People tend to have individual responses to examinations, this is often based on their previous experiences, or the personal pressure they put upon themselves, or both. Some people actually enjoy them particularly if they  are good at them and always been successful . But most people find them a little daunting and are relieved when they pass. Some people struggle with them for a variety of reasons.

This section aims to give advice to those who are not succeeding. It will cover the following:

  • Coping with failure
  • Building self-confidence
  • Coping with anxiety
  • Dyslexia and specific learning difficulties


Coping with failure

Some doctors manage to cope with the demands of a very busy job and pass their professional examinations, but others do not. For these doctors, many of whom achieve a high standard in clinical practice, failing an examination can have a big impact on them as individuals, personally in terms of self-esteem and confidence, and professionally both financially and in terms of career progression. People can feel very isolated and demotivated.

There are often complex reasons, and it is worth trying to determine what they are, you can then move on. They include: competing demands of job, family and revision time, i.e. time and energy; insufficient revision and or ineffective revision strategies; poor planning; dyslexia, poor concentration; lack of confidence, anxiety; limited supervision,  and poor developmental conversations i.e. (bad advice). Most of these problems can be solved to some degree, and the strategies presented earlier should help. It is important to keep perspective, failing can be hard to accept as it changes challenges one’s self-belief, so make sure you acknowledge your clinical strengths. No- one should be defined by failure in an examination. Many medical examinations can be retaken several times. This is recognition that taking examinations when doing a full-time and often very demanding job is very hard.  And remember, if you perform well in the clinical setting, lack of success in exams usually means it is a matter of examination practice, so ultimately you should succeed.


Mike's Story on Coping with Failure


Building self-confidence can be challenging. One definition of self-confidence is:

1. Our self-assurance in trusting our abilities, capacities, and judgements.

2. The belief that we can meet the demands of a task. To be confident on what you have done is okay.


Self-confidence is a complicated concept and overlaps with self-belief. It is possible to be confident in one aspect of your life but lack confidence in another.

For example, people can be very confident socially but find giving presentations nerve wracking. And many doctors are very confident in the clinical setting but find it hard to transfer this confidence to an examination setting. It can help to remember that being good at professional examinations does not necessarily lead to being a good clinician. It just means they are good at taking examinations! And the reverse is true: being unsuccessful in exams does not mean that you are not a good clinician, it may simply mean that you are not very good at the examination process. Continued failure can undermine confidence, however it could be argued that you are getting more practice in the examination setting, and if you can perform well in a clinical environment, and cope with the challenging demands of your job, you will ultimately succeed.


Activities to boost self-confidence:

  • remind yourself of what you are good at-when you have solved a problem or being complimented on a task
  • make a list of all the patients who said thank you
  • remind yourself why you want to be a doctor or dentist
  • build a motivation board
  • think about your knowledge base, and expertise. The elements of expertise are knowledge, practice, and experience – you will have all of that and be using it on a daily basis. You are a clinical expert


Coping with anxiety is another challenge that many people face, and anxiety will affect performance in an exam particularly if they have failed an exam. Many people experience increased anxiety under exam settings. If it becomes overwhelming, professional help should be sought. However, the following may help:

  • Try and identify the source - talk it through with someone
  • Rest relaxation and exercise, anxiety is often increased by extreme tiredness
  • Yoga or mindfulness or breathing techniques
  • Assault your senses with perfume or strong mint tea
  • Positive visualisation and verbalisation techniques

Try positive phrases to remind yourself:

  • I can do this! I do a good job
  • My patients like me
  • My colleagues trust me
  • My supervisor thinks I can do it


Dyslexia and other specific difficulties

If there is continuing failure in the examinations and this is inconsistent with clinical practice, it may be worth considering that there is an undiagnosed specific learning difficulty, i.e. dyslexia, dyspraxia, attention deficit disorder. They are all misunderstood in adulthood, as they are still often seen as childhood problems. Dyslexia can best be defined in this context as an information processing difference/ difficulty. This processing difficulty results in problems with reading and writing. It also impacts on the working memory system resulting in additional difficulties with organisation, planning, memory recall, speed of processing particularly in unfamiliar situations.

Dyspraxia is more of a coordination difficulty leading to problems with organisation of thought, ideas and planning, motor coordination difficulties are often less obvious in adulthood.

Attention deficit disorder is better understood, it is difficulty in maintaining concentration.

It has to be noted that working at this level indicates that people with specific difficulties have the ability to do their job and they have largely developed the skills and strategies to manage their problems. However, under certain circumstances, such as in examination settings, these strategies are not sufficient and need refinement and extra time.   

The characteristics below are some of the indicators, in addition to unexpected examination failure, that suggest referral for further investigation.

  • Recall of information, i.e. names under examination conditions
  • Working very long hours to revise
  • Poor concentration
  • Not completing the examination paper in time 
  • Slow at reading or frequently re-reading to comprehend
  • Difficulties with planning and or time estimation
  • Taking longer to complete paperwork
  • Inconsistency in performancegood at clinical worknot good in assessment settings, written or oral.


If you have these difficulties you can contact the PSU, or you may prefer to find out more on your own initially. General and screening advice can be found at:

However, caution is advised with online screening, they can be a good tool but there is also the risk of false positive and negative results. A full diagnostic assessment is advised. This assessment should provide a review of the skills and abilities, an explanation for the specific difficulties, and suggest recommendations and solutions. Greater understanding of the nature and impact of the difficulties on performance enables people to develop the skills they need to become more successful.


Further advice

If you would like confidential individual assessment and support for any of the personal aspects, please contact the PSU’s Individual Support Team (IST). One of the team can meet with you and assist in reviewing your strengths/weaknesses and a holistic support plan in preparation for the next examination attempt. To find out more about the Individual Support Team and request an appointment please click on this link.