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Mastering Your Skills for the Viva Part of Orthopaedic Exams
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Mastering Your Skills for the Viva Part of Orthopaedic Exams
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Language: EN.
Segment:0 .
So just some notes, please, guys, again, if you have any questions, please write it in the chat session. Raise your hand, the hand symbol, please, everyone is encouraged to ask questions and interact to make this session helpful.
And again, just because I wasn't recording earlier, thank you for reminding me I just introduced Mohammad again, who is like, I'm consultant from knowledge, and he's presenting on mastering techniques for the first survivor. Over to you, and I'm Mohammad, oh, thank you for us for introducing or introducing me and for this amazing project everyone is sharing to do so.
I'm one of them, as you said, an upper limit surgeon from Norfolk and Norwich. I'm going to give you a presentation today about mastering the technique, which is really important. We all get this message. And after having that message, you have a short period of initial elation that will quickly followed with fear or fear that you now have to prepare for fiction, too.
And I think that's really important to master your techniques because you've demonstrated the knowledge and passing part one in section 2. And I'm talking about survival part here. It's all about technique. What I'm going to tell you is actually experience my own experience, experience I've got from examiners. I've done practice with experience from the exam itself, experience from senior colleagues, from my colleagues, from other mental skills that are prepared with more about two years ago.
And also these experiences, I think, is crucial to master for your driver. I think the first part of this presentation or is going is mainly for those who are doing part 2 in a few months time. Second part is for everyone, especially those who are doing the exam in a few weeks' time. Part two is a tough assessment of the curriculum set by the GCSE and the specialist advisory committees.
And so I think personally, which is helpful as well, is the first thing you should do is to read the ICP syllabus. It is almost 300 pages long and any topic on the syllabus can be covered in the exam. So therefore we should have a broad range of knowledge to bus rather than the depth of knowledge and all discuss the details. The logic here is to understand what is the exam about and what they are assessing, basically.
You hear stories about candidates being marked down for wearing wrong size or simply because an examiner doesn't like them. Also, in reality, this perhaps is true. However, the exam is no longer an unstructured chat anymore. The modern exam has structured questions, starting with an opening stand, followed by more detailed questions. And I know colleagues who are very good surgeons who are very good, who are experienced and knowledgeable, and they failed.
And others who are less knowledgeable and less competent who passed. And it's simply because it's all about the technique. Basically, this exam is testing a day one consultant, and this is a crucial step for this exam. One consultant in a digital age. So when you are sitting at the table, these two consultants examining you, they are colleagues. You are discussing with your colleagues and a trauma meeting in which you started in your first week.
It's not a master's. You shouldn't waste time on things like this. X-ray looks to be a lot views and we'll go through it by time. So the key to passing here first key is to answer the questions. As a consultant, no, as a examiners want to know what you would do if you saw the patient in the clinic. If you saw this patient on a post, take war down and the decision you would take in your clinic or an entity meeting.
So the answer to every decision based question should start with I would not. You you should not say the options are or my consultants would do do not refer every difficult scenario to a colleague. Some stations would get their own human that should be managed in sponsored community. Well, I'll go through that entity. But remember, this is an exit exam.
You're meant to be able to cope with these things as a consultant. If you were the consultant and a small age, you should be able to diagnose an accurate, accurately and urgently manage make fish in. You're not required to do a bill to me on someone with a massive osteosarcoma of the pelvis, but all emergencies is a must. So survivor here doesn't test your knowledge.
It is the ability to convey the required information to the examiners in a confident and coherent way. So one important thing and I was told this by 2 different examiners. This exam is testing your high order thinking. Passing this exam is all about the technique. People who fail again do not fail because of lack of knowledge. It is like a game.
You need to learn how to play that game. You need to be. So it's very well to quote 10 papers worth of evidence, but if you cannot make a decision, you're not ready to be. I'm a consultant. They will give you some time to prepare to become a consultant because, as I said, you've demonstrated your knowledge, your knowledge, so you're expected to process information given and formulated.
So looking at this here, you know, like what is the higher level of thinking here? So, you know, I would start this by saying this is a fracture dislocation. I wouldn't waste time saying X-rays looks so and so I would say this X-ray showed a fracture in discussion. He will ask you at some point you cannot reduce it. Then you would say, check my ulnar nerve fixation. You still can't do it.
Then the examiner will ask you. Then you should mention there might be soft tissue interposition. An example of higher order of thinking here is that you would say this is a mature bone. The head is not well-formed. I'd like to check the other side. Take another radiograph of the opposite elbow to make sure this is not congenital dislocation of your head.
If it is one form you should think about as well, you can say, usually I would be worried if I cannot reduce it, I'm going to do another X-ray or another radiograph of the opposite elbow to make sure it's not congenital dislocation. However, here I can see the radial head is well formed. You know you're not going to do that in real. You can do it the real life. I did it before in real life, but the thing is, I think you should mention it.
So mention that makes you stand proud in the candidates. And then the one thing of one demonstration of high order thinking and, you know, doing more practice will make things perfect. Performance can be achieved only by practice. And that's as general advice everyone have told you. So I think it's really important to practice in a group and this is already published evidence. If you practice for survivor and clinical in a group.
Is there is a chance to pass is twice either number, I would say. Three but remember, this advice is always personal issue for each individual candidate. So what works for you might not work for me. I think when you do this practice, especially like settings like here, it's really important to examine it to practice in an exam scenario. If there is an examiner in your region who's happy to conduct a practice vyver, then jump at that chance.
Don't waste it. He or she knows the structure. He will tell you all the tips, if possible, if also discussed, you know, doing this practice with your consultant as well. Because although he might not have the time to do a proper revision session, but it would be helpful, you know, to make him ask you questions and you should learn how to get used to answering questions on a wide range of topics.
Finally, practice with your partner, with your dog, with your matter, with practice makes perfect. Also, general advice on a long term plan. I think you should. If you're especially if you're not really, you should do more and more courses. Also, some of them are expensive, but I think you should ask for a recent feedback. Some courses are well known, and they actually have good reputation because they are, you know, these institutions are dedicated in giving these courses.
There are different websites. There are different books. There is no it's actually all about the feedback you get, but I would advise doing more important courses on the day of Survivor. It's really important when you say a survivor, you should sit confidently upright with your hands on the table. You know you should demonstrate confidence.
Do not cross your arms, do not slouch. Most examiners will offer you a handshake. If so, do the handshake. If they do not offer just, it's best to sit down, smile at them. They will be bored. You have to come as a pleasant and confident candidate who knows what he or she is saying. I would.
Another good advice is to avoid all toys or chairs as simple as it gets, and you will be asked by one examiner, just look at them and look at the other examiner as well. On the day, if you can afford to stay in a nice hotel dresses as the cheapest one available, the exam is expensive. You've paid a lot of money, don't you know, find a decent hotel? It will make a huge difference to your.
Ask the receptionist, which have done when you put the hotel to find you a room in a quiet part of the hotel. Tell them that you are sitting an important exam. You don't want to sit-in a room over overlooking the backstreets where there are nightclubs and people shouting at. I personally also think it was finding a hotel, but not where survival is going to be, because that's usually what the examiners are saying.
And, you know, if you're sitting for breakfast opposite to an examiner who gave you a tough time in clinical yesterday, that wouldn't be helpful. However, it's up to you. What is the exam about? It's about saved search. You keep hearing that word all the time. You must be safe in your answer when several options are available to treat the patient in your favor.
Start with the most widely practiced option that has the greatest evidence base you can take. You can then talk about new techniques, pros and cons, but you do not want to come across as a Maverick. It's also unwise to get into an argument with your examiners, and you shouldn't be operating and describing surgery you've never seen before on that day. And if you don't know what you're talking about or you haven't done it yourself, you can always say I have no experience with.
I have no experience with this type of procedure. But the principles of surgical intervention or non-operated intervention here are so and so you know, and because if you would become as an honest candidate, however, they would know anyway, you know, if you haven't seen it or done it before, it's easy to get it. You are an orthopedic surgeon with 10 years experience sitting in front of an orthopedic surgeon with 30 years experience.
So it's obvious as soon as you sit down, the questions will begin. Listen extremely carefully to every question, both for a second to digest when you have what you have heard. They will usually ask a very specific question. If you answer a different question, you are about to lose the examiner. Most people struggle here because of the technique. So you lost what is the examiner's first rule?
So make sure when answering a question, avoid saying something. You know nothing about it. So if you say I'm going to do carpal tunnel decompression, he will ask you how to do a decompression. I'm going to. I think this might be osteosarcoma. Tell me more about osteosarcoma. If you say a weird syndrome, you're suspecting he will ask you about that weird syndrome.
The examiner also unlikely to give you feedback during the questioning. This that can be difficult, especially if you're used to having lots and sounds of encouragement from colleagues or consultants while you're practicing. You must remember also that the aggregate marks you will have to say, I don't know, because they will ask you a very simple question. You answer that one.
The question will become harder and harder. And you know, usually those who pass it will tell you that they felt they failed the exam. And those who failed the exam. They will tell you, most of the time I've done well, I've answered every question they asked me. One crucial step here also is drawing draw whenever you can, and that drawing should be as clear and big as possible. If you have the opportunity to draw, you should do so.
Pictures tell a thousand words, especially for English. If English is not your first language, you should, however, speak as you draw it. Add to your point scoring very quickly, and that was a tape I had from. A gold medalist, we work together. So he even exposes he will draw the exposure and that to me, he will draw the anatomy and drawing should be simple, clear, big so that both examiners can see simple, big and clear.
Remember the practices, drawings and an important step? This is also important. It takes the pressure off your shoulders as because when you are drawing, you're not looking at your exam. So looking into the paper, so that will take you the pressure off your shoulder. Also, you've done visual and the audio and audio demonstration of your knowledge, which is really important.
Another important step as well if you shown pictures ready grab diagrams, ipods, iPad screen also do not touch the images. Just be professional. Look and put it down. Use descriptive technology also on the day before the exam. Sometimes also I would. This is an important step. I would say.
If you if you finish your clinicals, you shouldn't be worried much between your clinicals and your wives because the wives are part of the exam takes place one or two days after the clinical cases. Half the time in between is very stressful, and it's very difficult to spend productively as you mull over your performance in clinical cases. So try to relax and take your time. Also, I would advise for drivers in the week before your exam, revise your basic sciences, and I didn't do any revision between my clinical and 5 hours.
You don't have to do that, and that will just stress you more. So when you are sitting at your wife was one of the examiners will ask a question for three questions for 15 minutes. And since they would swap over. Remember, this exam is conducted by specialists, so you know where the surgeon will ask you a hand surgeon? So the questions consist mainly of a different question competence question and advanced question.
Say, you know, as I said, when you start answering, do you have to draw a mental checklist of what you are going to do? If he asked you, what would you do, then say, my boss does no one care, what does I would do? One, two three. Why? because one, two three. You know, you can say I have good experience with this, but that's actually, you know, your experience.
You know, there are surgeons who have done surgery, a specific procedure 100 times. And actually that outcomes are really not that good. So when answering the question, do not try to make up an answer. If you don't know, the examiner will see through this and you will know immediately. So admitted, you know, I have no experience with that, but principles of management involve one two three.
Also, you might not understand what they've asked you, what they hear. He wants you to answer, so ask him, can you please repeat that question, please? And ask him to repeat it. And before you answer. This was very helpful. Mentally, construct a checklist of the main points you are going to make and start your answer slowly that avoid blurting out the first thing that comes out of your mind.
And even if that happens, apologize and say, I'd like to retract that, please. And that's valid. That's what we call damage control. And once you finish your answer, stop and keep quiet. Try to avoid the temptation to add extras at the end of your answer, because that might make you look as if you're waffling and can also, if they can, if they bring you into an area you don't want to talk about, which is bad, you know, tell them I have no experience.
Remember, the examiners have to pass the candidate. They want to feel that you're a safe consultant. Also, it's really important to hear, you know, this practice. There are common scenarios that come in survivor, but you have to be prepared that one or two might come in my exam. That was the last station. You know, you hear stories about the cut section and the plane. You can hear stories about all these odd scenarios and odd questions, but then don't panic Follow the rules.
And it's a valid if they ask you a different questions that you don't know what they're talking about or you have no clue what is, then say I'm going to discuss it with my senior colleagues. I'm going to check for guidance, I'm going to check for evidence, I'm going to check my local trust protocol because that happens on daily in daily life and every NHS hospital. And the important thing also is what is the evidence and we need to know papers?
Yes, you do. You're not, you know, we're not convinced when you, things is they are not convinced when you were here, it wouldn't say here, people say you don't need to. You don't need to consider it, Richard. Actually, you should be safe. Literature slap is to differentiate between a sex mark and the seven mark, or even more so by quoting the latest journal articles is complicit.
But look to examine it if you put it in appropriately. So you have to know seminal papers in orthopedics multinational multicenter trials like draft or proof. For all these trials you should be aware of, it should be aware of nice guidelines, you should be aware of post guidelines. And when you see one of the posts, the scenarios in your visor, you should mention the word truth because that's evidence and you've cited evidence.
Also, evidence is ideally cited when you say I would manage this typekit plot to fracture with so and so he would ask you why you say there is evidence published in 2012 demonstrating how satisfactory outcomes, but you wouldn't. You shouldn't be quoting evidence for different treatment options while answering a question. If you want to score an aide, the examiner would expect you have an excellent command of the literature.
Seven you should be familiar with the literature, but if it's core five, such as literature doesn't really matter. As you're struggling to keep your head above the water and you're not demonstrating, you're a safe surgeon who can demonstrate the safe practice. Another important thing is, you know, you have to keep your examiners asleep while you're doing this examination, and that can only be done by using buzzwords.
They want to listen to. You know, I'll give you a few examples now, but you know, you have to remember things like mice whose non-accidental injury list protocol open or closed network neurovascular assessment. If something is very obvious, you should be confident and say it outright. This radiograph can substitute this location because of these features.
These features are 1 to 3 MRC s. As I said, smart are finding success at this location. Actually, if you cannot find if you cannot tell this ahead, this location, you shouldn't be sitting them. If you can see a montejo fracture, mention it first and then you can give a hint about it because it was called marks to score six, 7 and 8. You should be discussing management in details in most areas.
So something like that, what are the buzzwords here when the fracture immature brain immature bone worried about the non-accidental injury in all pediatric mentioned non-accidental injury? If you are good, says this is bad to type 1 injury. It looks like it might be an open fracture. And if you say I'd like to know whether this is an isolated injury, give him a chance or have a chance to tell you, yes, it's closed or not.
And if it is written in the paper in front of you, don't waste time. This five minutes are yours, you know, and they actually are in five minutes because they are this hour, four minutes, because it will take some time to swap between different stations. So these minutes are you should make the best benefits benefit out of it.
I would lose it. Then you can show how your order of thinking, as mentioned before, so so you have to do the mental checklist and take it from there. Another this is a fracture. You're worried about this fracture. Why? because there is a dislocation of the force and regular ulnar articulation. If you're worried, say it loud.
I'm worried because this is about the gravity of this scenario of this. And also what is this an open injury? He will tell you it's an open injury. Are we going to manage it? According to boost guidelines, we should mention open injury or cannot fail. At least I'm concerned about the gravity of this injury. This I'm going to manage as the protocols for open fractures.
I'm going to give antibiotics, tetanus prophylaxis, all of this. If they don't want to read the details, they will ask you to move on. And that's a very important step. We'll discuss it later. Then I'm going to discuss high order thinking here. I'd would like to take another radiograph of the opposite to see how does this affect you?
I'm not sure. And look, is there a risk? And if you say something, you can say whatever you want to remember in these exams, there is no correct answer there. There are few correct answers, but there is definitely a wrong answer, so if you can say something, if you have a case of osteoarthritis in the hip and you'd like to use pinnacle, you can say you can side the injured.
You can say this is my experience. You can set up application. So there is no right answer because this is the two examiners in front of you. One of them might be using old cement. Someone might be using old cement that, however, I would stick to the most safe answer that you can validate. This is a graph of a child who's like his Allen weight bearing chart.
You can cite all the evidence in the world here. You can talk about the implications for half an hour if you don't say MRI. That's a 400% a. So this is a buzzword. You should mention it here, actually. Personally, I would mention any and all pediatric fractures just to be safe. You wouldn't be marked negatively if you say so here, you should say my priority is to ensure the child is in a safe environment.
If you're considering any eye, you should mention nice guidance on AI and how to diagnose any heart. He will ask you a question whose responsibility to diagnose any AI. It's everyone's responsibility to diagnose any AI. And so you can cite the evidence because this is proper evidence that has been published and its big clients. A published in BMC, as I said, you know, you should always be aware of the trends published here, you can impose what you have to mention that large health Sachs defect in the humeral head.
So there are passwords for everything you should hear. Also mentions the neurovascular assessment Nick fresh, life threatening condition. You should express your concern. You should mention that you're worried here. They can show you a picture of cellulitis. That's fine, but you're not going to be tested on cellulitis in an effort in this scenario. So you should be worried about life threatening emergency like compartment syndrome.
And if fresh, all. What you need to know about nefesh is about 10 buzzwords the Linux core. It is a life threatening mortality. 30% is a definitive treatment, is urgent and radical deployment. And you have, you know how the mistake I order of thinking here by saying, you know, I'll discuss with the patient prior to the surgery is the possibility of amputation that can demonstrate high order thinking.
And when you are demonstrating your knowledge here, as I said, you will say I'll do bloods. And then you mentioned the Linux code bloods because as per the score, because it has a positive predictive, positive predictive value of so and so. So what is really important here is that most examiners and a long day, if they ask you a question, you should listen carefully.
You must know during group practice, you should become familiar with the process of listening. They are listening carefully to the wording of the questions asked and answered accordingly. If you ask, how would you manage the process? The treatment options are that, you know, you know, even me telling you that may sound silly, but if you ask, what are the treatment options? You answer that question.
If you ask how you would manage it, I would manage it by so-and-so. So examiners are looking for answers that illustrate understanding and decision making process, not simply regurgitating material memorialized from books or from courses, you know, so it's a different lecture on the YouTube channel on mastering different, different scenarios, but I'll just give you small hints about.
With the four Mason scenarios, certain basic sciences, this is an easy scenario you shouldn't know in depth, actually, you should know. It's like so sort of should know about everything. And when you are doing the basic science, why you should teach the examiners, it's really important you're teaching them. And remember, if they increase the difficulty of the questions, that means good outcomes.
And in the exam, there will be two or three anatomic anatomy related questions or approaches, type of thing. So, you know, this is a good station for marks and especially remember, you know, examiners are orthopedic surgeons who read these two or three topics in the last couple of days because they are going to ask you about it. And one also important trick that I've used as well, you know, when you're doing stress strain curve, Google write stress strain curve on YouTube and see you will find the few videos describing the stress strain curve.
When you find these videos, you can hear a few tips that demonstrate that something more broad. Knowledge is really important here and required. And again, true true. Whenever possible in this Viva station in the trauma Viva, I would say that's the only Viva. The in-depth knowledge is required because the other day, one consultant in a trauma in the digital age, you should back to front how to manage hip fracture.
You should know everything about ankle fractures. It's not optional to. Mason, a patient with compartment syndrome, because when an examine them right for his intention, he or she intentionally want you to fail the exam because he doesn't think you're a safe surgeon. So here, high level of knowledge is expected from day one consultant and also the importance of such trauma.
If you are a consultant on-call, you have to take that decision during the NIPE. Was it what to do for a compartment? How to manage it? What is the protocol? You're not expected to manage a sclerotic patient. You're in the middle of the NIPE. But in trauma, it's really important. And also remember any non-accidental injury and remember boost guidance nice and have a peaceful clinical approach for every patient and discuss it as if you are in the fracture clinic.
The minute you forget you are in an exam and you start a new practice or perform as if you are in a clinic, in a fracture clinic scenario or an emergency scenario, you will do better. There are common scenarios come most of the time. You should learn and practice this more as much as you can, and the emergency is like compartment syndrome, neck, fresh legs, screws, principles of fracture fixation.
It can be a fellowship, a fellow of the Royal College of Surgeons and ops medics and you don't basic principles of growing tension, band and management of emergencies in orthopedics. And you can be as superconductor, fractured humerus in a kid in a pediatric Viva. You can be as the same scenario in a trauma vessel, but they will come one way or another. Controversial things like grade 3 ECG disruptions.
You should have. You should have one. You know, you should have a protocol in your mind. And if they tell you, like, this is great city disruption as bedrock classification, you will ask them. As I said, last port, first port, last port. He will ask you, what is local classification? Then you draw, draw, draw an accordion.
Say read one is disruption here to the brain here 3 is less than 100% So when you are drawing, you're adding to your marks and anatomy as n approaches here. You know, it's really important to know your anatomy because you are a surgeon sooner. You are a surgeon and the anatomy is in. The variable anatomy wouldn't change. You can change any other thing. But anatomy is not the variable and also tell a story from your perspective as a surgeon.
So I would do having prepared more than consent that my patient. I'm going to position my patient in a chair position. I'm going to do the vector approach by identifying the coracoid marking my incision. I am going to do a survey, you know, do my approach in the technique. I usually swipe my finger underneath my telling it a story is much better than saying Alba's position so and so and never sent an aeroplane is between so and so tell as a story.
And then my approach was superficial. Dissection will be between X and y, and I'll be worried here about the vein, or the nerve or the vessel. I'm going to take it to the direction or the other direction as a story. And actually, you can summarize all surgical approaches into three pages because all what you need is position, bony landmarks, superficial dissection section and not a trip or to cross sections is really important.
You should know them. You can be shown to an exam. Usually that's a compartment syndrome, so be familiar with these cross sections in other pathology. Actually, it is. You can be asked about everything. Anything just stick to the rules. Stick to the basic principles side evidence whenever you can, and discuss management in other pathology.
You should be discussing management in most scenarios. There are common other pathology like ACL disruption, and the other actual other pathology can be of anything beats. It's easy because you're not required to have in-depth, but there are certain scenarios that you should back to front as well can include any trauma, and you should also be here. You should mention that you will be discussing stuff with the parents or guardians in hands.
Also, it is the same. Don't pick things up. As I said, there is a detailed the detailed presentation discussing different scenarios. And finally, you are a day one consultant who is confident and he knows and you know what you're talking about. Just stay calm, to not panic and stick to the basics, and practice is the key answer to everything. But as I said, you know, it's all about knowing the.
Game mastering your technique. You have the knowledge. Knowledge is really a problem if you don't have the knowledge, you wouldn't have bought one. If you don't have the knowledge, you shouldn't be sitting for part two. But as I said, it's all about the technique and playing the game to be suitable to join the club. And you should make your examiner confident that if his mom or sister had a fall outside your BGH, he's happy for you to do across for his mom or relative.
Thank you. Thank you, Mohammad, that's excellent presentation. Thank you for all the experience you gave us from your. Exam knowledge and from the experiences you had, I think, was extremely useful, and I have to say when we were doing the exams, we had to. We didn't have access to such amazing advice, to be honest. Yeah, definitely. As I said, you know, actually, you know, this is what separates us.
You know, these techniques and simple stuff is what differentiates, you know, a 7 from a five, and it's really crucial to collect as much marks as you get. You know, these tips are available to some candidates long time in advance. It's not available for everyone. And that's why orthopedic fellowship group is formed in. Thank you, Robert.
I like, you know, particularly like the. The fact you're emphasizing the necessity of talking like a first day consultant. Yeah, definitely. Not, you know, juniors anymore. So you say I would do this, not we would do or in my trust, they would do this or in my department. They would do this. I would do.
And the reasoning behind it, you back it up. It's very important this kind of attitude and little things like what I liked today is if those examiners are extremely bold, they're fed up. And when they come, when you come into their table, they want to see a candidate who lifts the spirits up. Someone who's smiling, confident, pleasant, who gives them a little bit of joy and lift the spirit up.
They don't want someone who comes look like defeated, bored and scared, or they want someone relaxed, confident, smiling to them. This gives them a little bit of good time. Also, they will like that. I think actually it is easy to demonstrate it, and it is. You can be easily picked up because, you know, like few members here in the group have been faculty and a lot of courses, and you can tell that candidate doesn't know what he's talking about, either how much he's wanted.
And also, you can tell, you know, whether you're confident what you're saying or not, it's not what you're saying. It's the way you're saying it. But don't say stupid things. And yeah, you're definitely right for us. I couldn't agree more. And also staying in our hotel nice hotel before the exam is very important.
It's costly, unfortunately, but I think, you know, you hear those horrible stories of those people who stayed in a very noisy room. I couldn't sleep overnight, and that's can't be good. Yeah, definitely. And I think I have some of my colleagues who didn't have a good NIPE experience before the exam and that didn't reflect well on them. So unfortunately, the exam is run in a very expensive hotels normally.
Well, I think you have to account for that in your budget for it. Yeah, definitely. That's really important because that thing I've mentioned, you know, it's a hotel with a nightclub underneath it and especially you do the clinical onset, some days, you know, so having a busy NIPE on Saturday night, you know, 500 AM never helpful.
Whoever you are, you know, it's never helpful. So far, you know? And also, you know, contacting the hotel, emphasizing that you're doing that crucial exam for your career in advance to find a better room for you is actually helpful. And usually everyone will help you their. Yeah I mean, people are different, obviously. So I think most of us would like to be staying in a quiet room for good sleep, but I understand some people maybe want to stay with friends just to help them to get through the NIPE.
Difficult NIPE. I mean. Um, up to you, but think about carefully about the NIPE before the exam. That's the meaning, the plan, how it's help you optimize your performance next day. It is, you know, unfortunately difficult day and one of the most important days of your life. So you need to plan it and use it.
Make sure you use your pencil. You draw big diagrams that they can see properly. Use the entire sheet. Don't take shortcuts because a simple, quick diagram can actually get you the marks before you even start to talking because you probably cover the topic, for example, things like benninghoff, arcades and cartilage, and so on. As soon as you draw that, the examiners know you're in the right way and they're just going to relax and special on important stuff that would affect your management.
Yeah, I think it's important, like that's why we're doing all this preparation. I agree with this principle. Swiftly move on to the scoring points within 30 seconds. If you take in more than 30 seconds to move to scoring points, you're losing the chances to pass the exam. If they put anything over you, they should. You should know straight away what they want.
What if they put a child X-ray in front of you? Femoral shaft fracture like mama show? They want you to say non-accidental injury, so you should say it straight away, but then they want you to move quickly to the management of this frontal fracture, according to the age of the patient. So there's no point to wasting a lot of time on asking a lot of questions quickly.
You know, they want to discuss the management of this. Get to the management within the first 30 seconds after 30 seconds. That's it. And then they will ask you after that. You know, whatever about there would be bored, and they want to sometimes just ask you very highly advanced questions once you pass. So, yeah, move swiftly to that scoring points.
And for me, I have to support both for us and not that of the mentors. One of the questions asked by Matt if he was told not to use eponymous. What are your opinions, guys? I personally don't like opponents very much. However, you cannot resist saying Montezuma and Gagliardi for these four arm fractures, I mean, they. But I personally, when I'm on the spot, I struggle to remember all these names and classifications, so I normally describe what I see.
However, if it's something well-known like Fantasia and collegian, you know. You've got to know it and say it, I think I think. I don't think there's anything wrong with that, but I don't go into some opinion that's very rare also for specialized people will know. And I don't know, Mohammad, if you think about this. I agree with for us, I think what you said, you know, as I said, you know, you're a consultant.
It's like in a trauma meeting. You can say this is a fractured radius with dislocated, you know, or this is a fracture like this was dislocated, the distal ulnar dislocation. But you would say opponents are really well known. You know, I would do so because it's a discussion, and I don't think that is right or wrong here. But if it is well known as follows said I think I should say, but you know, don't take yourself a whole and other less known stuff for months or years.
I think I would say if I remember if you think, you know, because here it's very easy to say, but on the day under the spotlight, if you can, if you're not sure, just stick to the basic principles. What you can see. I can see that I'm worried about expectations. That's what I would do. What do you think? I think I fully agree with and mother that you need to mention the most common ones, but not the rarest one, because then you are digging a hole for yourself if you're mentioning the rare but the common one, which we see in our daily practice.
You have to need to know and probably the best you need to mention the common one, but not the real one. For my money, I agree and don't use the rare ones, but I think opinions are very useful. We were stuck trying to remember just leave the word block alone. Just move to describing, as Muhammad has said in for us have said. But the reality is for me, the word Fantasia conveys an immediate picture of an X-ray that I know in my head what it is.
If someone says Liz franks, I now know exactly what this person is worried about and thinking along the lines. If someone says Jones fracture, it's in my head. However, if you say something like Jones fracture, yeah, it's wrong. And it's not actually the junction of dialysis and the deficits, and you're in trouble because you need to understand what exactly that epidemic is referring to, because there's a real head dislocation, because there's a ulnar starting ulnar dislocation at the wrist or because this is a fracture at the dialysis to the metathesis junction, which is.
Segment:0 .
So just some notes, please, guys, again, if you have any questions, please write it in the chat session. Raise your hand, the hand symbol, please, everyone is encouraged to ask questions and interact to make this session helpful.
And again, just because I wasn't recording earlier, thank you for reminding me I just introduced Mohammad again, who is like, I'm consultant from knowledge, and he's presenting on mastering techniques for the first survivor. Over to you, and I'm Mohammad, oh, thank you for us for introducing or introducing me and for this amazing project everyone is sharing to do so.
I'm one of them, as you said, an upper limit surgeon from Norfolk and Norwich. I'm going to give you a presentation today about mastering the technique, which is really important. We all get this message. And after having that message, you have a short period of initial elation that will quickly followed with fear or fear that you now have to prepare for fiction, too.
And I think that's really important to master your techniques because you've demonstrated the knowledge and passing part one in section 2. And I'm talking about survival part here. It's all about technique. What I'm going to tell you is actually experience my own experience, experience I've got from examiners. I've done practice with experience from the exam itself, experience from senior colleagues, from my colleagues, from other mental skills that are prepared with more about two years ago.
And also these experiences, I think, is crucial to master for your driver. I think the first part of this presentation or is going is mainly for those who are doing part 2 in a few months time. Second part is for everyone, especially those who are doing the exam in a few weeks' time. Part two is a tough assessment of the curriculum set by the GCSE and the specialist advisory committees.
And so I think personally, which is helpful as well, is the first thing you should do is to read the ICP syllabus. It is almost 300 pages long and any topic on the syllabus can be covered in the exam. So therefore we should have a broad range of knowledge to bus rather than the depth of knowledge and all discuss the details. The logic here is to understand what is the exam about and what they are assessing, basically.
You hear stories about candidates being marked down for wearing wrong size or simply because an examiner doesn't like them. Also, in reality, this perhaps is true. However, the exam is no longer an unstructured chat anymore. The modern exam has structured questions, starting with an opening stand, followed by more detailed questions. And I know colleagues who are very good surgeons who are very good, who are experienced and knowledgeable, and they failed.
And others who are less knowledgeable and less competent who passed. And it's simply because it's all about the technique. Basically, this exam is testing a day one consultant, and this is a crucial step for this exam. One consultant in a digital age. So when you are sitting at the table, these two consultants examining you, they are colleagues. You are discussing with your colleagues and a trauma meeting in which you started in your first week.
It's not a master's. You shouldn't waste time on things like this. X-ray looks to be a lot views and we'll go through it by time. So the key to passing here first key is to answer the questions. As a consultant, no, as a examiners want to know what you would do if you saw the patient in the clinic. If you saw this patient on a post, take war down and the decision you would take in your clinic or an entity meeting.
So the answer to every decision based question should start with I would not. You you should not say the options are or my consultants would do do not refer every difficult scenario to a colleague. Some stations would get their own human that should be managed in sponsored community. Well, I'll go through that entity. But remember, this is an exit exam.
You're meant to be able to cope with these things as a consultant. If you were the consultant and a small age, you should be able to diagnose an accurate, accurately and urgently manage make fish in. You're not required to do a bill to me on someone with a massive osteosarcoma of the pelvis, but all emergencies is a must. So survivor here doesn't test your knowledge.
It is the ability to convey the required information to the examiners in a confident and coherent way. So one important thing and I was told this by 2 different examiners. This exam is testing your high order thinking. Passing this exam is all about the technique. People who fail again do not fail because of lack of knowledge. It is like a game.
You need to learn how to play that game. You need to be. So it's very well to quote 10 papers worth of evidence, but if you cannot make a decision, you're not ready to be. I'm a consultant. They will give you some time to prepare to become a consultant because, as I said, you've demonstrated your knowledge, your knowledge, so you're expected to process information given and formulated.
So looking at this here, you know, like what is the higher level of thinking here? So, you know, I would start this by saying this is a fracture dislocation. I wouldn't waste time saying X-rays looks so and so I would say this X-ray showed a fracture in discussion. He will ask you at some point you cannot reduce it. Then you would say, check my ulnar nerve fixation. You still can't do it.
Then the examiner will ask you. Then you should mention there might be soft tissue interposition. An example of higher order of thinking here is that you would say this is a mature bone. The head is not well-formed. I'd like to check the other side. Take another radiograph of the opposite elbow to make sure this is not congenital dislocation of your head.
If it is one form you should think about as well, you can say, usually I would be worried if I cannot reduce it, I'm going to do another X-ray or another radiograph of the opposite elbow to make sure it's not congenital dislocation. However, here I can see the radial head is well formed. You know you're not going to do that in real. You can do it the real life. I did it before in real life, but the thing is, I think you should mention it.
So mention that makes you stand proud in the candidates. And then the one thing of one demonstration of high order thinking and, you know, doing more practice will make things perfect. Performance can be achieved only by practice. And that's as general advice everyone have told you. So I think it's really important to practice in a group and this is already published evidence. If you practice for survivor and clinical in a group.
Is there is a chance to pass is twice either number, I would say. Three but remember, this advice is always personal issue for each individual candidate. So what works for you might not work for me. I think when you do this practice, especially like settings like here, it's really important to examine it to practice in an exam scenario. If there is an examiner in your region who's happy to conduct a practice vyver, then jump at that chance.
Don't waste it. He or she knows the structure. He will tell you all the tips, if possible, if also discussed, you know, doing this practice with your consultant as well. Because although he might not have the time to do a proper revision session, but it would be helpful, you know, to make him ask you questions and you should learn how to get used to answering questions on a wide range of topics.
Finally, practice with your partner, with your dog, with your matter, with practice makes perfect. Also, general advice on a long term plan. I think you should. If you're especially if you're not really, you should do more and more courses. Also, some of them are expensive, but I think you should ask for a recent feedback. Some courses are well known, and they actually have good reputation because they are, you know, these institutions are dedicated in giving these courses.
There are different websites. There are different books. There is no it's actually all about the feedback you get, but I would advise doing more important courses on the day of Survivor. It's really important when you say a survivor, you should sit confidently upright with your hands on the table. You know you should demonstrate confidence.
Do not cross your arms, do not slouch. Most examiners will offer you a handshake. If so, do the handshake. If they do not offer just, it's best to sit down, smile at them. They will be bored. You have to come as a pleasant and confident candidate who knows what he or she is saying. I would.
Another good advice is to avoid all toys or chairs as simple as it gets, and you will be asked by one examiner, just look at them and look at the other examiner as well. On the day, if you can afford to stay in a nice hotel dresses as the cheapest one available, the exam is expensive. You've paid a lot of money, don't you know, find a decent hotel? It will make a huge difference to your.
Ask the receptionist, which have done when you put the hotel to find you a room in a quiet part of the hotel. Tell them that you are sitting an important exam. You don't want to sit-in a room over overlooking the backstreets where there are nightclubs and people shouting at. I personally also think it was finding a hotel, but not where survival is going to be, because that's usually what the examiners are saying.
And, you know, if you're sitting for breakfast opposite to an examiner who gave you a tough time in clinical yesterday, that wouldn't be helpful. However, it's up to you. What is the exam about? It's about saved search. You keep hearing that word all the time. You must be safe in your answer when several options are available to treat the patient in your favor.
Start with the most widely practiced option that has the greatest evidence base you can take. You can then talk about new techniques, pros and cons, but you do not want to come across as a Maverick. It's also unwise to get into an argument with your examiners, and you shouldn't be operating and describing surgery you've never seen before on that day. And if you don't know what you're talking about or you haven't done it yourself, you can always say I have no experience with.
I have no experience with this type of procedure. But the principles of surgical intervention or non-operated intervention here are so and so you know, and because if you would become as an honest candidate, however, they would know anyway, you know, if you haven't seen it or done it before, it's easy to get it. You are an orthopedic surgeon with 10 years experience sitting in front of an orthopedic surgeon with 30 years experience.
So it's obvious as soon as you sit down, the questions will begin. Listen extremely carefully to every question, both for a second to digest when you have what you have heard. They will usually ask a very specific question. If you answer a different question, you are about to lose the examiner. Most people struggle here because of the technique. So you lost what is the examiner's first rule?
So make sure when answering a question, avoid saying something. You know nothing about it. So if you say I'm going to do carpal tunnel decompression, he will ask you how to do a decompression. I'm going to. I think this might be osteosarcoma. Tell me more about osteosarcoma. If you say a weird syndrome, you're suspecting he will ask you about that weird syndrome.
The examiner also unlikely to give you feedback during the questioning. This that can be difficult, especially if you're used to having lots and sounds of encouragement from colleagues or consultants while you're practicing. You must remember also that the aggregate marks you will have to say, I don't know, because they will ask you a very simple question. You answer that one.
The question will become harder and harder. And you know, usually those who pass it will tell you that they felt they failed the exam. And those who failed the exam. They will tell you, most of the time I've done well, I've answered every question they asked me. One crucial step here also is drawing draw whenever you can, and that drawing should be as clear and big as possible. If you have the opportunity to draw, you should do so.
Pictures tell a thousand words, especially for English. If English is not your first language, you should, however, speak as you draw it. Add to your point scoring very quickly, and that was a tape I had from. A gold medalist, we work together. So he even exposes he will draw the exposure and that to me, he will draw the anatomy and drawing should be simple, clear, big so that both examiners can see simple, big and clear.
Remember the practices, drawings and an important step? This is also important. It takes the pressure off your shoulders as because when you are drawing, you're not looking at your exam. So looking into the paper, so that will take you the pressure off your shoulder. Also, you've done visual and the audio and audio demonstration of your knowledge, which is really important.
Another important step as well if you shown pictures ready grab diagrams, ipods, iPad screen also do not touch the images. Just be professional. Look and put it down. Use descriptive technology also on the day before the exam. Sometimes also I would. This is an important step. I would say.
If you if you finish your clinicals, you shouldn't be worried much between your clinicals and your wives because the wives are part of the exam takes place one or two days after the clinical cases. Half the time in between is very stressful, and it's very difficult to spend productively as you mull over your performance in clinical cases. So try to relax and take your time. Also, I would advise for drivers in the week before your exam, revise your basic sciences, and I didn't do any revision between my clinical and 5 hours.
You don't have to do that, and that will just stress you more. So when you are sitting at your wife was one of the examiners will ask a question for three questions for 15 minutes. And since they would swap over. Remember, this exam is conducted by specialists, so you know where the surgeon will ask you a hand surgeon? So the questions consist mainly of a different question competence question and advanced question.
Say, you know, as I said, when you start answering, do you have to draw a mental checklist of what you are going to do? If he asked you, what would you do, then say, my boss does no one care, what does I would do? One, two three. Why? because one, two three. You know, you can say I have good experience with this, but that's actually, you know, your experience.
You know, there are surgeons who have done surgery, a specific procedure 100 times. And actually that outcomes are really not that good. So when answering the question, do not try to make up an answer. If you don't know, the examiner will see through this and you will know immediately. So admitted, you know, I have no experience with that, but principles of management involve one two three.
Also, you might not understand what they've asked you, what they hear. He wants you to answer, so ask him, can you please repeat that question, please? And ask him to repeat it. And before you answer. This was very helpful. Mentally, construct a checklist of the main points you are going to make and start your answer slowly that avoid blurting out the first thing that comes out of your mind.
And even if that happens, apologize and say, I'd like to retract that, please. And that's valid. That's what we call damage control. And once you finish your answer, stop and keep quiet. Try to avoid the temptation to add extras at the end of your answer, because that might make you look as if you're waffling and can also, if they can, if they bring you into an area you don't want to talk about, which is bad, you know, tell them I have no experience.
Remember, the examiners have to pass the candidate. They want to feel that you're a safe consultant. Also, it's really important to hear, you know, this practice. There are common scenarios that come in survivor, but you have to be prepared that one or two might come in my exam. That was the last station. You know, you hear stories about the cut section and the plane. You can hear stories about all these odd scenarios and odd questions, but then don't panic Follow the rules.
And it's a valid if they ask you a different questions that you don't know what they're talking about or you have no clue what is, then say I'm going to discuss it with my senior colleagues. I'm going to check for guidance, I'm going to check for evidence, I'm going to check my local trust protocol because that happens on daily in daily life and every NHS hospital. And the important thing also is what is the evidence and we need to know papers?
Yes, you do. You're not, you know, we're not convinced when you, things is they are not convinced when you were here, it wouldn't say here, people say you don't need to. You don't need to consider it, Richard. Actually, you should be safe. Literature slap is to differentiate between a sex mark and the seven mark, or even more so by quoting the latest journal articles is complicit.
But look to examine it if you put it in appropriately. So you have to know seminal papers in orthopedics multinational multicenter trials like draft or proof. For all these trials you should be aware of, it should be aware of nice guidelines, you should be aware of post guidelines. And when you see one of the posts, the scenarios in your visor, you should mention the word truth because that's evidence and you've cited evidence.
Also, evidence is ideally cited when you say I would manage this typekit plot to fracture with so and so he would ask you why you say there is evidence published in 2012 demonstrating how satisfactory outcomes, but you wouldn't. You shouldn't be quoting evidence for different treatment options while answering a question. If you want to score an aide, the examiner would expect you have an excellent command of the literature.
Seven you should be familiar with the literature, but if it's core five, such as literature doesn't really matter. As you're struggling to keep your head above the water and you're not demonstrating, you're a safe surgeon who can demonstrate the safe practice. Another important thing is, you know, you have to keep your examiners asleep while you're doing this examination, and that can only be done by using buzzwords.
They want to listen to. You know, I'll give you a few examples now, but you know, you have to remember things like mice whose non-accidental injury list protocol open or closed network neurovascular assessment. If something is very obvious, you should be confident and say it outright. This radiograph can substitute this location because of these features.
These features are 1 to 3 MRC s. As I said, smart are finding success at this location. Actually, if you cannot find if you cannot tell this ahead, this location, you shouldn't be sitting them. If you can see a montejo fracture, mention it first and then you can give a hint about it because it was called marks to score six, 7 and 8. You should be discussing management in details in most areas.
So something like that, what are the buzzwords here when the fracture immature brain immature bone worried about the non-accidental injury in all pediatric mentioned non-accidental injury? If you are good, says this is bad to type 1 injury. It looks like it might be an open fracture. And if you say I'd like to know whether this is an isolated injury, give him a chance or have a chance to tell you, yes, it's closed or not.
And if it is written in the paper in front of you, don't waste time. This five minutes are yours, you know, and they actually are in five minutes because they are this hour, four minutes, because it will take some time to swap between different stations. So these minutes are you should make the best benefits benefit out of it.
I would lose it. Then you can show how your order of thinking, as mentioned before, so so you have to do the mental checklist and take it from there. Another this is a fracture. You're worried about this fracture. Why? because there is a dislocation of the force and regular ulnar articulation. If you're worried, say it loud.
I'm worried because this is about the gravity of this scenario of this. And also what is this an open injury? He will tell you it's an open injury. Are we going to manage it? According to boost guidelines, we should mention open injury or cannot fail. At least I'm concerned about the gravity of this injury. This I'm going to manage as the protocols for open fractures.
I'm going to give antibiotics, tetanus prophylaxis, all of this. If they don't want to read the details, they will ask you to move on. And that's a very important step. We'll discuss it later. Then I'm going to discuss high order thinking here. I'd would like to take another radiograph of the opposite to see how does this affect you?
I'm not sure. And look, is there a risk? And if you say something, you can say whatever you want to remember in these exams, there is no correct answer there. There are few correct answers, but there is definitely a wrong answer, so if you can say something, if you have a case of osteoarthritis in the hip and you'd like to use pinnacle, you can say you can side the injured.
You can say this is my experience. You can set up application. So there is no right answer because this is the two examiners in front of you. One of them might be using old cement. Someone might be using old cement that, however, I would stick to the most safe answer that you can validate. This is a graph of a child who's like his Allen weight bearing chart.
You can cite all the evidence in the world here. You can talk about the implications for half an hour if you don't say MRI. That's a 400% a. So this is a buzzword. You should mention it here, actually. Personally, I would mention any and all pediatric fractures just to be safe. You wouldn't be marked negatively if you say so here, you should say my priority is to ensure the child is in a safe environment.
If you're considering any eye, you should mention nice guidance on AI and how to diagnose any heart. He will ask you a question whose responsibility to diagnose any AI. It's everyone's responsibility to diagnose any AI. And so you can cite the evidence because this is proper evidence that has been published and its big clients. A published in BMC, as I said, you know, you should always be aware of the trends published here, you can impose what you have to mention that large health Sachs defect in the humeral head.
So there are passwords for everything you should hear. Also mentions the neurovascular assessment Nick fresh, life threatening condition. You should express your concern. You should mention that you're worried here. They can show you a picture of cellulitis. That's fine, but you're not going to be tested on cellulitis in an effort in this scenario. So you should be worried about life threatening emergency like compartment syndrome.
And if fresh, all. What you need to know about nefesh is about 10 buzzwords the Linux core. It is a life threatening mortality. 30% is a definitive treatment, is urgent and radical deployment. And you have, you know how the mistake I order of thinking here by saying, you know, I'll discuss with the patient prior to the surgery is the possibility of amputation that can demonstrate high order thinking.
And when you are demonstrating your knowledge here, as I said, you will say I'll do bloods. And then you mentioned the Linux code bloods because as per the score, because it has a positive predictive, positive predictive value of so and so. So what is really important here is that most examiners and a long day, if they ask you a question, you should listen carefully.
You must know during group practice, you should become familiar with the process of listening. They are listening carefully to the wording of the questions asked and answered accordingly. If you ask, how would you manage the process? The treatment options are that, you know, you know, even me telling you that may sound silly, but if you ask, what are the treatment options? You answer that question.
If you ask how you would manage it, I would manage it by so-and-so. So examiners are looking for answers that illustrate understanding and decision making process, not simply regurgitating material memorialized from books or from courses, you know, so it's a different lecture on the YouTube channel on mastering different, different scenarios, but I'll just give you small hints about.
With the four Mason scenarios, certain basic sciences, this is an easy scenario you shouldn't know in depth, actually, you should know. It's like so sort of should know about everything. And when you are doing the basic science, why you should teach the examiners, it's really important you're teaching them. And remember, if they increase the difficulty of the questions, that means good outcomes.
And in the exam, there will be two or three anatomic anatomy related questions or approaches, type of thing. So, you know, this is a good station for marks and especially remember, you know, examiners are orthopedic surgeons who read these two or three topics in the last couple of days because they are going to ask you about it. And one also important trick that I've used as well, you know, when you're doing stress strain curve, Google write stress strain curve on YouTube and see you will find the few videos describing the stress strain curve.
When you find these videos, you can hear a few tips that demonstrate that something more broad. Knowledge is really important here and required. And again, true true. Whenever possible in this Viva station in the trauma Viva, I would say that's the only Viva. The in-depth knowledge is required because the other day, one consultant in a trauma in the digital age, you should back to front how to manage hip fracture.
You should know everything about ankle fractures. It's not optional to. Mason, a patient with compartment syndrome, because when an examine them right for his intention, he or she intentionally want you to fail the exam because he doesn't think you're a safe surgeon. So here, high level of knowledge is expected from day one consultant and also the importance of such trauma.
If you are a consultant on-call, you have to take that decision during the NIPE. Was it what to do for a compartment? How to manage it? What is the protocol? You're not expected to manage a sclerotic patient. You're in the middle of the NIPE. But in trauma, it's really important. And also remember any non-accidental injury and remember boost guidance nice and have a peaceful clinical approach for every patient and discuss it as if you are in the fracture clinic.
The minute you forget you are in an exam and you start a new practice or perform as if you are in a clinic, in a fracture clinic scenario or an emergency scenario, you will do better. There are common scenarios come most of the time. You should learn and practice this more as much as you can, and the emergency is like compartment syndrome, neck, fresh legs, screws, principles of fracture fixation.
It can be a fellowship, a fellow of the Royal College of Surgeons and ops medics and you don't basic principles of growing tension, band and management of emergencies in orthopedics. And you can be as superconductor, fractured humerus in a kid in a pediatric Viva. You can be as the same scenario in a trauma vessel, but they will come one way or another. Controversial things like grade 3 ECG disruptions.
You should have. You should have one. You know, you should have a protocol in your mind. And if they tell you, like, this is great city disruption as bedrock classification, you will ask them. As I said, last port, first port, last port. He will ask you, what is local classification? Then you draw, draw, draw an accordion.
Say read one is disruption here to the brain here 3 is less than 100% So when you are drawing, you're adding to your marks and anatomy as n approaches here. You know, it's really important to know your anatomy because you are a surgeon sooner. You are a surgeon and the anatomy is in. The variable anatomy wouldn't change. You can change any other thing. But anatomy is not the variable and also tell a story from your perspective as a surgeon.
So I would do having prepared more than consent that my patient. I'm going to position my patient in a chair position. I'm going to do the vector approach by identifying the coracoid marking my incision. I am going to do a survey, you know, do my approach in the technique. I usually swipe my finger underneath my telling it a story is much better than saying Alba's position so and so and never sent an aeroplane is between so and so tell as a story.
And then my approach was superficial. Dissection will be between X and y, and I'll be worried here about the vein, or the nerve or the vessel. I'm going to take it to the direction or the other direction as a story. And actually, you can summarize all surgical approaches into three pages because all what you need is position, bony landmarks, superficial dissection section and not a trip or to cross sections is really important.
You should know them. You can be shown to an exam. Usually that's a compartment syndrome, so be familiar with these cross sections in other pathology. Actually, it is. You can be asked about everything. Anything just stick to the rules. Stick to the basic principles side evidence whenever you can, and discuss management in other pathology.
You should be discussing management in most scenarios. There are common other pathology like ACL disruption, and the other actual other pathology can be of anything beats. It's easy because you're not required to have in-depth, but there are certain scenarios that you should back to front as well can include any trauma, and you should also be here. You should mention that you will be discussing stuff with the parents or guardians in hands.
Also, it is the same. Don't pick things up. As I said, there is a detailed the detailed presentation discussing different scenarios. And finally, you are a day one consultant who is confident and he knows and you know what you're talking about. Just stay calm, to not panic and stick to the basics, and practice is the key answer to everything. But as I said, you know, it's all about knowing the.
Game mastering your technique. You have the knowledge. Knowledge is really a problem if you don't have the knowledge, you wouldn't have bought one. If you don't have the knowledge, you shouldn't be sitting for part two. But as I said, it's all about the technique and playing the game to be suitable to join the club. And you should make your examiner confident that if his mom or sister had a fall outside your BGH, he's happy for you to do across for his mom or relative.
Thank you. Thank you, Mohammad, that's excellent presentation. Thank you for all the experience you gave us from your. Exam knowledge and from the experiences you had, I think, was extremely useful, and I have to say when we were doing the exams, we had to. We didn't have access to such amazing advice, to be honest. Yeah, definitely. As I said, you know, actually, you know, this is what separates us.
You know, these techniques and simple stuff is what differentiates, you know, a 7 from a five, and it's really crucial to collect as much marks as you get. You know, these tips are available to some candidates long time in advance. It's not available for everyone. And that's why orthopedic fellowship group is formed in. Thank you, Robert.
I like, you know, particularly like the. The fact you're emphasizing the necessity of talking like a first day consultant. Yeah, definitely. Not, you know, juniors anymore. So you say I would do this, not we would do or in my trust, they would do this or in my department. They would do this. I would do.
And the reasoning behind it, you back it up. It's very important this kind of attitude and little things like what I liked today is if those examiners are extremely bold, they're fed up. And when they come, when you come into their table, they want to see a candidate who lifts the spirits up. Someone who's smiling, confident, pleasant, who gives them a little bit of joy and lift the spirit up.
They don't want someone who comes look like defeated, bored and scared, or they want someone relaxed, confident, smiling to them. This gives them a little bit of good time. Also, they will like that. I think actually it is easy to demonstrate it, and it is. You can be easily picked up because, you know, like few members here in the group have been faculty and a lot of courses, and you can tell that candidate doesn't know what he's talking about, either how much he's wanted.
And also, you can tell, you know, whether you're confident what you're saying or not, it's not what you're saying. It's the way you're saying it. But don't say stupid things. And yeah, you're definitely right for us. I couldn't agree more. And also staying in our hotel nice hotel before the exam is very important.
It's costly, unfortunately, but I think, you know, you hear those horrible stories of those people who stayed in a very noisy room. I couldn't sleep overnight, and that's can't be good. Yeah, definitely. And I think I have some of my colleagues who didn't have a good NIPE experience before the exam and that didn't reflect well on them. So unfortunately, the exam is run in a very expensive hotels normally.
Well, I think you have to account for that in your budget for it. Yeah, definitely. That's really important because that thing I've mentioned, you know, it's a hotel with a nightclub underneath it and especially you do the clinical onset, some days, you know, so having a busy NIPE on Saturday night, you know, 500 AM never helpful.
Whoever you are, you know, it's never helpful. So far, you know? And also, you know, contacting the hotel, emphasizing that you're doing that crucial exam for your career in advance to find a better room for you is actually helpful. And usually everyone will help you their. Yeah I mean, people are different, obviously. So I think most of us would like to be staying in a quiet room for good sleep, but I understand some people maybe want to stay with friends just to help them to get through the NIPE.
Difficult NIPE. I mean. Um, up to you, but think about carefully about the NIPE before the exam. That's the meaning, the plan, how it's help you optimize your performance next day. It is, you know, unfortunately difficult day and one of the most important days of your life. So you need to plan it and use it.
Make sure you use your pencil. You draw big diagrams that they can see properly. Use the entire sheet. Don't take shortcuts because a simple, quick diagram can actually get you the marks before you even start to talking because you probably cover the topic, for example, things like benninghoff, arcades and cartilage, and so on. As soon as you draw that, the examiners know you're in the right way and they're just going to relax and special on important stuff that would affect your management.
Yeah, I think it's important, like that's why we're doing all this preparation. I agree with this principle. Swiftly move on to the scoring points within 30 seconds. If you take in more than 30 seconds to move to scoring points, you're losing the chances to pass the exam. If they put anything over you, they should. You should know straight away what they want.
What if they put a child X-ray in front of you? Femoral shaft fracture like mama show? They want you to say non-accidental injury, so you should say it straight away, but then they want you to move quickly to the management of this frontal fracture, according to the age of the patient. So there's no point to wasting a lot of time on asking a lot of questions quickly.
You know, they want to discuss the management of this. Get to the management within the first 30 seconds after 30 seconds. That's it. And then they will ask you after that. You know, whatever about there would be bored, and they want to sometimes just ask you very highly advanced questions once you pass. So, yeah, move swiftly to that scoring points.
And for me, I have to support both for us and not that of the mentors. One of the questions asked by Matt if he was told not to use eponymous. What are your opinions, guys? I personally don't like opponents very much. However, you cannot resist saying Montezuma and Gagliardi for these four arm fractures, I mean, they. But I personally, when I'm on the spot, I struggle to remember all these names and classifications, so I normally describe what I see.
However, if it's something well-known like Fantasia and collegian, you know. You've got to know it and say it, I think I think. I don't think there's anything wrong with that, but I don't go into some opinion that's very rare also for specialized people will know. And I don't know, Mohammad, if you think about this. I agree with for us, I think what you said, you know, as I said, you know, you're a consultant.
It's like in a trauma meeting. You can say this is a fractured radius with dislocated, you know, or this is a fracture like this was dislocated, the distal ulnar dislocation. But you would say opponents are really well known. You know, I would do so because it's a discussion, and I don't think that is right or wrong here. But if it is well known as follows said I think I should say, but you know, don't take yourself a whole and other less known stuff for months or years.
I think I would say if I remember if you think, you know, because here it's very easy to say, but on the day under the spotlight, if you can, if you're not sure, just stick to the basic principles. What you can see. I can see that I'm worried about expectations. That's what I would do. What do you think? I think I fully agree with and mother that you need to mention the most common ones, but not the rarest one, because then you are digging a hole for yourself if you're mentioning the rare but the common one, which we see in our daily practice.
You have to need to know and probably the best you need to mention the common one, but not the real one. For my money, I agree and don't use the rare ones, but I think opinions are very useful. We were stuck trying to remember just leave the word block alone. Just move to describing, as Muhammad has said in for us have said. But the reality is for me, the word Fantasia conveys an immediate picture of an X-ray that I know in my head what it is.
If someone says Liz franks, I now know exactly what this person is worried about and thinking along the lines. If someone says Jones fracture, it's in my head. However, if you say something like Jones fracture, yeah, it's wrong. And it's not actually the junction of dialysis and the deficits, and you're in trouble because you need to understand what exactly that epidemic is referring to, because there's a real head dislocation, because there's a ulnar starting ulnar dislocation at the wrist or because this is a fracture at the dialysis to the metathesis junction, which is.
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