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The enjoyable article by Mr Cascarini and Dr Irani (April 2005 JRSM1) outlines the authors' personal viewpoints on how to pass postgraduate clinical exams. This prompts me to ask: can we offer any advice backed up by evidence? The answer is maybe just a little. There is some evidence that getting organized early helps medical students to pass.2 Wright and Tanner found that students who were sufficiently organized to fulfil simple administration tasks during their course were more likely to pass. This research was subject to confounding factors and was done on medical students but the results might reasonably be extrapolated to postgraduate students. What about advice on how best to study? McManus et al.3 found that medical students' success in their final examination was related to a strategic or deep learning style in the final years. Students with such styles are best able to relate ideas to evidence and to integrate material across courses; they also are ambitious to achieve high grades. But worryingly, in this survey, success in the final examination was not related to a student's clinical experience, so the exam itself might not be valid. The fact that pass rates for Royal College exams are 44–79% for British graduates and 28–67% for non-British graduates4 has prompted some to cry racism, but the likely reason for the difference is that British-educated doctors have better English and know the system.
Overall there are precious few hard facts and figures in this area. The high failure rates in postgraduate exams suggest an enormous need for research.4 If we knew the internal and external factors that influence success in exams we might begin to offer evidence-based advice.