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Ahhh Royal College/CCFP year. That span of long, long months where you have the privilege of paying $5,000 to take a harrowing two-part exam that feels like it will determine your future forever. Yeesh.

I’d like to think that, despite the attendant stress of certification year – with a pandemic thrown in on top, in my certification year – I have managed to a degree I’m happy with. I will share some of my thoughts on how to survive this awful year and thrive. Along the way, we’ll touch a bit on finances specific to examination year and some low-cost or free options to help make life easier.

While this post is mainly geared towards the almost year-long process of preparing for the last certification exam most of us will have to take, the principles can be applied to any large, high-stakes test you are preparing for.

Here are my two Royal College/CCFP year pillars:

1. Studying
2. Self-Care

This will be a two-part series, and today, we will look at the pillar of Studying.

P.S. You’ve made it this far in your academic career, and I’m sure you have found ways of studying that work for you! These are some things that worked for me and/or were discussed with me by more senior residents. Feel free to use them as reference or just food for thought.

Studying

General advice I have received falls into one of these three buckets:

1. Start early (but not too early)
2. Study with a group
3. Pace yourself

Do you find this advice vague? Me too. That was my reaction when I heard this from a variety of people. But honestly, the right answer in terms of specifics is different for everyone. Here are some guiding questions to help you figure out your studying this year.

1. What is my preferred study style?
2. Given the volume of knowledge needed for the certification exam, will my preferred study style work? Do I need to make modifications?
3. How can I break down the task of “study for certification exam” into smaller, bite-sized pieces?
4. How can I reward myself and track progress?

Here is my example:

1. What is my preferred study style?
   Start early and take my time. If I leave too much toward the end, I begin to panic unproductively. My eyes also glaze over, so I need a more interactive form of studying, such as flashcards.
2. Given the volume of knowledge needed for the certification exam, will my preferred study style work? Do I need to make modifications?
   I usually started a month in advance of larger exams for undergrad and medical school. Given the stakes and cost associated with the Royal College exam, I decided to start several months in advance. On the advice of more senior residents, I gave myself the summer to just enjoy and put together my base study materials. I slowly started studying in September 2019, and continued to ramp up the pace.
3. How can I break down the task of “study for certification exam” into smaller, bite-sized pieces?
   I’m going to draw inspiration from the Best Self planner that I got to in order to try and find a less expensive replacement for my beloved Panda Planner once I ran out of Panda Planner pages in June. While I still love the Panda Planner most, I really liked how the Best Self planner broke down projects. Here is a modified version of the Project Plan page for your use; one for the Royal College and one for CCFP.

What I did for this section is break my specialty down by topic, then by relevant textbook chapters/guidelines/landmark studies/etc., as well as tasks such as making flashcards and then going through flashcards.

4. How can I reward myself and track progress?
   I used my planners to track progress on habits that I wanted to maintain. A calendar that you look at often would work just as well. In the habit list was “Studying for RC.” There was something satisfying about checking off a checkmark each day that I studied, even if I only cracked open the study materials for a half-hour. As I got closer to the exam, I started tracking how much time I spent studying each day and set a lead goal for weekly average time spent studying.

Lead Goal vs. Lag Goal

I use the term lead goal vs lag goal, but there also lead measure vs. lag measure. One example to illustrate the difference would be exercising.

Lag Goal: I want to lose 10 lbs.

Lead Goal: I want to exercise 15 minutes a day three days a week.

With a lag goal, your “success” mark will be contingent on achieving that lag goal. Sometimes, there are factors outside of our control that will influence whether or not the lag goal will manifest. With studying for the Royal College exam, my lag goal would be passing the exam. That’s a very distant goal to keep me motivated through the months of studying (and then the extra months of studying, given COVID hit right before RC exams started in 2020).

My lead goal in September 2019 was to study 3-4 times per week. No time limit on how long a study session was, but generally half an hour at minimum. By March 2020, the goal was to study about 2 hours a day on average (allowing for longer study times on the weekends and some rest days).

My study style was time-based rather than content-based, partly because the different topics (I felt) had too much variation in the amount of content to split them up by study deadlines. Mr. Sparks was the opposite; he studied with content-based lead goals (e.g. finish this topic by next weekend).

As mentioned earlier – you have done lots of studying by this point throughout your life, and have a feel for what works for you. My hope is for some of the above to be of use in helping you optimize things for this last big exam!

Studying and Finances

Minimize the Coffee Shop Productivity Tax

I’m all for increasing productivity. I just don’t think it’s necessary to pay for the privilege every single time. Every time you hunker down in a coffeeshop (or in my case, a bubble tea shop) to use a power outlet and borrow the ambient noise, you will be paying money for the privilege.

Now, I definitely did this at times. When I was living with very sociable roommates, I went out to study. If there was a 2-in-1 study-and-socialize aspect with friends, I went out to study. But not all the time, and not even most of the time.

(This may not be as relevant in the current COVID-19 pandemic context, but I’m hopeful that the pandemic will be over at some point and this blog post will be useful for years to come)

Three FIREfly Alternatives:

1. Go to a public library. Pick a nice one, ideally with open areas, large windows, and lots of power outlets.
2. Do a house swap. Sometimes, you just don’t want to do work at home, or bring work home. I know people who like to draw clear lines between where work happens and where not-work life happens. That’s cool. Someone else’s home could be a free and cozy alternative to working in your home. Be cool though. Swap. Don’t just mooch.
3. Use a workplace area. Most medical workplaces have an area where residents can hang out. This could be a resident lounge. Maybe a hospital library. Maybe even the clinic after hours / on the weekend can be a nice workspace to be in.

Avoid the Eating-Out Penalty

Eating out is quite expensive. Wherever it is you study, see if you can access a microwave nearby. That way, you can bring a lunch and/or supper, eat well, and not have to break your work flow by leaving to grab food AND pay premium for the food.

Borrow, Not Buy

If you love having textbooks as references for the future, ignore this section. Personally, I love books, but I don’t find that I refer back to textbooks too often (outside of exams). Usually I’ll try to look for a recent review paper, or go to Uptodate or Dynamed, and if I really need a textbook, access it online through the university library website.

Studying from physical books is great, though. Sometimes, flipping is faster than the digital versions, which I find can lag and crash when I try to do “ctrl + f”. I have asked senior residents in the past if they would mind lending me a copy of their textbooks, and because they are generous and awesome, they have always agreed. (To be fair, I haven’t asked toooo often). You could try this too!

Alternatively, Mr. Sparks came up with the idea of a textbook recirculation program, which could be interesting. Essentially, more senior residents who may not want to keep textbooks for reference after the exam is done could sell the textbooks to more junior residents who are about to start prepping for the certification exams. Then when those residents are done with the textbooks, sell them to more junior residents again, and so on. This could even be done in a more organized fashion in larger programs. Textbooks do not get updated too often in many specialties – you could do this for a few years before a newer edition comes out. I used to only get used textbooks in undergrad, as there was an organized avenue for this. You could think about setting one up in your own residency program!

Credit Card Rewards

Speaking of the $5,000 exam fee (…ouch…), this is a great opportunity to do some credit card travel hacking – if we work on the assumption that COVID-19 will be manageable at some point. Or at the very least, a cashback credit card. You are definitely spending that money regardless, so you may as well get something for it. I got the AMEX Business Platinum card and easily met the minimum spend by paying for both my exam and Mr. Sparks’.

This brings us to the end of Part 1 of How to Survive and Thrive During Certification Year.

Up next: practical pointers for Self-Care during certification year. See you there!

-Dr. FIREfly