The FRCS (Tr & Orth) Oral Examination

General guidance for the FRCS (Tr & Orth)

• The FRCS (Tr & Orth) exam sets out to provide an assessment of the knowledge and skills and the ability to use these to the required standards of a consultant orthopaedic surgeon working in the National Health Service in the UK. It is a significant career hurdle to pass and involves an intensive 6–12-month period of study during which time everyday life and activities increasingly assume secondary importance to passing ‘the exam’.
• The viva exam or ‘structured oral examination’ as the Intercollegiate Specialty Board (ISB) prefers to call it is an important component of this exam. Whilst most candidates are more fearful of the clinical component, the oral section is never as clear-cut or straightforward as some examiners (or consultant non-examiners) would have us believe.
• This general introduction provides an overview of how to improve your score and pass the oral exam with flying colours.
• Careful tactical planning is required beforehand as on the days of the exam it is usually too late to alter your game plan and poorly thought-out tactics may lead to your downfall.
• We have avoided the temptation of solely focusing on what successful candidates believe are the important tips and tricks that will get you through the oral exams. We have additionally looked at the exam process itself and what it sets out to test. The logic is that if you understand how and why the exam acts as an assessment tool you will increase your chances of success.
• At most revision exam courses current or past examiners and recently successful candidates give a 5–10-minute talk on the key features needed to pass the exam. Most advice is fairly reasonable but opinions and views may occasionally be counterproductive and best ignored.
• Remember that advice is always a personal issue for each individual candidate and what works best for you may not necessarily work well for the candidate sitting next to you.
• Be a bit sceptical and question in your own mind the value of any guidance that you might receive. It could be completely wrong or include tactics and plans you have tried before which just don’t work for you. Work out in detail your own individual viva tactics, before exam day, and stick to this strategy. During the exam only change your game plan if it is absolutely crystal clear you have adopted the wrong exam approach but this shouldn’t be the case if you have done your homework correctly!
• The FRCS (Tr & Orth) examination is the final hurdle at the end of higher surgical training. It usually enables the successful candidate to apply for his or her Certificate of Completion of Training and therefore a consultant post. In turn it leads to largely unsupervised surgical practice.
• The FRCS is split into two sections, with part 1 comprising the written exam and part 2 the clinicals. Part 2 in turn is divided into clinical cases and the structured oral interviews or vivas. Half of the marks for the part 2 section are allocated in the clinical cases and half in the vivas.
• The examiners are not looking for a narrow inflexible candidate but rather a safe surgeon with broad knowledge and sound basic principles that they would trust as a consultant colleague. It is with this standard in mind that the viva should be approached.

• The viva examination is a test not only of knowledge but of the ability to convey the required information to the examiners in a confident and coherent way that persuades them you are a safe orthopaedic surgeon.
• All the basic knowledge required for the orals should have been acquired in preparation for the Part 1 exam. This does not mean, however, that you can relax and assume that you can give a good verbal answer based on this knowledge. We have all been in trauma meetings when, put on the spot by a consultant, we have seen colleagues clam up and deliver a rushed, illogical answer when the trainee knows the answer but cannot present his or her thoughts clearly.
• The focus for preparation should therefore be on practising technique and formulating logical answers to any possible questions. Quite a task!

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