Exams!

Last Friday, the 26th January 2024, I (hopefully) completed my last ever exam. This was the 'Clinical Assessment of Skills and Competencies', or the CASC. A rite of passage for psychiatrists practicing in the UK, it's essentially the entrance exam for the Royal College of Psychiatrists. It takes place at a huge sports hall at the English Institute of Sport, up in Sheffield. It's an early start so I drove up the night before, arriving at a premier inn jointly booked by nervous psychiatrists and the Team GB boxing team, who were competing the following day. At breakfast, I couldn't help but notice other candidates, and exchange furtive glances of anxiety, solidarity and knowing smiles at our shared plight. At 7:30am, we finally finished poking at our food and sipping our coffee and begrudgingly made our way to the venue.

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This huge sports hall contained 72 little cubicles, arranged in nine circuits of eight. We were each silently led to one cubicle, and made to sit down in front of a short written explanation of what was to come. It might say "take a history", "assess the patient's capacity", "devise a management plan", or even just "reassure". These scenarios are designed to represent the breadth of UK psychiatric practice and are situations a competent clinician should be able to manage.

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An eery silence descended, as we all scan the instructions, furiously scribbling down relevant info. At the ninety second mark, a bell sounded and the room snapped to life. We each enter our designated cubicle and are met with an actor and an examiner. We have seven minutes to complete our task until a bell rings. The silence re-descends and we leave, quickly moving to the next cubicle to focus on the next task. Each day for one week, twice per year, one hundred and twenty eight psychiatrists complete two loops of eight scenarios and complete this gruelling challenge. Some of the stations I experienced included the expectant mother with bipolar disorder, wanting advice on her medication, a person with schizophrenia experiencing a relapse of their condition, and a person experiencing depression, wishing to discontinue their medication due to unwelcome side effects.

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To say I was relieved when it was over would be an understatement. Not even a three hour delay on the M1 back to Oxford put a downer on my spirits. To say I was stressed prior but would be a bigger understatement.  In the weeks leading up to my exam, I spent a good amount of time revising with colleagues, and an equal amount of time trying to manage my increasing levels of stress and anxiety. Of all the things I tried though, one stands out as being more effective than others. That was my daily walk.

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Every day, I would set aside some time to explore the surroundings - whether of the hospital I work at, or my home. I don't know why it was so powerful. Perhaps there was something mindful or grounding about noticing the beauty of the surrounding nature, the sounds of the birds or the crisp cold air? Perhaps it was purely a distraction. Perhaps there is something inherently restorative about being in nature or greenspace? Perhaps the physical act of walking helped to release physical tension. Perhaps it gave me some space and allowed my mind to reflect on my revision and process my thoughts and emotions in a more constructive way.

Who knows what the mechanism is, but I suspect its a mix of all the above. My personal feeling is that curiosity and observation of the world around me played a key part. I often find myself pausing to admire an architectural detail, a street name or like Alastair Campbell, a good-looking tree. I'm lucky that I'm surrounded by interesting stuff: The hospital I work at was built in 1826 and is the oldest in the NHS still providing patient care; my village has both a pre-conquest church, and the remains of a Roman road.

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Now that the exam has finished, I've actually continued the walks. Not because I'm overly stressed, but because I enjoy them. It fostered a deeper appreciation for my environment, my own resilience and a greater connection to my thoughts and feelings. More than that, it reminded me of the power of exploration, curiosity and sense of adventure - values that are central to guidl's mission. By embracing them, I was able to transform a potentially overwhelming experience into an opportunity for growth and learning. As we continue our journey with guidl, I'm excited to apply these lessons to my own exploration of places. The simple act of walking can be a powerful tool. To anyone reading this who may be feeling overwhelmed, anxious or simply in need of a change of pace, I encourage you to try taking a walk. You might be surprised by the treasures you find, both within yourself and world around you.

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