Studying for a higher diploma.
Authors: P Rhodes
Journal: BMJ (1983)

Without a higher diploma you are unlikely to get anywhere in medicine nowadays. The graduating degree is an entry qualification to postgraduate medicine and does not signify the end, or exit, of training. It is not strictly necessary to have an MRCGP (membership of the Royal College of General Prac? titioners) in general practice, and a few specialties, such as microbiology or genitourinary medicine, may recruit doctors without higher diplomas though they may expect the MD of a university. Nevertheless, even these disciplines are closing their doors to doctors without higher qualifications, and having a higher qualification makes it easier to be appointed and accepted as trained by those outside the discipline. It is an educated guess, attested by historic educational precedent, that the MRCGP will come to be recognised as the appropriate higher qualification for general practice. The prudent doctor will therefore settle down quickly to working for and acquiring a higher diploma. The easiest time to do this is early on in your career, when academic learning is easiest and knowledge stays in the mind, and the best time to pass an examination is at the first attempt?which means being fully prepared for it. There is a technique for preparing to take an examination that may be learned. It demands hard work and application, but it can be done. As a preregistration house officer your major duty is to learn and relearn your clinical skills. Consider and read about the nature of the clinical consultation and what is happening between the doctor and patient. This has been studied in general practice, so go to the library at your postgraduate centre to find out what has been discovered. As you see patients, make a note of their diagnoses and refresh your memory about the diseases from your favourite textbook in the evening. It does not take long to skim through a book if you make it a habit. It will give you ideas on treatment and management, too. For practical procedures you will probably want supervision at first from another junior doctor or your consultant. Do not hesitate to ask. You might as well get the technique right at first. It is useful to compile a checklist of the common procedures in the subject you are working in, and then tick them off as you do them. You might ask your consultant or registrar for help in compiling the list and in arranging for you to carry out the procedures. Try to get to know the library and its resources, and attend the educational sessions in the postgraduate centre when you can. It does not matter if the subject is not immediately relevant to what you are doing now, or to your proposed future career. You should maintain a wide interest. If nothing else, it might teach you how to give good and bad lectures and seminars. By the time you have become a senior house officer you might already have decided on your future career and found out about the requirements of experience and the examinations. You should start work for the first part of the examination. If you are in doubt about where you wish to head start work for part I of the MRCP (membership of the Royal College of Physicians), and for part I FRCS (fellowship of the Royal College of Surgeons) if you will do surgery. You may switch from one to another or change direction entirely, but no matter. You will be learning and maintaining the habit of learning, which is all important. When you have part I of the appropriate examination start straight into reading and learning for part II. The sooner you have the higher diploma the sooner you will be free of routine academic work.