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Right. I think we might be live. Are we live? We're live. Hello, welcome everybody. Sorry about that. I was having an argument with my camera. Um My name is Laura Hamilton. I'm an orthopedic consultant down in Brighton and I'm on the Council of the Royal College of Surgeons of England. Um I'm chairing this session today. Uh We've had 400 people register and we're over 100 already, which is great. Um First of all, we're gonna hear from Ran who is an orthopedic consultant, knee surgeon. He did the RC sa few years ago. He's got some tips and tricks on how to prepare and then we're gonna do Q and A. Um, we also have Professor Batty here who's a cardiac surgeon and also on the Council of England, uh who's actually an examiner. So she's not allowed to give all the tricks and tips away, but she can definitely answer some questions and give you some advice and possibly reassure you that the examiners are all really, really nice. Um So before we start, we do have a few polls just to see who is here so that we can um ta tailor our teaching and tailor our chat basically. So we're just gonna ask you a few questions. It's all anonymous. What level you are when you're planning to do the exam, things like that. So the first question, if you can just tick off here, what is your current stage of training? Uh This is just to give us a rough idea of how detailed we need to be with our advice. So once we get a few answers for that, we'll put the next one up. Let me get my chat going. If at any point, you have any questions, if you just put them in the chat box and I'll ask them at the end. So most of the people here are ST six, ST seven and SAS. So pretty much coming up on the exam really, which is great. So in orthopedics, we do it a bit earlier in other specialties, they do it later. Um So I think probably all of you are getting quite close, uh, to the exam right now. Ok. And we've got some more questions. So, Jane, if you want to put the next question up. So, yeah, it's a similar question. Um, when are you planning to do the exam? So part one, this is for not part two. So have you already done part one? Have you done the written or not? And let's have a little look. Oh, we forgot to put on there already. Done it, which might be an option. Just put, not sure if you've already done them. How long? Ok. So most of you are planning to do it again soon or you've already done it? Ok. And the next question I think is fatalities? Oh, sorry part two. So this is the scary one. When are you planning to do F CS part two? So within six months, within, within one year, I'm not sure. Uh, no, you're planning ahead. Well done. I think I just uh left it last minute, prepare for the f so well done just to get in advance. And we've got another pole. I think this is a speciality now. So we can just see here we go. So what is your speciality? Hopefully, hopefully you will know this. I have lots of options here. There might be some, we miss off, um, just the nearest option and this is just so that we know how to target it. Our information again, we thought there might be lots of Ortho people here and I are here, but we'll see if any cardiothoracic people, the doctor. Ok. Ok. So we've got the majority of people are actual surgery with, sorry, I keep getting notice mostly general surgery with then. Ortho and Larg. Ok. A bit of plastics. Lovely. Right. So, pretty much the breadth of the specialties. That's pretty much how the surgeons are spread. It's mainly general surgery then TN O and then the other um, smaller groups. So, first of all we're gonna hear from, er, Mr Runway who is an orthopedic consultant. He's gonna give us some tips and tricks and then we'll do some questions. So I think I'll just give the floor to you, ran. Um Thanks Laura. That's very kind. Um Hi, everyone. Thanks for attending. Thanks for dedicating a um Monday evening to listen to us. Hopefully help you a bit in your preparations for your FRCS exam. Um So I'm I'm a consultant uh down in Kingston Hospital in Surrey, down in Southwest London. Um And uh next slightly and so full disclosure that John next slide, please. Excellent, some technical difficulties. Here. There we go. Uh So full disclosure, I am an orthopedic surgeon. Therefore, at my experience and um the advice I'll be giving out is is obviously based on uh the orthopedic exam, which is I, I've tried to keep this uh presentation quite generous. So because I know that it's a pan specialty um webinar and um hopefully, the tips and tricks I give is more for um general preparing for the exam rather than anything specific about the uh the orthopedic exam itself. But um in the question bit afterwards, if you want to ask some specifics, I'm more than happy to answer those as well. Um So I did my exam in 2019, which is pre COVID. Clearly, things have changed slightly with the um abolition of uh patients in the short cases for your clinical part of the part two exam um been saying that II know II am currently faculty on the postgraduate orthopedic uh Viber course which is due to run tomorrow. Um And we, so we do keep up to date with what's happening um Currently. Um So I do have AAA good idea of, of what uh is asking how, how it's run. Um So next slide, please. Uh so a few considerations, I know that some of you have already done part one, but for those that are coming, I haven't uh started your journey. Um a few considerations really to, to have the back of your mind. So timing, you know, when it, it's, it's a stressful part of your life and you really don't want to be coinciding that with other stressful parts of your life. If you could help it, uh whether that's, you know, has move a um a wedding or a birth of a new child, um All these things can add additional stress and, and look, if it has to happen, it has to happen. But if you can try and avoid it, then it certainly will give you that slight edge and hopefully help you stay a bit more focused and help you pass first time because really you, you wanna get this done first time. Um Timing also in terms of uh how long you want to dedicate to it because look, uh everyone's slightly different. Some people may only need six months. Um, and they can get through the exam quite easily. Some people might need a year and a half and really it's doing a bit of introspection, uh, to know what sort of person you are and what sort of background or baseline knowledge you have. Um, and what you need to, to dedicate to this exam. It's a costly exam. Um, the exam itself, you're looking at just shy of 2000 lbs just to do the part one and two. And that's not, um, including all the other stuff that you'll be spending money on such as um resources courses. Um, and ultimately closer to the exam, er, hotels and uh potentially, er, travel as well to get to your test centers. Um, wellbeing is really important and, and I know we, we hark on about this but really if, if you're burnt out you're not gonna do well in an exam and it's the old adage, whether it's a marathon or not sprint, it's a long slog and really you need to make sure that you, um, you stay on top of your wellbeing. Uh and whether that's, you know, make sure you exercise or make sure you have the right people around, you make sure that you, you stay positive for that um, next slide, please. Uh So what you need to apply for those that haven't looked at this already, I'd suggest that you go to the website the, at the bottom there JCI E website. Ultimately, you need your up to date CV. You need your up to date book that, that will allow the um uh the JCI E to see whether you're, you're adequately ready for the exam. Um And you need three references. So if you're a trainee, you need a reference from your TPD. And uh the other two references will come from um consultant trainers that you work for within the last two years. Um If you're a non trainee, I think it's just your department head, who's your clinical director? Uh And uh your uh I've done two consultants that you've worked with um within the last two years. Uh next slide, please. Um So getting started, um you want to apply early. So as soon as you've decided that you can do the exam and you're eligible for the exam you want to apply uh because you, the later you leave it, the less likely you are to get the uh second part of the exam. Pardon me that you want? Uh So you might have a big gap between part one and two and really don't want that because that will add to the additional time that you, you're gonna end up doing this and the strain that's gonna have on your life. Um When do I start revising? Well, like, like let's not kid ourselves. Um when we talk about revising for any postgraduate exam, a lot of times you're learning for the first time. Um the the aspects of the curriculum that you may never visited, you not really revised, you're learning for the first time. And therefore you need to have a good idea of what your baseline knowledge is. Now, if you're purely revising, then you probably don't need more than three or four months to revise to, to refresh your memory. But if you're learning, then you probably need a lot longer um to, to cement that, um consolidate that knowledge uh for the uh to cover the breadth of the curriculum. Um I would suggest that you start slow. So even if it's like an hour or two a week initially, as long as you get that momentum going and get that habit, it's all that habit, um built up then really, then that'll sort of do you do you, well, um, there's no point, um keeping everything till the end and trying to do the in big lumps. Um, it just doesn't work. So you need to, you need to build a bit of a habit much like those of you who, um, do fitness and you go to the gym, you know, there's no point going to the gym uh three times uh for a week uh in every two months, but you have to do it every week and just to make sure that you get had underway, uh next slide, please. So my advice, um, you really don't want to use more than two textbooks. Um And I don't mean resources, these are textbooks, these are, these are textbooks that cover the, the breadth of your curriculum. Um So in orthopedics, there's quite a few. And really if you start reading each bit of the, the subspecialty text uh using like three or four textbooks, it will confuse you. Um So you want to have one or maybe two textbooks to cover the breath and, and learn from that. Um You, you wanna, you wanna utilize uh e notes, electronic notes. So one of the best advice that someone gave to me as an sho is use Microsoft one note. So uh next slide and um this is a screenshot of my, er, one note uh that I still have and that I still use because guess what, like when you've done the exam, the knowledge fades away quite quickly and sometimes you need to revisit these, whether it be for the sake of your patients or when you need to buy about other people. But these are my notes that I still use um on a day to day basis on the breadth of, of my curriculum, which is orthopedics and uh you know, it's things that I would never be able to remember and there's no way you can have all of this in your memory but to have it in a uh electronic format that you can go back revisit, edit and, you know, use throughout your career. I think it is, it is actually quite useful. So I would suggest everyone use Ils, I think it's free. So um you know, get one note, start taking notes, you can screenshot stuff when you're at conferences, take a photo on your phone and you can then upload it onto this and you can build up a really good compendium of knowledge. Uh That, that is your notes uh Next slide. Um So you wanna set short term goals? I mean, I'm not gonna labor this point because all of you would have done exams up until now, whether it be school or postgraduate exams, but you, you wanna set your short term goals so that you can achieve those goals. Otherwise you get disheartened and you get demoralized and you get disillusioned about the whole process. Um You want to ensure that you cover the breadth of your curriculum and you don't want to be uh delving into rabbit holes and I know they're an initi of uh certain, you know, pathological processes. And if that doesn't come up, then you spent all that time and completely wasted your time. So you want to cover the breath, you wanna be a jack of all trade. Uh You also wanna couple your theory with practice and that's the only way you're going to consolidate your memory. Uh There's no point in reading about something albeit might be quite interesting if you then don't see that clinically or, or at least uh discuss that. Um And, and sort of understand why that's useful to your uh day to day practice. And don't forget this exam. It's all about how I order thinking and that's about coupling your theory with your practice. Um And you want to lock in a study partner. So, and I don't mean that you need to study together straight away, but you wanna eye out someone that you trust and you like that you get along with, um, that acts as your business partner, your partner, um cos you know, some of the, so if you're starting a small, small business, it's really hard to go by yourself. You really need one or two other uh business partners to, because that at some point you're gonna get demotivated, you're gonna lose the drive uh and need someone else to pick you up and, and vice versa. So you want to identify those people early on even when you're an S D3 or you're early on and you're at Joe, if you're in the gonna be in the same region that, um, I think it will be a good, er, study partner that you get along with, um, and do it together and, and I guarantee you that will make things a lot hell of a lot easier to, especially towards the end uh next slide. Uh So one year before, I don't mean one year before part one, I'd say one year before part two. You don't, I don't think you need more than one year. Um If you are truly, uh if you have truly worked up until that point, uh ie you, you've been doing your training, going to regional teaching and taking notes and, and learning stuff, learning the, the curriculum rather. Um So you want to plan your year? So, uh that's things like your study leave, your annual leave. Have you got any uh big anniversaries coming up? Have you got, are you the best man or d oh, no, for, for your best friend at the wedding? You know, have you got potentially big holidays that you've planned for years? You know, like to, to take off your bucket list. But you, you know, which I recommend you still do. Um But you don't wanna not think about that and, and then get your timings all mixed up and that you're having to go to on a stag do two weeks before your part one exam. And that's just not clever. But uh but also, you know, that just shows that, you know, you won't be that disorganized. I'm hoping none of you are given that you, you're, you've been organized to attend tonight. Um You wanna gather, sorry you want, if you can, for those of you who have got a TPD, you want to keep your placements light. So you all know if you're a trainee, which jobs in the region are slightly uh potentially easier to navigate than others. Um And to that day, you really also want to do a self specialty that maybe that you don't, it's not your favorite self specialty that you don't want to do as a career. Because, you know, it's a shame to give up a, um, well, potentially not, um, get as much out of the placement that you potentially want to do as a self specialty because you've had to dedicate that time on your, uh, exam. But you know, that that is, it may not be possible. But if you can keep that in mind, that certainly would help you want to gather all the resources you can, there'll be loads of people in your region that have done exams recently. There'll be examiners, there'll be people that, um, like myself, the, the, the Viber on courses and we'll have a AAA quite a lot of resources that we can help, um, you with or sorry, rather give you um, to try and help you with your exam. Um You want to start with your preferred subspecialty when you're revising. So you don't get disheartened because it's, you know, if you're doing something that you like and you find it easy, it's much easier to keep it going. Uh rather than if you start with the one that you hate most, you, you just get disheartened and you just give up most likely. Um So do something you like first because you've got, you know, a year before the exam so you might as well start, you know, be kind to yourself initially. Uh, you want to warn, uh, you, you definitely want to warn your family and friends and, and because it's gonna be, it's a stressful part of your life, there's no doubt about it. It is traumatic, it's stressful. Um, but it's worth it. So, uh, make sure that your family and friends are on board and they know that you might be an absent husband, wife, mother, you know, father, best friend, son, daughter, whatever. Um So it's important to make sure they know that so that they can help you through it as well. You know, you, you are invariably you'll get um, bad days where we, you, you need to offload a bit and you need to, uh, and if you don't understand how difficult and how important this exam is, they, they may not be able to help you as much as they can. Uh, next slide. Um Within about two months of your part, one is a very high risk of burnout. And ii really, really, really suggest that you consider taking a week or two off. It sounds silly. It sounds crazy that you're just gonna stop studying and go on holiday or maybe even just stay at home and, or just not think about the exam. But actually sometimes your brain needs that. If you, you've been, if you've been truly and working hard up until now, if you haven't then, you know, obviously don't take, take off because you need, you need to put it up and, and study. Um, but if you have been working hard then you want to make sure that you, you sort of give your brain a bit of a rest and give you a bit of a rest as well. Um, and at this point, you need to be concentrating on your part. One questions, your past paper questions and, and don't worry too much about, um, you know, reading more about the curriculum, you know, practicing vib and doing all that sort of stuff and you wanna be getting the skills that you need to answer queues because it is a skill ultimately. Uh and a lot of you will have, they have developed that skill through, er, MRC S medical skill. Um, but you need to, you need to further develop that skill for Fr CS cos, it's slightly different with the certainly for orthopedics. The stems are quite short and it's, uh, it tests your higher order thinking and really if you haven't, um, done a lot of those questions, you might find it difficult to, to utilize aspect of your uh skill set. Um, next slide um, night before, make sure you sleep well, you know, don't drink coffee or high caffeinated drinks, make sure you, um, you clear your mind. You know, there's no, there's absolutely no point reading about some biochemical statistical stuff that you just can't remember, uh, the night before cos you're just gonna end up remembering that and thinking about everything else. Um, let, let, let's face it. If you don't know it until the night before the exam, you're probably not gonna know it. Um, and just do something relaxing whether that's, I don't know, um, going for a run or having a bath or getting a massage or meeting a friend for a meal or what, whatever that is that helps you relax. Um, and make sure you eat well, um, obviously don't eat something that's gonna upset your stomach, don't eat something that you, that, um, that potentially might give you a bad day the next day. Um, so, you know, you gotta treat yourself like an athlete really. And I think, uh, that these are all things that athletes certainly would do before, uh, the day before a big competition. All right. So next side, please. So part one exam, those of you sat at you, you, you know about this, it's, it's the, it's not a pleasant environment to be in, in a test center, potentially beside people. Uh, that are 17, doing their driving, uh, test has a perception test. Um, but it's gotta be done. Uh, make sure you read the instructions of JCI carefully. They are, it's not the most intuitive system. So it's, you don't want to be having it issues that adds the stress on the day and you want to be arriving early to test to the test center. Um, I would suggest bringing some airpods or something to music to listen to or a book to read or something because, um, unfortunately there are gonna be people there who, and then, like, some people, um, this is a way to deal with it. They'll be asking everyone questions about stuff, uh, some random stuff and, and that'll psych you out and they'll, and there'll be people that are very anxious and that, that's just the way they are and that's the way they deal with the exam and you may be one of them. But, you know, for me, like that really piss me off. So I just wanna get away from anybody, uh, be in my own space, not listen to other people. Um, and you'll see people like, you know, flicking through the textbook the morning of the exam. You're like, why? Like it's too late now. And I think people do that sometimes because that's the way they deal with the stress, but that sometimes can put you off. So just ignore everyone around you. You do your thing and you'll be fine. Uh, so stay hydrated, stay well, make sure you have a decent breakfast a long day and, and it's knackering by the end of that day, you will be knackered cos you read so many questions and your brain's on overdrive for the good part of six hours. Um, so please, and then the wait and this is the most frustrating part of the, the whole experience because you think it's, it's on a computer, you know, they can probably tell you exactly what your score is. Why they will, they'll know exactly what your score straight away and they'll be able to, you know, level you, they'll be able to fit all the scores into a database and be able to figure out whether you passed or not. But there is a good reason. Um why you need to wait because it needs validating. There's lots of things that happen with the part one results. Um There's certain formulas, there's questions that are really hard to get taken out questions that are really easy to get taken out. So there are, there are loads of things that happen in the background. So that's the reason for the wait. Um I would forget about the exam. It's done. There's nothing you can do about it. Don't keep on going over your head. Oh, I should have answered that question this way and then you start asking people. It's like, oh, what would you have said for that question? And then that's one question out of like 100s that you got wrong. And somehow you think that means you're gonna fail everything, just forget about it. It's done. Um take a holiday if you can. And like I know the cost of living, you know, you might not be able to afford a holiday or for whatever reason just take a bit of time off. Um, definitely don't do any study and just to clear your mind, give your mind a break and if you can take holiday, take holiday cos you deserve it. It's been a harsh log up until then. Uh, as soon as you get your part two exam results, sorry. As soon as you get part one exam results, you find a study group, you set up a study group. Uh, next slide, please. Um, my advice for the study group is you don't really want any, uh, any more than four people. Uh, it gets really difficult to organize dates and, uh, you, you end up having a bit of a bit of a too many cooks, um, scenario where everyone wants to sort of have their own bit and there's too many personalities you just want. Ideally three, I think three good, you know, similar level people that you get along with. Um, and it's much easier to set evenings and days to do Viber and clinical practice. Um, you want to utilize a collective knowledge and experience because all the three or four of you or, or more within that study group are not going to be all, um, budding knee surgeons or budding, you know, I don't know. Sorry, I'm not going to go down into other specialties. I'll stick to my own, but, you know, they're going to be, um, all of the same, um, interest. So utilize that and they'll have their own contacts. So, get them to see everyone bring to the table, um, you know, tutors that might be able to arrange VR sessions with the group. Um, and that's really important and ultimately you need to have a plan, you can't just meet up and just flick through a book, you need to say. Right. Well, we've got six weeks or eight weeks or however long we need to cover this, this and that. Um, this week we're doing pediatric, this week we're doing, this week we're doing trauma the week we're doing et cetera, et cetera. And, and you need to cover that. And, um, that's the only way you're gonna cover the breadth of, uh, of what you need to know. Um, so next slide, please. Um, so my pa tips for part two is that you, you do again ask around for past questions and I'll have a bank of past questions. I'm not saying that that's, you know, that's cheating, but it gives you a flavor of, of what's coming up. And ultimately, it's just a curriculum. So, or past questions are just aspects of the curriculum that were tested. Um, but common things are common and for good reason because they are common in your day to day practice and they're quite important in your day to day practice. Uh, like, you know, you don't want to miss AAA tumor, um, for, for an orthopedic surgeon. So, therefore that comes out, you know, you don't want to miss a, a, quite a, a fracture with a very poor prognosis because of co, I guess what that comes up. So, um, it's important to inquire about that. Inquire about the, the best courses. And by that, I mean, value for money, there's loads of courses out there. They're all pretty good and otherwise they, they wouldn't have been around, but some are more value for money than others. And because some charge quite a lot and really, unless you're made of money, there's, you're just wasting money, uh, doing those courses. So ask around and people know which ones, the best ones to do. Um, I would highly recommend taking leave for the week before your part two exam. Uh, whether that's to so that you, you've got that you're in that frame of mind and you're waking up, you're, you're, and I suspect, uh, hopefully sorry. Uh, hopefully you can do that with your study partners and then you can get together do vs all day clinic and clinical examinations in the afternoon, et cetera and, and get into that frame of mind because you don't wanna be, be doing AAA Clinic, you know, on a Friday afternoon or Friday morning when you're due to go sit your exam on Sunday. It's, it's just not a good strain of mine to be in. So if you, if you've got the leave and if, if you're organized enough, make sure that's what you do. Book a nice hotel. Um, cos with that said treat yourself an extra 50 100 lbs. You don't wanna be staying in the Premier Inn where there's a wedding going on and that, you know, you get drunk people coming in at two in the morning and they're like sitting outside your door and they wake you up the night before your exam. Uh That would be an absolute nightmare. So just treat yourself a bit, make sure you uh you're in a decent hotel and that you get a good night's sleep. Uh You wanna minimize your knowledge gap. So you, you, you want to take a shotgun approach and you really want to cover all bases, even like one or two things and three things um in every topic. Um If you know that you're, you're good to go because you can talk about it because at the end of the day, this is a part two is the talking exam. They assume that your knowledge is there and it's how you talk and, and how you come across and how you think and really you want to be thinking, I am a day one consultant or I am a consultant discussing a case, that case with a colleague. And if you think like that, then you hopefully act like that. And therefore the person that is examining, you will have a better uh feeling towards you, hopefully of, of that topic. And uh hopefully will pat you. So it's important that you act like a consultant if you wanna be a consultant. Uh next slide, please. Uh So how the part two exam scored? Well, sorry. Well, it's split into two days. Uh it may, may not be consecutive days. Um So in orthopedics, I know that you've got your clinicals one day and your Vival vs over the course of two days and depending on where your surname lies and they change it around. So sometimes you can do it, the clinicals on Sunday and the vibe on a Tuesday, rather the clinical on Sunday and vibe on Monday. I don't know what it's like in other specialties because it might be less um candidates and therefore you might be able to fit into two days. Uh but there are 96 scoring opportunities. Each of those scoring opportunities you can get eight marks in. So that's a total of 768 marks. Um uh Next, please. Uh that means that uh you really need a six for a pass and this is a, this is on the JC JCI U website, so it's not, you know, secret. Er So look at it, look at what they're looking for for a six, really don't wanna be aiming for a six cos sometimes you might get five. and if you aim for a seven and you drop to six or you get a few fives and fours, if the majority of sevens, then, then you pass. So you wanna be aiming for the sevens and if you can eighth great, but seven is a good aim. So have a read of that. Um And that's what you wanna be aiming for. Uh Next please. And ultimately, the three things you must do is you listen carefully and the amount of times that when I'm vibing people and I ask them a question and they, they clearly haven't listened to me because they're stressed because they're like, because they've seen an X ray or, or, or a clinical photograph and they think they know what I'm asking, but just listen to the question you wanna think rationally and that means taking a bit of time to think that's fine and you want to speak clearly because if you, if you say it rushed and mumbled, it's not heard, then it's not said. So you have to speak clearly and, and uh and sometimes there are issues with accents and obviously that's taken into consideration. But, but really you gotta work on it because at the end of the day, you know, if you're a bit mumbled or a bit rushed in your speech, when you're with the patient, that's a problem as well. And, and this is a test of your ability to be a consultant, dealing with a patient as an independent practitioner. So, you know, that's part of the test as well as your communication skills. Um And if you do that next slide, please. You pass and hopefully, uh you will never have to think about this again and you'll be relieved and not have to spend another 1300 lbs on part two again. Um That's, that's all for me. Thank you very much ran. That was great. Um Yeah, I agree with everything you said. II didn't stay in a nice hotel and I had people coming in drunk 234 in the morning knocking on the door, singing outside and I was opening the door, screaming, go away. I have an exam and nobody cared. Um, so yeah, just go somewhere nice. Um, and I think, yeah, ra raise some really good points there. Part one is miserable. You just have to do the bookwork and the questions are completely random and you think even afterwards you look them up and you're still not sure what you should have said, but as long as you get the important stuff right, and you play it safe, er, you'll pass. Part one. Part two is scarier. Part two is a lot more about technique. So for part two, you don't really need that much knowledge. You need to be calm and you need to have a structured, uh, a structured thought process and you need to be safe. And we always say basically if, if you can survive an orthopedic trauma meeting, being asked questions and staying calm and being safe, you can pass the exam. So there's not some magical knowledge you need, there's no magical knowledge. It's stuff you would need to know every day anyway. So, don't get too upset about the little bits of information you can't remember. Don't stress. That's what I did. I'm like, what's part four of the classification of this really bizarre pediatric genetic deformity that doesn't matter as long as you're safe and structured and calm. Um, and they would trust you as a, a senior registrar as a first year consultant, then you'll pass the exam. So we've got some questions coming up. The questions I've got so far in the chat are asking me how much the exam costs on the website. What are the eligibility criteria on the website? What's the gap between exams on the website? And we are not gonna answer questions about the website. Go on the, the first test is, can you read the website? Can you see whether you fit the criteria? What we wanna do is give you human feedback and human questions about how to do this better and how to not waste your time. Um, the exam is so expensive. Oh my God, I've been involved in some of this. I was furious when I was doing the exam. It's for the hire the venue we did, um, for the orthopedic interviews. It's 50,000 lbs just to hire a venue for two days. And that's not including paying the expenses of all the patients to come food, drink tea, coffee, all the admin costs. Um, it is just really expensive, it's really expensive to put an event on. Um, there's no one's making money from it. Everyone's breaking even all the examiners aren't paid. Um, and quite often we don't even get the travel costs and things like that paid. So, um, nobody is making a profit from the exam just to, if that reassures you, it's not great news but it is what it is. If anyone's got any questions, I'll invite, er, Professor Batty and ran to put the microphone on and if you've got any questions, if you pop them in the chat and we'll try to answer them. So, and this is all gonna be recorded so you can watch it at your leisure and it'll be available on med all afterwards as well. Um Hi Laura. Laura, can I come in a little bit? I was gonna say, is there anything? And um yeah, lots to add, but I'll try and sort of base it around the questions that are coming through. There's one about the um curriculum and syllabus. So if you go on to the I SCP website, um if you click on various things, you'll find the curriculum and then you can actually go on to the specialty specific curricula. Um So there's one for Cardiothoracic, there's one for all the others. Um and in fact, at the bottom and you'll see the breadth and then also you have a blueprint for assessment. So you see where different things are going to be assessed and which bits are going to be assessed. The part one and the second part of the um FRCS brackets, whatever specialty you're in. So it gives you a feel for it clearly. The so you need to, before you start revising, you need, you should know what's actually on the curriculum uh for a start in terms of um revision, et cetera. Um If I'm talking about cardiothoracic, um I, I'm a cardiac surgeon and people keep asking in the chat if it's being recorded, it is being recorded and you will get access to it. So, um so just follow the conversation and you will get the um the um the webinar. So there's a lot of breadth of knowledge and certainly as a cardiac surgeon, I found it quite hard um to cover all the breadth of the thoracic because I wasn't doing that day in day out. And you realize it's not just lung cancer or pneumothoraces, there's a lot within that chest cavity and lots in the media, pleural disease, cancers of, of course airway disease. So it's the first part is a test of knowledge and the breadth of it. So, whilst, um so I would say you do need to hit your books for that, for sure. I, you know, I would find that far harder. Um And so I had books galore and you need to um practice the e the stuff that you might not find easy but you know, will come up in the examination. So for example, if you, you, you may need to learn about shunts, you might need to learn for, for cardiothoracic of pediatric terminology because congenital is tested within the examination, basic sciences are tested within the the the um written paper. So you really need to be up to and speed with it because it's actually testing higher order. So you really want to know as much of the knowledge that you can just rattle off if it's a quick formula, et cetera. And then use that time to actually think about answers. And I found the clinical and it's easy to say this. Once you've passed it at the time, I was stressed out. I stayed in a really expensive hotel. I was in bed with all my books. I took a suitcase with all my books in the boot of my car. So I was trying to do everything to alleviate my stress and it didn't really work. I was very stressed because it's a big time thing in your life. And if you're in a small specialty, you often everyone knows that you're that person from the rotation, taking the exam. So there's a lot of pressure on you from outside and within. But so II made it sort of, I sort of threw money at it and I appreciate not everybody can. But um I think that the part two is certainly from what I as both as an examiner and when I took it, it really is like doing a, an outpatient with a new patient, maybe presenting it, maybe presenting something at NBT, maybe discussing something. So it should be something you are doing all day, every day and it should be the bread and butter of, of your work. So I think um if you just treat it like that and how you would deal with your colleagues and explain stuff to a patient um et cetera and obviously the breakdown of different exams, the cardiothoracic again, you can look up um on the website as to how it's broken down and, and I'm happy to go into that later. So I'm going to stop and see Laura. Thank you. So there's a question here. Um Yeah, are there any someone's asking are images used? Um I'm not sure about Ortho. It's been so long since I've done it. But yeah, no, there are images in or the images used will be really obvious, you know, when you get your sorry, I Yeah, I sorry, oh sorry to to interrupt. But I the the images um they're, they're on that it system and I have to say some of the images are not the best quality of images and that is sometimes a problem, but that's a problem for everyone doing that sitting. So, uh for example, recently there was an MRI scan that was quite granular and there. So if an MRI scan is quite granular, it's quite difficult to see. But that will be taken into consideration because when you know why I said there's a bit of a wait um that all those questions get validated and all those things get looked at. So that question is hitting a, a quite a low um correct. Um Sorry, that's not the right English. But I, if, if lots of people are getting that, um, question wrong, despite it being quite an easy one, they'll then look at that and, and see why that is the case and it is because the image is inadequate, then they'll get rid of that question. So I won't worry too much about that, but there is a good question here from James. Uh WSD. Sorry, I might have pronounced that wrong. I apologize, James. Um asked about, uh, sorry, that's, that's James this question. So there's a question about evidence. Uh I can't remember who said that now. Um, but asking senior colleagues and whether you need to know all the evidence for part two and I can guarantee you, I think I've quoted one paper throughout my whole er, part two exam. You do not need to quote evidence, at least an orthopedic, sorry, it might be different now, subset. So I'm going to Thanks Ran and I, I'm going to come in here now. Thank you. So that, that's all great advice. Now, from a cardiothoracic perspective and II know there's only 4% of the people so that I don't know if that's one person or two or three. But hello, um we do have instrument stations and we do have images. The images are on ipads. They're all quality assured, they're all, you know, things that you should have come across. I mean, I, I'm not saying uh what they might be, but think of what you might come across as a day one consultant, either electively or in emergencies and common things are common. So I think the images are reasonable. Sometimes they'll play, scroll through like a, a ct et cetera. So you will see it, they're standardized and the um during that sort of part of the examination, all the candidates will have similar either instruments and of course instruments, it's not just what is it, you may be, you know, you might be asked, how would you use it? Where would you deploy? There's, you know, be nice to know that you would know what instrument went where during an operation in terms of evidence, my expectation would be, yes, you should know the evidence in cardiothoracic. I would expect somebody to know. I'm not saying that my show of every single trial and you know, those sort of appendices or whatever, but you have to um be able to explain during consent what you're doing to a patient, why you're doing it to a patient? Why are they having a set of grafts rather than a stent? For example, obviously, I'm basing my examples on cardiothoracic and what's the advantage of those over doing nothing? Um Or we, we know all the sort of cases that have come, you know, through, about telling people what they think would be important to them. So, yes, my expectation would be, why am I doing? Um um If somebody's got triple vessel disease and they're diabetic, why I'm advocating um a set of grafts rather than multiple P CS, which would say yes, you do need to quote. But for, for cardiothoracic, you know, you have the American Heart Association guidelines. I don't want to get too detailed. I'm sure it's the same similar for every specialty and you have European guidelines um for cardiothoracic. So pick, pick your thing, know your guidelines, know the evidence that it may be different for different specialties. But absolutely, you should know and there was another question about um so regarding the pictures, the pictures were for part one. So on part one and you're just getting like machine with a million questions. So that's the ones where if you see a funny picture, don't worry if you're just like, I have no idea what that is. Have a sensible guest. Don't worry about it because everyone else is in the same, in the same position. So part one and in terms of for the, for the bigger specialties. Like also there is so much evidence um that, that you could, you the most important thing like you said is the decision making process. So I am going to do this because in this patient, this patient, you know, there's a risk of nonunion. So I will offer them. So as long as you have thought process and you're sensible and you're for the right, right reason, you don't need to quote the, I think we would expect you to know like the boast and the guidelines because you need to know them every day. So I think NHS national guidelines that you're using every day I think would be expected. Most people do know the big trials, cos we talk about them but don't get obsessed with worrying about memorizing every single reference because you can pass without that if you've got a sensible thought process and you know why you're choosing it? I spent my entire Fr CS saying, oh my God, there's a paper and I've read the paper, um, and it's by a Scottish person and the name has gone. But I know it's this, this, this and this and that's enough. So it's great if you have got the quote, but don't obsess and worry because a lot of people do about remembering what date it was published or what paper it was published in. It's the principles, it's the understanding why you're making the decisions you're making and you do need to know that you do need to know the evidence. So, um but yeah, sorry you were saying, yeah, if I can come back, there were a couple of other thanks for clarifying that there were a couple of other things in the chat that popped through. They may, may have gone up the sort of screen. Now, there was somebody asking N SAS colleague asking was it um is it worth um somebody who's 50 plus or lo thinking of sitting the FRC S um exam at that stage of their life? Well, as you know, the um it depends if you want to have ses or gain access to the specialist register and it is all changing with a portfolio sort of um principle. So the exam isn't essential. However, it is a way of um um demonstrating that you have the knowledge. So it's really, I think a personal thing, there's if you do it the portfolio where there's a lot of evidence to collect, having the exam clearly demonstrates your knowledge, but you still have to um demonstrate all the other areas. And there was also a question saying you that from somebody saying that they are the only person in their region or their rotation sitting in the exam and should they delay it to go with a group? No, do you do it when it's right for you? And with these days, if you do have friends in other regions, et cetera or competitors or somebody you think you can manage to sit with, you can always do things online. But um, no, you do it when it's right for you personally. At your stage of career, you don't want to delay it just because you can have a buddy, even though I agree. Um, depending on your learning style, it is good to bounce um, questions off each other cos especially in the, um the clinical parts of the exam and in the VRS when you certainly, for me, when I say it in my head, it sounds really clever. When you say it out loud, it doesn't always. So you need to practice saying it out loud in you, talk to yourself in the mirror. Thanks. Um with regards to the SAS senior surgeons, you don't necessarily need to do the Fr CS to go on to the, to become a fellow of the college. So there's something called the adi unden process that I'm part of where you basically give us your CV. You say I've done all these exams. I've worked as a consultant for years and years and years. I have the knowledge and the equivalence to become a fellow of the college. So there are equivalent you can get without doing the exam. Um And there's lots of information again on the college website about that. I'm just scrolling down. I'm just picking up points. Lots of people saying they, oh, sorry, Laura, just Caris Brown has asked about whether she should delay her application because there's not enough. Well, there's no one else doing the exam. II mean that, that was not the point that I was trying to make. Hopefully it didn't come across as that you, you do the exam when it suits you. Um, if you don't have a group that, you know, there are some specialties that are much smaller and therefore there's not enough, um, trainees around orthopedics were, were blessed with lots of colleagues. Um, but, you know, if you're in a smaller, sub, smaller specialty, you, you may not have, um, people at your stage of training that can do the exam with you. It doesn't mean you can't explore out with the region. Um, you, you might find that you, you can get some contact uh, with another trainee sitting your specialty exam in another region and the, the post pandemic era. Now we're using, you know, technology to, to chat. There's no reason why you can't organize study groups uh online and, and do it that way, but certainly don't delay it just because there's no one else doing it. Um, you need to do what's right for you. Um, at that point in your life. Yeah, lots of comments here about people failing part one, part one is just miserable. It, it is just miserable. The revision is miserable. The exam is miserable. You're just getting like a scatter gun of questions. You've just got to make a decision and cane through it. Um And as I said, you sometimes come out of it and you still don't know what the right answer was. Um It's that is trying to cover the bread and it's trying to be safe. So just be very aware of things like most fractures are treated, generally, fractures are treated. Lots of words that um a very specific brand, you might have more recent knowledge of this, but I think rarely means less than 10 or there's like little numbers are, as you say, part one is miserable and it's sometimes it, you, you, you have no idea what they're trying to get at and there'll invariably be two answers out of the five that that can be writing. It's a educated educated guess. II think it's important to realize that this webinar is not a chance to um try and change a process. It's, we're here to try and give you advice of how to make the most of the current system and trying to help you. Um And if you've got any woes with regard to how the process is run, this is not the right platform to be raising that unfortunately. Um But I appreciate if you have failed, it is very demoralizing and, but look, you know, plenty of people have failed and passed and so I I'm sure you can get there. It's just, you know, hopefully from what we said, we can inspire you to to do something differently, maybe tweak your uh your studying um method to try and help you to get through that exam, which is which no one likes to do. Um But you have to do it. It's technique, isn't it? There's definitely a technique. Um so far, Laura, and so I can see a couple of questions coming up about different specialties. At the point. I think the point of this was actually the generic sort of things about how to prepare what kind of things to expect. Although obviously, uh main speak, spoke to orthopedics and I can sort of talk about things. So it's about the principles of the thing. There's a few questions I can see about who can be your referee. And, um, and you do need people the with, you know, holding the appropriate sort of qualifications. So if it's not within your department, um I'd be surprised if there's a department without any surgeons with the appropriate qualifications, you can go outside your department. But the point is that they have to, you have to have structured references and they have to know you and they have to be able to sign you off as competent as a day one consultant. So they will have to know you and have a, you know, some knowledge of where you sit. There's another question from a colleague saying that they don't know what grade they are or, um, and I don't know whether that means whether they know if they're SAS or locally employed or whatever, but maybe I'm not quite sure about the question, but if they want to, you know, come back to one of us afterwards, I'm sure we can have a chat and guide them to speak to the appropriate person. There was also something about how do you approach an unwell patient. It's how you approach an unwell patient if you were called down to it, um A and D or the emergency or, or on the ward of someone collapsed, you, you know, you don't forget your ABC S um before you sort of go into your sort of whatever um specialty you're in and whatever they're trying to show you. So you don't forget the basics, it's to keep people safe and make sure you and then obviously demonstrate your knowledge in that particular specialty or subspecialty. So that's what I could see coming up. Thank you. I think part of that as well is listen to the question in terms of the viva because it, it's very frustrating when we do viva practice and we've given you the information in the question and then you go back and start asking about airway. So, you know, I if, if the question is, you're, you're asked to see a very well patient and outpatient clinic with this problem, you don't necessarily then need to go ABC. You can say, I presume the patient is stable and this is an isolated injury is a quick way to scan through. So I think, listen to the words that the, the examiner uses because they will be giving you the information. Um If you're called to A&E resource, then you're thinking ABC. So, so listen to the words, take a moment and try and imagine in your head what you would actually say or do in that situation. Um And the other thing for referees, you're, you're asking someone to, to tell you that you are ready for the exam. So if you're having people say that they're not willing to be a referee, maybe take that as a clue that you need to do a bit more work and that you need to improve your knowledge or your confidence or your skills. Um, because somebody is putting their name to you saying, I think this person is ready. I think they're ready to be a consultant. And if you're struggling to find people to do that, maybe you need a bit more time or a bit more work on your technique uh, before you go for it. I'm sorry, we don't know en TFRC S cos we haven't done it, but it's all the same process. It's do the bookwork, bore yourself with all the bookwork. And then for part two, you what is practical, what is useful. So it's good to have that really odd, bizarre, rare complication in the back of your mind. So it pops up if you need it. But what do you do day by day by day, how do you act safely? How do you treat patients? How do you consent them? What do you do on a day to day basis as a senior registrar basically. Um and that's all you need to pass the part to. You need to be safe and you need to care about the patient and you need to do at least the best sensible, safe minimum. Even if at that point, you say, I don't know how to handle this, but I would do this, this, this and this and then I would ask my colleagues for help. Um Let's have a look here. Got some more neurosurgery. Same as all the rest. You, you learn all the minutia, you learn the breadth. Um And then for part two, you learn how to be a consultant. Basically, I'm just scanning through any more questions there. Um So far, I'd quite like to ask you a bit about being an examiner. So what kind of guidance are there things you can and can't say or are there things you're looking for or what's, what would be your tips for preparing for part two in terms of behaviors and the way you answer questions. Um I guess being I've been an examiner, I started uh many examiners start as um ques on the question writing groups, which is how I was approached when IQ uh when I became a consultant and had done my exam about two years previously. Um And then you sort of, you need to certainly cardiothoracic need to be qualified as a consultant for five years. And then there's an application process. So you do have to demonstrate, for example, I could demonstrate that I was doing work at my local university and doing AYS, et cetera and involved in question writing um at that. So there is an application process, It's not just anybody can do it. Examiners have an induction. So the induction that's run up usually at the Edinburgh College where JCI E sits, um that's an induction for all specialties. And you cover various things like your behaviors, your expectations as an examiner and also usual things as you know, your an ei update and, and what is expected of you as a professional in terms of the actual exam for cardiothoracic, it runs over, um I guess a day and a half. But we, for example, on, we'd go up on a Tuesday afternoon and we go through, um, colleagues, the local host will have prepared. Um I know there's not patients now but prepared a lot of this sort of the, the venue and the sort of organization on, on the shop floor. And we go through all the questions that are going to be asked, they've already been prepared. They've already an oral, oral question, writing group group, but you then still do double check of the examination. The questions, including for the orals and, and the cases that you're going to have the intermediate cases. Now go through them, check if there's any inaccuracy, et cetera, et cetera. So it's quite sort of, uh full on. It usually starts at four o'clock in the afternoon. Um, sometimes you can have debates and it goes into the, you know, middle of the evening if you don't agree. But you know that and you have like a general chat of this is what we, it's not that we separated in cardiac and thoracic and subgroups and yes, you set the standard. It, it should be done already but you talk around it. What's the sort of not question but what that standard is, then the next day it's usually the sort of all the um the clinical cases instruments, etcetera. A whole day of that. It's a very full day, long day for the examiners and then the orals or VRS as they used to be called the, the last morning. Now I took it very seriously when I II went up with textbooks. But I might be a bit unique in that when I first a, an examiner because it's a lot of pressure and it's a lot of responsibility and anything that somebody does work like at college, if you, you're representing, you know, your specialty, et cetera. So I take it so very seriously in terms of expectations of colleagues, I just expected to be dressed like they were in clinic, you know, first impressions count, not that you have to, you know, just do what you would normally do in a clinic or if you're going or, or, or that kind of environment, a clinical environment and you do have global marks, et cetera, you know. So think about the eye contact, I mean, don't stare the person out but, you know, think of eye contact, think how you'd behave with another colleague if they were on a ward round or sitting in a clinic or an MDT. So it's really that level of professional behavior. So, um hopefully that's answered what you were asking me about in terms of an examiner. It is, you know, and each uh when we before we do do the standard setting just before the exam, again, we have an ed top up anything that's come up before and it's all taken, you know, very seriously because it's a serious uh we appreciate the time that colleagues have put and these are our future um colleagues, consultant, colleagues or um or um you know, a colleagues. And so it's really important that we treat them with respect. And at the end of the day, it's about patient safety. Nobody's trying to catch anybody out. So it's about patient safety first and foremost. Thanks, Laura. That's, that's really important. I think like all the examiners now these days, it's very different in the old days. They used to be a bit of a, a law unto themselves. Whereas now it's so standardized, everyone who's an examiner is a nice person who's been teaching and teaching and training and has gone through equality and diversity. And they've got a very set list of questions of what they're asking and they're following very clear criteria. So everybody is getting the same question, everything's very standardized, um which is such and what used to happen. People used to just ask their pet topics was these days it's very, very fair. Um And they're all really nice people. They're all really lovely people, grumpy people do not want to become examiners cos it's hard work. Um It's really hard work and it, it's quite stressful. Um And these were really, really nice people. So I think that's a really important thing to try and calm you down. Um And can I come in in there? Laura, we as examiners, we actually get taught, we perform in pairs. If there's any discrepancy in our marks, if they, if they differ by more than one or if they differ by two, you have to, well, you have to justify all your marking with comments often on the back of the, the form that you're filling in. If there's a discrepancy of more than two between a pair of examiners, you need to justify it and it gets flagged up to the chair of the examination, that particular specialty immediately. There's um you are also afterwards you're, you're not allowed to be examined by the same pair. Um You might see the same examiner but not the same pair. It's really to make sure that your multiple touch points in as fair a manner as possible. And then we get feedback. There are always assessors within the examination from your own specialty and perhaps another specialty. And so often you have observers, so don't be frightened there, there to observe, there either be new examiners just observing or assessors and they're not there to assess the candidate, although it probably adds to the tension there to assess us. And we get all get feedback on our, our perform, how we performed compared to other examiners, how we performed according to different um protected characteristics. So that there is a lot of data that we we shared and so anybody behaving in, in a manner that wasn't appropriate or professional will certainly get called up. So please be reassured about that. Thanks, Laura. Thank you. I'm just looking through. Um, so yeah, the, the timings have to be strict because especially in orthopedics, there's 100s and 100s of people going through. So they are quite strict and they will, they will stop you talking. Don't be offended if someone stops you talking and says sorry, we're moving on now. It doesn't mean that you've done something wrong. It just means you're out of time. Um So try not to let that fluster you try and take a deep breath. In between cases and then go frustra into the next one. But sometimes they will have to move you through because there will be a pile of people behind you coming through. Uh, quick question. There was something about bear below the elbow. Even though it's not always patients. I would, I would dress like I was going to a clinic. So that would be, be below the elbow. No watches, et cetera. Um, so that's what I would advise. Yeah, I think for the viva, I think a suit jacket would be fine for sitting down. Absolutely. I'm talking about the clinical. So the clinical scenarios you should be the elbow. Yeah, because the clinical scenarios are patients, you're going to be examining patients. So that's the other thing to bear in mind is that I knew I'd have to be examining hips and knees. So I wore trousers because I knew I might have to climb around and yank people about. So, so in terms of what you wear, wear something practical for what you will be doing in clinic. It's the same again, isn't it? It's just what would you do in clinic? Um, the question about volunteers for cases. Um, certainly in cardiothoracic we moved away from patients after COVID. So it is, uh, so volunteers mean somebody, um, I guess, um, acting as if they were a patient and they'd be prepared in terms of what, um, they'll be primed as it were about what they, you would be examining et cetera. So, so I think orthopedics, we still use them because you can always find someone with a sore knee for you to examine. So, orthopedics, we, we, we quite often still use, I think uh real patients who are lovely. They're the, again, they're the lovely patients who don't mind being examined and giving a history and they sometimes help people out a little bit. So if you're nice to the patient, um they will work with you as well. So they give you clues. So, so it's only for the intermediate cases. So the short cases you don't get any patients anymore, you get a video or a photograph. Um So for the intermediate cases, you still get a patient. Um That's my bit for that. II think we we've been asked to wrap up Laura. Um I, oh, it's seven o'clock. Ok. Uh Let me have a look. Anything else? No, I think we've got them all. Ok. Well, for me, best of luck, everybody. Um Thanks for joining. Hopefully you've got an idea. Thanks to Ran and Laura about the generic sort of um um thoughts behind preparing yourself and best of luck. So that's a buy from me over to Laura. Yes. Good luck everyone. Thank you for joining us. Um You'll be sent to recording of this if it happened too fast or if your sound cut out. Um Lovely to see you all and hopefully I'll see you at the college at some point, uh, in the near future to get your diplomas and get your certificates. Bye.