Soundings: Is omniscience enough?

In the real world, some of us know a little about a lot, quite a few know a lot about a little, and there is a troubling minority that knows practically everything about hardly anything. That's in the real world. But when it comes to examining in the Practical Assessment of Clinical Examination Skills for the Membership of the Royal College of Physicians, we are all omniscient. It takes a bit of getting used to. I have seen a gastroenterologist fiddling anxiously with an ophthalmoscope at quarter past eight in the morning and clearly wishing it made half as much sense of things as his trusty colonoscope; but by the coffee break he is a changed man: a calm authority on the widespread spiculated pattern of retinitis pigmentosa, chatting casually with candidates about Usher's syndrome, Refsum's, and Laurence-Moon-Biedl. Clearly we get some assistance: from briefings provided by a registrar who has passed the exam sufficiently recently still to know this stuff; from the quick look round before the candidates arrive; from the better informed candidates as they come and go; and from each other as the day goes on. But the convention that we all have it all at our fingertips all of the time seems to me at best precarious, at worst hypocritical. A year or so ago I spent a morning with an honest fellow-examiner: a most unusual, unsettling, but eventually liberating experience. She was a forthright Ulsterwoman from a specialty that does much good but sees very little of what we saw that day. She was refreshingly—no, shatteringly—explicit about what was going on. (“D'you mind me asking...? D'you actually know a lot about this kind of stuff, Colin? Because I don't.”) Her frankness made an honest man of me. I said I knew a bit about, um, some of it, but had examined before and, er, usually more or less got by: honest confession, good for the soul. We got by that day, and it was more fun than usual because it felt a lot less hypocritical. And of course among the exotica were the standard exam war horses: the multiple sclerosis, the kidney transplant, the Marfan's, the knobbly liver—the things the candidates know we know they know they have to know, and knowing this makes it easier for all concerned. That day we were omniscient enough.