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Ex-Examiner's Advice for the FRCS Orthopaedic Exam
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Ex-Examiner's Advice for the FRCS Orthopaedic Exam
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Language: EN.
Segment:0 .
Good evening, everyone, thank you, everyone for joining this teaching session, organized jointly by laduke and farces mentor group. As you know, the focus of all our teaching program is preparing candidates for the FRCS examination.
We have the pleasure of having Mr Paul Marshall as our guest tonight. Mr Marshall is a consultant, orthopedic surgeon, a University hospital hospital in Morecambe bay, and he is the associate medical director there. And what makes him a perfect guest tonight is that he is an ex FRC examiner. So we were just talking about before we went on air being ex examiner, that means he has lots of experience.
But what we are very interested in tonight is that he is an exceptional case examiner. He has lots, many, many years being examiner for many years. He is a committed a lot of experience and wisdom that he is going to speak to us about it this evening. So his main lecture tonight is about it's a little bit of interactive lecture, and he will tell us about the best approach for the exam and how the examiners look at the candidates and what they're looking for in the candidates.
And how can a candidate impress an examiner and score high? And we were talking about we're talking before we went live. That's his recommendation was generally that we should aim for a top score in any citation we do. So we're very pleased that we have Mr. Marshall tonight, and I'm certain that each one of us will learn a lot from him. So I'm not. I'm representing the our splinter, the group and I have with me other mentors from our large group.
And we have Schwann and you're helping us tonight. And also we have the team from our UK, the educational team from our UK, Imogene and Hannah. So this session basically will include this talk from Mr. Marshall. There will be a little bit of interaction and there will be an opportunity for some Viva and some questioning as well and some feedback. So if those who are interested, please express your interest and Hannah will be taking names.
We understand that this could be stressful for any candidate to speak in front of 130 people, so we will take that into account and we understand this stressful situation. We all have been there and we all respect you, whoever comes forward. Just after the session, there will be the usual survivor practice, and CPD certificates will be available if you contact the or UK educational team.
If you missed any part of this lecture, don't panic, we will. We are recording it and with the permission of Mr. Marshall, we'll be able to share that later on. So without any further ado, I will leave you with that, Mr Paul Marshall. Thank you very much for us. It is a pleasure to come and talk to you this evening. I don't know whether KneeKG Walsh is here.
KneeKG is an associate specialist who works with myself and Lancaster, and we worked for many years, and I know that KneeKG is encourage me to participate to the group, which I got an email yesterday saying, your speaker's not here. So can I help? And yes, I'm very pleased to be here. I'm going to just give a little bit of a talk about what I think is helpful for you to approaching it as an examiné.
So I examined in trauma and pediatric orthopedics for five years, and I was probably. Five years ago when I stopped, so things may have changed a little bit, but there's still the same emphasis on scoring the candidates to give them a mark. I mean, you've all come this far in your medical careers. You all sort of know it's a little bit of a game. You know that it's not quite the same as clinical practice and particularly the short pieces, and probably less so the vivas, where you don't, it's just not something that you do day to day.
You never approach a patient and examine this patient's shoulder. Examine this patient's brachial plexus without taking a history. It's very sort of a foreign experience, especially with somebody watching you. And I think the best way to do well at that, as you probably already know, is to practice it, practice it with colleagues, pretend it's an examination and it becomes more and more sort of ingrained in how to do it.
So I'll talk a little bit about what give you some, I hope with some hopeful, some helpful tips about the exam, if we sort of. Then we'll probably open it up to questions. And if you had experience of the exam and you want to share that, that is fine with me. If you've got particular questions, you know, specific questions around orthopedics, trauma, pediatrics, then we could open that up to the group and discuss that.
But essentially, the examiner, as I said, is trying to give you a score. He's got 5 minutes in the Viva pediatric Viva 15 minutes and that's three questions and you score each question, so each question last five minutes. And that's not a very long period of time, really to get to the bottom of a topic. And it's certainly very difficult to test what the examiners like to call higher order thinking and higher order thinking, I think comes from sort of human factors, background where you were sort of thrown things which are a bit unusual.
And I think one of the ways of thinking about it is airline pilots. When they're sort of got nothing to do, they're up in the sky. They sort of play human factors, games they play. What if games? What if this happens? What if that engine fails? What if this happens? What if we have this incident and examiners can sometimes bring that in?
What if this happens and that is their best, best way of trying to test your, your higher order thinking and how you can think on the spot? But essentially, each section, each sort of question is scored, and most candidates will get a five, six or seven, and a 5 is a borderline fail and a 6 is a borderline pass and a 7 is a good pass.
And occasionally you might get an eight if you've got a really excellent answer and a 4 is the sort of bad fail. It's not to say it's irredeemable, because if you score well in other sections, you can make it up, but you don't want to score a four. So to try and avoid scoring a for the cat, the examiner wants to make sure that you're safe. So the first part of the question will be, is this person safe?
Is it safe to be a consultant, trauma or orthopedic surgeon on day one? OK, so the way they will format their questions is that they were the first part of it usually is how can I test if this patient is safe, ok? And then once they've established that the candidate can give a safe answer is safe to practice, then they'll sort of rack up the questions a little bit more and say, well, yeah, he's safe.
But has he got the knowledge and the sort of experience, I suppose, to pass? And then if he's got that level of skill, you see, is he a good pass? Can I ask him a little bit more of a difficult question just to see if he can, if he can answer that. So we can get him into a good pass? So there's a stepwise progression, really. So every question starts with that stepwise progression, particularly the first question that you get asked in the vyver if you answer the first question, well, I'm sure it does have an effect on the examiners to think, well, this is a, you know, this is a good candidate and he's doing well.
So the first question is key. But I think you probably know that already with any sort of consultation, any sort of. Interface between people, the first 7 seconds are really important. So, yes, you can walk in and the examiner will, may, may or may not offer you their hand to shake. Obviously, in Kobe times, we can't do that. But do the appropriate thing.
Say Hello. The examiner should introduce themselves and they'll check your identity. So the first part of the question is sort of a settling, settling question, examiners are sort of vetted. So we don't like examiners who are sort of a bit maverick, a bit difficult to throw, to throw sort of Googlers. If you like to try and catch you out, especially early on in the vyver.
So you might start in sort of Pediatrics where you supracondylar fractures of the humerus. You sort of expect you might get that question and you might say, well, you're called to the emergency department. They tell you you've got a child with a supracondylar fracture. He's fallen out of a tree. He's eight years old. And then I sort of ask, well, what do you want to down the phone?
I mean, it's not a difficult question. What do you want to know from the emergency department about this, this child sort of what's the neurovascular status? When do they eat or drink? And then? What are you going to do next? So I want to hear that, yeah, I'm going to go down straight away and see this child with a super contra fracture.
OK, well, that's all good. It's pretty easy. And then how are you going to assess the neurovascular status? What are you going to do to assess the neurovascular status? So it's just getting a little bit more sort of involved, if you like. I want to see that the candidate can assess radial median, ulnar nerve.
OK, so that does take about a minute. And then we sort of move on. And my general approach after that is to of, you're taking this child to the theater. OK and what I probably don't want is a lot of preamble about getting everything ready, et cetera. So we want to if the examiner asked you a specific question. Answer the question.
OK, so you've got the chart in theater and how are you going to reduce the fracture? OK so if someone is giving you a fairly specific question to answer, you do your best to answer the question. Ok? and then the examiner might want to interrupt you if you get a chance to talk. It's probably a good idea to talk, and so particularly if you can show confidence in the management of a condition.
So one. One question I might ask is, have you been involved with these cases of this nature and you may not have had that much involvement? Hopefully, the Super controller fractures, you've got a reasonable amount of experience, but there may be cases, for instance, slipped a pipe assist where you may not have had that much experience, but there is.
You are expected as a day one consultant to be able to manage that condition. So yes, I have had experience of managing this condition. So it then progresses as to essentially, how are you going to. Are you going to stabilize this fracture? Are you going to? Are you going to fix it with wires? What? why is he going to use?
If you can sort of lost the examiners sort of guiding you along, try and rack your brain for anything that you can about the literature or about boast guidelines. Because if you can bring those in to the discussion at some point, even if you don't get it completely right, it stands you in good stead because one of the things that differentiates a sort of a borderline pass from a good pass.
And as I say, you want to aim for a good pass rather than a borderline pass for every question is knowledge and application of the literature. So there are certain sort of key papers if you like, and even if you can't remember the authors, you can, you can put into the discussion. Well, the both guidelines say this, or there's a good paper that I've read recently, which says this, and they come, and it might take you up at NIPE and say, well, where did you read that?
What did you think of the paper? And you might then say, well, I'm sorry, I can only remember the abstract. That was the message that I got from the paper one, which is, OK, you know, you've done your best. You've you've put something forward. And it is good to be able to the recent literature bone and Joint Journal over the last sort of a couple of years. It papers that have been published recently in that journal or the height, a highly valued journals with things to contribute.
So trying to score four seven, you never know quite how the examiner is going to give you, often you walk out thinking often terrible, you know, I didn't answer that question very well. But what you think and what the examiner thinks is not the same. And then once you've got 5 minutes is up, you've got to start again. So it's like, I guess, a bit like cricket in the sense.
You know, the examiner bowls your ball and you can sort of see where it's going to go, you know, supercontinent fractures slip to persist infection, Chuba. What the boat, once that's been bowled to you, so to speak, think in the back of your mind, what do I know about the literature around this topic? What can I sort of bring into the discussion in, say, two minutes time?
That will convince the examiner that I've got more than just to borderline knowledge that will convince the examiner that I've got it, that my destiny is a good, a good pass. So those are the sort of fairly simple things I would sort ask you to focus on. I mean, you may say that's fairly obvious. And I guess it is a little bit obvious, but the examiner is trying to give you a number and you want to get a good number from the examiner.
So that's. I think that's probably the main things I wanted to say, so we probably open things up, I don't know whether I've got any questions. I'm going to have a look here. Yes yeah, we got them. I think that was wonderful advice really and really reaffirms that general approach that I like that you advise candidates to go to have a sort of a timeline, isn't it?
I noticed that within 1 minute you said we starting on the theater questions. Yes, because some candidates have that tendency to ramble along and keep talking about assessing neurovascular and consenting and preparing theaters and stuff. They find themselves into the fourth minute, and they haven't really answered the question yet. So the good examiner? Yeah, Thanks for us.
Good examiners will have a way of sort of stopping you. You know, I'll do the consent and et cetera, et cetera. But it's all good to do that, and I'll examine the patient according to its protocol, which is a good thing to say. But you've got to think in the back of my mind, where is this going? This is a question about supracondylar fractures of the humerus, and you've got to wrap your brain for any sort of extra little bit of information about that topic.
And sometimes it takes a while in the pressure of an exam to bring that information forward. So my suggestion is, once you know what this is about, I think, what do I know? What extra do I know about this topic? And then towards the end of the five minutes, you know, minute four, you might be able to say, well, there's some literature on this. And I remember reading a paper about this, and this was the message from the paper.
And that gives the examiner a good impression because at the end of the sort of five minutes you've told him, you know, a little bit about the literature, you may think, well, they knew a little bit, but they didn't know very much. But it might be just enough to get you up into a 7 from a six. So that's sort of where I'm coming from for us. Yeah so yeah, the examiner, good examiners will stop you from waffling on.
But if you're on, if you think I know this, I really know this, then. Then you keep talking, keep talking. They will let you talk. Sometimes if you make an error, they will. They will pick you up, and sometimes they won't, but if you know it. Keep talking, I think, but be always be guided by their sort of eye contact and whether they want you to stop.
OK I think you just answered the question that was asked by one of the candidates in our audience, chenille koshy, he's asked. If the subject very well or can sense where this is going, shall we just keep going and she, as a candidate, just keep talking all the time. Or, you know, let's say examiner says, how would you examine this patient? Just he just examined and then move on with the topic or just examine and wait for more questions.
Yeah, in the short case is the examination. It is OK to seek some clarification. But, you know, the examiners are really fairly specific, examine this patient's shoulder and you have to have a mechanism for examining the shoulder. I think it's permissible in the short cases, I think it's permissible just to ask the patient, do you have any discomfort or tenderness in your shoulder? Before I examined you, I'd like to know whether you've got any pain and could you show me where the pain is?
I think that is a nice thing to ask, and I don't think the examiner is going to stop you from saying that because even though it's a bit of a theater, it shows that you've got appropriate concern for the patient before you examine them. So that, I think, is a good thing to do in the short cases, but they are very specific. Examine this patient's shoulder, this knee.
They may want to be more specific, like examine this knee for clinical instability. Examine this shoulder for evidence of rotator cuff tear or impingement. So if they are specific, then you need to tailor your examination to what the examiner is asking for. I don't think you might be able to comment on this for us, but I I'm quite happy for candidates to talk as they're examining.
And some people don't like that. I sort of input into that would be my default. To talk as you, as you're examining it helps you in your own thought process as well. It gives the examiner something to listen to as well as to watch. And they might then sort of just. Yeah, just guide you a little bit or interrupt if you're talking as you go along.
So I don't know whether you've got any views on that yourself for us about should you talk when you're examining the patients? Yeah, I think we totally agree with you because the examiners, sometimes in the heat of the moment, they don't know what exactly the candidate is trying to examine. It could be a little bit confusing what they are trying to palpate here or what tests they are doing.
So at least if they talk as long as they don't overthink it and as it's just of professionally saying, well, I'm putting the knee in at 20 degrees, the Gluckman test I'm doing, you know, just gently, you don't have to have because they also don't want to irritate the examiners or insult the intelligence of the examiners. So it's, I think, definitely talk. But, you know, keep it to the minimum.
That's the examiner will need to know. I mean, if you, you know, doing trundling back test, for example, you don't have to tell examiners exactly each step you're doing. I'm putting my hand, my hand on the pelvis. Now and now I'm asking don't have to do. These are very obvious things, but you could just talk to them about the salient points, how you are assessing the abductor, you're looking for pelvic tilt.
This kind of thing. So it's a game, just have comes with practice. But I think we've got to talk. If you're just someone goes silently and just goes and examine, I think that's very, very difficult for any examiner to score them. So if there is a danger that you are going to describe the examination without actually performing the examination correctly.
So anyone that's planning to speak in the exam, which is not a bad thing, I agree with it because it gives information as you're doing the examination. So you're findings. But also what are the key points in your examination? But yeah, I mean the doing that in real life as well, because what tends to happen is you tend to stop and describe what you're doing before you do it.
And that's think it is that irritates examiners, Yes. And irritates me when I'm trying to examine someone on their practice. Yeah, you don't want this to slow you down if you're talking, if you have to stop to speak, that's also we will be wrong. You'll be using a lot of time. So you have to talk as you go, not losing time, obviously, and it just comes with practice.
It does. It exactly does come with practice. It's not something that you do in a clinic. You don't talk to, you don't talk to the wall whilst you're examining a patient in clinic, you maybe talk to the patient. You maybe get more of a history, but you don't tell them I'm doing it. This is a trend.
Now I'm going to trend Allen books test, and it is a very, very alien sort of alien to clinical practice, as you know. I mean, we've all come we've all done these sort of clinical exams in the past, but I do think a little bit of talking can be helpful. And I think it is also very good practice to of, you know, think it's good to introduce yourself to the patient was that's a nice thing to do.
It doesn't take a minute to do that. And I think it's also good to ask them if they've got any particular discomfort in the area where you're going to examine and say that you examine it very gently and please tell me if it is uncomfortable for you. So that's I think, is a reasonable exam. Don't waste a lot of time with that because the examiners, you've only got a few minutes to do the examination, but I think it is quite a good thing to do.
But again, for us, if you've got views on that or you just get on with the examination. I think you just took, I think, but you have to not overthink it, basically. Example, if you think, you know, examining the arc of movements and putting the arm in an external rotation, you don't have to say I'm doing external rotation. So it is very obvious. So you just say external rotation is so and so internal rotation is so you don't have to tell, well, I'm doing external.
It becomes too basic. And like a medical student, kind of. Indeed yeah, you want to make sure that you're pitching it out at the level that you are sort of at Fox trauma and North. So you could sort of say supersprint itis impersonator subscapularis in terms of your assessment of the rotator cuff. I think there's a tendency to go away from eponymous names now isn't there in the exam, but all the examiners still know the eponymous name.
So if the eponymous names, then I would volunteer those names. It won't do you any harm, and it's very good to hear from you. Sorry so the points out to the guys who are watching. Yes, we are talking about examinations, and I know that over time we're not having any patients in the exam and that the patient is actually going to be the examiner. But you're still not allowed to touch the examiner because of COVID restrictions.
I do. We appreciate that. But we are talking about normal times and there are people who are preparing for the exam next year, and we're hoping to do that. I mean, I'm not actually you would know how the fix for North exam has sort of is going ahead with COVID restrictions, isn't it? So there are sort of in these dark days of covid, things are different, but things will get back to normal.
I think the I think and ironically, the guys who were practicing talking while they're doing the examinations will probably do better because what the examiners will ask you to do is describe the examination to them. Yes, or demonstrate on yourself or, for example, how you're going to place your hand, where and so on that yes, it must it must be very difficult examining somebody, you know, doing on a screen like this really very, very difficult. So, Mr Marshall, I've really liked when you were discussing about how to kind of score high mark by quoting literature and you passed on very, very important message here.
You know, if you've only read the art, the abstract, you could say that, isn't it? You can. Definitely yeah, for me, you can say that. I mean, in the heat of the moment, and it is very difficult to recall. I mean, everybody, it's such a big syllabus, at Big Lots to learn. But if you can just remember something from the literature or read through the bone.
And Joint Journal for the last two or three years, you can say, well, I remember reading an article within the bone and Joint Journal within the last two or three years because that if that's the journal that you've read, then you can put that forward. And the message from the paper was this. And I think the examiner knows that you probably haven't, you know, you can't critique the method of all papers and be able to discuss them.
But I would put it forward that you've read the paper and this was the message of the paper. So it's the message that does come across quite well that you're looking at the literature and you're saying, well, what's the message in this for me? I mean, we often sort of in our own areas of expertise. We we sort of finely critique papers. But if we're just trying to keep ourselves up to date, then we're looking for the message in the paper.
And I think if you give that message to the examiner, it shows that you're reading the general literature in a sort of an intelligent way. Yeah, I totally agree with this. I think there are a little bit of mixed messages here. Some candidates worry that if they quote literature, they might be quizzed on a paper so that the examiner can't tell them, OK, you're cutting this paper, so tell me how many patients recruited was there the statistical analysis method they used?
How reliable is this paper you are quoting? They get too worked up about this, so I don't know what my thought, my thought. I think if, if, if that paper is just supports the general understanding. And it's not controversial and does not contradict anything that's common practice, then you actually are very unlikely to be challenged. But if you suddenly say this paper says you can cover in a wound and there will be no infection, then of course the examiner is going to ask you about it in details.
But I don't know what your views on that. And because we had a lot of questions about this, how the best way of putting literature on them, you know, people want to know why it is difficult, but I would. I would sort of encourage you to do it because I think you're more likely to do yourself a favor than to dig yourself a hole and the examiners, you know, maybe they wrote the paper or they know somebody who wrote the paper.
It may be their area of expertise, and they may want to just show you how knowledgeable they are about the paper, but they're not supposed to do that. They're there to assess you, the candidate. So I think it's unlikely that you will get that sort of they'll probe a little bit. It's this sort of what's the depth of knowledge here? So, yeah, OK, well, tell me a little bit more about the paper.
And all you can say then is, well, I'm sorry, I just remember the message for if you can remember a little bit more, you know, just give a little bit more that you can do without sort of digging the hole. I suppose you've got to be guided by the signals that you're getting from the examiner. But it is OK to say, you know, I'm sorry, but that I remember the message from the paper, but I don't remember the details of the method and the discussion, and I think that's OK.
You know, I would've thought of I would support that. I don't know whether I definitely think it's worth quoting literature, but you need to quote it correctly. So where examiners, where I have always picked on someone is when they've misrepresented the literature or misunderstood it, and that's when you can dig yourself a hole, isn't it? That's when the examiner you. That's it.
The examiner will take you into that direction and start. Yeah so I would, with that in mind, know every paper that you read in preparation for the exam. Ask yourself, what is the message from this paper? You know, I might have to regurgitate, you know, I might have to recall this in an exam situation. What can I tell the examiner about? What is the message for me or for my clinical practice from this paper?
And you get that from the abstract, really? So that's in the days before the exam, you know, before the part two comes around, sort of glancing back through the journals, looking at the abstract. But if you find something that catches your eye and you're interested in it, then by all means sort of follow that up and maybe Google it or look on also bullets and just see where it takes you.
Because sometimes that sort of inquiry helps you think helps you to remember things. If you let your your, your, your, your sort of mind your natural tendency to inquiry into things that often helps to secure it in your memory a little bit. But yes, it's the message. What is the message in this paper? You know, you don't have to know where it comes from or who the authors are, but the message is, is what I would encourage you to put forward in the exam.
Thank you, Mr Marshall. We have a few questions that also come in with people. So they didn't ask is from your experience as examiner, what do you think the main reason that people candidates unfortunately fail the exam? And is there any particular irritating traits that you noticed in the candidates that you think that could be avoided?
OK, I think sometimes you get a feeling that somebody hasn't really done this procedure or they haven't really seen this sort of problem, and it can be difficult depending upon the training that you've done. And if you haven't done a pediatric job or if you haven't done a hand job, then you're sort of at a disadvantage. I suppose you are at a disadvantage. But to those people who haven't sort of I haven't seen this particular procedure, but these are the principles of management.
So I think. Uh, if you aren't confident in an area, then the examiner sort of gets a feeling for that fairly quickly. They get that sort of vibe. And I suppose just sort of. Keep, you know, keep yourself going, we've all been in those sort of situations where we're not particularly confident in the topic, And the examiner is sort of asking us more and more questions, and we're wishing that the Earth would open up.
But I think you can come back to the situation you. This is another little point, actually slight, slight sidetrack, but they often ask you, ask you a difficult question and you say, well, there's more than one answer to this question, you know, so you can say, well, there are two different, you know, it's not a bad idea to say, well, there's this approach. And that approach.
But on the unit where I worked, this is how we manage this problem. OK so that is certainly more sort of that's certainly stronger than this is my opinion. What you were saying is where I worked, the person who trained me, the person who supervised me, this is what they did. So it's a little bit more there's a bit more strength to it than this is just what I would do.
It's what my trainer would do and what my supervisors would do. And the examiners might think, well, I don't really think that's a good idea. But you know, that's what some people do, and that may be help you a little bit. And if you're feeling really, really confident and this might be slightly overconfident, you can say, well, I've worked on two units and this is what we did on one unit and this is what we did and another unit.
And then the examiner is going to say, well, what are you going to do? So you have to put that forward. But you can sort of if you introduce into the discussion on the unit where I work, this is how we manage this sort of problem that can be helpful if you're really just try and ground yourself in being safe. And sometimes the answer is I would refer to a bone tumor service or something like that, something tumors come up quite often.
And you know, the examiner wants to do to know that you in the real world that you are not going to sit on this problem and not refer it to a bone tumor service for a bone tumor opinion. OK, so your threshold is pretty low, but and it's good to put that into the conversation, you know, in a practical situation. I would look at this imaging.
And I would discuss it an MDC meeting, and I would specifically want to know whether it needs to be discussed with a regional tumor or a national tumor service. So you're putting you've been in that situation before, and the examiner might then say, well, OK. You all that, you all the regional tumor service. How are you going to respond to this colleague who's referred to you this bone cyst?
How are you going to manage it, so to speak? I mean, it sounds as though they're making very few of us are going to be bone tumor specialists because it's a very niche sort of area. But it's a good way of the examiners sort of testing your knowledge a little bit. But the point I would make is come back to the practical situation in a practical on a day to day basis on my unit.
This is how we would manage this patient, whether it means referring on to another unit for good reasons or getting another opinion that shows that you're not going to. Um, there's a fine line between having confidence to deal with. Problems which you're expected to deal with yourself as a day one consultant, but a day one consultant, you're also expected to say, well, I know what this is and I know I haven't got the expertise to fix it or to do it.
So I'm going to do the right thing and I'm going to get an opinion from somebody who's got the expertise. And there's sort of no shame in that. But then you can make that point and then say, well, these are the principles of treatment of this sort of more difficult condition. But make the point that in practice, you're not going to take this on yourself as a day one consultant, you can see that this is something that needs somebody else to have a look at.
That means you're safe. Yeah, so being safe is really important. Absolutely, we try to emphasize the same safe mdc-t approach is the way forward in the exam. We have one more question. Also, we just all three key questions. OK, so Mohammad egawa asked. He's worried that if he gets the first question wrong? Yeah, that's going to leave a wrong impression for the whole of the station and probably the whole of the table with both examiners.
If you get the first question, just, you know, he's worried about the first impression. And if he answers the question wrong, leaving a bad impression. Is that correct? Is there a way to come back from that or? But there is a way back know, I've seen kind of a handle on the first question badly and then and then handled second and third questions well.
And the examiner has got to move on. He can't just go on. He cannot just ask you one question. He's got to. He's got 5 minutes and he's going to ask you a second question. So they should know. They try and ask a sort of a question, which is based upon an everyday, you know, like super superconductor.
Fractures in children tend to treat infections in hands, things that you would sort of expect to come across, you know, fairly often. And that first question? You might not think it's a particularly easy question, but someone is probably. It's his first start of questions, so try and be really confident in that first question. Thank goodness.
Thanks for asking me about tendon sheath infections. This this is how you manage tendon sheath infections. Thanks for asking me about supracondylar fractures. I'm just going to talk about this until. And the complications and go from there. So, yeah, try and be more confident than you sort of feel deep down in your response to the first question. The examiners will give you credit for the second and third questions, but I think it's just a human thing in a way that people perform well in the conversely, if you perform well in the first question, then you can sort of you're off on a good footing with the second question.
So it's not impossible to make up the ground. So every time they bowled you a new ball, think I'm going to hit this for six? I'm going to try and score a 7 for this. This this particular question. I'm going to think about the literature in the back of my mind. I'm going to try and introduce that at the end of the conversation, even if there's not a particularly obvious place to put it in.
And I'm going to try and force this my knowledge about both recommendations and the literature that I've read. So sorry to go on about that. No, it's been examined, and it would have cut me up a long time before the going on like that. They would have stopped me. They would have put up their hand and said, let's move on. We have one more question. Now there are some examiners, so my apologies.
Just just to reinforce what the commercial was saying. And if you've done really badly and it's 5 minutes per topic, if you've done really badly on the very first topic, the examiners are not allowed to take that impression to the next question they're going to ask you. So they've put it behind them. Maybe they're all human. Of course, they might have something in the back of their mind, but they've put it behind them.
You need to put it behind you. You need to develop. The technique of this is a new question. This is a new chance. This is your chance to get a 7 to make up for the five on the last question. So don't be despondent. Just put it down. Take a deep breath and focus on the next question that you need to develop that technique as well.
So don't panic about getting a question bad in the first. Yeah, I would completely accurate. That's one you've got to this is a new question. I'm going to go and I'm going for this question is though it's I've forgotten the previous question already. I'm going to this new question. You've got it. You've got to have that mindset. It's not easy.
I know it's a pretty high, stressful, high stakes exam, but that sort of approach is the way to do it, I'm sure. Absolutely yeah, it's not easy, but it's the way to pass this exam now. I have a 1 question for us, if you don't mind. Yeah Yes. Yes, we have some more questions. Go ahead, honey. What's your question?
Sometimes Mr Marshall, the candidate is like speaks faster than he thinks. So if he said like a stupid answer and they want to stop and rephrase his answer again, what do you recommend for him to do? Or to say some people do say things that they realize are not correct. And if you do do that, you can correct yourself. And I would suggest if you say, well, I've said, you know, I said something that was incorrect and I didn't realize, you know, it just came out because I was like a little bit nervous.
I suppose you can correct yourself. And the examiner will have noticed if you said something wrong, because these are questions that they've asked a lot of times before. So they sort of know what people are going to say, and they've had a number of candidates who they've already asked that question to. So they have favorite questions. So if you think what I did say something wrong there, you know, it was a minute ago and I said something wrong.
You know, I just remember that I said what I said at the beginning. I just want to clarify that what I really what I really meant to say was this. So if you do say something that you think, well, I shouldn't have said that and that was wrong. I think it's good to go back and make it clear that you, you realize you've said something wrong. I think it's better to do that than to hope that.
The examiner didn't notice it because I think the examiner will notice it, so fluorescent changes the faculty today want to comment on that one? Yeah, absolutely. If if you've made something, if you can actually watch the other person who's not asking you the questions. I often say that if that person just suddenly sits forward or puts his head up more often than not said something that you shouldn't have said.
So take a moment to think about what you said. Don't overthink these things. But if you feel that something is wrong? Take a deep breath. Again, I can't emphasize this enough. Rehash what you said. And, Uh, say I misspoke. I meant x, y and z. But waking the bear, which is often who I call the other examiner, is a bad sign.
He could only say I misunderstood the question and I answered wrongly. And I would like to withdraw that and restart. That's definitely the examiner would even acknowledge this, and there will sort of respect the candidate that's that's, you know, admitted their mistakes rather than just continuing to bluff around and hope the examiners will have noticed. So, yeah, Mr Marshall, one more question, if you don't mind.
So there are some examiners who have a reputation of being difficult and they fail everyone. So candidates can go to that station and see Mr so-and-so, I think, oh, I'm failing the station, definitely. He fails everyone. He failed me last time, he said, my friends. And how true is that? Is there some truth in that? How true it is.
What's the best way you can approach such a situation? Yeah, I don't think there's much truth in it. I think the protocol for sort of assessing examiners, examiners. So do examine because they like failing people, they sort of do it because it's a sort of part of their own development and they feel it's a good service to do for training and they really just want to give somebody an accurate. They want to give them.
They want to get the best out of a candidate. That was my that was going to be my final point. I as an examiner, I as an interviewer want to get the best out of you. I don't want to get the worst out of you. I want to get the best out of you, so you want to give me your best and I want to get the best out of you so that I can give you what I think is a good score.
I mean, we've all in our past, I suppose, had bad examiners examination. You know, give us a lecture on something when we've said something, which we didn't perhaps mean to say. But the vetting process for examiners and the sort of quality assurance, if you like of examiners is such that, you know, I don't think those days are over, you know, everybody can sort of. Think, oh, he's so and so he's does this, but.
We all get at the end of our examinations, we've got a sort of a breakdown of our story. And you should try and, you know, you shouldn't be an outlier like in anything in orthopedics, don't be an outlier. So you don't want to be an outlier where you were too much of a dove, which is a dove, is somebody who basically gives the marks too high.
And then the hawk is the one who gives the marks too low. So at the end of the examination sort of session, all the examiners get their own marks Fed back to them. And you should sort of look and make sure that you're not sort of, you know, that you want to be sort of scoring, you know, like everybody else is scoring. And if you're scoring too high or too low, you've got to ask yourself, you know, why am I scoring too high or too low?
And I do honestly feel that people who are examiners do want to do really want to get the best out of the candidate and to help them through, which is really tough. You know, a really tough exam. So, yeah, maybe I'm biased because I was an examiner. But you know, I've also, you know, I do remember being examined, and you do sort of think this exam is apt to get me for some reason.
But I think a lot of that is in your mind. Honestly, I do think it is in your mind, and I think they just want to assess you and give you a fair sort a fair assessment. I really would say that. Thank you. I think that that's thank you for explaining this. That will put a lot of mind at rest and especially those going for the exams.
Your words are very reassuring on that aspect. Do you have time for more one more? Yeah, Yeah. If you've got a couple, yeah, please do something. How of it? Ask if, if, if you are unfortunate in that situation, when you got the first question wrong, the question that's only maybe starting or competency question, you got it wrong.
And the examiner then or you say, I have no clue about this, this topic and the examiner didn't change the topic or change the question completely? Or does that mean it's a fail? Well, they will, probably not. Probably not change the topic completely, they will give you a sort of more prompts, really. That's often what you know, if you're struggling in order to get the best out of a candidate, you give them a prompt, you know, sort of what.
You know. So supracondylar fractures and an absent pulse, you know, what would you do with that sort of situation and a good candidate would be able to say, this is what I do and this is what I've done. You know, it's quite OK in the exam to say in my I have had a case like this, which I managed, and this is what this is, what I did or this is what I did with my supervisor.
But if you're struggling, the examiners usually gives you a little bit of a prompt. And then if it's just like any other sort of difficult situation, you can sort of try maybe go back to first principles or you can try and go back to in a practical situation in a work situation. This is how I would answer this problem. So you can sort of go back to that point.
And I think if the examiner chooses to move on, you've got to move on to I mean, you don't really have a choice, but they will give you that give you quite a bit of prompting, I think, before they move on. And if in that situation with this kind of still have a chance to pass that question or I think it depends how much prompting they need, I think, you know. To sort of get it to be to get a sort of bad faith, if you like to get a for you, probably the most examiners would feel, well, this candidate was unsafe.
He was not he or she wouldn't be safe to be a day one consultant. So I think for me, that was often my justification for giving for and you may say, well, there's a certain core knowledge that you need to be a day one consultant. And if you don't have that knowledge at your fingertips, I mean it knowledge in the world today is on your phone, isn't it?
Or every single bit of knowledge in the world is on your phone. So this but you've got to there's a certain core knowledge that you've got to have inside your head, particularly from the examination point of view. So yes, the examiners should give you prompts. But I, you know, I guess if you're really struggling to go back to if it's sort of basic science or, you know, those sort of things go back to first principles.
These are the principles. This is what I know about this topic. You know, even if it's not exactly the question. That I've been asked, this is what I know about this topic. So I would, you know. Try your best, I think, being silent and saying, I'm sorry, I don't know anything about this. It's a difficult one for the examiner to. I can't help you through that you've sort of given them that, I don't know anything about this.
That's not a good way forward. But just tell them what you do know, even if it's sort of not exactly what they've asked for. I mean, they will then sort of maybe sort of pull you up on that a little bit, but I think it is probably better to give. Some knowledge, which, you know, to be sort of true if you like or good knowledge, even if it's not exactly what they've asked for, then they will probably prompt you and ask you and probe and see where exactly where your level of knowledge is.
I don't know. What do you think about that Schwann and for us? I'm from yeah, I won't. So I would never buy someone to just say, I don't know something if you don't know something, you really don't know. And it's at a higher level. That's fine. You can say it if you're already at 7 or 8 and you've done really well in the last minute.
I don't know is a sign of integrity in a lot of ways when they're asking you about that particular literature in Journal of hand from 1947 or whatever. But if you are on the very first question and you say, I don't know, the examiner can't do anything for you, what you can say is if you don't know the answer they're asking you, you can say, please, could you rephrase? I'm not sure.
I understand the question that gives the examiner a chance to prompt and rephrase and maybe add an extra little bit of information onto the question that he was asking you. And it would be considered a prompt, but it could pull you into the situation where you can answer the question much easier. I think that's a very good point. John, you.
Could you rephrase it, I'm. Uh, or even going back to the. Even if you're not sure the question repeating the question back to the examiner in a slightly different way, is this what you want me to talk about? So that sort of clarification is good? Yes, Yes. Or can you rephrase, is it possible for you to ask that question and to rephrase it is a reasonable thing to do, but I would always, you know, to try your best to try and.
You know, do your best with the question, obviously. But there are some questions, I guess, which are really difficult, but those difficult questions should come at the end rather than at the beginning. So you really got to try the initial questions. You sort of try and put together an answer, even if you can feel a bit uncomfortable with it, but try and put an answer together. That would be my suggestion, I think.
Yeah, totally agree. We've been doing this for some time and we've seen hundreds of people who slip into the exam and we've heard a lot of people. I don't think I've ever seen a candidate who cannot answer the first question or say something about the first question. Things are extremely rare situation, but maybe the advanced questions obviously that can happen and that not always a bad thing, as Sean said.
But, you know, would be extremely rare. I mean, if they are not behaving to talk something about the opening question, something at least, you know, say something that's, you know, has some meaning. So just give the examiner something to hang on to and to help you. I think we can all say something about any x-rays or any topic, even if they're not going to give you anything that's not you've not seen or not read in the books anyway.
So I think they'll be extremely rare. Yes Yeah. That's not knowing about the first question in the table. So I think I think, yeah, I think all the messages we had is just echo what you said, Mr. Marshall, about you have to redeem yourself and be confident and try to gather yourself up. And it probably the examiners will, you know, have a lot of respect to candidates who maybe has been put off a little bit to start with by not answering well.
And then he picked up himself up. And you know, for the rest of the questions, I think they will definitely respect that. Yeah, I think that yeah, you're not sunk. If you find the first question difficult, do your best and then think deep breath. This is the second question I'm going to make up for it. I'm going to make up for that first question. I'm going to I'm going to really show them.
So you have to have that sort of different that sort of approach, which is difficult, but you've got to I'm sure that's a way to score marks and to get through it. Sure, that's the way. Absolutely well, that's wonderful, I think. Does anyone know if I also the ministers have any questions to Mr. Marshall while he is here? I know Mr. Marshall has another meeting to go to.
don't want to hold you back from that meeting, but actually, Mr. Marshall, just quick question, if you don't mind if a candidate demonstrates unsafe, what you would consider unsafe level four, does that carry on to the other, to the rest of the exam? No, they. You'll get that before. There's no the philosophy of a killer question that the pediatric surgeon sits alongside the hand surgeons.
And the idea of a killer question is, is it's a bad concept, really, because sometimes what the hand surgeon might think is a sort of killer question. pediatric surgeon, I think, well, I don't think that's really fair to ask that killer, make that a killer question. And similarly, in pediatrics, you might say, well, that was a really bad thing to say, but the hand surgeon might think, well, I don't think it was that bad, you know?
So the concept of a killer question to completely fail somebody for everything, and that's not the way it works. I mean, you may get a four at one point, but you can make up for a fall. You can make up for a fall. So that's why the philosophy of I'm going to school, I'm going to get 7 out of every single question they ask me because, you know, life, sometimes you don't.
You don't quite get a seven every single time, but you need to aim for a good pass for every single question because there'll be one or two questions where you may be a little bit borderline and that's just the nature of exams and questions. But to have that mindset that every single ball ball that they bowled to me, I'm going to I'm going to try and get a good pass from this. I'm going to try and get a 7 from this, and I'm going to do that.
I think I think the question may be and trying to get to or, you know, if someone is really, really said something really unsafe in the exam, let's say they missed a terribly display, cervical fracture dislocation and the patient dies from respiratory arrest or something. Is there a decision made collectively that this candidate, no matter how well he does in the other stations, he killed the patient and therefore he cannot save to pass the exam?
Is there such a thing? No well, I can only speak on the basis of my experience of an exam five years ago, us. But no, there isn't. You cannot sort of play that sort of card and say this. I failed this candidate completely. You can give them a 4 and it is a little, you know, you've got to score well on your other questions if you want to overcome a four, but you cannot be sort of completely wiped out because you, somebody thinks you, you've done something that's unsafe, that doesn't work.
So, yes, you can still make it up if you felt you've said something that's unsafe, it's obviously. Don't try not to say anything that's unsafe, but that is quite an important message because we want people who are safe, even if they then maybe their knowledge is not sort of. You know, really, really on top of everything, but we want people who are safe and who will be able to recognize that maybe their own limitations where they need to ask for help in a practical situation.
But we also want to make sure that they can function and they have the competencies and capabilities to work as a day one consultant. I don't want to put yeah, I don't want to. I definitely wouldn't want to put people under the impression that there is a way that you can be just sort of eliminated because you might want bad one bad question. You've still got time to make things up. So that the idea, the mindset, if you like, I'm going to put that behind me.
I'm just going to focus on what's coming at me now is definitely the way to approach things. Yeah one more question, given that you have 12 scoring opportunities in a single Viva to examiners, can you still compensate for one or two fours? Well, yes, you can. I mean, as long as when all the numbers add up, you've got, you know, you cross the line, you've got a borderline pass and you've passed so you can make it up, you can make up for it.
I don't disagree that you can definitely make up for a single for maybe two, but if you've got three fours, I think even the standard that they pass is to get a 6 and how hard you have to work to get a 7. So if you get 6 on every table and every fiber question, that's a pass of the exam. Yeah, if you get one five, you need to get a 7. Yeah, so is right. And you know, that is why I know I keep saying it, but aiming for a seven.
Aim for a 7 for every single question because you won't get a 7 for every single question and that. But if you do, it'll help to make up for the odd the odd five that you might collect. So aim for a seven. But it is very difficult for a few. So four, you need two sevens to opt for four. So it really gets more and more difficult. I'm not saying it's impossible.
I agree with Dr. Marshall. It's not impossible. You should never give up. Yeah, but don't accept it for trying. No no. Try not to. There is one more question that we get very often asked, is that candidate? There are two examiners in the table and there is one examiner asking questions.
The other examiner is very busy looking in a piece of paper and writing letters and numbers and codes and stuff. And some candidates have reported that been looking at that second examiner, what they're writing, and they see them write five or six or seven or eight or whatever. Is that correct or is that just? Uh, well, not in my experience, I mean, you do make notes on the candidates, as you say, the other examiner is scoring as well, but that shouldn't be visible to the candidate.
So that would be bad examining for it to be visible. But from the point of view of the candidate, obviously, you know, do your best to focus on the examiner. You may get, as we mentioned earlier, the subtle movements of the non examining examiner who might lean forward or lean back. And those sort of movements without any facial expression, you might sort of pick up little things from that, but don't try, not try and focus on the examiner that's asking you the questions.
And from your experience as examiner, I don't know if you got involved in the marking, but obviously in the sort of overall marking. But is it common for I mean, for someone to score a 4 and the pass the exam? Theoretically, they probably have to score lots of sevens or an eight. Is that? I presume that's rare.
I mean, with someone who scored four in a question, be able to score lots of sevens or 8 to compensate. Is that common? Well, the honest answer for us is, I don't know. I wasn't involved in that sort of in those sort of scenarios, but it would be. I mean, it's not impossible to score a 4 and then to make up for it.
So that is the message I would pass on. And it's just a simple mathematical formula. You know, you've got to score a certain number of high marks to compensate for a low mark. It's just a mathematical formula. Lovely so, Mr. Marshall, I don't want to be holding you back. Well, you came at such a short notice out of your busy schedule and you squeezed us in your daily program and the pleasure.
I hope you have a good Viva session now. And thank you to all your participants for sort of your questions. And guys, I know it a really tough exam, but it is. It is an exam that is. Yeah, it is possible. You know, I know there's lots of it's always difficult when you're on the wrong side of the hill and you think I'll never get up there, but you've got to have the mindset.
Yes, I can. I can do this. I can get through this and every single, every single question they ask you, I'm going to try and get a good mark on this. I'm going to try and get 7. I'm going to think about the literature. I'm going to think about what the biggest recommendations are, and I'm going to try and bring that end at the end of the conversation because I just want to try and tip the examiner for giving me a tip me from a 6 to a seven.
Guys, thank you very much for inviting me. Thank you. Thank you so much for your short notice. Brilliant OK. Yeah, it's very good. Hope you have a good rest of the session and I'll have a chat with Nicole tomorrow. Thank you very much. Thank you indeed, Mr. Marshall.
Thank you. And we hope to see you again. We really enjoyed it. And OK, well, Yeah. Yeah, it's been great. Great to be here. Thank you very much. Good NIPE for us. Thank you.
Bye bye now. Bye bye. Thank you. Bye
Segment:0 .
Good evening, everyone, thank you, everyone for joining this teaching session, organized jointly by laduke and farces mentor group. As you know, the focus of all our teaching program is preparing candidates for the FRCS examination.
We have the pleasure of having Mr Paul Marshall as our guest tonight. Mr Marshall is a consultant, orthopedic surgeon, a University hospital hospital in Morecambe bay, and he is the associate medical director there. And what makes him a perfect guest tonight is that he is an ex FRC examiner. So we were just talking about before we went on air being ex examiner, that means he has lots of experience.
But what we are very interested in tonight is that he is an exceptional case examiner. He has lots, many, many years being examiner for many years. He is a committed a lot of experience and wisdom that he is going to speak to us about it this evening. So his main lecture tonight is about it's a little bit of interactive lecture, and he will tell us about the best approach for the exam and how the examiners look at the candidates and what they're looking for in the candidates.
And how can a candidate impress an examiner and score high? And we were talking about we're talking before we went live. That's his recommendation was generally that we should aim for a top score in any citation we do. So we're very pleased that we have Mr. Marshall tonight, and I'm certain that each one of us will learn a lot from him. So I'm not. I'm representing the our splinter, the group and I have with me other mentors from our large group.
And we have Schwann and you're helping us tonight. And also we have the team from our UK, the educational team from our UK, Imogene and Hannah. So this session basically will include this talk from Mr. Marshall. There will be a little bit of interaction and there will be an opportunity for some Viva and some questioning as well and some feedback. So if those who are interested, please express your interest and Hannah will be taking names.
We understand that this could be stressful for any candidate to speak in front of 130 people, so we will take that into account and we understand this stressful situation. We all have been there and we all respect you, whoever comes forward. Just after the session, there will be the usual survivor practice, and CPD certificates will be available if you contact the or UK educational team.
If you missed any part of this lecture, don't panic, we will. We are recording it and with the permission of Mr. Marshall, we'll be able to share that later on. So without any further ado, I will leave you with that, Mr Paul Marshall. Thank you very much for us. It is a pleasure to come and talk to you this evening. I don't know whether KneeKG Walsh is here.
KneeKG is an associate specialist who works with myself and Lancaster, and we worked for many years, and I know that KneeKG is encourage me to participate to the group, which I got an email yesterday saying, your speaker's not here. So can I help? And yes, I'm very pleased to be here. I'm going to just give a little bit of a talk about what I think is helpful for you to approaching it as an examiné.
So I examined in trauma and pediatric orthopedics for five years, and I was probably. Five years ago when I stopped, so things may have changed a little bit, but there's still the same emphasis on scoring the candidates to give them a mark. I mean, you've all come this far in your medical careers. You all sort of know it's a little bit of a game. You know that it's not quite the same as clinical practice and particularly the short pieces, and probably less so the vivas, where you don't, it's just not something that you do day to day.
You never approach a patient and examine this patient's shoulder. Examine this patient's brachial plexus without taking a history. It's very sort of a foreign experience, especially with somebody watching you. And I think the best way to do well at that, as you probably already know, is to practice it, practice it with colleagues, pretend it's an examination and it becomes more and more sort of ingrained in how to do it.
So I'll talk a little bit about what give you some, I hope with some hopeful, some helpful tips about the exam, if we sort of. Then we'll probably open it up to questions. And if you had experience of the exam and you want to share that, that is fine with me. If you've got particular questions, you know, specific questions around orthopedics, trauma, pediatrics, then we could open that up to the group and discuss that.
But essentially, the examiner, as I said, is trying to give you a score. He's got 5 minutes in the Viva pediatric Viva 15 minutes and that's three questions and you score each question, so each question last five minutes. And that's not a very long period of time, really to get to the bottom of a topic. And it's certainly very difficult to test what the examiners like to call higher order thinking and higher order thinking, I think comes from sort of human factors, background where you were sort of thrown things which are a bit unusual.
And I think one of the ways of thinking about it is airline pilots. When they're sort of got nothing to do, they're up in the sky. They sort of play human factors, games they play. What if games? What if this happens? What if that engine fails? What if this happens? What if we have this incident and examiners can sometimes bring that in?
What if this happens and that is their best, best way of trying to test your, your higher order thinking and how you can think on the spot? But essentially, each section, each sort of question is scored, and most candidates will get a five, six or seven, and a 5 is a borderline fail and a 6 is a borderline pass and a 7 is a good pass.
And occasionally you might get an eight if you've got a really excellent answer and a 4 is the sort of bad fail. It's not to say it's irredeemable, because if you score well in other sections, you can make it up, but you don't want to score a four. So to try and avoid scoring a for the cat, the examiner wants to make sure that you're safe. So the first part of the question will be, is this person safe?
Is it safe to be a consultant, trauma or orthopedic surgeon on day one? OK, so the way they will format their questions is that they were the first part of it usually is how can I test if this patient is safe, ok? And then once they've established that the candidate can give a safe answer is safe to practice, then they'll sort of rack up the questions a little bit more and say, well, yeah, he's safe.
But has he got the knowledge and the sort of experience, I suppose, to pass? And then if he's got that level of skill, you see, is he a good pass? Can I ask him a little bit more of a difficult question just to see if he can, if he can answer that. So we can get him into a good pass? So there's a stepwise progression, really. So every question starts with that stepwise progression, particularly the first question that you get asked in the vyver if you answer the first question, well, I'm sure it does have an effect on the examiners to think, well, this is a, you know, this is a good candidate and he's doing well.
So the first question is key. But I think you probably know that already with any sort of consultation, any sort of. Interface between people, the first 7 seconds are really important. So, yes, you can walk in and the examiner will, may, may or may not offer you their hand to shake. Obviously, in Kobe times, we can't do that. But do the appropriate thing.
Say Hello. The examiner should introduce themselves and they'll check your identity. So the first part of the question is sort of a settling, settling question, examiners are sort of vetted. So we don't like examiners who are sort of a bit maverick, a bit difficult to throw, to throw sort of Googlers. If you like to try and catch you out, especially early on in the vyver.
So you might start in sort of Pediatrics where you supracondylar fractures of the humerus. You sort of expect you might get that question and you might say, well, you're called to the emergency department. They tell you you've got a child with a supracondylar fracture. He's fallen out of a tree. He's eight years old. And then I sort of ask, well, what do you want to down the phone?
I mean, it's not a difficult question. What do you want to know from the emergency department about this, this child sort of what's the neurovascular status? When do they eat or drink? And then? What are you going to do next? So I want to hear that, yeah, I'm going to go down straight away and see this child with a super contra fracture.
OK, well, that's all good. It's pretty easy. And then how are you going to assess the neurovascular status? What are you going to do to assess the neurovascular status? So it's just getting a little bit more sort of involved, if you like. I want to see that the candidate can assess radial median, ulnar nerve.
OK, so that does take about a minute. And then we sort of move on. And my general approach after that is to of, you're taking this child to the theater. OK and what I probably don't want is a lot of preamble about getting everything ready, et cetera. So we want to if the examiner asked you a specific question. Answer the question.
OK, so you've got the chart in theater and how are you going to reduce the fracture? OK so if someone is giving you a fairly specific question to answer, you do your best to answer the question. Ok? and then the examiner might want to interrupt you if you get a chance to talk. It's probably a good idea to talk, and so particularly if you can show confidence in the management of a condition.
So one. One question I might ask is, have you been involved with these cases of this nature and you may not have had that much involvement? Hopefully, the Super controller fractures, you've got a reasonable amount of experience, but there may be cases, for instance, slipped a pipe assist where you may not have had that much experience, but there is.
You are expected as a day one consultant to be able to manage that condition. So yes, I have had experience of managing this condition. So it then progresses as to essentially, how are you going to. Are you going to stabilize this fracture? Are you going to? Are you going to fix it with wires? What? why is he going to use?
If you can sort of lost the examiners sort of guiding you along, try and rack your brain for anything that you can about the literature or about boast guidelines. Because if you can bring those in to the discussion at some point, even if you don't get it completely right, it stands you in good stead because one of the things that differentiates a sort of a borderline pass from a good pass.
And as I say, you want to aim for a good pass rather than a borderline pass for every question is knowledge and application of the literature. So there are certain sort of key papers if you like, and even if you can't remember the authors, you can, you can put into the discussion. Well, the both guidelines say this, or there's a good paper that I've read recently, which says this, and they come, and it might take you up at NIPE and say, well, where did you read that?
What did you think of the paper? And you might then say, well, I'm sorry, I can only remember the abstract. That was the message that I got from the paper one, which is, OK, you know, you've done your best. You've you've put something forward. And it is good to be able to the recent literature bone and Joint Journal over the last sort of a couple of years. It papers that have been published recently in that journal or the height, a highly valued journals with things to contribute.
So trying to score four seven, you never know quite how the examiner is going to give you, often you walk out thinking often terrible, you know, I didn't answer that question very well. But what you think and what the examiner thinks is not the same. And then once you've got 5 minutes is up, you've got to start again. So it's like, I guess, a bit like cricket in the sense.
You know, the examiner bowls your ball and you can sort of see where it's going to go, you know, supercontinent fractures slip to persist infection, Chuba. What the boat, once that's been bowled to you, so to speak, think in the back of your mind, what do I know about the literature around this topic? What can I sort of bring into the discussion in, say, two minutes time?
That will convince the examiner that I've got more than just to borderline knowledge that will convince the examiner that I've got it, that my destiny is a good, a good pass. So those are the sort of fairly simple things I would sort ask you to focus on. I mean, you may say that's fairly obvious. And I guess it is a little bit obvious, but the examiner is trying to give you a number and you want to get a good number from the examiner.
So that's. I think that's probably the main things I wanted to say, so we probably open things up, I don't know whether I've got any questions. I'm going to have a look here. Yes yeah, we got them. I think that was wonderful advice really and really reaffirms that general approach that I like that you advise candidates to go to have a sort of a timeline, isn't it?
I noticed that within 1 minute you said we starting on the theater questions. Yes, because some candidates have that tendency to ramble along and keep talking about assessing neurovascular and consenting and preparing theaters and stuff. They find themselves into the fourth minute, and they haven't really answered the question yet. So the good examiner? Yeah, Thanks for us.
Good examiners will have a way of sort of stopping you. You know, I'll do the consent and et cetera, et cetera. But it's all good to do that, and I'll examine the patient according to its protocol, which is a good thing to say. But you've got to think in the back of my mind, where is this going? This is a question about supracondylar fractures of the humerus, and you've got to wrap your brain for any sort of extra little bit of information about that topic.
And sometimes it takes a while in the pressure of an exam to bring that information forward. So my suggestion is, once you know what this is about, I think, what do I know? What extra do I know about this topic? And then towards the end of the five minutes, you know, minute four, you might be able to say, well, there's some literature on this. And I remember reading a paper about this, and this was the message from the paper.
And that gives the examiner a good impression because at the end of the sort of five minutes you've told him, you know, a little bit about the literature, you may think, well, they knew a little bit, but they didn't know very much. But it might be just enough to get you up into a 7 from a six. So that's sort of where I'm coming from for us. Yeah so yeah, the examiner, good examiners will stop you from waffling on.
But if you're on, if you think I know this, I really know this, then. Then you keep talking, keep talking. They will let you talk. Sometimes if you make an error, they will. They will pick you up, and sometimes they won't, but if you know it. Keep talking, I think, but be always be guided by their sort of eye contact and whether they want you to stop.
OK I think you just answered the question that was asked by one of the candidates in our audience, chenille koshy, he's asked. If the subject very well or can sense where this is going, shall we just keep going and she, as a candidate, just keep talking all the time. Or, you know, let's say examiner says, how would you examine this patient? Just he just examined and then move on with the topic or just examine and wait for more questions.
Yeah, in the short case is the examination. It is OK to seek some clarification. But, you know, the examiners are really fairly specific, examine this patient's shoulder and you have to have a mechanism for examining the shoulder. I think it's permissible in the short cases, I think it's permissible just to ask the patient, do you have any discomfort or tenderness in your shoulder? Before I examined you, I'd like to know whether you've got any pain and could you show me where the pain is?
I think that is a nice thing to ask, and I don't think the examiner is going to stop you from saying that because even though it's a bit of a theater, it shows that you've got appropriate concern for the patient before you examine them. So that, I think, is a good thing to do in the short cases, but they are very specific. Examine this patient's shoulder, this knee.
They may want to be more specific, like examine this knee for clinical instability. Examine this shoulder for evidence of rotator cuff tear or impingement. So if they are specific, then you need to tailor your examination to what the examiner is asking for. I don't think you might be able to comment on this for us, but I I'm quite happy for candidates to talk as they're examining.
And some people don't like that. I sort of input into that would be my default. To talk as you, as you're examining it helps you in your own thought process as well. It gives the examiner something to listen to as well as to watch. And they might then sort of just. Yeah, just guide you a little bit or interrupt if you're talking as you go along.
So I don't know whether you've got any views on that yourself for us about should you talk when you're examining the patients? Yeah, I think we totally agree with you because the examiners, sometimes in the heat of the moment, they don't know what exactly the candidate is trying to examine. It could be a little bit confusing what they are trying to palpate here or what tests they are doing.
So at least if they talk as long as they don't overthink it and as it's just of professionally saying, well, I'm putting the knee in at 20 degrees, the Gluckman test I'm doing, you know, just gently, you don't have to have because they also don't want to irritate the examiners or insult the intelligence of the examiners. So it's, I think, definitely talk. But, you know, keep it to the minimum.
That's the examiner will need to know. I mean, if you, you know, doing trundling back test, for example, you don't have to tell examiners exactly each step you're doing. I'm putting my hand, my hand on the pelvis. Now and now I'm asking don't have to do. These are very obvious things, but you could just talk to them about the salient points, how you are assessing the abductor, you're looking for pelvic tilt.
This kind of thing. So it's a game, just have comes with practice. But I think we've got to talk. If you're just someone goes silently and just goes and examine, I think that's very, very difficult for any examiner to score them. So if there is a danger that you are going to describe the examination without actually performing the examination correctly.
So anyone that's planning to speak in the exam, which is not a bad thing, I agree with it because it gives information as you're doing the examination. So you're findings. But also what are the key points in your examination? But yeah, I mean the doing that in real life as well, because what tends to happen is you tend to stop and describe what you're doing before you do it.
And that's think it is that irritates examiners, Yes. And irritates me when I'm trying to examine someone on their practice. Yeah, you don't want this to slow you down if you're talking, if you have to stop to speak, that's also we will be wrong. You'll be using a lot of time. So you have to talk as you go, not losing time, obviously, and it just comes with practice.
It does. It exactly does come with practice. It's not something that you do in a clinic. You don't talk to, you don't talk to the wall whilst you're examining a patient in clinic, you maybe talk to the patient. You maybe get more of a history, but you don't tell them I'm doing it. This is a trend.
Now I'm going to trend Allen books test, and it is a very, very alien sort of alien to clinical practice, as you know. I mean, we've all come we've all done these sort of clinical exams in the past, but I do think a little bit of talking can be helpful. And I think it is also very good practice to of, you know, think it's good to introduce yourself to the patient was that's a nice thing to do.
It doesn't take a minute to do that. And I think it's also good to ask them if they've got any particular discomfort in the area where you're going to examine and say that you examine it very gently and please tell me if it is uncomfortable for you. So that's I think, is a reasonable exam. Don't waste a lot of time with that because the examiners, you've only got a few minutes to do the examination, but I think it is quite a good thing to do.
But again, for us, if you've got views on that or you just get on with the examination. I think you just took, I think, but you have to not overthink it, basically. Example, if you think, you know, examining the arc of movements and putting the arm in an external rotation, you don't have to say I'm doing external rotation. So it is very obvious. So you just say external rotation is so and so internal rotation is so you don't have to tell, well, I'm doing external.
It becomes too basic. And like a medical student, kind of. Indeed yeah, you want to make sure that you're pitching it out at the level that you are sort of at Fox trauma and North. So you could sort of say supersprint itis impersonator subscapularis in terms of your assessment of the rotator cuff. I think there's a tendency to go away from eponymous names now isn't there in the exam, but all the examiners still know the eponymous name.
So if the eponymous names, then I would volunteer those names. It won't do you any harm, and it's very good to hear from you. Sorry so the points out to the guys who are watching. Yes, we are talking about examinations, and I know that over time we're not having any patients in the exam and that the patient is actually going to be the examiner. But you're still not allowed to touch the examiner because of COVID restrictions.
I do. We appreciate that. But we are talking about normal times and there are people who are preparing for the exam next year, and we're hoping to do that. I mean, I'm not actually you would know how the fix for North exam has sort of is going ahead with COVID restrictions, isn't it? So there are sort of in these dark days of covid, things are different, but things will get back to normal.
I think the I think and ironically, the guys who were practicing talking while they're doing the examinations will probably do better because what the examiners will ask you to do is describe the examination to them. Yes, or demonstrate on yourself or, for example, how you're going to place your hand, where and so on that yes, it must it must be very difficult examining somebody, you know, doing on a screen like this really very, very difficult. So, Mr Marshall, I've really liked when you were discussing about how to kind of score high mark by quoting literature and you passed on very, very important message here.
You know, if you've only read the art, the abstract, you could say that, isn't it? You can. Definitely yeah, for me, you can say that. I mean, in the heat of the moment, and it is very difficult to recall. I mean, everybody, it's such a big syllabus, at Big Lots to learn. But if you can just remember something from the literature or read through the bone.
And Joint Journal for the last two or three years, you can say, well, I remember reading an article within the bone and Joint Journal within the last two or three years because that if that's the journal that you've read, then you can put that forward. And the message from the paper was this. And I think the examiner knows that you probably haven't, you know, you can't critique the method of all papers and be able to discuss them.
But I would put it forward that you've read the paper and this was the message of the paper. So it's the message that does come across quite well that you're looking at the literature and you're saying, well, what's the message in this for me? I mean, we often sort of in our own areas of expertise. We we sort of finely critique papers. But if we're just trying to keep ourselves up to date, then we're looking for the message in the paper.
And I think if you give that message to the examiner, it shows that you're reading the general literature in a sort of an intelligent way. Yeah, I totally agree with this. I think there are a little bit of mixed messages here. Some candidates worry that if they quote literature, they might be quizzed on a paper so that the examiner can't tell them, OK, you're cutting this paper, so tell me how many patients recruited was there the statistical analysis method they used?
How reliable is this paper you are quoting? They get too worked up about this, so I don't know what my thought, my thought. I think if, if, if that paper is just supports the general understanding. And it's not controversial and does not contradict anything that's common practice, then you actually are very unlikely to be challenged. But if you suddenly say this paper says you can cover in a wound and there will be no infection, then of course the examiner is going to ask you about it in details.
But I don't know what your views on that. And because we had a lot of questions about this, how the best way of putting literature on them, you know, people want to know why it is difficult, but I would. I would sort of encourage you to do it because I think you're more likely to do yourself a favor than to dig yourself a hole and the examiners, you know, maybe they wrote the paper or they know somebody who wrote the paper.
It may be their area of expertise, and they may want to just show you how knowledgeable they are about the paper, but they're not supposed to do that. They're there to assess you, the candidate. So I think it's unlikely that you will get that sort of they'll probe a little bit. It's this sort of what's the depth of knowledge here? So, yeah, OK, well, tell me a little bit more about the paper.
And all you can say then is, well, I'm sorry, I just remember the message for if you can remember a little bit more, you know, just give a little bit more that you can do without sort of digging the hole. I suppose you've got to be guided by the signals that you're getting from the examiner. But it is OK to say, you know, I'm sorry, but that I remember the message from the paper, but I don't remember the details of the method and the discussion, and I think that's OK.
You know, I would've thought of I would support that. I don't know whether I definitely think it's worth quoting literature, but you need to quote it correctly. So where examiners, where I have always picked on someone is when they've misrepresented the literature or misunderstood it, and that's when you can dig yourself a hole, isn't it? That's when the examiner you. That's it.
The examiner will take you into that direction and start. Yeah so I would, with that in mind, know every paper that you read in preparation for the exam. Ask yourself, what is the message from this paper? You know, I might have to regurgitate, you know, I might have to recall this in an exam situation. What can I tell the examiner about? What is the message for me or for my clinical practice from this paper?
And you get that from the abstract, really? So that's in the days before the exam, you know, before the part two comes around, sort of glancing back through the journals, looking at the abstract. But if you find something that catches your eye and you're interested in it, then by all means sort of follow that up and maybe Google it or look on also bullets and just see where it takes you.
Because sometimes that sort of inquiry helps you think helps you to remember things. If you let your your, your, your, your sort of mind your natural tendency to inquiry into things that often helps to secure it in your memory a little bit. But yes, it's the message. What is the message in this paper? You know, you don't have to know where it comes from or who the authors are, but the message is, is what I would encourage you to put forward in the exam.
Thank you, Mr Marshall. We have a few questions that also come in with people. So they didn't ask is from your experience as examiner, what do you think the main reason that people candidates unfortunately fail the exam? And is there any particular irritating traits that you noticed in the candidates that you think that could be avoided?
OK, I think sometimes you get a feeling that somebody hasn't really done this procedure or they haven't really seen this sort of problem, and it can be difficult depending upon the training that you've done. And if you haven't done a pediatric job or if you haven't done a hand job, then you're sort of at a disadvantage. I suppose you are at a disadvantage. But to those people who haven't sort of I haven't seen this particular procedure, but these are the principles of management.
So I think. Uh, if you aren't confident in an area, then the examiner sort of gets a feeling for that fairly quickly. They get that sort of vibe. And I suppose just sort of. Keep, you know, keep yourself going, we've all been in those sort of situations where we're not particularly confident in the topic, And the examiner is sort of asking us more and more questions, and we're wishing that the Earth would open up.
But I think you can come back to the situation you. This is another little point, actually slight, slight sidetrack, but they often ask you, ask you a difficult question and you say, well, there's more than one answer to this question, you know, so you can say, well, there are two different, you know, it's not a bad idea to say, well, there's this approach. And that approach.
But on the unit where I worked, this is how we manage this problem. OK so that is certainly more sort of that's certainly stronger than this is my opinion. What you were saying is where I worked, the person who trained me, the person who supervised me, this is what they did. So it's a little bit more there's a bit more strength to it than this is just what I would do.
It's what my trainer would do and what my supervisors would do. And the examiners might think, well, I don't really think that's a good idea. But you know, that's what some people do, and that may be help you a little bit. And if you're feeling really, really confident and this might be slightly overconfident, you can say, well, I've worked on two units and this is what we did on one unit and this is what we did and another unit.
And then the examiner is going to say, well, what are you going to do? So you have to put that forward. But you can sort of if you introduce into the discussion on the unit where I work, this is how we manage this sort of problem that can be helpful if you're really just try and ground yourself in being safe. And sometimes the answer is I would refer to a bone tumor service or something like that, something tumors come up quite often.
And you know, the examiner wants to do to know that you in the real world that you are not going to sit on this problem and not refer it to a bone tumor service for a bone tumor opinion. OK, so your threshold is pretty low, but and it's good to put that into the conversation, you know, in a practical situation. I would look at this imaging.
And I would discuss it an MDC meeting, and I would specifically want to know whether it needs to be discussed with a regional tumor or a national tumor service. So you're putting you've been in that situation before, and the examiner might then say, well, OK. You all that, you all the regional tumor service. How are you going to respond to this colleague who's referred to you this bone cyst?
How are you going to manage it, so to speak? I mean, it sounds as though they're making very few of us are going to be bone tumor specialists because it's a very niche sort of area. But it's a good way of the examiners sort of testing your knowledge a little bit. But the point I would make is come back to the practical situation in a practical on a day to day basis on my unit.
This is how we would manage this patient, whether it means referring on to another unit for good reasons or getting another opinion that shows that you're not going to. Um, there's a fine line between having confidence to deal with. Problems which you're expected to deal with yourself as a day one consultant, but a day one consultant, you're also expected to say, well, I know what this is and I know I haven't got the expertise to fix it or to do it.
So I'm going to do the right thing and I'm going to get an opinion from somebody who's got the expertise. And there's sort of no shame in that. But then you can make that point and then say, well, these are the principles of treatment of this sort of more difficult condition. But make the point that in practice, you're not going to take this on yourself as a day one consultant, you can see that this is something that needs somebody else to have a look at.
That means you're safe. Yeah, so being safe is really important. Absolutely, we try to emphasize the same safe mdc-t approach is the way forward in the exam. We have one more question. Also, we just all three key questions. OK, so Mohammad egawa asked. He's worried that if he gets the first question wrong? Yeah, that's going to leave a wrong impression for the whole of the station and probably the whole of the table with both examiners.
If you get the first question, just, you know, he's worried about the first impression. And if he answers the question wrong, leaving a bad impression. Is that correct? Is there a way to come back from that or? But there is a way back know, I've seen kind of a handle on the first question badly and then and then handled second and third questions well.
And the examiner has got to move on. He can't just go on. He cannot just ask you one question. He's got to. He's got 5 minutes and he's going to ask you a second question. So they should know. They try and ask a sort of a question, which is based upon an everyday, you know, like super superconductor.
Fractures in children tend to treat infections in hands, things that you would sort of expect to come across, you know, fairly often. And that first question? You might not think it's a particularly easy question, but someone is probably. It's his first start of questions, so try and be really confident in that first question. Thank goodness.
Thanks for asking me about tendon sheath infections. This this is how you manage tendon sheath infections. Thanks for asking me about supracondylar fractures. I'm just going to talk about this until. And the complications and go from there. So, yeah, try and be more confident than you sort of feel deep down in your response to the first question. The examiners will give you credit for the second and third questions, but I think it's just a human thing in a way that people perform well in the conversely, if you perform well in the first question, then you can sort of you're off on a good footing with the second question.
So it's not impossible to make up the ground. So every time they bowled you a new ball, think I'm going to hit this for six? I'm going to try and score a 7 for this. This this particular question. I'm going to think about the literature in the back of my mind. I'm going to try and introduce that at the end of the conversation, even if there's not a particularly obvious place to put it in.
And I'm going to try and force this my knowledge about both recommendations and the literature that I've read. So sorry to go on about that. No, it's been examined, and it would have cut me up a long time before the going on like that. They would have stopped me. They would have put up their hand and said, let's move on. We have one more question. Now there are some examiners, so my apologies.
Just just to reinforce what the commercial was saying. And if you've done really badly and it's 5 minutes per topic, if you've done really badly on the very first topic, the examiners are not allowed to take that impression to the next question they're going to ask you. So they've put it behind them. Maybe they're all human. Of course, they might have something in the back of their mind, but they've put it behind them.
You need to put it behind you. You need to develop. The technique of this is a new question. This is a new chance. This is your chance to get a 7 to make up for the five on the last question. So don't be despondent. Just put it down. Take a deep breath and focus on the next question that you need to develop that technique as well.
So don't panic about getting a question bad in the first. Yeah, I would completely accurate. That's one you've got to this is a new question. I'm going to go and I'm going for this question is though it's I've forgotten the previous question already. I'm going to this new question. You've got it. You've got to have that mindset. It's not easy.
I know it's a pretty high, stressful, high stakes exam, but that sort of approach is the way to do it, I'm sure. Absolutely yeah, it's not easy, but it's the way to pass this exam now. I have a 1 question for us, if you don't mind. Yeah Yes. Yes, we have some more questions. Go ahead, honey. What's your question?
Sometimes Mr Marshall, the candidate is like speaks faster than he thinks. So if he said like a stupid answer and they want to stop and rephrase his answer again, what do you recommend for him to do? Or to say some people do say things that they realize are not correct. And if you do do that, you can correct yourself. And I would suggest if you say, well, I've said, you know, I said something that was incorrect and I didn't realize, you know, it just came out because I was like a little bit nervous.
I suppose you can correct yourself. And the examiner will have noticed if you said something wrong, because these are questions that they've asked a lot of times before. So they sort of know what people are going to say, and they've had a number of candidates who they've already asked that question to. So they have favorite questions. So if you think what I did say something wrong there, you know, it was a minute ago and I said something wrong.
You know, I just remember that I said what I said at the beginning. I just want to clarify that what I really what I really meant to say was this. So if you do say something that you think, well, I shouldn't have said that and that was wrong. I think it's good to go back and make it clear that you, you realize you've said something wrong. I think it's better to do that than to hope that.
The examiner didn't notice it because I think the examiner will notice it, so fluorescent changes the faculty today want to comment on that one? Yeah, absolutely. If if you've made something, if you can actually watch the other person who's not asking you the questions. I often say that if that person just suddenly sits forward or puts his head up more often than not said something that you shouldn't have said.
So take a moment to think about what you said. Don't overthink these things. But if you feel that something is wrong? Take a deep breath. Again, I can't emphasize this enough. Rehash what you said. And, Uh, say I misspoke. I meant x, y and z. But waking the bear, which is often who I call the other examiner, is a bad sign.
He could only say I misunderstood the question and I answered wrongly. And I would like to withdraw that and restart. That's definitely the examiner would even acknowledge this, and there will sort of respect the candidate that's that's, you know, admitted their mistakes rather than just continuing to bluff around and hope the examiners will have noticed. So, yeah, Mr Marshall, one more question, if you don't mind.
So there are some examiners who have a reputation of being difficult and they fail everyone. So candidates can go to that station and see Mr so-and-so, I think, oh, I'm failing the station, definitely. He fails everyone. He failed me last time, he said, my friends. And how true is that? Is there some truth in that? How true it is.
What's the best way you can approach such a situation? Yeah, I don't think there's much truth in it. I think the protocol for sort of assessing examiners, examiners. So do examine because they like failing people, they sort of do it because it's a sort of part of their own development and they feel it's a good service to do for training and they really just want to give somebody an accurate. They want to give them.
They want to get the best out of a candidate. That was my that was going to be my final point. I as an examiner, I as an interviewer want to get the best out of you. I don't want to get the worst out of you. I want to get the best out of you, so you want to give me your best and I want to get the best out of you so that I can give you what I think is a good score.
I mean, we've all in our past, I suppose, had bad examiners examination. You know, give us a lecture on something when we've said something, which we didn't perhaps mean to say. But the vetting process for examiners and the sort of quality assurance, if you like of examiners is such that, you know, I don't think those days are over, you know, everybody can sort of. Think, oh, he's so and so he's does this, but.
We all get at the end of our examinations, we've got a sort of a breakdown of our story. And you should try and, you know, you shouldn't be an outlier like in anything in orthopedics, don't be an outlier. So you don't want to be an outlier where you were too much of a dove, which is a dove, is somebody who basically gives the marks too high.
And then the hawk is the one who gives the marks too low. So at the end of the examination sort of session, all the examiners get their own marks Fed back to them. And you should sort of look and make sure that you're not sort of, you know, that you want to be sort of scoring, you know, like everybody else is scoring. And if you're scoring too high or too low, you've got to ask yourself, you know, why am I scoring too high or too low?
And I do honestly feel that people who are examiners do want to do really want to get the best out of the candidate and to help them through, which is really tough. You know, a really tough exam. So, yeah, maybe I'm biased because I was an examiner. But you know, I've also, you know, I do remember being examined, and you do sort of think this exam is apt to get me for some reason.
But I think a lot of that is in your mind. Honestly, I do think it is in your mind, and I think they just want to assess you and give you a fair sort a fair assessment. I really would say that. Thank you. I think that that's thank you for explaining this. That will put a lot of mind at rest and especially those going for the exams.
Your words are very reassuring on that aspect. Do you have time for more one more? Yeah, Yeah. If you've got a couple, yeah, please do something. How of it? Ask if, if, if you are unfortunate in that situation, when you got the first question wrong, the question that's only maybe starting or competency question, you got it wrong.
And the examiner then or you say, I have no clue about this, this topic and the examiner didn't change the topic or change the question completely? Or does that mean it's a fail? Well, they will, probably not. Probably not change the topic completely, they will give you a sort of more prompts, really. That's often what you know, if you're struggling in order to get the best out of a candidate, you give them a prompt, you know, sort of what.
You know. So supracondylar fractures and an absent pulse, you know, what would you do with that sort of situation and a good candidate would be able to say, this is what I do and this is what I've done. You know, it's quite OK in the exam to say in my I have had a case like this, which I managed, and this is what this is, what I did or this is what I did with my supervisor.
But if you're struggling, the examiners usually gives you a little bit of a prompt. And then if it's just like any other sort of difficult situation, you can sort of try maybe go back to first principles or you can try and go back to in a practical situation in a work situation. This is how I would answer this problem. So you can sort of go back to that point.
And I think if the examiner chooses to move on, you've got to move on to I mean, you don't really have a choice, but they will give you that give you quite a bit of prompting, I think, before they move on. And if in that situation with this kind of still have a chance to pass that question or I think it depends how much prompting they need, I think, you know. To sort of get it to be to get a sort of bad faith, if you like to get a for you, probably the most examiners would feel, well, this candidate was unsafe.
He was not he or she wouldn't be safe to be a day one consultant. So I think for me, that was often my justification for giving for and you may say, well, there's a certain core knowledge that you need to be a day one consultant. And if you don't have that knowledge at your fingertips, I mean it knowledge in the world today is on your phone, isn't it?
Or every single bit of knowledge in the world is on your phone. So this but you've got to there's a certain core knowledge that you've got to have inside your head, particularly from the examination point of view. So yes, the examiners should give you prompts. But I, you know, I guess if you're really struggling to go back to if it's sort of basic science or, you know, those sort of things go back to first principles.
These are the principles. This is what I know about this topic. You know, even if it's not exactly the question. That I've been asked, this is what I know about this topic. So I would, you know. Try your best, I think, being silent and saying, I'm sorry, I don't know anything about this. It's a difficult one for the examiner to. I can't help you through that you've sort of given them that, I don't know anything about this.
That's not a good way forward. But just tell them what you do know, even if it's sort of not exactly what they've asked for. I mean, they will then sort of maybe sort of pull you up on that a little bit, but I think it is probably better to give. Some knowledge, which, you know, to be sort of true if you like or good knowledge, even if it's not exactly what they've asked for, then they will probably prompt you and ask you and probe and see where exactly where your level of knowledge is.
I don't know. What do you think about that Schwann and for us? I'm from yeah, I won't. So I would never buy someone to just say, I don't know something if you don't know something, you really don't know. And it's at a higher level. That's fine. You can say it if you're already at 7 or 8 and you've done really well in the last minute.
I don't know is a sign of integrity in a lot of ways when they're asking you about that particular literature in Journal of hand from 1947 or whatever. But if you are on the very first question and you say, I don't know, the examiner can't do anything for you, what you can say is if you don't know the answer they're asking you, you can say, please, could you rephrase? I'm not sure.
I understand the question that gives the examiner a chance to prompt and rephrase and maybe add an extra little bit of information onto the question that he was asking you. And it would be considered a prompt, but it could pull you into the situation where you can answer the question much easier. I think that's a very good point. John, you.
Could you rephrase it, I'm. Uh, or even going back to the. Even if you're not sure the question repeating the question back to the examiner in a slightly different way, is this what you want me to talk about? So that sort of clarification is good? Yes, Yes. Or can you rephrase, is it possible for you to ask that question and to rephrase it is a reasonable thing to do, but I would always, you know, to try your best to try and.
You know, do your best with the question, obviously. But there are some questions, I guess, which are really difficult, but those difficult questions should come at the end rather than at the beginning. So you really got to try the initial questions. You sort of try and put together an answer, even if you can feel a bit uncomfortable with it, but try and put an answer together. That would be my suggestion, I think.
Yeah, totally agree. We've been doing this for some time and we've seen hundreds of people who slip into the exam and we've heard a lot of people. I don't think I've ever seen a candidate who cannot answer the first question or say something about the first question. Things are extremely rare situation, but maybe the advanced questions obviously that can happen and that not always a bad thing, as Sean said.
But, you know, would be extremely rare. I mean, if they are not behaving to talk something about the opening question, something at least, you know, say something that's, you know, has some meaning. So just give the examiner something to hang on to and to help you. I think we can all say something about any x-rays or any topic, even if they're not going to give you anything that's not you've not seen or not read in the books anyway.
So I think they'll be extremely rare. Yes Yeah. That's not knowing about the first question in the table. So I think I think, yeah, I think all the messages we had is just echo what you said, Mr. Marshall, about you have to redeem yourself and be confident and try to gather yourself up. And it probably the examiners will, you know, have a lot of respect to candidates who maybe has been put off a little bit to start with by not answering well.
And then he picked up himself up. And you know, for the rest of the questions, I think they will definitely respect that. Yeah, I think that yeah, you're not sunk. If you find the first question difficult, do your best and then think deep breath. This is the second question I'm going to make up for it. I'm going to make up for that first question. I'm going to I'm going to really show them.
So you have to have that sort of different that sort of approach, which is difficult, but you've got to I'm sure that's a way to score marks and to get through it. Sure, that's the way. Absolutely well, that's wonderful, I think. Does anyone know if I also the ministers have any questions to Mr. Marshall while he is here? I know Mr. Marshall has another meeting to go to.
don't want to hold you back from that meeting, but actually, Mr. Marshall, just quick question, if you don't mind if a candidate demonstrates unsafe, what you would consider unsafe level four, does that carry on to the other, to the rest of the exam? No, they. You'll get that before. There's no the philosophy of a killer question that the pediatric surgeon sits alongside the hand surgeons.
And the idea of a killer question is, is it's a bad concept, really, because sometimes what the hand surgeon might think is a sort of killer question. pediatric surgeon, I think, well, I don't think that's really fair to ask that killer, make that a killer question. And similarly, in pediatrics, you might say, well, that was a really bad thing to say, but the hand surgeon might think, well, I don't think it was that bad, you know?
So the concept of a killer question to completely fail somebody for everything, and that's not the way it works. I mean, you may get a four at one point, but you can make up for a fall. You can make up for a fall. So that's why the philosophy of I'm going to school, I'm going to get 7 out of every single question they ask me because, you know, life, sometimes you don't.
You don't quite get a seven every single time, but you need to aim for a good pass for every single question because there'll be one or two questions where you may be a little bit borderline and that's just the nature of exams and questions. But to have that mindset that every single ball ball that they bowled to me, I'm going to I'm going to try and get a good pass from this. I'm going to try and get a 7 from this, and I'm going to do that.
I think I think the question may be and trying to get to or, you know, if someone is really, really said something really unsafe in the exam, let's say they missed a terribly display, cervical fracture dislocation and the patient dies from respiratory arrest or something. Is there a decision made collectively that this candidate, no matter how well he does in the other stations, he killed the patient and therefore he cannot save to pass the exam?
Is there such a thing? No well, I can only speak on the basis of my experience of an exam five years ago, us. But no, there isn't. You cannot sort of play that sort of card and say this. I failed this candidate completely. You can give them a 4 and it is a little, you know, you've got to score well on your other questions if you want to overcome a four, but you cannot be sort of completely wiped out because you, somebody thinks you, you've done something that's unsafe, that doesn't work.
So, yes, you can still make it up if you felt you've said something that's unsafe, it's obviously. Don't try not to say anything that's unsafe, but that is quite an important message because we want people who are safe, even if they then maybe their knowledge is not sort of. You know, really, really on top of everything, but we want people who are safe and who will be able to recognize that maybe their own limitations where they need to ask for help in a practical situation.
But we also want to make sure that they can function and they have the competencies and capabilities to work as a day one consultant. I don't want to put yeah, I don't want to. I definitely wouldn't want to put people under the impression that there is a way that you can be just sort of eliminated because you might want bad one bad question. You've still got time to make things up. So that the idea, the mindset, if you like, I'm going to put that behind me.
I'm just going to focus on what's coming at me now is definitely the way to approach things. Yeah one more question, given that you have 12 scoring opportunities in a single Viva to examiners, can you still compensate for one or two fours? Well, yes, you can. I mean, as long as when all the numbers add up, you've got, you know, you cross the line, you've got a borderline pass and you've passed so you can make it up, you can make up for it.
I don't disagree that you can definitely make up for a single for maybe two, but if you've got three fours, I think even the standard that they pass is to get a 6 and how hard you have to work to get a 7. So if you get 6 on every table and every fiber question, that's a pass of the exam. Yeah, if you get one five, you need to get a 7. Yeah, so is right. And you know, that is why I know I keep saying it, but aiming for a seven.
Aim for a 7 for every single question because you won't get a 7 for every single question and that. But if you do, it'll help to make up for the odd the odd five that you might collect. So aim for a seven. But it is very difficult for a few. So four, you need two sevens to opt for four. So it really gets more and more difficult. I'm not saying it's impossible.
I agree with Dr. Marshall. It's not impossible. You should never give up. Yeah, but don't accept it for trying. No no. Try not to. There is one more question that we get very often asked, is that candidate? There are two examiners in the table and there is one examiner asking questions.
The other examiner is very busy looking in a piece of paper and writing letters and numbers and codes and stuff. And some candidates have reported that been looking at that second examiner, what they're writing, and they see them write five or six or seven or eight or whatever. Is that correct or is that just? Uh, well, not in my experience, I mean, you do make notes on the candidates, as you say, the other examiner is scoring as well, but that shouldn't be visible to the candidate.
So that would be bad examining for it to be visible. But from the point of view of the candidate, obviously, you know, do your best to focus on the examiner. You may get, as we mentioned earlier, the subtle movements of the non examining examiner who might lean forward or lean back. And those sort of movements without any facial expression, you might sort of pick up little things from that, but don't try, not try and focus on the examiner that's asking you the questions.
And from your experience as examiner, I don't know if you got involved in the marking, but obviously in the sort of overall marking. But is it common for I mean, for someone to score a 4 and the pass the exam? Theoretically, they probably have to score lots of sevens or an eight. Is that? I presume that's rare.
I mean, with someone who scored four in a question, be able to score lots of sevens or 8 to compensate. Is that common? Well, the honest answer for us is, I don't know. I wasn't involved in that sort of in those sort of scenarios, but it would be. I mean, it's not impossible to score a 4 and then to make up for it.
So that is the message I would pass on. And it's just a simple mathematical formula. You know, you've got to score a certain number of high marks to compensate for a low mark. It's just a mathematical formula. Lovely so, Mr. Marshall, I don't want to be holding you back. Well, you came at such a short notice out of your busy schedule and you squeezed us in your daily program and the pleasure.
I hope you have a good Viva session now. And thank you to all your participants for sort of your questions. And guys, I know it a really tough exam, but it is. It is an exam that is. Yeah, it is possible. You know, I know there's lots of it's always difficult when you're on the wrong side of the hill and you think I'll never get up there, but you've got to have the mindset.
Yes, I can. I can do this. I can get through this and every single, every single question they ask you, I'm going to try and get a good mark on this. I'm going to try and get 7. I'm going to think about the literature. I'm going to think about what the biggest recommendations are, and I'm going to try and bring that end at the end of the conversation because I just want to try and tip the examiner for giving me a tip me from a 6 to a seven.
Guys, thank you very much for inviting me. Thank you. Thank you so much for your short notice. Brilliant OK. Yeah, it's very good. Hope you have a good rest of the session and I'll have a chat with Nicole tomorrow. Thank you very much. Thank you indeed, Mr. Marshall.
Thank you. And we hope to see you again. We really enjoyed it. And OK, well, Yeah. Yeah, it's been great. Great to be here. Thank you very much. Good NIPE for us. Thank you.
Bye bye now. Bye bye. Thank you. Bye
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