Exam Recap with Ben Finlay

Welcome to First Incision, the podcast about preparing for the General Surgery Fellowship exam. I'm your host, Amanda Nikolic. So let's get started with our team timeout. Our patient today is the fellowship exam, which we've both just successfully passed. And we wanted to share with you guys all of our recollections and reflections on the whole process.

But first off, congratulations, Ben, on successfully passing your exam. And you. So we just wanted to, I guess, reflect on the journey that was the monster of getting through fellowship.

and talk a little bit about each of the individual stages of preparation and actually sitting the exam and try to share as much information as we can because I think both of us found it a little bit difficult when we were first starting out and first trying to think about studying how to approach it and what to do.

This is obviously our experience and everyone will be different. So make sure that you ask around all the other people you know that have sat the exam and get a real breadth of experiences to decide what would be best for your preparation.

So let's start off with our actual preparation and study for the exam. When I was reflecting on the exam, I felt like there were almost... specific individual stages that I went through in the preparation process which I didn't know that I was going to go through beforehand but reflecting back I can see that there really were these specific stages. So I think in general, there was the first couple of months where I was sort of figuring out.

what the fellowship exam actually was, what the components were, looking at the curriculum and getting my head around that and thinking about preparing a study group and how that was going to work. And that actually took a lot more time than I was expecting. probably two or three months before I really started to feel like I could actually settle into starting a study process. Would you say the same thing, Ben? Yeah, I think so. Yep, definitely a long information gathering stage.

And then there was about a year where we were just covering the curriculum and that was that real grind of learning. topics over again that you might know about before you've come across in your practice a whole heap of things in the curriculum that I'd never come across before like all the head and neck stuff and a lot of the vascular and a lot of the different pathophysiology and grading and class

classification systems. And that was quite a long period, I think. And I found it really hard to keep the momentum going regularly through that period. Yes. Particularly because we were a long way out from the exam, but still a lot of content to get through and it was hard to stay disciplined through that, I think. And we set up the study group.

so that we covered a module over about four or five weeks, depending on how big the module was. And we did schedule in a kind of lighter revision week at the end of that block, which in retrospect, I think, although it... sort of blew out the time that it took us to cover the curriculum, I think was quite useful because if you had had a busy week at work or you just had a week where you weren't so...

motivated for example you had a bit of a chance to sort of catch up and feel like there was a little bit of a buffer there I think to be clear as well we should say that we started studying for the exam probably a lot earlier than most we started thinking about it two years, two years before we sat it. And I think that was good for me. And I think, you know, it seemed to work well for both of us. I think we studied in a similar way.

kind of a slow burn but I know that's certainly not for everyone and most people don't start thinking about things that early so you need to have some kind of idea as to how you best study. Yeah definitely. I know some people that are real crammers and really just smash themselves for six months. But you and I think, yeah, that slow burn is a good description or a sort of a marathon approach rather than a sprint. But everybody's different. And so then the next...

stage really was once the curriculum was finished I felt like that was when I could really start doing previous questions and previous exams and start focusing on trying to essentially recall all of the information that you've studied and try to get it to a point where you can actually talk about it and think about it and remember things and I found that took quite a few repetitions.

before it really started to stick. Yeah, it was really a shift into consolidating knowledge and then integrating it. into a form where you can recall it mentally at short notice and consolidate all of these notes. and resources into a form where you can use them on the fly to answer exam questions. Start focusing on exam technique.

Yeah, I found it really hard to start doing questions before I'd finish the curriculum because if you're getting asked questions about things you haven't covered yet, you sort of just feel a bit panicked and it's not really useful study.

started doing questions I'm not sure how you felt but most of them seemed completely overwhelming and very difficult to answer and I started with an approach where I would do them essentially open book not to time and then as we progressed you're kind of getting more focusing on doing them to time and doing them without any resources available and more to exam conditions.

Yeah, definitely. I found them really hard at the start. And I found that the more I practiced, the more I sort of got into the practice of starting with. headings and then trying to fill in the blanks and then you'd realize what you didn't know because a lot of that stage was you've sort of covered all this knowledge but which bits of it do you not actually remember and the only way you can figure that out and what you need to cover again is to just

go to tutes, be asked questions, practice written questions, do bank after bank after bank of spot questions to figure out which ones you don't remember everything for and then you just go over that again and then you don't remember it next time as you go over it again. I got really sick of doing written questions though, I must say. Yeah, terrible. But yeah, as we got closer and closer to that exam, we were doing more to time. I found it really useful to meet up with the...

a study group and set an hour or two hour timer and do the questions and then talk about them because doing them one after another for two hours is actually really exhausting. So having that time pressure with other people around was quite useful. Definitely. And then the next stage was between the written and the clinical, which was a complete shift in the way of thinking.

I guess. So you have all this knowledge, you know more than you've ever known when you've done your written exam and then shifting that to being. available to you to be able to talk about, as well as we revised anatomy and some of the history and examination taking things, which was going to come up in the clinical and anatomy exam.

which was a bit of a shift between the two exams as well. And I guess we'll get into this a little bit later, but I really felt my knowledge was peaking for the written and we had seven weeks between our written and clinical and I found it difficult. emotionally to ramp up again and also it felt difficult to maintain my knowledge of what I felt was my peak even over that two-month period. It was a really long time between the exams.

At times it felt like it was not long enough when you'd forgotten something again, but then, yeah, it was long enough to forget things, which made it really tough. That's right, yeah.

So in terms of study group, that can be our next topic. Do you want to talk to us, Ben, about your study group approach and what things you found kind of worked and didn't work and what you found useful? So in terms of study group, obviously, Amanda, you and I studied.

together on zoom and i also had a great group of local people in my city that we studied with regularly and i think I found that so helpful, just having people that I was accountable to because with everything else going on in life, putting time aside for study is often difficult and the last thing. You feel like doing so, committing to doing some questions or a previous exam and then discussing it or swapping answers with other people in the study group was really good for keeping me on track.

I think it was very helpful having a shared study plan with my study group to ensure that we were covering the same things at the same time. And it worked well trying to... Keep our study discussions based around questions and cases rather than going through content because the expectation was that we would come to study group being familiar with...

the information and troubleshooting it together rather than hearing it for the first time. Yeah, I definitely agree with that. I think early on, both with you, Ben, and with my Melbourne study group, our approach was that... study group should be time for talking practice because especially at the beginning

talking was really hard and answering questions out loud was really hard and you felt really stupid, but study group really is a safe place to start talking out loud and being forced to talk out loud. Yeah. And so the way we did it initially was we would cover certain topics in the week and each person would have to come up with a few spot questions based around those topics. And then in the study group, we would ask each other. And so it was...

Putting everybody on the spot, trying to make sure that everyone had covered the curriculum that you were supposed to cover and then also to start practicing talking and then if there was something the other person didn't understand, they could ask questions and you could sort of nut it out together. And then more towards the exam end of things, we had a bank of questions that we could go through and then...

it turned more into that short cases, long cases, anatomy, and specifically going through previous exams. Yeah, definitely. Study group is where you pick up so many nice phrases and nice ways to structure things. colleagues. I learned a lot by listening to other people and their approach and reflecting on that and I found that crucial.

I am aware of a study group from the exam before me where they did cover the curriculum by teaching each other though. So they all had a different curriculum topic and taught it to the other people and they had a PowerPoint that they would then put into a shared drive.

had the notes and so they were sort of sharing the load of doing the investigating and looking up what actually needed to be known for each topic. So I think there are different ways of doing it but that obviously was the way that we approached the study groups. So the next topic we were going to talk about is about tutorials in the lead up to the exam. Amanda, do you want to tell us about what tutorials you accessed to help with your preparation?

So we didn't have a formal program at my hospital. So I helped to organize one where we had a surgeon each week and a couple of little topics that the trainees would present on and then we get feedback. I found that really useful because just having access to the consultants to ask questions of especially some of the things that you don't find in the textbook, like operative approaches or the little tips and tricks for operations or the little...

information about different nuances of management. Like I still remember one of the HPV surgeons talking about pancreatitis and cholangitis and how it's difficult to tell the difference and when you might do an ERCP. And that was one of the questions I got asked in the exam. And I could still remember him talking through why that was difficult and from his own experience.

when he did and didn't do different things. And I just regurgitated that in the exam really, because that sort of stuff you don't really get in the textbook. So I found that quite useful. On top of that, we don't have a statewide course in Victoria, but there are some really great state-based courses in Queensland and WA and New South Wales that are recorded on the GSA website as webcasts. And so I used to...

I watched those when I was going to cover a topic that I hadn't heard of before or when I really didn't feel like reading a textbook anymore and just wanted somebody else to tell me about it. They're a little bit hard to search, but if you have the time to sort of trawl through and find a topic.

that's been covered on one of those to listen to, that's really useful. And I used to also listen to those on my commute. And then there's other courses that I accessed, like obviously the trainees days, and they're also recorded on the GSA webcasts. different conferences and especially for HPB upper GI there are a lot of courses run by Anne Scozer and the colleges themselves so just basically tried to access as much as possible to get that sort of wide range of

information from lots of different places. Yeah, I found there was really, you know, more online content available than was almost able to be digested, I think. ANZHPBA. put on the online courses, as you said, which were very high yield. GSA run a national online course, which for the most part was high quality and very useful. The small group sessions were often difficult to participate in.

because of COVID and tutors being away. Is that the fellowship exam course, prep course? The fellowship exam course, yes. So sometimes up to 20 people in a small group, so not so small and difficult. to have practice but even if I wasn't talking I found it useful to listen to other people often and how they were answering. I guess for me in South Australia we do have a state.

based some state-based courses they're not recorded but whatever exposure i could get to practice talking and interacting with consultants around a topic and practice clinical questions with fellows that have been successful at passing the exam was really useful. I also just bugged the fellow I was working with to ask me questions constantly. And in the few months between the exams, I also just put a call out to lots of the fellows and consultants that I knew.

ask them if they would mind giving up half an hour, an hour of their time. And a lot of them did. And especially with Zoom, it's much easier these days to do that. So I was really grateful for those people that really helped get me slick and ready for the exam. So Amanda, what do you think?

Maybe your top five resources for the exam preparation are your faves. Oh gosh, that's so hard. So varied and so different. You could plug your own podcast. Well, this is great podcast. I mean, there's some specific highlights that I think were really useful for topics that I wasn't that. good with so for head and neck i loved the open access atlas of otolaryngology head and neck operative surgery which is free and available online i also

I really liked the YouTube videos from Johan Fagan on the operative head and neck surgery. I found them extremely useful and a really good way to get my head around the anatomy, which they seem to love asking in the exam and came up in both of the... exams so for anatomy i loved jamison's book on general surgery operative general surgery anatomy

And there's also some really good podcasts by Robert Whittaker as well as Instant Anatomy. Those were real highlights for me. Apart from that, it was pretty varied. It was a combination of... Textbooks from racks, finding articles on PubMed or Stats Pearls articles. If there was a Stats Pearls article on something, it was absolute gold.

And for surgery, we used a pretty broad range of things like Kirk's, but I really liked operative dictations in general in vascular surgery, which is just on the RACS website. That was... Really good. Yeah, that was excellent just for sort of thinking about how to structure talking about the operations and they had pitfalls on there and just what language to use around how to describe what you were actually doing. I think those are the things that...

jump out in my head at the moment. How about you Ben? In the early stages when I was going through the curriculum I used companion series as a framework for my study and I think in general that was a really good place to start for me. To expand on that, I found UpToDate invaluable for almost every topic. It's such an excellent reference. And if you're hospital...

has a subscription to it, I highly recommend it. It's got everything from operative strategy to pathophysiology in there and you know it's right. So I really lent on up to date. I agree for anatomy. I found Jamison's really helpful and I really liked the Instant Anatomy book as well. I didn't use lasts so much. The curriculum would be the MVP. Yeah, I guess so. The curriculum statement. Yeah.

It's boring and dry, but it's just a good thing to come back to, especially if you're not sure with a specific topic what they actually want you to know. Because if you dig hard enough, infinite information on topics and actually sort of trying to figure out what it is you need to know for each topic. can be quite a challenge.

I think at the beginning I overread and I wanted to learn every tiny little bit of information and histopathology and everything. And as I went along, I found that it was easier to figure out what the important things were for each topic. Listening to other tutorials or consultants talk about things also helps you realise what the actual critical parts of a topic are that you need to know for the exam. And the more questions that you do, I think you've come to understand.

more the depth of knowledge that's expected within the exam. Definitely. Which is why it's important to eventually just make the jump into starting to answer questions, I think.

Yeah, so you get a framework for what it is that they're actually looking for. Yeah. We did do a few questions early on that were... specific to the topics that we'd covered but i don't we didn't keep that up that well but i think especially early on it sort of just gave us a bit more of a framework to know what to do it's always good to have some podcasts and digital resources of course i listen to your podcast

almost every day. Behind the Knife was great. The Melanoma Institute Australia have some really good podcasts on skin things. The St Mark's podcast is excellent, although a little bit old. It's excellent about some perianal and IBD-specific pathologies. For some of the medical topics, I just used to search that medical topic in the podcast thing and come across various podcasts like about hyponatremia or whatever the medical thing was we needed to cover. Because sometimes you just...

Don't feel like reading a book anymore. You just need somebody to give you the information passively. So obviously this entire podcast has been about...

preparing for the fellowship exam. So we should talk a little bit about our experience of the exam and if there's anything other people might be able to take away from our retelling. I'm sure you'll get a lot of different retellings of everybody's different experiences that you talk to. Why don't we start with something easy? Let's talk about some of the practicalities of the exam.

So Ben, how did you structure your leave around the exams and why? And did you think it was the right thing to do in retrospect or would you have changed anything? Yeah, so I think it's important to put it into context that... We studied for this exam like we would train for a marathon and having been diligent about our study, we didn't really feel the need to cram too much. So I was keen to max out my...

leave during this term whilst still having time for a holiday after the exam, hoping that I would pass. So I took two weeks of leave before the written and one week of leave before.

The clinical. I think ultimately that was exactly what I needed. Two weeks doesn't seem like a long time, but when you're stressed and... cramming anyway and doing multiple written exams per day you kind of get over doing that pretty quickly so I wouldn't have wanted to have any more than two weeks I think for the sake of my sanity and during that time

It was mostly about meeting up with my study group and I was aiming to do at least one written, one previous written exam a day and in the second week, usually two. go through that with my study group online and then that would inevitably generate a very long list of topics for me to reread over and revise in the evening. Yeah, the two weeks seemed like a really long time at the time. And because I found that because the curriculum was so broad.

that I felt like what were the odds I was going to cover something that was going to come up in the written in that two weeks. Like I couldn't cover all of the content. And so really I did the same thing. I focused just on practicing the written. really practicing them to time and trying to get a feel for doing an exam the whole way through because it is really exhausting doing that. And so just getting used to that process and thinking about my kind of approach for the day and then also trying.

to take a little bit of time in the evenings to relax and to try to do other things just to make sure that I was mentally ready for the day itself. So for the clinical exam as I said I took one week off before. Being in South Australia, I had to travel to Melbourne to sit the clinical. So I had four days at home. Prior to travelling to Melbourne, I went to Melbourne on the Wednesday and then the exam was Friday, Saturday, Sunday. So I just wanted to make sure that I was...

there with plenty of time so that nothing would go wrong. Did you find the travelling stressful or it was okay? No, all of my study group were on the same flight so it was kind of like we were going on holiday. We all just wanted to go out to dinner and do fun things in Melbourne, having not been able to travel for so long. But, yeah, instead we were holed up in our apartments. But I just felt more comfortable being there with plenty of time. Did you bring any books with you?

I brought most of my study. I had a very heavy suitcase. I didn't need most of it ultimately, but I brought all my flashcards and my written notes, my computer and a few key textbooks because... If I needed to know something, I wanted to have it at hand.

I also took just the one week off before the clinical and my reasoning in my head was that it's a clinical exam so it would be good to be at work and seeing patients and talking to my bosses and of course it was extremely busy at work and I didn't get... much time to do that at all and I felt quite stressed that.

week before my week off but then on my week off before the exam same thing I felt like it was an extremely long time to be sitting at home isolating because we didn't want to catch COVID and being worried and stressed about the exam. So I'm glad I didn't take any extra time before the clinical, but everyone will be different, I think. So shall we talk about the written exam yeah we've talked a little bit about the specific

preparation for the written and doing the practice questions is there anything you wanted to add to that in the lead up to the written in the last few weeks and particularly the two weeks beforehand i found it really important to try and hone my written exam technique by utilizing certain frameworks that I could adapt to different questions to ensure that I put down a comprehensive, broad answer.

whilst keeping it as concise as possible. And I think you and I spend a lot of time practicing this, putting kind of headings into the question, answer. box and then expanding it with dot points afterwards and yeah trying to make sure that we put down as good an answer as we could in the shortest amount of time do you want to run through what the components of the two written exams actually are yeah so

Two two-hour written exams on the one day. In Adelaide, they were conducted at Clifton's, which is a business centre venue. So essentially just rooms with computers in them. There were staff from the college there, but the invigilators were just staff from Clifton's. So in the morning was the spots exam, which was two hours and 25 spot questions. And then in the afternoon was the medium answer questions, which were eight of those in two hours. Yes, exactly.

And so my approach for the spot exams, which was where there was 25 questions in two hours, and you also get 10 minutes of reading time, but they... you're allowed to start writing within that 10 minutes. So you really have two hours and 10 minutes to do the whole exam. So my approach was I was trying to do six questions per half an hour.

And that should have left me with one question to go in the last 10 minutes of the exam. And so I practiced to that time. And there's also a timer on your screen, which was a countdown timer that you could use to keep track of where you needed to be. to with the questions how did you find the spot exam ben so i found the whole day extraordinarily stressful it was everything

that everyone had told me it would be, but I still didn't expect it to be like that. It was totally a race against the clock. Four minutes sounds like plenty of time, but it really runs away. I found it ran away from me. And I'd got a great tip to keep to time from another colleague who sat previously. so once i'd sat down at the computer before i clicked start because that's an individually timing timed exam i took about 20 seconds

to write down all the question numbers and work out my timing before I actually started the exam and I found that really useful. I just did that on the scrap paper and that way I could keep track of if I was on track, and mark down any questions that I needed to come back to. I had always felt during my practice that I had plenty of time to answer spot questions, and I found that that was not the case on the day. I don't know how you felt.

Amanda? I had the exact same experience. I was doing spot questions and finishing them in three minutes thinking, oh, these are so easy. And at the time, I have so much time and this is going to be awesome. It's not going to be a problem. And I think I...

fell behind quite early on because the first few questions were really involved. And I think I was lucky some of the later questions weren't so involved. And I spent the whole time feeling really stressed and racing to try to make up those few minutes. And even though we'd planned to have 10 minutes.

spare I finished the last question with about 20 seconds to go I didn't have any opportunity to go back and look at questions again and that had been my approach because I found in the practice exams that you sort of lose your train of thought and it takes quite a lot of time to regain your train of thought if you try to go back to a question. And I felt like that would be lost time. So I tried to complete the question as completely as I could.

and move on. And ultimately I passed. I don't know whether I passed by the hair's breadth or whether I passed well, but it worked.

The examiners I've spoken to have always stressed that if you don't have anything down for a question, that question is a fail. And failing spot questions by not putting anything down really... sets you behind i think for the exam overall so the goal from what i gather has to be to finish the exam to give yourself the best chance so i think it's really important to keep to time

And I also found, because I felt so rushed, reading the whole question was really difficult. And then a lot of them would have all this completely useless information, like an entire stem about a lady diagnosed with a thyroid cancer and going into all of her past. history and then the question was just about indications for central neck dissection for example yes and so i got into the habit of sort of being like oh well this isn't relevant and trying to sort of rush through the questions

And I remember one question about an adrenal gland and it said, what are the indications for adrenalectomy? And I wrote out the list of, you know, more than four centimeters functional, potentially malignant.

And then just as I was about to click to the next question, I realized there was a few more words after that that said, what are the indications for adrenalectomy in metastatic disease, which is a completely different thing. And I had to change my answer. And I don't know what the answer is to that because you're so pregnant.

And you're just trying to think and write and read all at the same time. But I guess just taking that extra one second to make sure you've actually read the whole sentence would probably be something I learned from the exam. wasted time rewriting that question yeah so after the after the spots finished i felt physically sick uh and i've never felt like that after after an exam before so

Took some time. I think there was about an hour and a half for lunch before we had to be back for the longer writtens. Yeah. My approach in that time... was I already had somewhere listed I knew was close by and I could just grab something easy like a sandwich and then we were lucky it was quite a nice day in Melbourne so I went back to the exam place and I did a little meditation that I had just on an app.

where I sort of did some mindfulness and cleared the original first exam out of my mind and told myself I just had to reset and prepare for the next one because, you know, you don't really know how you've gone. You get this feeling, you focus on... You know, you relive all the questions you think you got wrong and I just have to sort of stop that and say, right, I can't change that now and move on with the next exam. Yeah. So the long written exam, so eight.

questions, two hours and 10 minutes. So it's about 15 minutes a question. And similarly, in the practice, I felt like there was lots of time to answer these questions.

similar questions kept coming up and you sort of get a bit of a flow or a groove to the way that you answer those questions in practice. But in the actual exam, they were quite... different than what we had been practicing and i felt the same i felt like i had very little time um maybe not as rushed as the spot exam yeah and we had a few curveballs that threw me a little bit

So I had to spend some time actually thinking about what frailty was and what pre-hospital multi-trauma triage systems that there are. And so that sort of made me slow down a little bit, which I think was good. So it really is about... depth of knowledge in this exam. They're only going to ask you eight questions and you just need to have a structure really to write the answers. The other thing I'll say about the written is that

There's a practice exam that you can do online. It's through the RACS website. If you go to Fellowship Exam, you can follow through the different prompts to get to a practice exam. And that's the actual system that they use. in the exam. And it's really good to go through that beforehand. I think we did a few, we did the two practice exams, but then I also did other exams within that system because it's not the same rules as in Microsoft Word, for example. You can't just...

press a dash button to make a dot point. You have to actually choose dot point. Some of the commands don't work. And you have to actually flick through these individual boxes for each subpart of the question. And so just getting familiar with that system beforehand just takes that. sort of anxiety away and lets you know how to use it before you actually get to the exam. The other thing to say is, look, it may be overkill, but I bought a PC.

an $8 PC keyboard from Officeworks to practice typing on because computers at these places are very different to Macs and I found that helpful as well. Very, yeah. noble of you ben i didn't quite go that far but i think it's just doing the things that you can control to make you feel like you're as prepared as possible and that little things like

how do I make a dot point isn't what you're thinking about on the day. You're thinking about getting down the information and the answer that is going to get you the points and get you through. So I don't know what you did after the written exam. We went for a drink and then...

tried to reset and move on. I took a few days off after the written, but I found it very easy to stop studying and didn't want to slip. So I think after about three days, I... move my attention to the next exam and as we've talked about

It's really hard to keep that momentum going for another two months when you've really ramped up for the last few weeks and you feel like you're at the top of your game. You really have to keep that momentum going. But yeah, I also took a few days off just to rest and recuperate before. I felt like getting back into it and I found it really hard to get motivated again after that written exam. And I was also motivated a little bit by fear, I think, in the end because...

It was a bit unexpected, our exam. There was a lot of really subspecialty fringe questions and it made me quite concerned about what they might ask us in the Viva, which in the end I think was a bit unfounded, but at least I was. motivated by something to get back studying again yeah yep so tell us about your preparation for the clinical exam so really in between the two exams i just did lots and lots of talking

I asked everyone I knew to give me tutes. I organized as many study groups and chats with people as I could. I did a lot of practicing out loud and recording myself answering questions.

And answering questions to time. So we had some recalls of some previous exams that we went through together. And I did a lot of... recording myself and listening back and thinking was that structured how did I sound what could I have done differently and just practicing that delivery, I think, of the answers and getting other people to listen to me do that as much as possible and taking on board their feedback.

everybody's got a different approach. You get lots of different pieces of feedback and ultimately have to come up with your own kind of style, I think, for the exam. I found our practice exams to time that we made for each other based on recalls some of the most valuable preparation for the day because just moving through the questions to time and, you know.

Having to move past things that you don't know, recover from that and keep your head calm was ultimately very useful for the exam in practice. And getting used to... being thrown curveball questions or being interrupted and moved on. Yes. We'd been told that the examiners are quite stressed about keeping you to time. And so they will just keep prompting you and moving you forwards. And that was different than what we've been doing in the study group, which was just letting each other chat away.

figure out what we wanted to say and how we wanted to say it but that obviously wasn't going to work for the exam so getting really strict about that was really useful. Do you want to talk about what? The structure of the exam is and those relive those three days. Relive that torture. So the clinical viva is run over three days, Friday, Saturday and Sunday. For general surgery, we have two exams on the Friday. You start with an operative exam and then pathophysiology.

On the Saturday, it's clinicals. So it was long clinical exam in the morning and the shorts in the afternoon. And then the anatomy exam on the Sunday in the morning. So in terms of the... operative surgery viva this was a 30 minute viva and the way it works is you all

get there and there's different waves of candidates that go through. So if you're in the first wave, we had three waves, you do your exam and then you have to be in isolation until... the third group has gone in so that you can't obviously tell people who are coming in what the exam is and so you

get allocated to a room, you go to the door, you meet your examiners outside the room and they shake your hand or say hello, introduce themselves and they only call you by your candidate number and they'll explain to you what's actually in each exam at the door. put you at ease. If you have a bit of time, some of us had a bit of a chat and then you'll go in and you sit down in a room and there's a Mac desktop computer sitting on the table and your examiners are sitting either side of you.

For operative surgery, it was 30 minutes, one 10-minute question, which was a long sort of case, and then five mini scenarios over 20 minutes. So they're sort of shorter scenarios.

For the long 10-minute case, they took you through the scenario with a slideshow and the questions were on the slide and there might be clinical pictures or radiology and they ask you questions about... making a diagnosis and what are you going to do for this patient and it's going to be an operation because it's the operative surgery viva and then they'll ask you how you do that and there might be a couple of different operations to describe in the long case.

And then for the five mini scenarios, there's just a picture on the screen and the examiners ask you a question or ask you questions about it and you have to describe an operation. The second exam is the pathophysiology exam, which to be honest was the one that I was most worried about because it's something we don't really talk about that much.

in our clinical practice is technically pathophysiology and critical care and clinical reasoning. So there's a lot of things that come under that umbrella, but it's a 40-minute exam. And so there's two 10-minute scenarios. 10 minute longer scenarios and then four mini scenarios that are five minutes each. And similar thing, they take you through a slideshow with the questions on the screen for the longer scenarios. And then there's just a picture on the screen for the shorter ones.

So the next day you start the morning with the long clinical vivas. So this is two. questions in 40 minutes so two 20-minute stations talking through two different scenarios and they were quite long so I didn't get through all of the slides for my first one either which they said would probably happen and then the second

Exam in the afternoon is the short clinical viva, and this is another 40-minute viva with five short cases. And these are clinical cases, so they ask you questions about history and exam and diagnosis and decision-making around what to actually do. And then on the Sunday morning was the anatomy exam, which was extremely fast. So it's a 30-minute exam with eight different questions. It used to be for radiology and for...

sort of anatomy or operative photos. And I'm not sure if that actually happened in our exam. I'd probably have to go back and analyze it. But they basically show you a picture and they might ask you to... point out certain structures or ask you what something is and then they ask you to describe some anatomy and that went extremely fast because with eight questions in 30 minutes or only a few minutes each it just seemed to move really quickly.

Do you want to reflect on how you felt about the Fiverr exam? Yeah, I found it a very, it was a real emotional rollercoaster, the whole ordeal. I was in Melbourne in an apartment. with nothing to do with my books, just thinking about the next exam. I just felt like I was always trying to prepare for the next exam, although that probably wasn't useful.

I found the manner of the examiners very disarming and reassuring, and I was really impressed at how helpful they were during the exam, trying to get me to demonstrate my knowledge as much as I could.

When I did reach a mental block, they would try and facilitate me demonstrating further knowledge or just moving me along. So I think that was actually really nice. I think the biggest thing for this whole... exam was just me learning how to manage my stress and anxieties around the exam and maintain calm essentially.

I felt like I lost all sense of objectivity about my performance because you walk into the room and then walk out of the room. It's a total whirlwind. You only remember the things that you...

weren't sure about or got stuck on. And you get, in general, no feedback from the examiners about how you really went. So I found it difficult to... draw a line under it and back it up with the next exam five times in a row and I think all of the strategies that you and I talked about before the exam like mindfulness and meditation and exercise and power posing were all actually really really key in maintaining my performance. I completely agree with what you've said about all of it.

It was so many ups and downs over the course of the weekend. And it's actually an extremely long time when you think about the fact that you've done a whole day and then you have to actually go home and you have to go to sleep and try to sleep and then get up and get ready and come back and do it all again. So I was not really mentally prepared for how much sitting around and waiting there was, which is just time to stew and think about things. So my approach really was that I was not going to.

reflect on the exam that I'd done and that was extremely hard because everybody else is talking about it so I tried to sit with people especially when I was in the isolation area waiting to come out that

also had agreed that we wouldn't talk about the exam. And although it was really hard on my family, I didn't tell them how the exam was. I didn't talk about it because then even by talking about it, I would... sort of go over it in my head and come up with things and reminisce on those things that I'd forgotten or couldn't didn't think I did well and I found that useful just so that I could keep my attention forwards.

But yeah, you're right. The things that did just jump into my head were all the things that I felt like I'd missed or done wrong. I was really felt quite relieved after the first exam because. I realized that it really was just what we'd been doing in shoots. It had seemed this big scary thing that... seemed like it was going to be special in some way, the way that they were going to ask you questions or show you things, it was going to be fancy or special. It was just a PowerPoint slide.

surgeons asking questions like we'd done to each other, like we'd done in tutes. I think after that first exam, I felt quite calm because I thought, oh, well, we've done this before. This is the same thing we've always done. This is the way that we've prepared. We've done it the right way because this is how they're asking us. questions and I found the to and fro between you and the examiners actually easier than the written exam where you just had no feedback.

You didn't have another prompt or another question to push you on if you hadn't completely answered the question. You didn't know that in the written exam, you only had what you could do. So I quite liked that there was that two-way discussion almost with the examiners. I used to hate beforehand when everyone would tell you that it's just a conversation with colleagues because it's not. You're not their colleague yet and you're pretending that you're their colleague.

describing as I did in extremely flowery language how to do a thoroglossal duct excision that I've never seen or done before and making them believe that I had. So it is a bit of a show, but it did feel relaxed in that way, almost like you're talking. to your consultant like you do all the time. So I felt like the magic or the mystery of it was exploded after the first exam. Yeah. I did a lot of meditation. I did yoga each morning. I tried to eat well.

surround myself with people that were going to to build me up and not talk about the exam rather than people that were really, really stressed or maybe wanted to talk about things I didn't want to talk about. And everybody's different and there may be people that need to relive it in order to get it out of their system and move it on.

But that was my approach and I felt pretty calm as the weekend went on because I felt like the preparation that we'd done actually had prepared us for the Viva exams. Yeah. So in terms of... some things that we had prepared for, I guess, for the operative fivers you and I had talked about. doing a little summary at the start of the operation with sort of the principles and the pitfalls, not calling them pitfalls, but for example, saying...

The principles of this operation are safe entry into the abdomen, mobilisation, resection with adequate margins and oncological resection, restoration of intestinal continuity and closure. being mindful not to injure the ureter or injure the duodenum, for example.

Even though we'd practiced and practiced and practiced that, for my very first one, I totally forgot to do it. In the stress of the moment, I had to remind myself to do it. So there are some things that I sort of had planned to do that on the day, I were just totally out the window. And I think a lot of the sort of structures that we'd practiced in terms of

you know, breaking down potential diagnoses into benign and malignant or approaches to talking about pathophys or introductory sentences. I also didn't feel like I got to do that much of on the day just because of how fast moving the pace was. But I still think that was useful practice because it also helped a lot with the written questions where you did really have to use those structures and think more broadly. But I was...

I guess the pace of the clinical viva was something I hadn't really prepared for, I think, so much. I think I still found it very useful to have those sort of structures and frameworks because... in the situation where I didn't know something immediately or it didn't come to mind. I did find falling back on those sorts of mechanisms very useful to start talking. Was there any questions that you...

just didn't know the answer to and what was your approach when that happened? I don't think there was anything that I didn't know the answer to in the Viver. The glomus tumour? Did you know that? No, actually, I didn't know that. Well, I just said, I don't know what that is. I got asked, what is the...

definition of sepsis. And I knew the sepsis three criteria, but I couldn't remember that little catchphrase sentence that I'd practiced 6,000 times about what the actual one sentence definition of sepsis was. And I sort of floundered a little bit and apologized and stopped.

and took a breath and just gave a sort of a wider description of it rather than my nice one sentence. And then I just moved on and I just had to keep going. And then they asked me about sepsis three and I said, oh, okay, well, I can tell you all about that. So I think just... As I had prepared beforehand, I thought if I can't answer something or I feel like I'm getting stuck, I'm just going to stop, take a breath, acknowledge it.

move on. And really the examiners were really good. They just said, don't worry about it. And we just moved on. I felt like one of my major tripping points was in the anatomy where it was looking at liver anatomy, which I felt confident that I knew.

before the exam and i'd looked at lots of radiology and and gone over segmental anatomy of the liver but i found the ct that they put up very confusing it was somehow both portal venous and arterial phase and i got completely confused by the segmental anatomy of the liver which threw me because i knew that i knew it

So I just had to do exactly what you said, take a moment to stop, pause. I just said I need a moment to collect my thoughts. And then I just started talking out loud with my reasoning as to how I was interpreting the scan to help me. understand it and everybody was confused by that ct scan so i asked my examiner from that station who i met at the awards ceremony was it the portal vein or was it the hepatic veins because when i was looking at that picture

There was one little segment three branch that made me think that maybe it was the portal vein, but then it also looked like the three hepatic veins. And so I described both and what they would be if it was one or the other, but said I couldn't tell and why.

I asked him what it was and he said it was the portal vein. But he said everybody was confused. They knew that it was a bad photo and that they didn't mark anybody down for that. But he said somebody said the IVC was the hepatic vein. So he said that was...

an obvious error. So I think the examiners are also humans. They've seen the pictures for the first time that morning. They also know that it's a bit confusing. He said it was a funny level of funny exposure. And so you're not going to get marked down for that.

speaking out loud about your reasoning and talking through the issue and just not dwelling on it and making sure when they move you on that you get moved on because there's lots more points to be had and you're not going to fail for that little thing that you're getting stuck on.

Yes. So to finish us off, do you want to tell us about the Monday? So the results for our exam were released on the Monday, so one day after we finished the anatomy exam. And I didn't feel that great coming out of the anatomy exam, so I found the weight quite... daunting kind of did my best to to move through that the expected schedule for the monday was that results would be released online on the racks portfolio at about

10.30 in the morning and then successful candidates were invited to an awards or presentation ceremony at a hotel in the city an hour later. Of course that didn't happen. The exam results were released about 45 minutes to an hour later than they should have, about the same time the awards ceremony was due to start. So that involved me just refreshing.

My computer constantly within the RACS portfolio looking for a one-word answer as to the result of my exam, which ultimately was a pass, which was... an inconceivable, unbelievable relief. And yeah, and then so jumped in an Uber and went over to the presentation ceremony. Yeah, and you get to meet all the examiners that are there and a lot of the ones that examined me came up to me, which was really lovely and say congratulations and you see all the...

people there that you know that have passed and your family can come so it was a really nice time. Yeah it was really lovely to see the genuine interest of the examiners. This is something that they don't get paid for. They obviously care a lot about the process. And it was great to debrief and chat about the exam being over. And I think a relief, you use that word, is... Really the overwhelming emotion that I felt in the last couple of weeks more than excitement or anything really is just.

Thank God it's over. Yeah. Because I found the whole process really all consuming. And I think that's the only way at least I could ingest the entire curriculum and keep it there was that it had to take up. a lot of my attention constantly for that information to be available to me for that period of the exam and so for it to be over and to be able to let all of that go and suddenly have all this emotional energy and time and available to me just...

is such a relief. It feels like a whole weight's lifted off my shoulders. And it seems unbelievable now that it's just a hurdle when it was such a big part of my life for such a long time. Yeah. And a bittersweet day because of course, a significant proportion of people who sit the exam don't get through. And it was hard to hear from my study group that not everyone passed and, you know, they're still studying for their next attempt.

now which is which is really hard but um you know not uncommon either and i know so many excellent surgeons who are mentors of mine who had to sit the exam at least twice so There was also that to deal with on the day. I think our pass rate was 62% overall. So, yeah, it's a big challenge. for everyone involved, considering that everyone who's got to this point is very clever and very hardworking and has made such sacrifices to get to this point. I'm not going to ask you...

What's next? What you're doing next year? Because I feel like that's all anybody's asking me and neither of us really know. I think focusing on a bit more time with the family and a bit more of my other interests. outside of surgery is going to be my priority for the foreseeable future. Yeah, definitely. I mean, this exam was, as you said, all-consuming and I was so lucky to have.

People close to me who understood that and allowed me to neglect my relationships with them and neglect all other aspects of my life. to try and get this done the first time, which fortunately I did. And I'm very keen to get back to all the other things that I neglected over the last year and a bit. and try and remember why I went through this exam and remember what's great about surgery and try and re-engage with my job a bit more because it's pretty exhausting working.

studying and getting ready for this exam. It's a different feeling going to work now and it being about your future and what you're going to do rather than it all being about. how is this applicable for the exam, which although that does have to do with your future, it's a bit of a different focus. So it's been really nice, yeah, working for the last couple of weeks without that hanging over me.

Well, thanks so much, Ben, for coming on and revisiting this journey that we've been on for the last couple of years. People found it useful. And if you have any other questions that you have about the exam, maybe send them through. I'll try to get some other trainees together to do another chat about some other experiences. So if you have any specific questions, please send them and we'll try to.

chat about them as well and uh yeah all the best to everyone with their exam preparation for the future it's time to close up thanks for listening to first incision if you have any comments or feedback send us a message at firstincisionpodcast at gmail.com or follow us on Instagram at firstincision. Happy studying!