Proven Viva Tactics: Excel in Your Oral Viva Examination
Key Takeaway
For anyone wondering about Proven Viva Tactics: Excel in Your Oral Viva Examination, Viva tactics viva involves a structured oral examination where examiners assess candidates rapidly, often within the first two minutes. The exam progresses based on performance, with questions designed to evaluate knowledge, not to trick. Key viva tactics include being honest about unknown answers, clarifying questions judiciously, and maintaining a professional appearance, all aimed at demonstrating preparedness and securing a pass.
Candidate, we are looking at a 65-year-old patient who has presented to the clinic with chronic, progressive hip pain. They have failed all conservative management. I would like you to assess this radiograph and tell me how you would approach the management of this patient.
Candidate: "This radiograph shows features of end-stage osteoarthritis of the hip, including joint space narrowing, subchondral sclerosis, and osteophyte formation. Given the failure of conservative management, I would discuss the risks and benefits of a total hip arthroplasty (THA) with the patient, ensuring we optimize their medical comorbidities before proceeding."
Jumping straight to surgical planning without mentioning the patient's functional status, physical exam findings, or specific medical optimization. Candidates often forget to mention the 'clinical' aspect of the 'clinical-radiological' correlation, or fail to discuss non-operative optimization steps (e.g., weight loss, smoking cessation, diabetes control) before committing to surgery.
Structure your answer using a 'Clinical-Radiological' approach: 1. Clinical status: Acknowledge the patient's functional impairment (Oxford Hip Score, pain severity). 2. Radiological assessment: Describe findings systematically (Joint space, acetabular coverage, bone quality). 3. Optimization: Explicitly mention BMI management, smoking status, and HbA1c control. 4. Shared Decision Making: Emphasize the risks and benefits (infection, dislocation, leg length discrepancy) and setting expectations for longevity of the implant.
Following up on that decision, how would you specifically plan the templating for this patient, and what critical anatomical landmarks would you look for to restore the center of rotation?
Candidate: "I would perform digital templating using the contralateral hip as a reference if possible. I would look at the teardrop, Kohler's line, and the superior acetabular rim to define the anatomical center of rotation and plan the cup size and offset accordingly."
Failing to account for magnification errors in digital templating or ignoring the importance of restoring leg length. Candidates often forget to mention the 'high hip center' vs 'anatomical center' debate or neglect the significance of the greater trochanter's relationship to the femoral head center.
Demonstrate knowledge of: 1. Magnification scaling: Mention the use of a calibration marker. 2. Center of Rotation (COR): Targeting the anatomical COR to optimize biomechanics and abductor tension. 3. Landmarks: Specifically name the Teardrop, Shenton’s line, and the greater trochanter tip. 4. Offset Restoration: Discuss both femoral and acetabular offset to ensure soft tissue balancing and reduce the risk of impingement or dislocation.
