Royal London Rotation | Orthopaedics | London



CHRISTY COYLE’S TAKE ON THE FRCS EXAMS

Books

• I made my own notes combining:

▪ Miller

▪ AAOS Comprehensive Orthopaedic Review

▪ Current Orthopaedic Practice (Argarwal)

▪ Ramachandran Basic Science

▪ The last 5 years of JAAOS review papers

o None of these are comprehensive but combined they usually have enough information

▪ Hoppenfelds

• Very very important for vivas. Know it off by heart – especially the ones you haven’t seen ie posterior approach to knee, shoulder etc. Practice talking about all approaches as second nature

• Practice books

▪ Post Graduate Orthopaedics MCQ and EMQs (Sri Ram)

• This was the most helpful for MCQs

▪ Orthobullets and Stryker hyperguide

• Great source of MCQs but not exactly like the exam questions so can’t get away with this alone for the MCQs

▪ Black book

• I found I was taking too long reading the questions as it is quite verbose! Gave up

▪ FRCS trauma and Orthopaedic viva (Oxford)

• This was the most helpful for the Vivas. You get this if you do the Oxford viva course.

▪ Post Graduate Orthopaedics (Banaszkiewicz)

• Very helpful for the vivas, and a lot of the questions are still similar

Courses

• They book out early, so choose a few at convenient times and book EARLY (I would do one early (ie 6 months out) to highlight deficient areas and then 1 or 2 within 2-3 months. I would avoid doing any the week before!)

• I wrote to people before the course was advertised via word of mouth

▪ Queens viva course

• I think it depends on who is running it that year. I had a great time, lots of amazing patients.

▪ Wrightington

• I did the whole week about 7 months out. It was definitely worth it to work out key areas to read around and deficient areas

▪ Norwich

• Amazing patient load, very well organized, saw LOTS of patients with signs. The practice exam was really worth while.

▪ Oxford

• Unfortunately not that great for seeing patients (groups of 4, only saw about 4 patients per day), but lots of viva sessions. The practice exam was really worth while.

o In retrospect, I would have done fewer courses, they were really expensive!

Work load

• I had a study partner, and we spent lots of time asking bosses to viva us at any time convenient for them (ie 0700 in the morning, evenings).

o You have to hassle them a bit, and prepare to be humiliated a little, but DEFINITELY worth while, and most people are really happy to do it.

o PRACTICE TALKING ALL THE TIME – viva technique is half the battle

• Start seeing patients EARLY.

o Pretend each new patient in clinic is in the exam – practice your technique and don’t cheat by looking at the imaging or the referral letter.

o You’re meant to be able to examine a short case and a get a diagnosis in less than 5 minutes.

MCQs

We all thought we had failed! Difficult to gauge how you went afterwards, so don’t be disheartened.

Clinicals

• They want you to get to the answer. I was told you should be able to get to the answer in 3 minutes and 2 minutes for questions/moving to the next patient

o If there is no history or clues (especially in the shorts), don’t palpate every joint/carpal bone in the hand as this will take the whole 3 minutes and yield little. Functional tests are probably slicker and will yield more (see below)

• Upper limb shorts

o FPL rupture after prominent volar distal radius plate

▪ NO history and NO clues, so get them to do some functional tests first to look like you know what your doing!

o Dupuytrens

o Elbow OA

▪ Discussed surgical options including OK procedure

• Lower limb shorts

o PCL rupture

▪ Again no clues or history

o Foot drop after tumour surgery

o Stiff hip post acetabular ORIF

• Upper limb long case

o SLAC wrist

• Lower limb long case

o Left leg hip AND knee OA with left knee pain (mild groin pain)

▪ This was my worst station. A mean examiner, a complicated patient, and I ran out of time!

▪ GP referral letter saying the patient had left knee pain.

▪ Looked at the patient. Her left leg was her only normal limb!

▪ She had 3 fingers on each had, short limbs, what looked like tibial hemimelia, strange facies and short stature. She refused to give me ANY answers in the history regarding her underlying diagnosis.

▪ After answering all the knee questions, at the end I asked: ‘As a surgeon, if I could change one thing for you today, what would it be?’

• and she said ‘I want a new hip’

o Definitely a good question to ask!

▪ The examiner then said ‘Examine her’ – deadpan no clues, no guidance.

▪ After spending a long time on leg lengths, hip and knee exam, it came out that the dilemma was where her pain was coming from – hip or knee

• Discussed injecting the hip

▪ I guess the point is don’t get intimidated by mean examiners or crazy signs – focus on the surgical problem at hand and try not to get flustered!

Vivas

• Adult pathology

o Osteomyelitis

▪ They had a weird specimen that looked like a tree! It was an infected distal femur (not even in a specimen pot!) with a sequestrum Went through everything regarding osteomyelitis

o Loose charnely THR

▪ Had to rule out infection

▪ Gruens zones, modes of failure

o RA elbow

▪ Had total elbow replacement and discussed types, indications etc

▪ Next slide: soft tissues had broken down and prosthesis was on view

• Discussed management if this, including talking about Plastics involvement

o Massive disc prolapse –when to operate if the patient doesn’t have cauda equina

▪ Then developed cauda equina and management of this

o Metastatic breast cancer to bone

▪ Mirel’s score and management of spine

• Trauma

o Locked posterior shoulder dislocation

▪ AP view only

▪ Management of acute injury

o Pelvic trauma – APC pelvis fracture

▪ Ongoing bleeding mx

▪ Went through Massive Haemorrhage Protocol in detail

o Comminuted femur fracture in 10 yo plate vs TENS nails

o Lis Franc

▪ Acute and operative management

o Capitellum fracture

▪ Classification

▪ Operative management and which fixation is better and why

• Upper limb and paeds

o CMC OA

▪ Classification

▪ Management

o SLAC wrist stage 3

▪ Classification and management

o Cuff deficient shoulder OA

▪ Discussed deltopectoral approach and reverse TSR principles

o Cerebral palsy – definition and hip problems

▪ Shown bilateral hip dislocations

o Perthes disease

o Swansons classification

▪ Multiple pictures asking to classify each

▪ Also shown curly toe and asked to discuss

• Basic Science

o Principles of external fixation

▪ How to strengthen the construct

o Biomechanics of different running styles

▪ Usain Bolt vs long distance runner vs walker

▪ Shown pictures of each and footprints and shoes of each

▪ I don’t remember reading this anywhere, and I had real problems with this examiner. I think he wanted to prove some point, but I’m not sure what.

o Gross destruction of proximal humerus

▪ Infection vs charcot vs tumour

▪ Was shown H&E slide of TB (which I thought was a bit unfair)

o Stress strain curve

o How osteoclasts work

▪ In quite a bit of detail

▪ Where bisphosphonates work

o Osteoporosis and DEXA scan

▪ Shown results of 3 patients and asked to discuss

Advice (if you want it)

I spent a lot of my orthopaedic life hiding in the back and avoiding questions in fear of looking like an idiot.

Now is the time to shed this attitude and organize vivas, sit at the front at teaching, practice talking as a consultant

You will be a consultant soon, so now is a good time to start thinking and acting like one (

Good luck!

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