Why is the MEQ (Modified Essay Question) one of the hardest exams in psychiatry?
Because it doesn’t just test what you know, it tests how you think.
And here’s the problem: most psychiatric training doesn’t actually teach us to think. 🧵
1/12
Because it doesn’t just test what you know, it tests how you think.
And here’s the problem: most psychiatric training doesn’t actually teach us to think. 🧵
1/12
We’re taught to memorise.
To conform.
To defer to authority and quote the guidelines.
But real-world psychiatry? That’s messy. Uncertain. Full of grey zones.
The MEQ throws you right into that world.
2/12🧵
To conform.
To defer to authority and quote the guidelines.
But real-world psychiatry? That’s messy. Uncertain. Full of grey zones.
The MEQ throws you right into that world.
2/12🧵
Take this:
Textbook:
“How to manage akathisia”
Sounds simple.
But now look at a real-world MEQ slice:
“A 52-year-old male with schizophrenia on aripiprazole 10mg nocte for 1 year reports leg restlessness. It’s keeping him awake. Outline your approach.”
See the difference?
3/12🧵
Textbook:
“How to manage akathisia”
Sounds simple.
But now look at a real-world MEQ slice:
“A 52-year-old male with schizophrenia on aripiprazole 10mg nocte for 1 year reports leg restlessness. It’s keeping him awake. Outline your approach.”
See the difference?
3/12🧵
If you jump straight to “akathisia”, you risk missing the bigger picture.
This could be:
● Restless legs syndrome
● Anxiety-related psychomotor agitation
● Poor sleep hygiene
● Partial dopamine agonist effect
● Or yes, akathisia
It’s not about finding the answer.
4/12🧵
This could be:
● Restless legs syndrome
● Anxiety-related psychomotor agitation
● Poor sleep hygiene
● Partial dopamine agonist effect
● Or yes, akathisia
It’s not about finding the answer.
4/12🧵
It’s about understanding the phenomenology, the pattern, the context, the implications.
Only then does the management plan become meaningful.
This is what MEQs reward: diagnostic curiosity, clinical reasoning, and strategic thinking.
5/12🧵
Only then does the management plan become meaningful.
This is what MEQs reward: diagnostic curiosity, clinical reasoning, and strategic thinking.
5/12🧵
And yet, we don’t train for it.
We train to pass the multiple-choice questions. To cite the protocol. To learn static facts.
But MEQs ask you to integrate.
To bring systems thinking into a 9-minute clinical problem.
6/12🧵
We train to pass the multiple-choice questions. To cite the protocol. To learn static facts.
But MEQs ask you to integrate.
To bring systems thinking into a 9-minute clinical problem.
6/12🧵
It’s like tennis.
Reading a textbook about footwork won’t help you when the ball’s flying at you.
A tennis player practises footwork thousands of times, under pressure, in motion.
Psychiatric reasoning needs the same training.
But we don’t get enough of it.
7/12🧵
Reading a textbook about footwork won’t help you when the ball’s flying at you.
A tennis player practises footwork thousands of times, under pressure, in motion.
Psychiatric reasoning needs the same training.
But we don’t get enough of it.
7/12🧵
That’s why MEQs feel like a punch in the gut.
And that’s also why they’re so valuable.
They prepare registrars for real-world chaos, where the patient isn’t a case vignette and the guideline doesn’t quite fit.
8/12🧵
And that’s also why they’re so valuable.
They prepare registrars for real-world chaos, where the patient isn’t a case vignette and the guideline doesn’t quite fit.
8/12🧵
So if you’re a supervisor, consultant, or trainee:
✅ Start practising this thinking daily.
✅ Don’t jump to labels.
✅ Train yourself to think in context.
✅ Use ward rounds, supervision, and case discussions to build the muscle.
9/12🧵
✅ Start practising this thinking daily.
✅ Don’t jump to labels.
✅ Train yourself to think in context.
✅ Use ward rounds, supervision, and case discussions to build the muscle.
9/12🧵
Because the MEQ doesn’t just test your memory.
It tests your clinical mind.
And that’s something worth training.
10/12🧵
It tests your clinical mind.
And that’s something worth training.
10/12🧵
We’ve put together a course to break this down, not with checklists, but by showing how psychiatrists think through diagnostic ambiguity.
Because real patients don’t come with multiple-choice options.
They come with complexity.
11/12🧵
Because real patients don’t come with multiple-choice options.
They come with complexity.
11/12🧵
To access this course and tailored MEQ marking feedback directly from Dr Sanil Rege, click the link below:
12/12🧵psychscene.co/3HyGwkP
12/12🧵psychscene.co/3HyGwkP
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