Name:
Top Tips for the Clinical Component of the FRCS Exam
Description:
Top Tips for the Clinical Component of the FRCS Exam
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Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Over the past the exam in November, so we're trying to incorporate some of the new things that have occurred due to the lockdown and a lack of patient actual presence in the exam. OK it still is going to be an intermediate station 15 minutes each.
It might be a case of you having two examiners asking you questions, or it could be a case of you have one exam that pretending to be a patient, you will have five minutes to take a history, five minutes examination and key five minutes discussion. Likewise, the upper limb and lower limb you will again have three five minute sessions. It might be they show you pictures and try and go through a discussion with you about the pictures and describe simply just describe what you see.
OK examiner's manual, so we've all seen this screen and seen the sheet before, it is very straightforward. We do this day in, day out, but it's kind of like doing a driving test. So remember to check your mirrors and check your tires the whole work as if you're doing your driving test again. Likewise, when you do a clinical examination, but again, you're not a medical student, you're not a registrar, you're trying to become a consultant.
So you're trying to present the fact that your stuff and that you are comfortable doing this. So it's really important. would suggest that before the exam, you spend plenty of time practicing with other colleagues doing the exams to get an idea and a feel of how to do this. So we've intermediates, you're going to have a history exam, you're acting as a patient, as we said before, with both candidates and examiners performing the act.
So the exam will be I'm a 65-year-old lady. For reason, whatever arthritis and it will go through that with you. It could be an examiner also telling you, what do you want to know from history, much like you would have baby in a upline pathology? More difficult, as the questions can be more about how do you justify those history questions? Why are you asking about family of neurofibromatosis, for example, where a person with, I don't know, rheumatoid again makes sure every question is justifiable because they will really want it?
And you don't want to waste time? Ok? can you think about the history, is that what you demonstrate professionalism, a quality of history obtained and it's organized, it's not all over the place, it's relevant to what you need to know. An ability to communicate with the patient in this case, the examiner, so they could also throw in a consent style procedure where they ask you to.
How would you go through consenting this patient for an operation after you decide what your treatment options are? The other wants you to think about the social implications of the condition. How does it affect their day to day life? So do ask them what occupation they do, what hobbies they do, particularly in upper limb. If their right hand dominant and they've got problems on the right hand, they want something being done about it.
It's also key to know about co-morbidities because again, you're a surgeon. You want to know I can do this operation. But is there anything that this patient has that will stop me doing the operation? I also have the ability to summarize the important history point. This is where it's key. So a very nice question that you could do in the past was, say, the patient.
Can I just summarize you key issues that you've told me this time around? You'll have to summarize the examiner. So it's good to practice with your friends and colleagues beforehand, so you get used to that concept. Again, simple things, as I said, it's like a driving test. Introduce yourself. Think about the present condition. Think of any red flags very key in spinal problems.
Treatment so far is also important and patient expectations again, social implications and things like that. It is really important. You ask these questions and past medical history. Any previous surgery, relevant issues and drug history is key. Anticoagulants, they love them because they want to know, do I need to stop this patient being on a rivaroxaban or apixaban?
How long do they have to be off it and diabetes? Do they need to be first on the list, last and list again? As I mentioned before, hand dominance, particularly upper limb cases, occupation and they do want you to ask about smoking. As I said, and always think about summarizing to the patient or the examiner, if you can and think of out about differential diagnosis because they might actually have a few streams to ask about that.
And without the patient there, they do actually get a chance to question you about your differential diagnosis more than in the past. Now these are Mason a bit is difficult. It's no, no patient. It could just be a clinical photograph, and you have a lot of that in the short cases. And it's very much a simple case of, say, what you see and try and be exact about it.
Again, you can't do a field, no patient, not usually critical in the case they would try and do. They will ask you about move, and they might ask you to demonstrate how you'll ask a patient to move their arms if you're doing a shoulder exam, for example, now they will definitely ask questions about special tests. So think of the principles, the steps and significance, and while false positive.
And a false negative might be. I used this by Nick Harrison, Pfizer Ali, and I suspect if I'm an examiner, that's the book I would have on my art, in my lap, on my wherever I am in my hotel room before the night, before trying to remember how to do a simple special test like a axilo a draw or Lachlan's test and not quite word perfect, but near enough what set there? I think the examiners will be happy.
OK, now the discussion is it basically a five minutes fiber, a long 10 minutes past with many positive findings, so you need to get those all in. You can't you can't write on a piece of paper to help you remember key features. Think of a list of investigations. We've expected positive findings. And you need to demonstrate the ability to of higher order thinking to score more points.
Now it is really, really important that you get the discussion. You don't get a score, a score for discussion. You're not going to pass the station and it tends to be you'll get the same score for your history and examination as you do or your discussion. So the discussion is key. So try and move swiftly but efficiently. Obviously, through the history and examination, they will draw you back if you're not getting there, but try and get to the discussion.
The exam is going to want to help you get to the discussion and actually in this instance is a little bit more straightforward. You can sometimes I've heard the nightmare stories where you have a patient who won't stop talking before you know it. You've had 10 minutes on history and all they've done this tells you about their train set. So that's one skill.
You don't have to worry about trying to move a patient on politely and not too surreptitiously, but you need to get to the discussion. Ok? sure, cases, as we said before, it's most likely going to be clinical photograph only again, describe what you see. Give a differential diagnosis starting with the most relevant. We don't want weird and wonderful.
We start with the wonderful. They'll focus on the weird and wonderful, and you'll have to start and you might end up digging yourself a hole. They'll also always get asked about special tests to help confirm the diagnosis and also how they might guide your management for the diagnosis. Do author investigations there might not be any X rays, but if they are brilliant, let's not say what you might expect on the findings.
And again, think broader management lines. So non operative operative and again also it's key as well as well to say you would ask what the patient wants. That's a very important question, because patient's expectation is key in this, in this as well. There's a very simple thing. They used to do as well. In the clinical short cases, they would ask you what, what think, what question you'd like to ask the patient.
So think about that as well. That's the end of my discussion presentation, so I wish you all the best. It's strange times, but plenty of practice will help you get through it, and I'll leave you back for us. Thank you very much, David. Really nothing much I could add to that. Perfect within the time limit covers everything, and I hope you guys have made notes and taken everything.
I think David heinously speaks with a lot of experience with exams, so I think everything you said is extremely valuable.
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