I fear that these teachers lack incentive to teach as much and well to the general student population, when they will get paid to do so better by the few.

Barry Paraskeva’s
Beyond my standard issues with the revision courses, the MDU course delivered by Mr Paraskeva for £200 is the one I can’t understand is allowed to continue. By far the most expensive, and hyped (despite the most useful information on the handouts) is held at a different university, yet it draws a huge Imperial following. Paraskeva doesn’t just examine during Imperial’s Finals, nor is he a well known lecturer in the school, or hold head of teaching position, he writes and sets the exams. Then charges £200 to the lucky few who can get a place. I am fundamentally opposed to his course, its exclusivity from someone with so much knowledge of the exam is unacceptable. I’m sure it must have been cleared by ethics committees, to not have done so would be even more galling, but I would like to see their rational, and that it’s offered at another university is not acceptable, because it is primarily attended by the soon to be examinees and unsurprisingly so.

The frightening aspect of the courses is how mandatory they are hyped to be, which represents a failing of the medical school to teach properly. In which case the best way to change the status quo, rather than continue to pay would be a mass boycott of the courses, to force the teaching to improve. While I still pay the relative modest fees, I resent the implication that I need to pay further to get appropriate education, and I fear that unless something is done, those paying the much higher fees will end up in the same position.

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9 Responses to Boycott finals revision courses

  1. I am so glad that someone has brought up this conflict of interest for Barry Paraskeva. It has been spoken about for years but no-one has done anything about it. Well done for bringing it out in the open!!

    I completely agree – avoid finals revision courses – they are simply confidence boosters, and not even very good at that. You’re confidence would be better boosted by going to see patients on the ward with a friend and then batting some questions back and forth. Or just sit with a group of friends looking at medical conditions on google images and youtube – use this as an opportunity to learn to talk about medicine!!

  2. TTBA(v)JD says:

    I agree the courses vary in quality, but of the ones I went to Dr Nigel Giam’s MentorOSCE course was massively helpful to me. It not only improved my knowledge (and identified gaps) it improved my technique and crucially, boosted my confidence.
    I agree that a system that penalises those who can’t afford it is everything that is wrong with medicine. But I’d already failed one final exam and needed all the help I could get, and wasn’t receiving from my medical school.

    I like the idea of setting up a bursary so that students like me, who have failed, don’t have finance as a barrier to getting any additional help they need.

    Interesting what you say about peer pressure – I really didn’t feel that. There was a respect for everyone having their own way and pace of learning, and we’d all get there in the end, in our own way.

    Btw, I have now passed and am an F1. Partly thanks to Dr Giam.

    • Roo says:

      I’ve failed PACES exams in the past, and it was through college and my personal tutor who arranged 1-1 consultant revision time, it was at unsociable hours but invaluable. I get the feeling there is a lack of good pastoral care in medical schools (that you felt unsupported after failing says that definitely is the case) I was amazed at how lucky I was to have a tutor who introduced me to a willing consultant. I think that kind of thing, or revision lecture series by the medical school in case or writtens for all those who failed an exam, that was included in the tuition fees would be more appropriate.

      Glad to hear you didn’t feel any peer pressure, I think there is a massive Paraskeva effect here…

  3. Interesting article! We’ve asked the question on Meducation – let’s see what other students think about course:

  4. Helen H says:

    I suspect it’s fairly location specific. From Glasgow, a lot of these courses seem prohibitively expensive (even if the course is a reasonable fee) because you have to get to London or Manchester first. Perhaps for that reason I don’t think there’s the same expectation that you WILL go on these courses.

    I’ve had friends who’ve gone on one or two of these, for specific areas they are worried about (paeds, for example). They seem to have been generally satisfied with them-but maybe that’s cos they chose them for a particular, considered need rather than out of pressure.

    I take slight issue with you suggesting that home ownership means you have money spare. The number of students who own a property outright must be pretty slim….and I’m sure if didn’t pay my mortgage my building society would be no more understanding than any landlord!

    • Roo says:

      I have no doubt about building society and landlords, the people I know who own their home rent out rooms to cover their mortgage / reduce their rent significantly (surely, or it’d not be economically sensible), my point was mainly the people most comfortable spending the cash seemed to have the least overheads.

    • Roo says:

      (I also have a chip on my shoulder about the rent I pay)

      Most importantly though, I’m glad this culture isn’t in Glasgow. I hope it means you’ve received better teaching…

  5. The Team says:

    Interesting. I’m only a few weeks out from finals and the only revision course I went on was the Ask Dr Clarke course, which I thought was excellent and a reasonable £50ish for each day. He obviously has to blow his own trumpet a bit but reckons 97% or something of people who go to it pass finals. That’ll do me. His website seems to have lots of feedback from previous years attendees who update him with what was in the exams so he can keep the course content up to date. A few juniors and SHOs I asked said that they’re key to finals was that course and just ploughing through the onexamination questions and don’t stress too much because, as you’ve said, it doesn’t count for anything, you only have to pass and not look like a knob in your OSCE!

    • Roo says:

      During FPAS time there was a talk by Imperial, which if memory recalls had some stats on how less than 10% fail an exam at finals each year, and 3% in total don’t pass the retakes, for some perspective while I root out the actual numbers.

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