Residents Psyche – My Royal Family: A Residents Journey Through the Royal College Exams

Residents Psyche – My Royal Family: A Residents Journey Through the Royal College Exams

My Royal Family: A Residents Journey Through the Royal College Exams
By Dr. Matt Ratzlaff

In my fifth year of psychiatry residency at the University of Manitoba, I returned to Winnipeg in September 2018 from a three-month external elective already feeling the heat of the Royal College exam looming seven(ish) months away. I had “casually” started studying on my own in the summer of 2018 and was having mixed feelings about it. Really, I was feeling dumber and more self-critical with every random textbook page I was turning and every question bank I was scraping by on. Shouldn’t I know this stuff already? I’m supposed to be on staff in less than a year. My elective supervisor seemed concerned that I wasn’t savvy with his favourite cytochrome P450 enzyme drug interactions that he periodically quizzed me on.

But as with many things in my life, fear was a motivator to keep going, and my primal drive to learn Royal College exam material was steadily overpowering my drive to avoid and procrastinate.

So this was my mindset when I returned to Winnipeg. I think other classmates felt the same. There had been whispers from a core group of my class of 14 that study groups were maybe forming. Some had even started trial runs of studying in pairs the odd evening, trying to organize the vast quagmire of handed down study materials. The residents in the year ahead of us had all passed their exam, but there was an underwhelming amount of verbal exam advice from them and most had basically studied on their own.

Then on October 9, 2018, I was invited to join a Whatsapp group with a few select classmates to discuss a study group. It looked like I wouldn’t have to study for the biggest exam of my life all by myself after all! This was a relief, but a change for me, as all through my undergrad and medical school, for better or (probably) worse, I had generally chosen to study alone. I half-jokingly suggested we rename our group the “Royal Family”. This was partly a tip of the hat to the Royal College exam, and partly because we were a subset of our resident cohort that consistently got along and could foreseeably tolerate dozens or hundreds of hours of high-stakes studying together.

Soon after, Geoff, a member of the Royal Family and a renowned hipster, invited us via text message to join him at “fourth” to have our inaugural study group. I walked to the hospital library, where I thought we had discussed meeting and started up the stairs. I got to the third floor and realized that’s where the staircase ended. Where the hell was the fourth floor? I slowly walked the entire perimeter of the third floor of the library looking for another staircase, anxious to get our study group going, but to no avail. Frustrated, I called Geoff’s cell and vented about the total lack of a fourth floor in the library. I could hear laughter through my phone. He explained that he and the rest of my study group were in fact seated at Fourth, the trendy coffee shop in the Exchange District. Apparently I was the only one to not figure that out. Twenty minutes later, there I sat with the five members of our family, four men and one woman with personal experience of having brothers.

Over the next seven months, our Royal Family met several dozen times to study through multiple choice questions, teach each other treatment guidelines using ridiculous mnemonics like Que Lu Li La Lu La, quiz each other on DSM-5 diagnostic criteria, and listen to each other talk through practice Objective Structured Clinical Examination (OSCE) stations. Our original plan to meet weekly in a library study room (on the third floor, not the fourth) quickly fell through and instead we rotated hosting each other at our houses and apartments. We made each other meals and kept our fridges stocked with beer and had music playing quietly in the background.

Like any family, we didn’t get along perfectly. There was a shifting hierarchy, various alliances over menial issues, differences over what to prioritize with studying and how we should do it, a sibling-like competitiveness. For a while leading up to the final weeks of the exam I felt like I became the scapegoat for my Royal Family to gang up on at study group with jabs about my various tendencies. By then I think everyone was pretty anxious about the exam and “let’s bug Matt” became a sort of pressure release valve. They eased up when I asked them to.

In the thick of study season in spring 2019, I had a vivid dream. I was trying to ride piggyback on a disheveled, dopey giant as it lumbered from one city toward another, far away, through a mountain range. I was frustrated by our slow progress and the giant’s incessant need to make detours and stops for food and water and I felt like abandoning it altogether because I was never going to get to my destination. I think the giant in my dream was a condensation of all of my study group members. We were this slow-moving entity, plodding through an intellectual wilderness toward a distant goal and constantly needing to be fed.

But all in all, our Royal Family compromised and collaborated with each other and made it work. We each brought something to the group that made us stronger. We volunteered (or were delegated) to create study references that should have already existed in our inherited study resources and shared them with each other. We trusted the knowledge that we were teaching each other or respectfully corrected each other when we had heard differently. No one took the corrections personally.

As the weeks to the exam dwindled down, we met more and more frequently; twice or three times a week, then almost daily. The Royal Family Whatsapp group was a dumping ground for all our unanswered questions, for hidden exam tips that we had found, for lively debate, for nervous jokes in an attempt to de-stress and to acknowledge the absurdity of it all. OSCE practice was a nonjudgmental space to hear myself and others think and get those mental scripts functional. “What is the group’s consensus on how we’re all going to answer this question if it comes up?” It was like we were becoming one mind—one unified, loyal effort to challenge the last big exam of our lives. It felt like we had all popped out of the trench together and were now running in unison through no man’s land toward enemy lines.

The Royal College exams came and went without any major hitches. After the written portion, our Royal Family went out for lunch together and the vibe was that we all, more or less, had the same reaction of cautious optimism. On the OSCE day in Ottawa, all but one of us was in the same circuit. Any flashes of eye contact between stations was reassuring—everyone seemed calm and confident. “I was really hoping I wouldn’t be in the same OSCE circuit as the rest of you because it makes me look less smart!” was Geoff’s comment.

On May 31, 2019 the exam results were released and the quieted Royal Family Whatsapp group stirred once again. By mid-morning it was out. Everyone in our study group had passed! That evening we all returned to Geoff’s house in Saint Boniface for a Royal Family barbeque. We split a very expensive bottle of scotch and sat around the dining room table to eat a delicious potluck meal to which we had all contributed—the same table at which we had nervously sat and studied for many hours in the preceding months.

Throughout our celebration dinner, a 90s pop mix was our soundtrack. Our voices grew louder and louder as we laughed and joked and reminisced about the past year and through which we had all emerged victorious together. Geoff’s young daughter was actually covering her ears at the table, we were so boisterous. I kept having flashbacks to that first study group meeting at the Fourth coffee shop. We were so nervous and unsure of how to navigate this hurdle, but we did it. “This whole year of study group and getting through the exam felt like it went exactly as I had hoped,” I said to Geoff, standing in his kitchen. “It feels like we did it right.” He agreed. It was a difficult road, and our family went through growing pains, but it turned us into something greater than the sum of its parts. Now I feel like I actually know some stuff, or at least where to look it up, isn’t that nice!

My advice to residents preparing for the Royal College exam is not to do it alone. Find peers that you like and trust, be likable and trustworthy yourself, and help each other get stronger. Be open to feedback, be willing to share your strengths and learn from the strengths of others. And try to enjoy yourselves along the way!

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