25 Invaluable tips to make the most of your last month of preparation.

The last month plays a crucial role in your preparation. So, let’s get right to how to make the best use of this time with these tips.

Mohamed Elnaghi

MSc, ChM, FRCS Colorectal surgeon Faculty- PrepMedico

August 4, 2023

The exam tests not just your knowledge but “other” qualities.

The exam is tough, not because the questions or the scenarios are difficult (some of them are) but also because the exam assesses lots of other qualities in addition to knowledge. Most of you will have the necessary knowledge to pass the exam but it is the lack of other qualities that may fail you. Make yourself very familiar with the published assessment and marking criteria and test yourself against these standards.

Be honest. If you don’t know, say you don’t know. Never speculate.

Definitely, you will have at least one unexpected topic or uncommon scenario in your exam and you should prepare a strategy or a standard format that you can use to answer these scenarios. But also be careful so that you don’t speculate or guess answers. If you don’t know an answer, be honest and say you don’t know and the examiner can move on and ask another question.

Identify your knowledge gaps and fill them now. Do not wait for the last week.

This is the time to fill in your knowledge gaps. Identify the topics that you have not covered yet and cover them now, you don’t want to be doing that just before the exam. I would advise you to have some time off before the exam ( ideally two weeks but at least one week ) . You need to focus only on the exam during this time. I advise you also that in the last week that you revise again what you have already read before. By this time you will be overwhelmed by the amount of information you need to cover and you will have forgotten most of what you read, so keep the last week to revise the high yield and most important topics.

The exam is very varied. You will get questions from areas you may not be familiar with.

The exam is very varied. It covers the whole of general surgery and its sub-specialities, so you will get questions that you may not be familiar with or have never seen before. Also the exam experience varies from person to person. Some people may have common straightforward scenarios or questions and some may have tough questions. But over-all, the exam is balanced between tough and easy scenarios. Stay prepared and read as broadly as possible.

Do not panic or lose control when confronted with tough questions.

This is intentional , it is intended in the exam to ask you tough and difficult questions to test how you perform under pressure and how you will deal with the situation. Will you be reasonable and safe or will you panic and lose control? They are testing if you are ready to be a consultant. It is a test, remember?

Practise your delivery and presentation as often as you can. This is a Viva exam after all.

This is a viva exam, it is all about structure and delivery of your answers. You may know a topic very well but if you are not able to present and deliver your answers in a structured organised manner, you will not get the mark you deserve. This only comes with practice, so you have to practice viva as many times as you can before the exam. I will recommend viva practice for an hour at least daily with your colleagues. Request honest feedback from your colleagues.

Master the common scenarios

During practice, try to master the common easy scenarios, so that if you get one of these scenarios in the exam , you can shine and get the highest mark. For example, pouch scenarios in colorectal, SBO, pancreatitis, DVT and PE, AKI, respiratory failure, etc.

Practise self-critiquing. Be as objective as you can.

Record yourself on video talking and answering questions. Then go back and view your recording and critique yourself and pick on the things that you need to improve. Ideally , you need to see yourself as confident, relaxed, structured, organised, talking with good pace (not fast nor slow) talking clearly ( words are clear and can be easily understood), your sentences are not interrupted by long silent pauses Avoid filler words like lots or umm, er, you know, like and so on.

Your objective is to deliver an accurate, clear, structured and concise answer and this is what you need to practise and assess yourself against

For Short Viva Scenarios you only get 5 minutes so do not get lost in the details.

In the short viva scenarios, you have only 5 minutes to answer all the questions, they fly very quickly so DON’T drown yourself in the details of everything. You need to be very concise and to the point so that you reach the management part and the end of the scenario.

Trials are good to know. Not Essential.

Trials are good to know if you have time but not essential. You will not be asked a lot of trials or their details.

Practice structuring your answers in categories.

You need to practise how to structure your answers in categories, for example, when you are asked about investigations , you can organise your answer as Blood investigations, radiological investigations, endoscopy etc., Another example : Complications : you can categorise them as Early versus late and then as CVS complications, respiratory complications, wound complications and so on. Another example, when you are asked to discuss consent with a patient, you can categorise your answer as , I will discuss procedure specific risks, general surgical risks, and anaesthetic risks ..etc. The idea is that if you structure your answers in categories, your answer will be clearer and will leave a good impression on the examiner.

Answer like the consultant you want to be.

You need to speak in the exam as a consultant who makes independent decisions based on the available facts. Show that you can have independent practice.

Make a good impression

Your first 30-60 seconds of the station are very important, if you give a good impression from the start of the station, you will make the examiner at ease and encourage them to help you get through the station. All of what I mentioned above will help you achieve that. Also, you need to demonstrate good performance under pressure and logical thinking so that you can get your first points scored quickly.

With an endoscopy image stick to only what you see.

When you are given an endoscopy image, describe what you see only, you don’t need to give a full diagnosis and say that you want to see the rest of the images and see the report.

Practise to the point where your answer flows naturally.

Again, your answer should be precise, accurate and concise, you need to be slick, confident, to the point but also thoughtful and know what you are talking about. Try to make your answer flow naturally. This only comes with practice. Practice makes things flow easily as if you did it a thousand times.

Don’t bring controversial topics to the discussion

Don’t speak about or bring to the discussion controversial topics. Try to be reasonable, safe, straight to the point, and don’t dig a hole for yourself. Only talk about what you know, talk about common practices and common stuff. Try to perfect the way you present your answers to convey clarity of thought and higher order thinking.

Strictly stick to the point while answering.

Your answer should be straight to the point, don’t faff around. If you waste time talking on irrelevant subjects, it is your time that is wasted. Remember that the examiner has a set of questions that they need to ask you in a specific time frame. The more time you waste the harder it will be to get to the end of the scenario and answer all the questions. This will affect your marks.

Keep the latest guidelines at your fingertips

Latest guidelines are very important to know, these are the cornerstone of evidence that you will fall on. The examiner will ask you to provide the evidence behind your answer. Also you need to quote the evidence in your answers. For example, NICE guidelines recommend this, and so on.

Consolidate your appraising technique.

Academic station is an opportunity to achieve high marks. It really is! Make sure you practise appraising papers at least once a week. Practise different types of articles e.g, RCTs, systematic reviews, cohort studies, etc. Use the latest BJS and JAMA articles. Do 2-3 papers in one session. Also record yourself presenting a paper summary and review the recording. Practice presenting the paper in no more than five minutes so that you give the examiner a chance to ask you questions.

Never use “I think” in an answer.

When you answer a question, don’t say I think , you need to be sure and you need to show confidence. Also if you mention numbers or percentages, make sure these are correct and you need to know the important numbers by heart. For example risk of anastomotic leaks, etc

A few failsafe standard sentences you can use

Practise some standard sentences that you can use quickly and subconsciously, for example, “I would systematically assess the patient according to ATLS/CCrISP guidelines while simultaneously resuscitating them” also “ My immediate concern with patient is (Diagnosis), which needs (main investigation). A good sentence to use in short vivas is “I would take a focused history of this patient’s symptoms, past medical history including performance status, drug history, family history, social history, concerns and expectations.” Then you can expand on this and say the relevant symptoms that you will ask about. Another good sentence to use with radiological images, “This is a single slice of (CT/MRI), showing – but I would like to look at the rest of the slides to assess the extent of the injury/pathology, read the report and discuss with radiology.

Never rush to answer. Pause, think, and answer.

Don’t rush to answer the question immediately, first take a couple of deep breaths in, take 2-3 seconds first to think about the question and how you are going to structure your answer in an organised manner. Believe me, these 2-3 seconds that you take to think are crucial.

When asked about management, talk only about what you do.

When you are asked about management or what you will do, Don’t say “you can do this” you must say I would do this or my management options are… When you are asked about management, say what you actually do in practice in your hospital and talk about what you are familiar with. Talk about what you do. Stick to what you know only.

What to do when face with an unfamiliar scenario

When you are faced with a difficult or unfamiliar scenario, take a few seconds to think and approach the scenario systematically and safely. If it is out of your expertise, say you will ask for help.

Always use appropriate medical vocabulary

Try to use appropriate vocabulary as much as possible, also try to use professional medical terms for example, instead of saying cannula infection or central line infection you can say IV catheter related bloodstream infection and so on . Another example, instead of wound infection, you can say Surgical site infection.

Practise on your English as much as possible

Most of you are international medical graduates, English may not be your first language, so it may be difficult to express yourself and organise your thoughts clearly in English. This is why it is very important for you to practise as much as possible. Record yourself and watch your recording as I explained above. Practice is your only way to convey your answer clearly and show your knowledge. Again it is a talking exam. You need to practise how to talk.

To conclude

Lastly, use the theory of marginal gains. If you try to improve yourself slightly in all the aspects I explained above, the cumulative sum gain of improvement will be enough for you to pass the exam. Remember the exam is marked in a cumulative marking scheme so you may fail completely in one station but still pass the exam provided that you compensate in the other stations. Please feel free to reach out if you have any queries.

Best of luck to you all!