As a Cardiology trainee, I sat my specialty certificate exam, the European Examination in Core Cardiology (EECC)[1], last year. I followed my usual study technique, memorising facts, guidelines and examples of mock questions and answers. Having gone through similar assessments for over a decade now, I have had some time to pause and reflect on the differences in decision-making between choosing ‘A’ or ‘B’ in a multiple choice format, and the actual decision-making that I practice whilst working in clinic, on-call or in a leadership setting.