In the examination hall

There are two examiners per desk and sometimes a third who is mainly assessing the examiners. One of the examiners will ask questions for 15 minutes and then they swap over. The oral interviews are conducted by non-specialists, that is, a hand surgeon may ask you questions about adult elective orthopaedics and a hip surgeon may examine you on paediatric orthopaedics. This is in an attempt to standardize the difficulty of the questions so that specialists do not focus on the minutiae of their topic and lose the big picture.

Marking

The scoring system is out of 8. A score of 6 is a pass, 7 is very good and 8 is excellent but difficult to achieve. A 5 is a close fail and 4 a poor fail. If you score 5 on one table you can make it up on the others. The marking system is described in detail later in this chapter.

Question format

The examiners often use objects in their questions. They may have a laptop with a photo of an implant, a histology slide or even an anatomical dissection. There may be laminated photos of X-rays or CT scans. There may be orthopaedic hardware on the table to look at, such as a trauma implant. You must be able to explain how plates, screws and nails work.

The structure of the viva has changed from spot diagnoses of pictures, X-rays and quick-fire questions to a fairly predictable set of three or four main topics from each examiner. This means the questions start (relatively) simple and become progressively more difficult until you will probably not be able to answer. If you cannot answer the first question, you are in trouble and the examiners can ask you a reserve question but this will probably result in you scoring a 4. If you answer 10 questions on the topic very well and only get stuck on question number 11 you are doing well and probably heading for a 7. The examiners will push you if you are doing well, usually until the point where you either say you don’t know or guess. Examiners can usually detect guesswork so it is generally better to admit defeat at this point and move on to a new topic.

Listen to the question

Listen closely to the wording of the question.

If you are asked about management of a patient, start with history, examination, investigation and treatment. If the question is ‘What implant would you use?’ don’t talk about all the different options, state what you would do and back it up with reasons and evidence. If you are asked ‘What would you do?’ don’t say ‘My boss did this’, you must give an opinion and justify it. When answering the question don’t try to make up an answer if you really don’t know. The examiners will see through this and will know immediately. Be honest, if you don’t know just admit it and they will move on so you have a better chance. If you try and blag it you may become unstuck!

You may not understand the question and in this scenario you are perfectly justified to ask the examiner to repeat it.

Answering the question

Before you answer the question take a few seconds to compose yourself, mentally construct a checklist of the main points you want to make and then start calmly with your answer. This avoids blurting out the first thing that comes into your head and gives the examiners the impression you are giving a considered response. If you do come out with something nonsensical, just admit that you said the wrong thing and correct it.

If you are confident on a topic keep talking, keep to the question that was asked and show off! Avoid going off on a tangent since you don’t score points for this. If you can direct the answer onto a topic you know well, try to do this. Once you have finished your answer stop and keep quiet. Try to avoid the temptation to add extras on the end of your answer, this sounds like you are waffling and can annoy the examiners. It can also bring you into an area you really didn’t want to talk about, which is bad. The examiners may cut you off; it can happen whether you are doing well or not so don’t let this put you off. Just concentrate on the next question.

Remember that the examiners are looking to pass the candidate that sounds like a safe, new consultant. This means that you need to give sensible answers but not be a world expert on anything in particular. You should approach the answer as if it is your first week as a consultant.

Quoting references

We suggest trying to remember the main author, journal title and year of a few important papers, for example long-term results of the joint replacement you use and joint registry survival data for your implant of choice. If you have time to read the last few editions of JBJS then this may come in useful but concentrate on the high-quality studies.

Recently there has been a focus in the orthopaedic literature on national joint registries, and knowing the basics of how these are organized and the results (at least of the England and Wales registry) is a good idea.