Teaching

FRCS Exam

A number of testimonials from those who have been successful in the FRCS exam are collated here. If you would like to add your own testimonial please email the website administrator.

FRCS Advice

General Advice

  • You can prepare lots for this exam – but still takes a bit of luck and ability to ‘talk the talk’.
  • Good piece of luck and good technique is required to pass – it is impossible to learn everything.
  • The FRCS is an exercise in managing depression, yours, your wife’s and your family….
  • Attend Friday teaching and read the relevant book chapter the night before or a good journal review article.
    This means by the time you come to the exam, you will be practicing technique, rather than learning. It also means less panic.
    Easier said than done, but with the advent of UKITE and Mr Braithwaite’s exam for year 1 and 2 there is a bit more incentive.
  • The clinicals are all about technique, we hear this so often that it doesn’t test your knowledge, but having the knowledge to some extent gave me the confidence and I am sure that reflected in my performance.
  • Please note: this is the hardest thing you will ever have to do. The exam requires 11 months of your life so it is best to give your partner a heads up before they give u a hard time. The best preparation for the Part 2 was having some amazing mates that you can spend upwards of 10 hours a week with and viva to death.
  • Speak to your family (If you have wife/children) before applying for the exam. They will suffer for 6-9 months
  • Reading in library is better than at home
  • Cut down TV time
  • For more junior colleagues-Try to read weekly teaching topic and the specialty you are working in, it will help you a lot when you are close to exam.
  • Go to teaching, sit on the front row and don’t fall asleep.
  • Oh and yes there will be children at the exam with weird problems!!

Timing

  • I started properly about 3 months before the written exams and just kept going.
  • The exam is hard but clearly you can pass it, you must put the hours in. Give up your life (&alcohol) for a year.
  • Part 1: 6 months solid prep got me through.
  • Part 2: 4 month solid prep.
  • It will waste a year of your life, but quite honestly is required to get knowledge up to standard of a day 1 consultant.
  • Six weeks before the exam they inform you where part 2 will be held.
  • I started preparing seriously in January, 5 months before my MCQ exam when I read daily, this was a bit late and I would suggest you start reading earlier. Make a group early on.
  • Started revising at least 1 year in advance of the MCQ’s
  • I spent 4 months for preparation of MCQS part and 2 months for clinical and VIVA.

Groups

  • Get a good small group of chums and get loads of people to viva you.
  • Get a good study group, small, 3-4 folk, ideal if you live near each other. You need to like them you will be seeing them 3 nights a week and one day at the weekend. Nearer the exam you we be meeting everyday.
  • Small group study sessions to practice your technique, smaller is better, otherwise you won’t get a chance to talk! Your colleagues will help explain concepts that you do not understand and vice versa. It’s also great fun, in a strange sort of way
  • Form a core study group of around 3/4 (if you have a large batch taking it like we did, its a good idea to touch base as one big group about once or twice a month just to make sure you are all in the same boat, especially for the clinicals).
  • A study group is really useful (particularly for the vivas) as you can bounce ideas off each other and get a flavour of what everyone else is doing.
  • Group study, especially for VIVA and clinicals is essential.

MCQ and EMQ paper

  • Part 1: Now taken at a computer centre (I did mine in sunny Birkenhead). Despite the fact that you will be doing an expensive and important postgrad exam, you’ll be sitting next to spotty 17 year olds doing their driving theory tests. If you find yourself answering a question on stopping distances from 70mph in the wet then you’re sitting in the wrong cubicle!
  • These are the 1st hurdle: For this you just need to sit and read as much as you can there is no other option. You practically need to know everything in Miller. Whether you read it form miller or somewhere else is your choice.
  • Read the books at least a couple of times. After the first read started doing the questions and carried on reading.
  • To start reading, which can be scary as you see a mountain of syllabus, Start by doing MCQs on websites 20-30 at a time from any topic and read the relevant chapter retrospectively. That draws attention to the important points in chapter and gets things rolling.
  • I found MCQ paper more clinically oriented. I had just sufficient time to do it once with only 5-­10 min to spare at the end to go back on some questions I flagged. My advice would be not to spend any time on the initial review paper because when we took our exam 6-­8 questions out of 12 were removed. They are very tough and poorly structured.
    EMQ paper was more textbook knowledge based and I had about an hour to spare and rechecked all my questions. I also found it very easy.
    Most MCQ websites and the material that goes round does not represent actual exam. They are good for practice and reading around questions. In real exam questions are well structured and more clinically oriented.
    While practicing I scored around 65% overall in Hyperguide and 70% on orthobullets. In real exam I got 86%, so don’t be scared if you get low score on these websites. Pass mark is usually around 65%.
  • The single best answers are quite tight for time as a large number of questions are based on a research paper (on pdf) that you’ll find yourself spending too much time reading.
    The extended matching questions seem to be better on the time front (although some would argue falling asleep for 10 minutes in the middle of it not to be the best use of the available time!).
  • The MCQs: Once you’ve done the reading, it’s a matter of doing countless numbers of MCQs. I would recommend that you form a study group for this section of the exam as well rather than go it alone, as you will learn more off each other when you discuss the questions and find out your strong and weak areas.
  • The paper part is essentially a waste of time, so don’t stress over it or spend extra time on it. MCQ appear awful until the EMQ in the afternoon when you fell the morning session was a walk in the park.
  • Unfortunately, most of the available MCQs are catered to the American Board Exams and the style is different. American questions tend to give more information in the stem and in general are less ambiguous than the real exam.
    I’m sure you’re now all aware how the written exam is organised. You will come out of it thinking that you’ve done terribly but there are so many bad, ambiguous questions, which are likely to be binned once the examiners have had their meeting. In the first MCQ paper, you get 15 minutes to read the research paper and you cannot start the first question until that time is up. My advice would be to spend no longer than 20 minutes on those first 12 questions. Contrary to popular belief, they are not easy, giveaway marks and you will waste a lot of time going through the paper trying to find the answers even though you think you’ve summarised the paper nicely. It wouldn’t surprise me if at least half those questions were discarded. Time in the MCQ paper is tight and you will have to work quickly; there is a lot more time in the EMQ paper to go over your answers.

Viva

  • It’s about technique as much as knowledge – tennis is a good analogy. Some examiners will try to destroy you if you vomit all your knowledge out in one go, they will know more than you.
  • There were at least 6 topics in each Viva
  • In Viva Examiners gave good feedback and prompts, which helps to steer you in right direction. They do not have a poker face as people think.
  • Few of my friends had different strategy to answer questions and gave only relevant information when asked, rather than telling everything about the topic you know. My sub group and I stuck to different policy. To try and deliver as much information about the topic as possible and to look for subtle signs from examiner, to see if I was heading in right direction. This gave me control of the viva and I could deliver all that I knew and score points.
  • Best thing is to always start from basics and build it up. Keep it very simple like teaching a junior SHO.
  • I never had problem in speaking or explaining things, which helps a lot in real exam. I developed this by teaching SHOs wherever possible. This got me into a habit of delivering knowledge in well-structured format, which is easy to understand.
  • Golden tip: You can predict and prepare at least 30 common topics that you definitely are asked in VIVA, try and prepare them well with literature and evidence to back your treatment plan. Idea is to try and score 7/8 in these. These 7s will cover up any mishap and odd 5/4 anywhere else.
  • Examiners will try and find out if you have understanding of subject rather than pure memory based knowledge. Try and understand things early on. Most of the things that I learnt few weeks before were hard to come out in real exam.
  • I never got time to read review articles but kept my ears and eyes open in teaching sessions and viva practice. Half of papers I quoted in exam were things I heard from my friends in practice sessions.
  • Most important thing is to make a group. This exam cannot be done alone
  • You need to be put on the spot in a less threatening atmosphere. The exam groups were really useful for learning how to put what you know into words.
  • Book consultants & post exam guys to viva you.
  • Get your boss to viva you on the job. J Banks at RLUH was excellent for this.
  • For the vivas, practise practise practise – get your seniors or even some of your bosses to grill you, you will be amazed how the same questions get asked in the exam. I would recommend at least 15 to 20 viva sessions leading up to the exam. At least 90% of the questions in the exam, I had already been asked in mock sessions and a sense of deja vu is a good thing in the exam.
  • The consultants were fantastic for helping out with viva practice.
  • For Viva you will need lots of practice sessions. I kept on learning till the last weekend and killed few patients in practice vivas, all for good.
  • Trauma is the most failed viva, so don’t assume you know it all because you’re doing it all the time. If you’re looking to get the higher marks you need evidence to support what you’re saying. You won’t fail for not being able to reel off tons of papers, but for the stuff we do regularly such as #NOFs it’s useful to have something to back up your statements.

Short Cases

  • The short cases are really short, you don’t know where you are or what your doing, then its over and you fell like a fool. It would appear everyone feel like this so don’t panic, its still all to play for.
  • By the time you get through part 1 you will have sufficient knowledge and will just need to get it organized and structured.
    When examining cases I tried and focused my history and examination towards finding diagnosis and excluding important differentials.
    If I spotted something I stuck to it and directed my examination towards it rather than following a set pattern as some of my friends did. There is very little time about 4 min in all and you cannot examine thoroughly in such short time, so it has to be focused.
  • Attend clinics for each sub-specialty, practice precise history and exam under exam circumstances. See loads pre op patients and practice focused history and exam.
    Go to Broadgreen in week pre exam and see all the pre op patients.
    The short cases are the tricky bit. I tried reaching the diagnosis as soon as I could, as the examiners then stopped me from examining the patient and usually moved onto investigations and management. Infact I was stating the diagnosis pretty much in the first minute of most of my short cases and we quickly moved on to the management options. It’s the easy case that caught me out. I struggled with a lipoma believe it or not!
  • The Clinicals: You need to practise examining patients and each other over and over again until you have a slick routine, which hopefully won’t fall apart on the day! In the last couple of weeks, I went to Broadgreen every day with the other members of my study group and took histories and examined all the pre-op patients. I also attended the clinics of Messrs Sirikonda, Peter and Kalra at Broadgreen. I found in general the examiners were helpful, kept you on track and guided you into exactly what they wanted you to examine.
  • Go to extra clinics, it’s the short cases which are hard. Make sure you practice doing everything in 4 minutes. Broadgreen the week before is invaluable, loads of pathology, you can see it, examine it and leave nice and quickly.

Intermediate Cases

  • The intermediate cases are lovely – its what we do. A nice wee chat with an examination then another wee chat.
  • The intermediate cases are the easy bit, we are unlikely to go wrong taking a history and examination, the discussion usually pans out well if we have done the first two parts well as the examiners I think have already formed an opinion of the candidate.
  • I took the week off before the test, and went to Broadgreen Hospital each morning to see the pre-op patients, with Andy Roche. 5 minutes for short cases, and 15 for the intermediates really isn’t long, and you need to get used to examining /history taking in a short period of time. Practise having your flow being interrupted, and being directed to examine certain things.

Books and Websites

  • Start reading from day 1. Read the book chapter relevant to your current job. Then start from page 1 of the text book. Basic sciences and tumours are not really covered in day to day work and often take more time to learn.
  • AAOS vs Miller:
    • I read the AAOS book. I never touched Miller.
    • Miller – only once you have read everything else
    • AAOS – start at page 1, and read both volumes twice (I wish I’d taken my own advice)
    • Miller – after AAOS.
    • Most MCQ and EMQ questions were straight from Miller. It’s a good book and does what it says on the tin Review of Orthopaedics. Some guys open it and start reading without any prior knowledge of subject. Obviously they find it hard to understand.
    • Some of my friends read AAOS which is easy read. I didn’t due to lack of time. They did have more knowledge than me on certain subjects.
    • I found AAOS review book easiest to read, but many use Miller. This probably equates to about 1-2 hours a week. As we don’t work more than 48 hours, this shouldn’t be too onerous.
    • I read both Miller and AAOS, both are good and one may have some stuff the other doesnt
    • Miller is probably the most common book used but I didn’t like it so switched to the AAOS Comprehensive Orthopaedic Review. It may cost ~£200 but it’s much easier to read and has an MCQ book included
    • AAOS Review – it may cost £200+ but it’s a much easier read than Miller and also comes with a good MCQ book. The examiners are supposedly using this book now to set the MCQs.
    • Miller – everyone has it but it really is a nightmare to read and I gave up and switched to the AAOS 4-5 months before the MCQs.
    • Miller is not an easy book to get to grips with. It took a lot of background reading to understand it. But once you get into it, it makes sense.
    • I used AAOS as my main book. Read few things from Miller as well.
  • Miller CDs: Miller audio is pretty good (although from 2003). Takes about 6 weeks to get through it all if listening in the car (unless you work in Leighton or Southport). The guy who does the tumor section is top quality. It’s quite a big file so memory stick or DVD will be needed if you want a copy. The Miller audio discs we got were really useful to listen to in the car on the iPod.
  • Basic Orthopaedic Sciences: The Stanmore Guide (Ramachandran)
    • by far the hardest topic to grasp, because we’re not used to talking about it on a regular basis, and it took me ages to get it into.
    • Basic Science is the one part of the exam where you really need to know your stuff. In the other vivas, there’s usually more than one answer for a given scenario as long as you can justify it but Basic Science is either right or wrong. It’s also a weak point for most candidates.
    • Essential reading for the exam
  • Hoppenfeld. Almost every approach involves an osteotomy and most bear no relation to anything you see in theatre but required reading nonetheless! – there is an increasing emphasis on anatomy and surgical approaches and you must be able to recite them in the exam as second nature. You may also get pictures or even worse, cadaveric pictures of cross sectional anatomy, and be asked to identify a number of structures. – standard for the approaches…and you will get asked several of them.
  • Netter’s Concise Anatomy Atlas is pretty good
  • Postgraduate Orthopaedics: The Candidate’s Guide to the FRCS (Tr and Orth) Examination by Paul A. Banaszkiewicz – for clinicals & Viva – it’s almost the UK version of Miller. Get it at the start of your revision and not in the 2 months leading up to Part 2!
  • Stanmore operative orthopaedics
  • Ortho examination – the ‘porn’ book
  • The secrets books – great to have one in your bag when its quiet
  • Koval trauma handbook. A mini Rockwood and Green. Nobody seems to use this, but it is a gem
  • Core Knowledge in Orthopaedic Series – I had the Arthroplasty / Upper Limb / Foot and Ankle copies and tried to read them whilst I was doing the relevant jobs.
  • Core Topics In Orthopaedics – gave some of the background reading. It’s a bit more expanded than Miller, but with more info and pictures. (foot & ankle, adult reconstruction, hand and upper limb, spine)
  • Post-Graduate Orthopaedics for the FRCS – not detailed enough, but ok for last minute revision when panic-ing!
  • Brinker Review of Trauma – out of print. You’ll have to beg someone to lend you this…but there are alternatives. I got given a similar book by Court-Brown from the Edinburgh trauma course which was ok.
  • Do any question book you can get your hands on:
    • AAOS review MCQ book - I read the topics from AAOS and the did MCQs after every topic
    • Postgraduate Orthopaedics: MCQs and EMQs for the FRCS (Tr & Orth) [Paperback] Kesavan Sri-Ram
    • Pankaj Sharma – mcq
    • 1000 EMQ’s for in Trauma & Orthopaedic Surgery
    • Do all of the hyperguide and all of orthobullets, its great to do when you are tired and motivation is low.
    • Orthobullets website for knowledge only – I did all the practice questions on orthobullets and hyperguide >3500!, and after the exam, I realised what a waste of my life it was. The MCQ questions are a level above what is available online. Closest examples are Mr Braithwaite’s paper that circulates, and the AAOS questions in volume 3.
    • Orthobullets & Hyperguide. Both these are American. Hyperguide is difficult, orthoteers is more reasonable. They help you get into the swing of things for the MCQs but you end up better at doing the American exams than our own.
    • Orthobullets was very helpful, it has most topics on one page in very easy to read and understand format, I would recommend it highly both for MCQ and Clinicals.
    • I answered all the questions on Orthobullets (about 1700) and about 800 questions on Hyperguide (4000 in total!). There are MCQs on the AAOS Portal but there are no explanations for the answers. I also used a book called Craig’s Review of Orthopaedics – although American and now out of print, the questions are quite difficult and the explanations to the answers are very good. I have PDFs of all the chapters and am happy to give anyone a copy. (J Chan)
    • Orthobullets is an excellent website. Do as much MCQs as you can
    • There are very few good quality UK MCQ books. The best by far is Kesavan Sri-Ram’s Postgraduate Orthopaedics: MCQs and EMQs for the FRCS – the style of questions is the closest you’ll get to the real thing. I also have a folder of MCQs and EMQs from the annual Oswestry exam – they are difficult as they’re essentially set from Miller and there’s no explanation for the answers but are still useful to do.
    • I did loads of MCQ’s from the hyperguide website. They are very American, and a lot of them are irrelevant, but useful for timing yourself doing questions. A few of the questions in the test i had seen before on the hyperguide.
    • OITE questions – useful, but not quite the same as those we got given.
    • Review Questions in Orthopaedics – out of print. There are photocopies of it floating around, and these are probably the most similar to what you’ll get in the test.
  • Journals:
    • JBJS review articles
    • Orthopaedics and trauma journal. Good review articles for Friday teaching. – http://www.sciencedirect.com/science/journal/18771327
    • NICE and BOA guidelines
    • JBJS Br exam corner
    • Current Orthopaedics – the journal for SpRs was really useful for the background stuff. Nicely written articles, bringing topics together.
  • Other websites:
    • FRAX website is good for osteoporosis.
    • Orthoteers
    • The Orthopaedic Trauma Association (OTA) website has a series of Powerpoint presentations that are used to teach the US Residents. I downloaded them all and used this as my Trauma revision as the standard textbooks aren’t that great for trauma.
    • JBJS (Br) website has both the Exam Corner and the “Focus On” section which has good review articles on common topics that come up in the exam.
    • Go onto Youtube and type in “Mike Hayton FRCS Orth” to get 4 movies, each about 5 minutes long, where you’re asked all the topics you’ll get in the Hand viva! – you only get the questions and have to make up the answers yourself.
    • You should have an understanding of: NICE guidelines on thromboprophylaxis and NOF #; BOAST guidelines (from BOA website); the most recent NJR summary – get the short version and use this as the basis for your answer on which THR / TKR you would do!
  • FRCS Revision Book: PDF is Here

Courses

Links to all these courses >> here <<

  • Mersey viva and clinical course (run by Mr Bhalaik)
    • a must
    • This is a brilliant course, mimicking the exam remarkably well, both in the viva and clinical components. Practice is essential, and it is mostly technique.
    • excellent and should be considered essential
    • excellent and closest thing to real exam.
    • no bias here but there is an excellent balance of both vivas and clinical cases. Although it’s a few months before the actual exam, it will give you a reality check of how little you know and the amount of work you need to put in!
    • As far as courses go- don’t do a basic science course as they are a waste of time unless you get viva practice. DO THE MERSEY COURSE!!!!
  • Alder Hey FRCS paeds course
    • You need to plan when you’re taking the test as this course is only once a year. Didactic teaching, but told me everything I needed to know for the viva
  • Warwick Basic Sciences Viva course:
    • VV good
    • only useful before the viva, it was ok
    • not as useful, the lectures by biomechanical engineer were not for EXAM but lectures by orthopods on 2nd day were great so were the VIVA sessions
    • Okay
  • Oswestry Basic Sciences
    • Good
    • I did this to scare myself to start working. However, it’s a week long, costs over £1000 and with some truly terrible lectures is not good value for money!
  • Stanmore Basic Science Course – it’s ok. I did it in the October before the November MCQ and it was useful. There are plenty of courses available, but I would highly recommend doing one to get your head around the topics. Worth doing well in advance of the test, and even consider doing in the early years of registrar-dom.
  • Wrightington Hand Course
    • was excellent. Really well organised course. 4 people per patient with lots of experience with clinical and viva topics in a timed setting. It is just a hand course though, and the viva is now upper limb (& paeds).
    • Excellent – also lower limb course
  • Miller revision course – I did this before the written, gave me a kick up the arse
  • Could not get on to the Writington course which people say is good
  • Edinburgh Hand Course – a 2.5 day course with a mix of lectures and clinical cases; not bad value for £400-500. I did this in April 2011
  • Peterborough Viva Course – a one day course on the weekend before the real thing; last chance to improve your viva technique. Not a bad course at all and only £250.
  • Oswestry Clinical Course – do another course…this was pretty ropey. Too many delegates, and not particularly well taught. However, there was a practice exam on the 2nd day which was timed as for the short cases, with similar cases to those that came up. If nothing else it taught me about polio patients!
  • Oswestry Viva Course – 1 day, too many delegates…not very useful. Find another 1 to do.
  • Oswestry Surgical Approaches – the best bit was the spine teaching by Mr Jaffrey (who is a great teacher) and Mr Trivedi on the 2nd day. The rest was ok, but I used it as a revision.
  • Warwick Clinical Courses – Good
  • Friday teaching – sit at the front!

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