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is actually the exam, the RCs exam. And I would like to, um, actually invite Hillary, who will tell us about the exam as well as Amanda approaching the, uh, podium. Thank you. Thank you. I'm going to try and stand this way so I can actually see the slides because I've learned from my predecessors that it seems to be quite difficult to see them. So let me know if I'm not in quite the right angle to the microphone. How about that? Okay, so, um, it was actually at our request. Um, that, uh, the intercollegiate exam, together with the S A C and baps um, asked to present at this meeting. I don't think 45 minutes is long enough probably to explain the exam to those present. And I doubt if it's long enough for all of you to ask some of the questions that you have in mind. Uh, but we'll do our best and perhaps have a plan in mind, which will again involve the S A C and the intercollegiate, uh, board in arranging a training day for trainers. Um, in respect of the exam and how you can prepare your candidates so the intercollegiate examinations have existed for something over 30 years. The aim has not changed in that time. It is to objectively assess the competence of the candidates to proceed to the post of consultant in their chosen surgical specialty. So in our case, pediatric surgery, the format has changed inevitably and currently consists of two parts which are blueprinted against the national curriculum, which came into being more like 15 years ago and has also evolved. And during the time there has been the introduction of examiner training of preset questions, um, the appointment of assessors who look at each exam, and and the examiners and the development of a psychometric team which analyzes the exams for validity and educational value, and also looks at individual examiners with enormous feedback. And all of that has been developed with the aim to make sure that we have equality and fairness at the basis of the exam. So these are the brief, the topics and briefs that I'm going to cover. So what are the criteria to be allowed to sit the exam and these are the minimum criteria. So if you're a UK or Irish trainee, you must have achieved an Outcome one at a R C E p for Year six, s t. Six. If you're an Irish candidate, that's the old year for Rita. See, you must, in addition, have the knowledge and skills appropriate. Two A day one consultant and there must be three consultant referees, which includes the T p. D. So the consultants who are here are asked to provide those references, and I'm going to proceed to tell you some of your duties are in that respect for the non in training candidates. They must have undertaken appropriate clinical training in the last four years. They must have the knowledge and skills appropriate to day one consultant, and they must provide three referees. Now all these referees have to be consultants on the UK Register, and they all have to have worked clinically with the candidate within the last two years. Very shortly, there's going to be tightening up of the non in training candidates, and there'll be a requirement that they have taken part in I S C. P and worked in the United Kingdom for a minimum of 12 months. So how many of you have actually looked up in depth? The referee and don't really want you to put your hands up. But the referee guidance, which is on the J. C i e website and as we all low the acronyms, that's the Joint Committee for Intercollegiate Examinations. If you sign up an applicant who does not meet the above criteria and who's performance in the exam is exceptionally poor, it could be perceived as a potential property issue for the referee with regard to patient safety. It's really quite long. What's on this? I've just picked out a few things. I don't expect everybody to to read it all. But we require your detailed comments on the candidate's suitability with respect to skilled, a logical and analytical elucidation of a patient's history, careful acquisition and processing of information and termed in clinical examination and construction of a satisfactory management plan for all patient's. And if you can't say that about your trainee, then they do not have not reached the level at which they should be signed up to sit part one of the exam or any part of the exam. There's a whole lot about communication. If if the board considered, it would be inappropriate to admit candidates to the exam. If there's any doubt as their ability to demonstrate satisfactory communication skills and English language skills, um, as necessary for daily practice in the UK and your communication skills are supposed to be in all respects. So that's, um, communicating with patients' with parents with each other, with fellow consultants breaking bad news, breaking up conflict between team members. It's quite demanding what you're signing your candidates up for. What's the format? Once you get there? Well, there's two sections, and Amanda's going to speak about Section one, which is where the prompt to to to to make this talk is. And I'll just say at this moment that, um, there have been concerned for some time about the Section one achievements, shall we say, um, and I was aware of that from the moment we'll from very shortly after I took on this poison chalice. And it was particularly evident in June when only four out of 35 candidates past for anyone in the room who does not know the last sitting, which was two weeks ago. The results were released earlier this week and 21 of the 41 candidates past, so that was a 51% pass mark. So there's been a radical change in the achievements of the candidates. There has been no change in the exam. Um, so the section one, the written section to about which there's been much less concern the filtering of section one is fairly effective. And so the past mark in, uh, Section two has generally been, um, fairly good. Uh, Section two consists of, um, Day one, which is usually scenarios and patient's. But for covid, time has not included patient's and has extended, um, scenarios instead. And then we've got 3 40 minute Viagras. Now each 40 minute Viber consists of 85 minutes. So there's a, you know, a huge range of subjects covered now, both exams. The section one is usually in June and November, the Section two in March and September. There's been a bit of variation in the last 18 months for reasons that are all too clear. They both examine higher order thinking, which means that they're testing, analysis and interpretation and also decision making and judgment. And that is a requirement placed on us by the G. M. C. That is not something pediatric surgery has decided it is not something that J. C. I. E. Has decided that has come from our regulator, which is the G. M. C. We all accept that it is easier to look at decision making and judgment in an oral exam when you have an opportunity to argue your your point in the written exam. We have to be as careful as we can be in making up the questions to try and allow for there to be a single best answer, and Amanda will speak about how she manages to do that later. So the exam maps to the I S C. Curriculum. So to anyone who says it's not fair, it's too broad. What's in the exam isn't in the curriculum. Oh, yes, it is. Every single question is mapped, blueprinted to the curriculum. It's important that you look at all particular sources of the curriculum, and this is for the trainers. You're signing up your trainees. If you don't know what's in the curriculum, how can you possibly sign them up? So it's on the J C I U website in inordinate detail, vast detail on all the common sir pediatric surgical conditions, but actually in quite a lot of detail on many of the things that we have concerns raised about. Like why is there cardiac Orthopedic? There's basic sciences in there. Yes, there is. And it is in the curriculum. You can also find things on the I S C P website. Uh, the curriculum is there, and there are several appendices, and it's important to look at them all. Not just appendix four, as has been suggested, but 12, and three as well. Um and so it's important to make sure that the candidates are prepared before you sign them up. So, at least six months in advance of sitting the exam, you should be considering whether your candidates are ready and they require three, um, referees. So clinical supervisor, Educational Supervisor TPD you all need to be thinking, How is my candidate doing? How is my potential candidate doing? They're coming up to the end of their ST six there in ST Seven. Do I think they're anywhere near where they should be so that when they come and ask me, should I sit the exam? I can tell them what I think. I think the multi consultant report will hopefully help because I think it should undoubtedly be discussed at the multi consultant report throughout the training. How is the candidate doing? Are they on track? Are they heading in the right direction? And remember, it's your It's your duty to your candidates as well as to your patient's to tell people if you don't think they're ready. Nobody likes being told that they're not ready. Everybody kind of hopes that you can see your wonderful I'm sure you're going to pass. Go ahead. But actually, that's not fair. If they're not ready and you know in your heart that you don't believe they're ready, then don't let them waste that money and that time and that energy, But you know, indicate to them how they should progress. Now, when you actually fill in the application form and the trainees fill them in, they have to, um, state the names of the referees, and they have to say who is their lead referee. They don't have to allow, uh, feedback to the lead referee. But please, please always encourage them to do so, because when the candidate is less successful than they might be, um, they get the results. They do. They will not go to the referees unless they've specifically given permission from it. And then they've got no, um, capacity. Really? For for someone who's clearly the person to discuss with them what might have gone wrong and how to take things forward? Um, and it's really important for the candidates who move around, make sure that if you know somebody sitting the exam, but they sat it before, but they've now come to your unit, make sure that they've updated the referees so that it's not someone who worked with them three years ago and another institution Who's going to go. Oh, really? Oh, how interesting. Um, but someone who's actually working with them now now do consider special needs. It's not just our Children who are severely neurologically impaired. Some of our candidates are more minorly challenged and dyslexia, you might think. I mean, I used to think, you know, how did you get to medical? I mean, how did you get your final exam if you're dyslexic? But actually, subtle differences can demonstrate themselves in the more challenging exams. Um, if you're deaf, you're entitled to have a space where it's not as noisy as it would be, um and some people have difficulty with screens, and you can choose to have a paper format. Now, you have to provide some evidence for this. Um, but that can be done, and this reasonable adjustment will be made. But you have to ask for certain advanced. You can't have to. You know, I forgot to tell you I was deaf or on the day. By the way, I'm deaf. Can I have another room? No, you can't. You know, because we don't have those facilities. Um, so when you're preparing for the exam, factual knowledge is fundamental. So it's up to the trainers to make sure Clearly, the trainees should be doing this themselves. But we're there to train our candidates. We want them to pass. So what we should be doing is encouraging them to read around a clinical case. And if one of your trainees goes off to see the lines list and there's a cardiac patient and there's an oncology patient, it would be good not to just to say to them, Is this a double LUMEN or a single Lumen line? And have they had any lines before? But to say what's the cardiac condition they have. And have you been away and read up about it? And are you going to be able to tell me about that? What is the nephrology condition that they want this dialysis line for? Do you know the background to it? So these are the things that you should be encouraged. The trainees should be doing it themselves. But of course, it a bit of encouragement goes a long way. And if when they come and present the case to you, they're trying to tell you about that, applaud them for doing it as opposed to going. Yes, yes, yes. But was it a double Lumen line or not? You know, you know, give a bit of help in that respect, CBDs. I mean, a lot of our conditions are rare. Clinical based discussion's are a really good way of covering differential diagnosis and all sorts of things that come up. So they're not just single item events, um, so that you can cover cases that are rare that you may not have seen but that someone else saw earlier in the week. Um, try and make sure that the candidates attend M D T. s encourage them to stay awake during the M D t s and if possible, um, to to contribute, um, try and set up exam practice early. I mean, ideally, we'd be doing it from ST three so that people were so border that that they really were not worried on the day. In fact, it would be easier on the day because they're strangers. Whereas in, uh, your normal working practices the people you know and love. And you really didn't want them to think you're an idiot. Um, but try and set it up in terms of the exam as soon as you can, and certainly before part one, um, exam practice is invaluable. Those who have local examiners in their unit are advantaged because we are allowed to, um, give training to those in our own centers were not allowed to take part in, um, Kraemer courses, but you can help your own candidates prepare, but consultants who are not, um, examiners can also do a fantastic job in terms of giving practice. But it's really important that you know what the exam consists of. If you're doing exam practice because the candidates need to prepare for each section. If you're doing a 10 minute or a 15 minute scenario, you have a very different approach from a five minute five er, Um, always listen or read the question carefully. It's a sort of thing you say to your five year old, and then you save them at all levels and a levels and all the way through. Um, and it still needs to be said because we all make mistakes. And the thing I say is, every time I do mandatory training, I get a few questions wrong. That really upsets me because I should have got 100% in my fire practice, and it's usually because you've misread the question or pressed the wrong button. Um, remember, it is an exit exam. So if you're asked what seems a simple question whiz through the simple bit and again, my classic example for that is a trauma patient. Um, if you're giving five a practice to someone and you've got a five minute Viagra and you ask them about a patient who's brought in badly injured multi trauma and they're still on airway and breathing at four minutes, they're never going to pass this exam So what you want to encourage people to do is say, in those circumstances, um, I would approach this patient according to APLS principles, if they were talking, I would be confident that airway and breathing were temporarily at least secure. Then they go on to the abdomen. If they don't reach the ruptured spleen, they're not going to pass this fiver. Um, so who are the examiners? Some of you may not know this. So the examiners are all volunteers. They have to have been a consultant in the UK for a minimum of, uh, yeah, Consultant for a minimum of five years. Um, you have to have had experience in assessment. In other areas. That could be T. P. D s people who run a lot of educational courses. People who examine in the M. R. C s or in undergraduate exams. There is an application process. All the applications are looked at by the board, and applicants are advised sometimes to do some other things to boost their experience. Before joining the Examiner panel. There is in a training course, um, the candidates, the examiner's in waiting, as you might say, then have to observe at least one exam before they take part. And of course, we have assessors who are senior examiners who QA the exams and the examiners. The basic timeframe for an examiner is five years. If you're perceived to be really quite good at it, they'll ask you to do another five. Generally, you don't do more than 10 years. But there's been a bit of laps with covid because we haven't been able to train anybody new. And, um, it's sort of from that the assessors tend to come. So just who oversees the exam in case any of you don't know g m c. That's the General Medical Council. They are our regulator. J C I E. The Joint Committee on Intercollegiate Examinations is all the surgical specialties. Um and, uh, you know, obviously there are people with particular I t skills and QA skills and things who are also part of that board. The Intercollegiate Specialty Board. That's for each specialty. So we have the pediatric one on which we have four college reps, one from each college. We have to baps reps. We now have a trainee rep. Lucy, we're so glad to have you here. Um, with the two question writing leads are on the board. And, um, the SEC chair also has a seat on the board. The chair itself, which has been I took over from David Crab in December, and that's a three year appointment. And it's by competitive interview. Um, and the board meets twice a year and we review the exams and we do read every single word of feedback that has come from trainees. So Section two, I'm going to speak about briefly before Amanda speaks about Section one. Just because I'm talking, um, you won't be surprised that those are the basic topics. The questions are prewritten. The question writing group for the Section two is essentially all the examiners. There are between 30 and 35 about 32 at the moment. Examiners. That's out of a total consultant body of 252 160. Did someone say the other day? 262? Thank you, Liam. So you can see it's a small number of people who are doing really quite a lot of work. The question writing groups meet twice a year. It takes about an hour to write a good scenario revive er, all those questions are nearly always based on patient's. If, as I was saying to the trainees yesterday, only because we don't have the imagination to think of things right from the beginning. So we tend to modify real episodes. I have had feedback from exams where people have said this would never have happened. It just couldn't be. This would never happen. Believe me, it would have been a real case. Um, probably d specialist a bit to make it seem less rare. Um, so in the exam, uh, we standard set the questions for each exam diet, which means every single question is discussed through, um, we buy those who are going to examine, and we reach an idea of roughly what sort of answers we expect and consider acceptable. Um, there are two examiners who mark independently are allowed to check. Sorry. Fact check, but they do not agree. A mark that you get two independent marks. Um, the remarking descriptors. In addition, which the candidates, uh, sorry. Which the examiners have because of course, candidates go off peace and your chosen Viber may move down a different lines. Um, so the marking descriptors are are quite helpful. And if there's a to mark discrepancy, then all of those are flags that all taken to the chair at the time. Um, and it's a closed marking system. So four is a bad Fail five is fail. Six is a pass, uh, seven is a good pass, and eight is Wow, I want this person working for me. Um, so these are the, um, marking two scriptures. I don't expect you to be able to see them all or read them all. Um, but essentially, they give useful information. So we see there were the five. The candidate failed to demonstrate competence. And before they have demonstrated incompetence, Um, whereas a six, the candidate demonstrated competence and confidence. If you look at some of the other things, they refer to whether the candidate needed lots of prompting whether they got in the essential information, Um, whether the information was complete. If they're actually involving the examination of a patient, um, whether they listened, whether they were patronizing, whether they approached and examined a child inappropriately there a lot of information which the examiners have to hand, which helps them to decide what Mark you're going. The candidates are going to get, so the tips that I think are important that we've We've said this to the trainees. But I think it's important that trainers are aware it's not about best guessing the Examiner. We all know that there's a range of clinical practice, and, uh, we anticipate that there will be answers given that would not be our own first choice of management if the candidate can give a good reason for it. If they can justify their approach even more helpfully, if they're aware of different options, then that's absolutely fine. So when you're in a ward round when you're teaching when you're doing cases discussion's, it's really helpful to explain that there is a range and to make sure that the candidates can justify their choice. Why are you doing this? Because Ms Cusick does, it is not an acceptable answer. You have to know why Ms Cusick does it, Um, and then they might or might not accept that that was reasonable. You need to give your own reasoning for doing things. Um, safety is generally better than virtuosity in the exam, And again I would say, Don't mention something you know, don't choose as your first actions something that you've seen one of your consultants do once, um, you know, go for what seems safe. You're not supposed to be in a consultant for 30 years. Um, you know, with a background of hopefully success and a feeling that you can go a little bit of peace because the special circumstances you want to go for the straightforward and the safe. Um, and it's reasonable to mention that you've seen other things done, but this is what you would do at this time. It is wise to ask for advice, and if things are difficult you haven't seen and you think that this is something that really is a day one consultant you would not have seen before, It's reasonable to ask for help. It's reasonable to take it to an MD tea, but we don't expect the candidates to take it to an MD tea and put a full stop after that. And if they're really not confident about doing the operation and they ask for help and no help is forthcoming, they are not allowed to let the trauma victim die without operating on them. If that's what's appropriate. So you. You have to make a decision. And I think of Mr Woodward sometimes, right? Sometimes wrong, never indecisive, Um, quite hard to do that in an exam, But you do need to make a decision. And finally, no one is ever trying to trick the candidates. Don't any of you ever tell anyone that someone's trying to trick the candidates? We are not, and the the examiners are being observed, and any behavior like that would be dealt with very strictly. If we ask for further clarification, it's because we think the candidate might know more and we could maybe inch them up to a higher mark. It might be because actually what they said is wrong, and you are just giving them another opportunity to be sure that is what they would want to do. Um, but we're never going to ask a candidate who's given us the correct answer to deliberately try and make them change their minds. We just want them to justify their answer. If we asked for further information, so it's important for you to guide your candidates through this by making sure that they are thoroughly prepared by teaching them to be systematic and disciplined and their approach, their preparation, but also in their answering of the questions to be aware of the timing of each events, which is critical for them in the exam to make sure that they pay attention to all the information that's given If you're doing exam practice, try not to give a great, long, lawfully story that takes 10 or 15 minutes in the exam. We want the candidate to be talking for 95% of the time. So we try and pair everything down so that the information we give is always relevant. Um, uh, and you know needs to be thought about if we provide images, then check them carefully whether they're X rays or clinical pictures. Move on. If you're stuck and feel free, you know the candidates you want to encourage them to feel free to say, I I don't understand what you mean here. Um uh, you know, I'm missing something or even I just don't I just don't know the subject. Please. Can we move on? Because that's sensible. If you're not making progress, you won't get any marks that bit. But at least you've moved forward. Um, and then if you're not sure of an answer, stream of consciousness is really important so that people are talking through what they want to do. And then you can get points for that. I'm sorry if I've already spoken to Long because Amanda needs to speak now. Yeah. Thanks, Hillary. And, uh, now, Amanda. Thank you. Could I have the first side, please? Do I press it? Uh, okay, right. Apologies. Now, there's a little bit of overlap in these slides, but I'll try and race through in the interest of time. So Part one, I'm I'm going to just try and give you a flavor of how we put the exam paper together. Um, What's in it? How you can guide your trainees to prepare, and then some top tips. Uh, we have two papers now. They're both single. Best answer. We've run this format twice, and this is a cross old specialty piece, not just ours. Uh, there are 100 and 20 questions, um, in each paper. Uh, there's just 22 hours and 15 minutes for each paper. So that gives you a minute and a bit to answer each question. So you need to You need to move on. When you're in the middle of it, there will be a stem and a lead in question and then five options. And that's the sort of anatomy of the questions that we are trying to write in the question writing group. The five options are placed alphabetically, and that's worth being aware of. More recently, we've been able to add in some pictures, Um, X rays, histology, um, to help us ask better questions. So what are we trying to assess? Well, Miller's pyramid points us to, um, the sort of progression of our training. And when our trainees come to take the exam, we just have to assume that they have the knowledge. But really, the the exam is is sitting in this area. We want to see how they're using the knowledge. So not just having the facts but putting the facts together. This is not a true false exam. I have to stress that, um, we are putting five options, one of which is the best option, and the other four are maybe nearly correct. But they're not the best answer, and that's really very different from what we've done at school or what you've done in undergraduate exams. This is quite different from simple truth falls. It's higher order. Try to take the less obscure facts out so that we're getting questions along the line of what's the next best step? What's the likely diagnosis? What would you do next? What test would you do next? We're looking for you to put the clues together. So in writing questions, there's a number of pitfalls that we try to avoid. Um, this is just a selection. But to demonstrate some of those, um, we sometimes get questions like this coming into the group. Um, and if you read quickly, the first three lines of that are not needed. So really, that's just been window dressed, Um, and it's not a very good question, or you might get something like this where a clever person will just work it out. They don't know anything about local anesthetics and their actions, but they'll just work that out because B is charged uncharged inside outside an ionic catatonic. They'll work that out. That's not a good question. And actually, there isn't a question there. This is just long. There's too much reading, and it's not worth reading. we try and just eliminate that sort of thing. So we're looking for a lead in a stem. A bit of a story. We're then looking for a question and then the five options, one of which will be the single best answer. So we want to see those clues that are in the question put together so that they get what the bigger picture of the scenario is and then are able to answer the question. The bank. It's been constantly evolving. Um, I think when the bank was created, a lot of textbooks were open and a lot of questions were generated just from factual stuff. And those questions are still in the bank. And they surfaced, Um, and and if they are relevant and up to date, um, we as a writing group can try and make that question better if we can. But if we really don't like it and we really think it's dated, then we'll just kill that question and it will go. But our question bank does still have the knowledge based questions in them, Um, so we can salvage questions. We can rework questions, but as each question is used in the exam. It acquires a history and it acquires statistics. And we can, when required, look back on those details about a question and we can see in the exam if that particular question is working, if it's managing to discriminate between the good candidates and they're not so good and again we're using more pictures operative clinical radiology, there's quite a variety building up, and they're quite nice questions. Uh, we've made comment of the curriculum. It's broad. It needs to be checked. You need to be sure what's in it, and we will ask basic science questions and we will ask questions about NHS structure. I think pediatric surgery is pretty private, Elin. Any Children's hospital. And so we have to be able to talk with our colleagues. We have to be able to talk with our medical colleagues. We have to know their language and therefore questions that extend outside our own shop floor are acceptable. Our exam and our questions do come under a lot of scrutiny. Each question comes through the writing group. Uh, there are a number of consultants who sit on the writing group, and we'll see those questions. Who will help will all collectively help each other alter those questions and make them better, make them clearer, make them more relevant. The questions are then selected by the computer at random, and then they appear in the exam, and then they are standard, set by a different set of consultants who are actually the examiners in preparation. I think reading underpins all of the preparation for this exam, but as we've said, trainees just really do need to be ready before they step forward. They need to organize themselves, and we can help them do that to some extent. But they're reading is their responsibility. It does take time, and each setting of the exam is costly. I've just jotted down some of the resources and I think you do start with the books. You start with seminars, but our shop floor really is the place to use the tools that we already have. We every patient interaction is something that we can glean, um, knowledge from glean knowledge outside our own shop floor outside our own specialty. And I think all of these things need to be used actively. At the M and M meeting at the M. D T R Trainee should not be Spectators. I think they can be Spectators. And I think they should be actively involved so that they're learning from all of these interactions. And I think as well. And I said this to the trainees yesterday, I think they should use each other in their preparation because I think you can teach each other in very in in clever ways, Some more top tips. Don't be tired when you get to the exam. Please don't have your trainees do the weekend on call that, you know the weekend before their exam let them be rested because there is a mental rigor to this exam. These papers are tough. Um, and again, I mentioned it yesterday and I underlined it. Um, the questions need to be read very carefully. There are clues throughout. Every word is loaded. There's a timeframe within the within the questions. There are ages of patient's, and they're all there for a reason. Um, when you read the question when you're prompted to see the image, that's when you should go to the image and take a look at it, because that's where it fits with the story. When I talked to trainees after they've done the exam. I do get a sense that some questions annoyed them, and it annoyed them. Not when they were doing the question, but they carry the annoyance into the rest of the exam, and I think it wastes your energy. So it was really, um just try and have that tunnel vision. See a question. Do it. And if you didn't know what was going on, just move on. But don't hold that irritation and annoyance throughout the, uh, two hours, 15 minutes. Okay, I remove this from the last exam. This is what we mean by a lower order question. You can go to the text book and the answer's there, or you can google this and the answer's there. That's not what we're after. So if I'm if I'm to ask, uh, and in erectile question, how can I do that in a better way? And what we found is is giving you a picture to interpret is a better way to to see how you put the scenario together. And this I feel it is a better question to the one before. Do you go over the questions If you think you're too difficult. Did you read all the options? Did you miss a clue? Um, the exhibits are relevant. They're not there for window dressing. And look at everything that we've given in the in each question. Often the sensible safe thing is the one that we want you to spot and not the complex. Um uh, wild thing. Keep it simple. Keep it safe. This is just something I have found when I've questioned trainees after they've done the exam is about how did they answer? Uh, did they read the question? Did they read the story first? Did they read the options First? Did they look at the image first, or did they read the story? Then think of an answer and then just go look for it. Remember, I said that the options were alphabetical, So if you think of your option, if you think of what the right answer is and you get down to see and that's the right, that's what you think the right answer is there might be a better answer that you didn't think of on D or E. So it's really important to read right through all the options. And sometimes you can think of an answer and it's not there. And these are the sort of questions that folk get angry about. But what you have to bear in mind is we've given you five options and which of those five is the best? So just thinking what the boss does might not work so some other time. So I'm just going to show you a question that surfaced on on call with me and one of my trainees. Uh, my trainee said to me, uh, this child has got an interesting X ray. Ms. McCabe, you could make a question out of it. So, um, I said, Well, why don't you make the question up and we'll work on it while we're on call together. So, um, this was the This was the X ray, and all the trainees will have seen this yesterday, so they they know how this goes. Um, but having this x ray, we had to think of a story. Uh, and then we had to think, What question are we going to ask about this? So it was a patient who's been born with gastro spices, and every now and then they would just vomit. Um and we weren't really getting to the We weren't really getting to the answer with this child, but, uh, then this X ray was done, and we put this little story around the x ray, and we then, uh, posed the question about we went for a management question. So just anybody just give me an idea of what options you might then start to think of. We need a single best option. And four. That might be sort of right. Just speak to me. Any thoughts? Sorry. Yep. We'll take that. Any others? Yeah. Reduce the hernia. Yep. A laparotomy? Yep. Can I have my slide back, please? Okay, So this is the sort of list that we we generated on the day. However, the word hernia in that means that the person who didn't interpret the X ray in the first place then got given the answer. So we then have to work without a wee bit to just make that a little bit more obscure. And so these were are these were are four distracters, and then we thought we'd go back and look at the patient, because that gets you to the right answer. But the word hernia has gone because we want the interpretation to remain so our messages be thorough. Um, in encourage systematic reading and being and discipline. Know the timing. Don't be tired before you come to the exam. Look for the clues. They are there and check the check. Any pictures, carefully move on. If you get stuck and keep talking with each other with your trainees and us, what do we do now? Um, well, there has been talk about Do we invent a course? I'm not in favor of that. I think are trained. Our trainees go to enough courses. Um, I think we've We've delivered a number of good messages to take back to your centers. Please spread the word. Um, and I think we're hoping to work on a training day for trainers, and I think that would be very useful. Um, we have had a recent appeal for Folk to join the writing group, and that's been very successful. I think there's a lot of centers across the country now that are represented in the group, and I think that's very welcome. Um, I think it's a good thing to write questions with your trainees. I think that's a very productive thing to do. And certainly that question. I told you, my trainee, once we got to the end of the process, was was just getting a better insight as to what we're after in this exam. Um, we've got tools that we've that we use every day, but we just need to use them in a more focused way with this in mind. And I think we got to start early. This is not We're not. We shouldn't be starting this when they turn s t six and have all night. Come one. We need to start early and get the right patterns of thought into our trainees so that they are robust enough to, uh, to do these two tough papers. That's all I have to say. Thank you very much. Thank you very much. Question, Uh, one of the things I was getting okay, Yeah. People who haven't, um, you're not examiners to be part of the your training that you're training for the examiners things so that I could come to do that course just to understand what the processes are to better help my trainees. I mean, I can answer that Jan it, which is that the J. C. I. Does not permit that at present it's, I presume, it's a function of expense and places. So, um, there isn't an opportunity for anyone to go on the examiners training course until they have been accepted as a, uh, an examiner. Um, but that's one of the reasons for baps thinking to promote a training, the trainers course and just one other comment. I often get asked to propose people for the exam, and quite often I think, before they are ready for the exam and the trainees consistently worry that they're going to fail the exam a couple of times. So they seem to want to start earlier than they really should. And they're really not ready just so that they can finish it all by the time they get to the end of year eight. And and that happens often, Uh, I mean, I think that's true, and we said that to the trainees yesterday. It will be a self fulfilling prophecy, and one of the things we said to the trainees yesterday, um, you know, if you were going to sit your what my day would have been low levels. You know, G C S E. S. And someone gave you the a level paper. Would you pass it? Um, So if somebody's sitting this at the beginning of year seven, the judgment is of a day one consultants. So that's effectively Year nine in your training. So you're two years away from where you would be. So if they're your trainers not if your candidates not a high flyer, someone in whom you're thinking. If this were a competence based system which theoretically it is, I could sign them off tomorrow and they could get their c c T. There's been a tendency in the past to sign people off early to do the written on the grounds that time time will pass, and by the time they're doing the clinical, they'll be ready. But the criteria have changed, and the written is set with the higher order thinking of a day one consultant, You might say it's illogical, but it's the rules that we're playing by. So, you know, don't sign someone up who who isn't ready. Um, it is not in their best interest, and it's tough sometimes saying to people, because we're quite a touchy feely, um, group of people in, Probably in pediatric surgery. Most of us, um, Bruce and, um, actually, having the guts to say what needs to be said to someone, which is I don't think you're ready to set this exam. Sit it in six months. Time is actually the kinder thing to do in the long run, Um, as well as being the right thing for your own potential property issues. Well, if they're running out of time, then they need to go to their TPD or they need to go to the dean ary and have the time extended. Um uh, and with a competency based system, there is potential for that. Um, you still they will still have to, um, justify that to the to the dean ary. But again, this should be being picked up at the A RCPs earlier along that that people are not reaching the level that we would expect them to reach. Um, And if the training is not ready, they're not ready. Um, you know, would you say Well, you've been training for, uh, six years, so I know you don't know how to do it, but you're just going to do this tough because, you know, times arrived, and you're you need to do it. Well, we wouldn't. And the same is true of the exam. If they're not ready, they're not ready. Uh, thanks very much for the talking. I think it's really helpful. Um, could you share your slides, both of you, with all of us so that we can share it with our colleagues who aren't here? Um, we think we agreed yesterday we would share it. You know, we agreed Yesterday we share with the trainees were quite happy to share with the trainers as well. We just need to. And in response to Janet's comment, I think I think it'll be easier for a group of consultants to say we don't think you're ready than an individual consultant. Perhaps to say I don't think you're ready. Yeah, I think that the multi consultant I think that the multi consultant report is a is a breakthrough in that respect. The other thing that I raised at the S a. C earlier in the week was that it should go on the year six checklist. Um, and I've been invited therefore now to write something in a form of words, but that that has exam ready Penis, you know, yea or nay and in detail or, you know, giving further information on that checklist. And that's something that should be being looked at and also taking out of the year. Seven. We're rewarding the Year seven checklist, so it doesn't almost make you feel guilty if you haven't got the exam, because it sort of says, if you haven't got both parts of the exam by now, you know, say when you're going to sit it. Whereas in practice, we wouldn't expect people to have got both parts of the exam by the time they do their year. Seven a. R c P exams set at the day level of a day One consultant You know, really your best time to be sitting the second. The second part, at least, is going to be in Year eight. The difficulty is that is the time frame. And because we're a small specialty, the exam only takes place twice a year. If you're an orthopedics, it's three times a year, you know, and in general surgery. But that's one of the disadvantages of us being in a small specialty. Right. Well, thank you very much. That was very, very informative, Hillary and, uh, Amanda, uh, Liam is here to answer any questions regarding the curriculum or yeah, just make a point that the exam is predicated on the breadth of the curriculum. And that's something I've spent a lot of time thinking about. When I was the s a C chair. Million apologizes for not being here, but as I'm now the X s a C chair. I think I'm expendable. Um, thank you very much. Uh, that ends the winter meeting. We will have a short break for coffee. And in that break, if you could kindly join the MPs counter and just make them feel important, that would be very appreciated. And if you come back in 15 minutes, we will have a council meeting, which is open to all fully pick members of baps to quickly run through some of the important aspects. True