Postgraduate Orthopaedics 2E Viva Guide to the FRCS(Tr & Orth) exam

The new viva book has been completed this week and sent on to Cambridge University Press for pre-production.We ended up a year behind schedule such was the difficulties of getting the material as good as we could manage

With the first edition viva book we were keen to write a viva book to compliment our main orthopaedic textbook.

We had a reasonable surplus of material available that we had been unable to fit into the 2e book. We were keen to go into a more detailed structured answer format to use in the viva situation rather than just going ahead with revision bullet points. We wanted to provide examples of higher order thinking and judgment for candidates to use in their exam preparation. The ICB have certainly gone down the path of structuring the exam towards higher order thinking rather than factual recall in recent years. We pre-empted this route 5 years ago without necessarily fully realizing that direction of travel at the time.

The 1e viva book was challenging in that there were a several viva type books already out on the market. This contrasted with the main Postgraduate Orthopaedics textbook which was the first of its kind with no previous road map to guide us.

We approached a number of post FRCS (Tr&Orth) exam registrars who did an excellent job of taking on the task of writing the allocated book chapters. Despite various   obstacles the viva book came together surprisingly well with the minimum of fuss.

When the book was published the complexity within some model answers took a while to be fully appreciated. In time there was a realization that perhaps 2 or 3 chapters didn’t quite hit our own expected high standards. The book was published very close to similar competing titles which ended up muddying the waters. The book became something of a slow burner gaining a favourable audience over time

As time passed we realized that the viva book was ageing. A decision was needed to either just let the book go out of date or revise it to a second edition. We chose to update the viva book to keep pace with the ever changing exam format

During the intervening years the standard of FRCS (Tr&Orth) exam revision books emerging had significantly improved and we wanted to stay ahead of these newer competing titles.

The two main areas that we have concentrated on are basic science and trauma. Basic science is by and large the most difficult subject for candidates to revise for and we wanted to significantly raise the bar for this section. Trauma is becoming more subspecialised with the emergence of MTCs so that candidates not only need a good working knowledge of standard trauma material but need to be aware of the updated thinking in polytrauma and open fracture management. There had been significant changes in practice in use of metal on metal bearing surfaces and the cement versus uncemented hip fixation debate continues to rage on.

Diagrams needed to be more professionally drawn and more photographs needed to be included amongst  the text

Although the whole exam is based on the T+O curriculum the mechanics of viva exam are very different to that of the MCQ’s and the clinicals. The viva exam allows for a more formal assessment of communication skills. If you are a gifted eloquent speaker with inherit tactical nous in answering viva questions that’s great but most candidates need some guidance. A standardized method of approach to answering a viva question needs to be learnt and thoroughly practiced.

These days the FRCS(Tr&Orth) exam is much fairer to candidates. It is rigidly standardized with defined protocols and etiquette that needed to be accurately reflected in the examiner/candidate dialogue.

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