Name: How to Get the FRCS Clinicals Right
Uploaded: 2024-05-31T00:00:00.0000000
Duration: T01H09M35S
Description: How to Get the FRCS Clinicals Right

Name: How to Get the FRCS Clinicals Right

Description: How to Get the FRCS Clinicals Right

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Duration: T01H09M35S

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Upload Date: 2024-05-31T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .
But OK.
Good evening, everyone, welcome to this teaching session on the orthopedic academy, one of the Orthopaedic Academy teaching sessions for preparation for the FRCS exam. And this evening, we have the pleasure of having. Akashdeep Bauer, who is an orthopedic surgeon from London, from Princess Royal Hospital.
He has been successful in to pass his exam in the recent setting in November, and he has been fully aware of with academia. I think a lot of our courses and teaching, and he has a lot of insight into the exam and he's going to impart his experience doing the exam twice.
Yeah, I have. First time was very close call and second time obviously passed easily after learning a few tips and tricks. But I think his experience will be very, very useful to everyone on how to tackle this exam and the challenges that are faced with the changes constant changing the exam setting, particularly, he'll focus today on the clinical part of the exam because it's, you know, it's the part that have changed a lot.
And just to remind you guys, so the session today will be mainly actually go talk. There won't be any manicures or Viva today, but we will have opportunity for discussions at the end and for you to put all your questions. Any burning questions about the exam to actually today? I remind you guys, we have two courses, the case discussions course and the basic sciences course.
These courses run multiple dates or next courses we have in December. And we have in January 2 and we are in January. I think most of these courses are fully booked. There might be one place left, but it's small courses. When we have a small group of students only 6 and all day sitting with faculty, and I will go through exam high yield exam topics and details and examine you and also give you the ideal answers and how to answer this.
So we'll give you the proper suggested answers. So if you want luck to find more details about these courses, please go to the Academy that code UK. Please stay tuned with us for our future events, webinars and teachings Follow us on telegram, Twitter and YouTube and Facebook. And so without further ado, I will now leave you with Steve to start his.
I took over to you. Thank you, thank you, Mr. Hi, everyone. I'll basically be giving you my perspective on the virtual clinicals, as you know, during COVID times, we're going to be having these virtual. Um, I happen based clinical scenarios and virtual exams, and yeah, so basically just be saying my giving my two pennies on what I think is the best way to approach these virtual particles.
And so just a disclaimer disclaimer, this is my personal opinion gathered during my preparation of the last eight months or so. I also take a Nugget from various courses, which I mention at the end. I borrowed some files from all the O2 Academy members who have been in touch with over the past year. And you can take what suits you best from my presentation. You all might be familiar with the exam format.
There's two intermediate cases 15 minutes each. There's five minutes of history taking five minute examination and 5 minutes of discussion, and then there's three separate, appallingly short cases and three separate law Allen short cases. Now, why this is important is when it comes to the short cases. If you imagine out of the seven 68 total number of marks, the three upper limit cases would carry about 192.
That's that's a lot of marks. Each short case is basically what two virus scenarios. And that examined in a way that you get examined by one examiner for the first two short cases and then the switch sides, and you would examine for the third shot case by the separate examiner, or it could be 1 and 2. Now, this separate points for both clinical skills and clinical knowledge.
And the way you wrap your head around it is the skills are basically knowing just how to perform the test. But where you get marks for political knowledge is when, you know, why are you performing this event to perform it and what is the significance of the test that you are doing? Because they carry such a lot of weight. You just can't ignore clinicals. You even then you practicing with your colleagues amongst yourselves, with your consultants.
This is generally what happens. We tend to ignore clinical examinations and which can very easily happen. But as you see from the slide, they are basically I would actually go on to say that I could be more important than the niche virus scenario. Not the way they are presented during these virtual physicals is your usually shown a photograph on an iPad.
For example, it might start with a pesky was with a patient having best tables on a cordoned block. So it's just a visual cue, and there's no point for you identifying that this is a code block test. What matters is you defining what the pathology is, how it evolves and doing a proper examination, explaining the examination. And then going on to management, saying maybe they might show you a penis with a single heel raised.
And again, there's no marks for identifying the patient is doing a single heel. We all know that where the marks start is when you start describing why and how the test is done. What is the significance of this test and how it guides your management? There may also they may also show you videos, say, for example, a child with a cerebral palsy with an equine escape.
And again, no points for identifying that this is egawa unless that is apparent in the video, although sometimes there might be tricky videos that you can't. And we'll talk about that in the future slides. But say in a bog standard case for cerebral palsy with an equine escape, no points for identifying that where the marks are is giving differentials. And telling the examiners how you would examine it.
And what would be the broad principles of management if you are giving such a complex scenario? Same with Allen discrepancy, which is an examiner favorite. You might be shown, say, a certain action date. And again, no points for identifying that. But where the points are, is you identifying correctly which side is conducting? So which side might be long or which side might be short? And then taking the Viva from there, basically doing a full blown discrepancy examination?
And going on to management. Now, this is, I think, one of the most important slides in my presentation and something that you really need to get familiar with when you start preparing, preparing for part two. And this is basically the examiner's manual of how they score you when they give you a scenario. They generally put this out, even when they email you your candidate number, so you're given a separate PDF on the examiner's manual or the examiner examiner descriptors.
And I think this is vital and you need to know this in your mind when you are practicing. Particularly the dreaded score 5. And to me, the most important things were. These are middle ones that I've highlighted here. So when you have difficulty in prioritizing. Gaps in knowledge, for deductive skills, for higher order thinking. I used to always find it confusing when people used to mention higher order thinking, but what is this enigma of higher order thinking?
I used to always get, you know, I used to ask my consultants, and nobody could really give me a concise definition of what higher order thinking is. But I made a couple of slides just show you just so I can explain it to you so you can understand. And another thing that really used to bother me was Dave mentioned frequent prompt as something that will get your file instead of a six.
No prompting can mean many things when everybody what is going on. So what exactly is prompting? I'll explain that in the upcoming slides. So, so these are basically my pearls for your answers in short cases. What you need to start with is the very basics. You need to identify things first.
What I used to do was and when I practiced it with my mate. Then you're shown a video or a photograph on an iPad. Don't just start blubbering whatever comes to your mind. First, you need to take a deep breath, take a step back. Take a couple of seconds. Make a sentence in your mind, because the first sentence is key. That is when you will be judged, whether you're a confident first day diet consultant, level colleague or not.
So the first thing that comes out of your mouth is crucial. And the way I think around it is. You need to be able to identify it correctly. And mention something that gives a cue to the examiners as to what the management will involve. So worst case scenario, you're unable to identify it, identify what's being shown. Then you can at least describe what you are seeing, and the process is basically thinking out loud.
And I've put up a slide where I'll describe you the process. Again, once you've identified it correctly, you need to move on to the differentials. And again, the differentials you need to show. That you're thinking surgeon, so you need to mention the common things first. If if you throw a complete blank, then things surgically. There'll always be some job post traumatic post infected post inflammatory style that can lead to, you know, the condition being shown.
Then you come to the examination. It's the look, feel move, which is universal, but you need to mention specifics when you look. What are you looking for? If it's a shoulder, you're looking for the controller of the shoulder. If if it's a foot being shown, you're looking at the medial longitudinal arch. How is the relationship of the heel to the leg?
What is the forefoot like? What is the midfoot like? What is the hind foot like? You need to bring on those descriptors in your initial description of the photograph being shown. One thing you must do is listen to the hints, and this is crucial because we don't have patience. So the examiners have thought of a scenario in their head. Normally what happens is it's a three day exam that on the first day the exam among themselves and drawn out case scenarios.
So they have given it due diligence, they have given it a lot of thought. So you need to listen to them if you're going up the wrong track. And again, when you come to management, always ask for what the expectations of the patient are. Because in the examiner's head. They must they might have decided that the patient is for conservative management because of whatever reason.
So you need to mention you need to ask what the expectations are and then decide on the management. If it's a very complex case, then it's safe to say MDT, but what I would suggest is you mentioned who all come in the MDT say, for example, if it's a case of cerebral palsy, that's for the sake of discussion you need to start by mentioning in the MDT it will be a pediatric my pediatric colleagues. It will be a cerebral palsy nurse.
It will be a physiotherapist. There will be community social care. I will involve the parents. There will be occupational therapists. There will be an orthopedist. If you mention the specifics, then it takes you further up from the candidate next to you who might not have mentioned all of that and would have just said MDT.
Now, again, very important sites. What what is this higher order thinking? I'll just start with an example. So one of my Mates got asked. This question basically in his a scenario where he got this EPL rupture post this latest fracture. And he felt that he because he went to tendon transfers, he'd scored a seven.
But that's not that's not really what the examiners are looking for. And I've made an example answer so candidate one, let's assume that is my mate. And he said it's an EPL rupture diagnose correctly. And I would use IP to transfer it. Absolutely correct. But what I think the examiners are looking for is it's a nipple rupture because of friction in a healing distal radius fracture.
I will let the factor heal first, because that is the scenario in their head and then blew the tendon transfer. Because, again, because, you know, repairing the EPL doesn't give you a good outcome when you explain all of that, you explain what is the thinking behind what you are saying, then the examiners think you are, you're safe and sound certain.
Again, I'll explain it another example. So say you're given a long case where the patient is unable to evade doctors shoulder two years after shoulder dislocation. Again, you might, you know, do a good history and examination and start by saying my differentials are. It could be a rotator cuff. It could be arthritis or frozen shoulder.
A lot more severe dislocation or a big Texas lesion. All of that is very good. But if you're tough, if you've come to the last 30 seconds of discussion. You need to. Give the examiner something I call it, I call it anticipation and guidance. And I've taken it from one of the mentors. So basically, you need to what you need to do is.
And you need to give the examiners something extra. So what I would say for this is I would consider NQF to look for brachial plexus ultrasound for rotator cuff tear, I would get radiographs to look for a posterior dislocation or humoral arthritis. You're giving that one bit extra. So not only have you given the differential, you've also given investigations and potential guide to management, and this is the thing that goes your extra.
And this is what they mean by higher order thinking. Now, just as an example in practice, sometimes in short cases, you can get bogged down when they show you this kind of a scenario where you're unable to identify it. I don't think anybody of us would be able to say it in first go as to what the condition is, but you can very safely describe what you're looking at, and that is something that the examiners are looking for.
So when you look at this? The way I would describe it is I've been shown a child in a wheelchair dysmorphic facial features. It's normal looking handsome, this short legs possibly deformed. There's a lot of posture, there's probably problems, the dentition. So in one go.
You've described that you're looking for. A child who is immobile. You've said that there's some discrepancy in the proportion of the child. You've said that you notice the deformity. You've also noticed dysmorphic facial features pointing toward skeletal dysplasia as to what that might be. That's up for discussion, and it doesn't even matter.
And if you approach this way for any complex scenario, I guarantee you you get to 6 or even a seven. Another example. So if you're shown this picture of a young male with a thoracic kyphosis and they ask you differentials. You need to start with the Communist first. And that is what I would strongly suggest if you start with something like tuberculosis.
You'll get bogged down into management of tuberculosis and all of that you need to start with. What do you think will be the commonest first and if you throw a blank? You can also always think of the surge conceived. So starting with, you know, all you can start from congenital and go age, face whatever you choose, you need to back back it up. And sometimes it's useful to give your differentials with little snippets.
See, for example, it could be congenital because of failure of segmentation of vertebrae. It could be post-traumatic after a thoracic compression factor. It could be an inflammatory disorder, such as ankylosing spondylitis. It could be an infection such as tuberculosis. It could be a tumor such as whatever it could be school and stuff. So what I mean is what can differentiate.
A candidate was scoring a 6 from a 7 is a six candidate will say all of these things congenital post-traumatic inflammatory part, because you've mentioned congenital is because of failure of segmentation. Both post-traumatic is because of thoracic blood compression factor. It could be inflammatory, such as ankylosing spondylitis. It already demonstrates that, you know about all these conditions.
And then the examiner can lead you down the path of, you know, had a trauma in the childhood. So what is your management? Say he didn't have any trauma. And it is congenital, what is your management that those are all secondary? It's these initial descriptors that basically determine what your marks are going to be. And again, another example they decided to.
You can mention all the differentials, but start with the Communist first, and that is what I would suggest. Then when it comes to examination. It is very useful, I think. I think it is actually vital. The screen first, especially enhanced risk scenarios, a useful thing that I found was to start with the grips, so you can mention the three fine grips, the two power grips as a starter, and then you can think about what the examiner was alluding to.
I felt were actually the key in these clinicals, because you always get at least one, and if you get lucky, at least two scenarios in the upper limb shorts. So that's like a full station and then a separate. Half Viva station, which is the beads and hand. Another important thing that I found, especially in these scenarios, is the sight of tenderness. Sometimes the examiners can give subtle hints as to where the tenderness is and that can guide you as to what pathology they're alluding to.
If they give you a hand on a risk scenario, which is becoming really common cause a lot of my friends and I got risk scenarios in both my exams. Don't forget the dart throwing motion, which is mainly in trouble. And it's a great thing to mention because you're doing two things. One, you're describing that, you know, the pathology could be in the entire couple joints.
And second, because it is the functional movement, it already demonstrates that you know, that it will guide your management. And once you get that thing, you need to tell you about your examination. And also, don't forget, you need to have the appropriate, age appropriate age when you mention your differential, especially your primary differential. Coming to the examination videos, this is something that I found slightly tricky.
And what I would suggest is you see these videos on YouTube. They're readily available, so you see all these gates. The scissoring gates shortly. Vandenberg conduction and target. Once you've seen a few of those videos, it'll be easy to spot. Identify all of them. In the exam, if you get the video and say it is slightly unclear, it is perfectly safe for you to say so.
And you can ask the examiner for it to be repeated. Because these examinations, these videos are perfectly new to them as well. So they're as unfamiliar to these videos as you are, but it's always best to ask. And the second thing that we were also told is that this process is still being audited, so it may happen that you might not get an examination video after all.
But what I would suggest is you practice the many ways. And if they show you a test being performed. And you can't identify what the pathology is safe, it's of internal work has been performed and you don't know if it's a problem with the hip or if it's a problem with the doctors. It's always safe to just identify the test being performed and lead on from there, and you always get the hint.
Now coming onto intermediate cases, which are basically the vital ones, you get one upper limb and one lower limb scenario spine can crop up in either of those. As you well know, another 15 minutes each, that is a bell, which rings after every five minutes, but it's not easy to hear the bell in all the commotion that is going on, so be aware of that. There's actually five minutes stipulated for history taking examination and discussion.
But generally, what I found is and talking to my colleagues, it's very flexible. So don't get bogged down by that. What I would suggest is you read the examiner descriptors again, which I mentioned before, because they're separate marks for mannerisms, for your language. Have you introduced, are you organized? All of those carry extra marks. And one thing that is no longer happening is examiners are no longer acting as patients.
So it's a third person scenario. One examiner basically gives you a scenario and then tells you to ask a few relevant questions that you ask in history taking, and then there's a virtual examination, which are a little later. So in this scenario, because you're not having a conversation with the patient, focused questioning is very important. And for those, I felt. You need to.
You need to attend the relevant courses, which are mentioned at the end where you get this practice of focused questioning rather than, you know, going on and on with your question because time matters. Time flies no matter how many times you're told when you get in the actual hot seat, you don't even notice when these 15 minutes fly by. So you need to have really focused questions.
And basically, this slide is the key to how you score well in history taking. You basically need to go back to basics because this is worth as much as half a bio station. You need to practice, practice, practice and tailoring your examination is, I think, the key. So if it's a hip scenario, you need to have questions on childhood affection. Was the child managed in a cast when he was a child alluding to, you know, dysplasia?
Was there any surgery performed and the child was a toddler alluding to his or slightly later, a young child? Was there any infection in the childhood, the secondary arthritis and so on? If it's post traumatic, you will obviously ask and then you'll get a hint. But you need to make sure you get the a, B and C of what the trauma was, what surgery was performed.
And was there any infection after the surgery and all of that? What implants they used? Everything, anything and everything that you can get in history. If there's any instability, you need to make sure that you mentioned the bait go. You mentioned the family history and any problems with the AIIS and the teeth because it can be a collagen disorder.
And in the end, there's a separate mark for a good summary. So you need to make sure once you've done a thorough total history taking, you need to summarize our history. Sometimes what happens is you're still on history taking and the bell rings and the examiners lead you onto the examination, especially in these virtual tentacles.
So what you can do is you can still summarize your history so you can still say. I'd like to now summarize what I have understood about this patient and carry on my examination. So in those two sentences, you can summarize the key points that you have gathered. And then you've missed something the examiners always help you out. In this fine scenarios, you need to mention red flags, so this is something that you just have to do.
In a division society where, as I mentioned before, any of wound problems, secondary procedures, a number of revisions because they're coming up with cases now where there's a revision elbow arthroplasty scenario where there's been a revision twice. So you need to make sure you've mentioned how many times you knew, you know, how many times a revision has been performed and the chronicity of the pain also becomes important.
Sometimes you can use your history taking to narrow your narrowed down your differentials, say, for example, or shoulder pain. You can ask for focused questions associated weakness, global limitation of movement. You can use the Oxford Shoulder score. You can use the Oxford Hip Score. And at the end, you must always ask for expectations and treatment trials so far.
And finally offering differential gradient. Now, when it comes to your examination, you need to have a system in your head. And again. No matter how many times. You have said it unless you've practiced it and said your examination, in so many words, to a consultant or your colleagues, or even during the courses, you need to have the system.
What happens is sometimes you're shown pictures and you need to comment on what the picture is showing. Say, for example, in a look feel move scenario for, let's say, a shoulder, you'll be shown a picture first where you're observing from the back and they'll be waiting. So you comment on that and then you don't do what movements or what specific patient you'll perform and what specific movements you perform. So you need to be led by the examiner.
Sometimes if they think that you're really slow and you're missing out on management, they lead you there. So don't get bogged down and don't repeat the examination again, if they've led you to management. If they've shown you a test, you need to nail that, you need to name it, you need to describe the test and how it is relevant to the condition.
See, for example, if it's a standard test, which side is dipping in the picture shown and then you need to mention if it's a problem with the fulcrum, the lever or the effort and which one is pertinent to the case that has been shown. So what I would suggest is you practice all these examinations and make them condition specific, say, for example, if you're doing a foot and ankle scenario, you need to make them condition specific.
So say, for example, an examination or peacekeepers give us an examination for clinics and examination for ankle arthritis. I promise you, it only takes half an hour of your time, and once you've done that, it will make your life easy. You need to be able to verbalize all the key tests you already know about them. I don't need to repeat all of them, but Coleman block Thomas's test Kelly at just 10.
It just as an example, and you need to understand the principle behind each test, the false positives and false negatives, and what would help you to get that XR7 and X And sometimes even an 8 is what was that test initially described for, because that is something that the examiners simply love. See, for example, the Limberg test, it was initially described in the pre axilo era for abductor function, for Nadh or for progressive muscular atrophy, if you know that they'll think that you are a step up from the next candidate.
So now coming on to the discussion part. Don't be alarmed. As I said before, if you're still on examination, that is perfectly fine. As long as you've done the examination well, you've done the history taking well. If you've done those two well, you will easily pass. You need to start with the investigations first and you will be shown the relevant ones.
Or sometimes what the examiners do is if they think that you're getting to the end of the station, then they'll show you the imaging modality and then you just need to describe it and not mention separate imaging modalities to annoy them. You can do fish for other investigations if you're shown a radiograph and you think ACT or MRI is appropriate. You can mention that.
But then you need to mention why you need that test. Say, for example, if they show you a coronal MRI dissection with a rotator cuff tear and you're in your head planning for adverse shoulder, then you need to say I'm looking for a surgical look for 48. Looking for battaglio sign? I'm looking for the engine sign. And if you're showing an arthritis and deformity, I'm looking for long leg viewers to see in the mechanical axis, all those things carry extra marks and some things that I would surely mention you need to mention.
Conservative treatment fast, but a big. But if the examiners have already said that the patient is exhausted conservative treatment and sometimes they say it in the question stem, then don't annoyed by mentioning it again. If they've mentioned it, that's fine. Just give these surgical or whatever further treatment you plan. You need to follow the sequence.
It's a basic sequence. You start with the Nsa WHO by opioids, physical therapy injections, joint preserving joints, sacrificing. You know that. As an example, if an infected also plastic scenario, which is becoming really, really common, so you're shown these scenarios in your pathology evaluations, you're short clinicals and even your long term goals. Apart from mentioning that they're considered and the revision, you need to mention other options.
So long term antibiotic suppression that can be an option if it's an elderly patient. After all, this is if it's the young patient amputation again, if the patient can't take a big surgery girdle stone as appropriate, if you're shown coming on to the management. Finally, you need to have the injured data for your total hip or opening of your choice. You need to have the primary center survivorship data, and there are books that can help you in that you need to mention your management for the typical scenarios during your practice, you need to talk to the consent.
So one principles don't forget. You need to state what would happen if non operative treatment was continued, so you need to mention the natural history and the risks and benefits and what are the long term results of the treatment that you're offering? And again, if it's a very complex case mentioned that it is a difficult scenario, but always give your treatment of choice, they always prompt you for it.
So now coming to a very important slide. Worst case scenarios. This this slide, I've basically put up, because these are some of the mistakes that I did. So see if it happens that you can't identify what is being shown. Again, you need to go back to basics. You need to describe and you will be led to the diagnosis, so don't get bogged down.
Safe, safe. What happens if you forget the name of the test? You can still describe what has been shown and the principle as to what is being described in a short, in short place. If you bomb the first short case, you do very do very badly in the first one. You need to take a deep breath. Deal with the second and third.
And for that, all the causes are really helpful and for the discussion in the long cases always state the principles. So even if you're shown a very complex brachial plexus lesion, you can always mention the principles of nerve grafting or transfers versus tendon transfers, depending upon how much time has elapsed. And then if it's a multiligament knee injury scenario, you can always mention the principles of reconstruction, even if you might not know actually how to do the reconstruction.
Now, again, very important what is exactly prompting? So you need to pick up cues early if it's a virtual clinical scenario. And sometimes the lead is actually in the stem that is being shown to you. So if it's hard to put runs where you see commercial codes, where you see that its previous scar tissue from previous searches, you see that it is bilateral affection. You know that they're looking for dial pieces.
If you don't mention that, then they'll probably count this as a prompt. So that is why it is crucial to have a prepared and executed common history and examination sequence. So these are some of the things that, in my mind, qualify as a prompt say, for example, if you're given a pesky was not performing condom block, that would probably be a prompt in a Vatican City.
You always need to check credibility and commentary on ulnar nerve for a hip case if you don't perform the Thomases and Tenderloin. That's definitely a prompt in a rotator cuff scenario. You always need to perform the special tests to test the rotator cuff power. You need to in an elbow scenario. Apart from the range of women, you always need to check the stability in the elbow arthritis scenario.
Um, and again, in history taking, if you're not asked about the history of prior surgical intervention, previous infection and trauma that would qualify as a prompt. And finally, you always need to remember that in any oral exam. There these examples are always going to be slightly subjective, no matter how hard you try. So you need to make the examiners like you always keeping a smile on your face, listening to the examiner, riding the wave if they're giving you hints, take that hint.
If you're unsure, just say, I don't know and just move on. There's bigger fish to fry. It's it's a massive exam. One bad one bad Viva. One bad station would not matter in the long term, and you need to avoid awkward silences. And having spoken to a lot of my colleagues who didn't make it the first time, what I've gathered it gathered is what happened was they didn't do well on a single.
Why was station? And then they ended up basically ruining the whole virus. And that is very common. It's more common than you think. These are some of the resources that I used. You're free to use these or use any that you like, but I basically attended all the most of the auto Academy lectures, courses or UK Viva courses, Cambridge course knowledge management course.
These are the courses that I found really useful books. There's loads of books. Just use any good book I used. These are the ones that I've shown, but yeah, you use any that helps your cause. Thank you very much. Poor, patient, patient listening, I think that have been going on for more than half an hour. Any questions I'd be happy to entertain?
Yeah, brilliant. Actually, thank you very much for preparing. This talk is very, very useful. I'm sure a lot of the. People listening and watching would pick a lot from it, very useful to the exam. So it's a wonderful to appreciate actually the time you've taken and know you've just finished your exam and you have a lot of things to catch up on.
So I appreciate the time you've taken for us here and for everyone watching. So, you know, for you guys who was, you know, just want to say obviously that this talk is being recorded and it will be on the summit Academy YouTube channel if you want to visit it again. I think I would definitely recommend you do you know, especially as you're approaching your exam? So what I picked from you today is that the exam changed a little bit because obviously of.
A COVID restrictions and now. In the past, we used to have when we're doing a test, we used to have to actually perform the test in a patient, and that patient sometimes can be a little bit awkward or uncooperative or in pain or whatever the communication and describe it. We used to have to describe it. But sometimes just performing the test properly will help you get Mark.
But now, all the way it all is on describing the test, isn't it? Yes, you I've actually to change how you practicing with your colleagues, you're able to give a crisp description of your test, as you, you mentioned. And what's exactly the taste? What exactly are tasting what constituted a normal or abnormal finding on the taste?
Another thing that I forgot to add then was just like you said, very lightly said it's very different to, you know, having examining a patient. What sometimes helps is if you get short cases or long cases and they're asking you examination focused examination questions, you can actually describe it on yourself. Say, for example, you're performing the Watson, you can actually point your fingers as to where they need to be and then perform it.
And at least in my case, the examiners loved it because I was able to actually demonstrate what I'm looking for. And, you know, basic testing, hand, wrist, elbow, shoulder, you can probably do hip and knee. It becomes a little difficult, so you need to be able to, you know, in lower limb clinicals, at least to be able to verbalize all the examination. And like Mr North rightly pointed out, to say the principles outlined very important.
Yeah, definitely. And so and also like what you said about, you know, if you faced with the. A scenario or a case, you have no clue. If you start describing what you see. Um, then you at least you could score something rather than this awkward silence that you mentioned. That's that's, you know, when he's not scoring anything, you need to be scoring every second of the exam.
So Yep. So just describing what you see go through the surgical sleeve, as you say, but I really like this how you went through the surgery, because if this is a new completely to me, which is wonderful actually that you actually say a congenital could be congenital and a little bit describe it a little bit more. Yes congenital because you know, it shows this and that or it's just traumatic because of this and that.
So having a little short sentence after each possible differential diagnosis. Yeah he's a wonderful and thus, I think, an example of the higher order thinking in a little bit exam type technique which differentiate you from other candidates. Yeah, no, I think that's a very useful tip, actually. So from your experience now, how did the exam change between June and november?
Claire, clinical in particular. Yeah so there were definitely less videos. Um, only a few candidates got video, so they've basically listened to the feedback because our feedback was some of the videos are very grainy. It's not very clear what is being shown and you're unable to identify. So they basically came that and they've stopped now play acting as patient.
So they're not acting as patients now. It's all in third person. And another thing that they listened to was because you can't sometimes hear the bell when it is when the long kisses are going on. So there's sometimes hurry you up. That's why I've included that slide. So you need to. If they're basically showing you investigation, then don't go around again, going back to examination, that's no longer useful.
You just need to play as they're playing the game, so you need to if they show you an investigation, just start describing that. That means examination is done and dusted. Yeah so now let's videos and more images, is it more clinical, more? More images, and sometimes they don't even show the images and the start of a scenario.
And then once you get to say describing a test, then they show you an image. And, for example, one of my Mates was Jonah was not shown, basically it was. He was basically given a scenario of a child with repeated falling. Or unilateral ankle instability? And he basically caught on early. You know, he read enough, all of us have basically read enough is just catching these little clues the age.
Repeated instability, defeat as a child, they're alluding to, you know, escape us. So you need to just need to pick those subtle hints up as soon as they're shown to you. And then when you mentioned Coleman block, he was given a slide of coal and block test and then asked to describe the principles what that involves all of that. But he was basically started off as something, you know, which is not very common or, you know, just a question stem rather than just a picture of basketball Kessler.
So that is also something to keep in mind. Yeah, definitely. That's a good way. That's a good way of doing the exam, I think. So this clinicals now what? They don't happen in hospitals anymore than in a hotel, you know? Yeah so they still we did it in Royal College of Surgeons in Edinburgh and say there's basically two different holes which are divided up further into two sections.
So they're basically four places where you need to go and you basically line up. There's like helpers who line you up and then you go into these separate rooms, but there's a lot of noise. Trust me on that. So you need to be loud. You need to be clear in what you're saying. And if you are unsure on what the examiners are said, you always need to ask.
Yeah don't be shy. So that's the first. That's that's the key thing I would say. Don't be shy. Just ask them. Ask them again. So they move you between cubicles. Yeah, Yeah. Yeah it's like, you know, it's like a big hole where they take you.
Yeah so more or less similar setting to the Viva. Yes Yeah. Very, very similar. I mean, identical, really, except that there's AI mean, it's a shorter span of time. So the chemicals only take one hour, whereas the rivals take a couple of hours. Yeah, I think apart with what you mentioned about speaking loudly and clearly and ask for clarification, it definitely applies.
Please, guys, don't be shy to do that. Speak loud. And we always practiced like that in the event of a previous exam. Uh, sort of, Uh, settings when you had patients, because even louder, there will be everyone packed in a small place and outpatient clinics and stuff like this in hospitals. And there will be a lot of noise and patients talking all over the place always have in the clinic had to be very organized.
Take the lead. And speak clearly so. But did you say that after they give you, there is a bell after the five minute history? Yes, so OK, they we didn't have that before in the past, in the past when I did the exam. They used to go and they will interrupt you. Obviously, if you keep going six, seven minutes, they will stop you there until you go on, examine the patient.
But there wasn't a bell. But but that's just fine. It's good to know. Mm-hmm it's yeah, there is a bell, but it's one thing is it's hard to hear. And the second thing is because we're in that flow. You sometimes don't even notice that the battle is done. You're not. You just focused on one.
Yeah one way. So, Mohammad, he's asked sensible question, obviously, I was going to ask you that and you as well is this virtual patient kind of scenario exam scenario going too long? It's going to continue for the future, any plans of going back to patients? Or is this now the way forward? Yes well, the yeah, the honest answer is we don't know yet, but there is a talk that there might be actual patients from Autumn to 2022 onwards from November 2022 onwards.
But don't hold me to court on this. We still don't know. Who knows? Who knows? No one knows exactly anything. My views, my personal views on this, which I don't have any inside knowledge, is just my own views is that you probably there will be patients for the intermediate cases.
But they will continue with the current format for probably the short cases, because it seemed to be probably the best way because to be honest, in the past, even when you had patience for the short cases, you don't tend actually to examine the patients much. It's more like a spot diagnosis and maybe one or two tests. And that's it. You're moving on. So maybe a photo and picture will, will suffice, but we'll see how it goes.
We'll see how it goes. So we have a question from. Uh, the siddiqa. He said just his comment, I think, yeah, he just mentioned the same thing. It goes in line with what I said and I don't know if you know what he got that from, but it doesn't make sense to me. But you know, I think we have just to at the moment, we're trying to keep you guys all updated with most recent exam settings, how the exam last exam went and then what?
We could only anticipate what happens. Um, another thing is not picked up from your before I say, I think honey. Honey, I have a question and you want to talk. You want to ask. Yeah, that's very nice. Thank you very much. Just about the history. In the long case, they will just show you and say, I'll ask about pain and then they will answer you.
Also, the patient doesn't have pain or this is how it is or the because there is no role to play. So I think special consideration, then he will answer you on the set of questions. Yeah, thank you, honey. Thank you for this question. This is actually an excellent question. And something that I deliberately didn't put in the slides because it's very different.
So I got in my two separate intermediate in one of the stations. It was like a pitter patter. So I was asking a question and the examiners were giving me an answer. I was asking a question. It examiners were giving me an answer. And that's how I was led on. But in the second one.
I asked you about pain, all that Socrates thing, you know, pain related and pain and function history. And then the examiners were basically just staring at me as to, you know, is there more history or is, are you finished? And I was like, you know, that is completely different to what happened in the second one. So I have actually put that in my feedback to the Royal College that, you know, we need to have in these virtual clinics a standardized way of history taking because we're not asking patients, but it's very hard to do.
So you need to be examined, is my answer. You need to have need, you know, you need to have your sequence and you can just start in. What I would suggest is you carry on unless the examiner stops you, and that's the best way. So you start with pain. You ask about pain. Then you start with function, you don't rate unless the examiners in traject.
And they will guide you, I promise. Roy? OK. Yeah yeah, I think that's a good tip. I mean, what's Steve's answer is basically even the examiners are probably. Yeah, that was my object. I think that's so you got to take sort of responsibility and take charge of your clinicals and agree, actually.
Keep going. Ask all the relevant questions. Yeah if the examiner is giving you the answers or not giving you an answer, just keep, keep going and just make sure he's cool your points. Yeah, you have to have a plan of what you want to score, what you want to ask. So another question from Mohammad is about.
What you views on this virtual clinicals, are they good? Better than before or worse? Yet again, it's a personal opinion, but I could show you the rare cases. He's saying, do you think they will show you their cases? They do not rare, but complex scenarios, I would say rare as well, sometimes if you are unlucky. But what I would suggest says that is to your advantage if they show you say, for example, bog standard scenarios say a knee arthritis patient, each and every candidate will things to an extent.
And then if candidate X knows more than candidate y. Then he'll probably get to 7. And you'll get a six, although you think you are the master of the arthritis. Yeah, you understand. Whereas if you're both shown a complex, let's say a revision scenario which has been revised twice, there's an infection. Again, you're planning a revision surgery.
Then even if you understand the principles, even if you understand the messiah's criteria, how and why they work and the treatment options, you see those principles, you still get good marks. Yeah I think my take on this, Muhammad, is don't be scared at all of. Difficult, unusual, rare cases, that is describe it. It's probably could be a gift.
It's a stressful and difficult. But, you know, if you get brachial plexus examination, for example. Yeah, that's your opportunity actually to pass this exam. And get extra marks on the clinicals because most people will struggle with this. And if you get the cerebral palsy charge, you get a difficult spinal scoliosis, whatever, they are difficult, but but it's your chance, actually, to shine.
But if you get a standard one ankle arthritis, knee arthritis, you have to get every single aspect of this answer correct for it, for you to pass. So it's having because you can't they can't get you now, maybe trauma cases as well, they can get you shoulder dislocation, probably in a clinical now. But that's not a disadvantage at all. You know, it's just how you look at it and you're prepared for all these cases anyway.
So, you know, I wouldn't think it makes a huge difference. Yeah so I have a question from Al Sadiq al-bab about international exam and is it the same format? And I think there hasn't been any international exam since covid, as far as I know, we don't know when is the next one or how is going to be run, but I expect they will stick to that format, I think. I think it's in June. One one of my fear, somebody has said, surfaced that it's in June and do my thing.
Yeah, but format, I don't know. I mean, Yeah. Yeah well, I said that probably the first one since COVID started, and they should be sending instructions to candidates, but not now. But Yes. I think they would have every reason not to bring patients. So it will probably be virtual. I would guess so.
I think from your view, I would prepare as a virtual on the basis of this virtual exam. But who knows? They can't change last minute, but I'm very unlikely because bringing patients, it's a very long process. They probably have to start now if the exam is in June, and I don't think they're in a position to start bringing patients and new variants of COVID coming and whatever.
They're not in that tool. Patients, even patients don't want to come. So, so based on all of that, it's probably be virtual. But who knows, maybe you could tell us after June, you have one of the international. Yeah, exactly. I agree with David this. I think bringing patients not going to be logistically worth it.
I mean, how can you even justify it? I mean, now patients dying in hospitals, they can't have visitors. And then you suddenly saying patients can come to be examined by a massive group of people. It just doesn't make sense. You know, Bush is not allowed visitors to come to see them in the hospitals, let alone people coming and examining them and random people coming in.
So it doesn't make. Sense, but who knows? So another thing good thing I picked from you, actually is. Is asking when you're taking clinicals, you asking patients about their expectations? And I think that's an example of the higher order thinking. Because that saves you a lot of trouble when you come to the examination discussion part, because if their patients and when you're discussing the conservative management because you could tell the examiner, well, these patients expect, according to patients expectations.
He can do well with probably just an injection or a physiotherapy or something, so it's very, very important. It's very, very hard to differentiate. These little things differentiate between a candidate who has this higher order thinking picture than someone else. I think I think I like that. Ask the patients, what are your expectations? OK, that's fine.
As simple as that, what are your expectations? And then I tell you, well, you know, I can't live like that anymore. Patients can tell you, candidate, that's it. I can't live that. Then you know, you have to do something and then you can discuss the complex management options. And I don't think it's which I totally agree with you is that condition specific examination.
Yeah now this is a FAST exam. It's not an MRI. Yes when you could do just the generic look, feel move. So I agree with actually condition specific, and I always practice, always encourage people to practice like that. Yeah condition specific. So in examining Alex Vargas, there are certain inspection and examination findings that you have to mention.
You have a cave of. You have Leonard Vargas, you have whatever you have, you have, you know, if you have an examining patellar, formal joint is different from examining the knee. You there are specific things you have to mention, like a beat on score and say the clock, the specific things. And so you have to practice specific conditions specific. And I think in our book the consensus to be diagnosed, we that's not how we structured it.
So each topic when you open it, you will find a few lines of bullet points of exactly what are the history specific questions you have to ask in the history of each condition. Whether to score and which we think are score is one of scoring scoring points and also the same examination exactly what you have to examine. Um, you know, be, for example, if you examining simple things, examining hallux fibers, let's see.
Yeah and if you don't do the grind test. You probably won't pass the test because you've not differentiated if this patient has arthritis and which obviously dictates your management plan, so it's very important. It has to be condition specific examination, as you said, actually. So I would strongly encourage that.
And one of the difficult things which was very important as well. I think from used to make examiners like you on the day. Yes, I think that is vital. I think you always I remember in your or UK courses when you take that 10 minute initial speech, you always mentioned this. Yeah and I think that is really, really underrated because you might come up after an exam feeling, you know, I've completely failed, you know, or, you know, but you still end up passing it.
It has happened to a few of my colleagues, and that is because you were systematic. Plus the examiners lied to you. Yeah and it's a subjective exam. You can't not make it subjective. There's human factors involved. There there are few. Yeah, there are humans examining you if you are nice enough, if you're not argumentative, if you are examiners, let that there's a good chance of you passing.
Definitely I think they will look at you guys. Is this person someone I could work with in my department is can because they all more or less taking that career move for you. You could be their next consultant colleague in their department. Yeah, that's possible. So they looking at you, so if they think you are someone they can work with.
Not arrogant, not argumentative, as you say, then that will definitely they will push you a little bit. It will definitely help. Yeah, if you are, if you come back, as you know, a little bit arrogant or. Maybe our devices. Then it will put you in a very difficult position they wouldn't want.
They would say, oh, this guy, think he's the best? And they don't want this kind of people to work with them, so, so always stay modest. Respect the examiners. They do deserve the respect. They definitely know more than the candidate. And no doubt of it, no matter how can you clever, they are in the topic. They have been preparing this, so so give them the respect they deserve, but also be confident of your knowledge because you got there and you wouldn't be there if you don't have.
Knowledge comparable to the examiners, so be confident, but also be modest. So that's brilliant. So any more questions goes, I think all the questions I have, but does anyone have any more questions or would like to speak with steve? Ask him questions directly or write it in the chat, please. This is your last chance.
And so I just say stay tuned with us, please, and also with the Academy. Visit our website, see the courses, particularly the case discussion courses we have. When we go through a high 40 or 40 45 high yield questions and give you the answers and discuss the answers with you and give you the ideal exam answers, we'll go through the Viva as well as clinical scenarios, so you could find these details of discussion with the Academy.
Is the uk? We see Follow us on. I said, this will be on YouTube channel, so this talk today, so so you can guys visit the game before the next exam? So it doesn't look like that any more questions, so based on that, we will end this teaching session I would like to thank again akashdeep Bauer for. The time and effort in preparing this wonderful presentation today, and I welcome you to the academy, hopefully you will see more of you and help us and help everyone around.
And thank you so much for this opportunity. It's a pleasure. It's good to see you. And so. I think if no more questions, so thank you, Steve, and good night, everyone. Thank you. Thank you. Bye but.

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