Advanced ENT training

A guide to passing the FRCS (ORL-HNS) examination

Joseph Manjaly, Peter J Kullar, Joseph Manjaly, Peter J Kullar

• Publisher: CRC Press
• Year: 2019
• ISBN:
  9781000753233
• Edition: 1
• Topic: Medicina
• Subtopic: Teoría, práctica y referencia médicas

The syllabus for the FRCS (ORL-HNS) is vast, and a sound preparation for the exams has traditionally involved assimilating knowledge from a wide range of sources. This book provides a focussed guide for exam candidates.

More than a question and answer book, this book is a coaching manual. Each section features a combination of model answers, pearls of wisdom, checklists and pointers for further reading. Detailed advice is provided for both Part 1 and Part 2 of the examnation. Viva topics that have featured in the exam in recent years have been included. and have then been supplemented by invaluable editorial contributions from leaders in each of the subspecialties.

Trainees frequently comment that exam preparation is an enlightening process and the knowledge gained would have served them well during their time as an ENT registrar or Otorhinolaryngology resident.This book will also serve as a valuable learning tool for trainees as early as ST3 and facilitate their development of effective and safe clinical practice.

1

Introduction

Joseph Manjaly and Peter Kullar

You may remember in the early years of your training looking up to senior registrars who had become Fellows of the Royal College of Surgeons, feeling that you had a long way to go before you had the knowledge and experience to join them. As you progress through training and the end of ST6 draws near, it’s not unheard of to start developing imposter syndrome. Are you truly ready for this hurdle? Or have you somehow slipped under the radar because everyone has assumed that you were doing fine? Is everything about to suddenly hit the fan with an ignominious revelation that you eternally follow patients up in clinic and can only just about do a tracheostomy?

And yet the FRCS (ORL-HNS), just like other exams you have passed along the way, is a very passable exam. You’ve reached this point because you are capable of meeting that standard. Once you have done so the next step will be to think about a consultant post, usually within 18 months though that may seem a far-away idea at this point.

What has probably changed since your last exam are your circumstances. As a registrar the need to be on top form every day, particularly on operating days, limits the number of late nights you can reasonably spend revising. Gone are the string of post-nights ‘zero days’ you could use as a senior house officer. You may have family responsibilities to juggle by now. The tools to be able to ‘work smart’ are more crucial than ever and our book is written in this spirit.

The syllabus for this exam seems endless: essentially try and know everything about ENT and its related specialities. There are many excellent texts and resources available for the task but arguably the most useful information is the pragmatic, working knowledge and gems of wisdom handed down by the preceding generations. In this book we have tried to bring these together in one place.

More than just a question and answer book, we hope this book will act as a coaching manual. Every section is centred on a combination of ‘model answers’, pearls of wisdom, checklists (

) and pointers for further reading (

). Rather than being an exhaustive ENT text, we hope this book will guide you to exam success in a thorough yet efficient manner alongside your work commitments. We have been comprehensive with topic selection. The viva topics included in this book touch on nearly every subject that has come up in the exam in the 5 years prior to publication.

We have gratefully called on contributions from colleagues around the country. All were identified as high achievers with a skill for teaching and mentoring. Thankfully for us, all have responded with enthusiasm and willingness to be a part of this project. All viva advice contributors have passed the exam within the last 3 years, including multiple gold medal winners. We are sure that many will go on to be leaders of their fields in the future.

The authority of this book is secured by our senior editors. In Manohar Bance, Neil Donnelly, Ben Hartley, Richard Hewitt, James O’Hara, Hesham Saleh and James Tysome, we have had the privilege of receiving internationally respected wisdom from current national and world-leading clinicians. We are very grateful for their time and critical input.

Preparing for the FRCS (ORL-HNS) examination will be a tough journey – both for you and those around you. We hope this book will help you prepare whether you’re a UK or international trainee. It will be a time when your patient care significantly matures. Enjoy seeing the rewards of that. You may end up strangely wishing you had gone through the whole thing earlier!

2

Personal Reflections on the FRCS (ORL-HNS) Part 1 Experience

Alison Carter

Currently the earliest point in training to be eligible to sit the exam is the beginning of ST7. If you are in a training programme that allows you to pick your jobs for the next year, it is important to select carefully. Now may not be the time to rank the busiest job in the deanery or the one with the longest commute. I returned to a hospital at which I had worked previously, where my colleagues were supportive and understood that my main focus over the coming months was the exam.

I have summarised my approach to the exam but this of course is very individual.

Many of my successful colleagues approached things slightly differently, so it is worth talking to those around you and so you can synthesise a strategy that suits you best. I hope this guide will give you an idea of what worked for me and what may work for you.

6 Months Pre-exam

Applications will be via the JCIE website (www.jcie.org.uk) and require you to fill in an electronic form with your work history, dates of your MRCS and university medical degree, a summary of your operative experience (a PDF of your elogbook is sufficient), your curriculum vitae, and three structured references from supervisors whom you have worked with in the last 2 years. If you are in a UK training programme this must include one from your training programme director stating that you have a ST6 ARCP outcome 1. The referees are asked to assess your diagnostic skills, clinical management, operative skills, professionalism and probity and communication and language skills. Getting the forms signed always takes longer than one might anticipate so make sure that you are organised in getting this done.

At the point of application, you have to pay for both parts of the FRCS (at the time of writing: Part 1 – £536, Part 2 – £1,313, total £1,849). Most will elect to do Part 2 FRCS in the next available sitting on the application form (3–4 months post Part 1). There have been occasions where the second part has been oversubscribed and entry is granted in order of receipt of applications, therefore in order to avoid any unnecessary stress or disappointment later an early application is advised.

Over your training you have likely been building your CV with publications, quality improvement projections and further degrees, but now is time to put all that to one side. Accept that for the 3–4 months before the exam, you will not be doing any of those things, and try and use the 6-month mark before the Part 1 to finish outstanding projects so that you can start revising with a clean slate. I was surprised at how understanding my colleagues and bosses were about this when politely declining to take on any extra projects, and was usually met with ‘of course, you have the exam – best of luck’.

4 Months Pre-exam

Gone are the days of university when you could dedicate hours on end to revision. You will likely be working in a busy job with long days, may have accumulated other things in your life such as partners and children and sadly dealing with sleep deprivation is probably not as easy as it once was all those years ago. Remind yourself that most people sitting the exam are also facing the same challenges, and you just have to manage it as best you can.

Look at your work week and try and identify areas where you can get some productive revision time in. You may have a morning or afternoon in your timetable that can be used for revision. Be disciplined in making sure that you use it effectively. Work out when you are at your most productive. For me, I know that I work better in the morning, and on looking at my timetable, three mornings I had to be at work for 7.30 a.m., but the other two were 9 a.m. Although it required a lot of dedication, and some that the alarm was switched off for, for those 2 days a week, I would wake up at 5.30 a.m. and get 2–3 hours done before work. In return, I never revised in the evenings, and made sure that I enjoyed times out with friends or relaxing at home ‘guilt free’. Although this worked for me, I know that not everyone would work best in the mornings, so be honest with yourself as to what your golden hours are, make it happen and make sure you enjoy the other hours and give yourself a break. At the weekend I had one day where I was productive (sometimes both), but again never worked in the evenings.

I started my revision using a textbook to give an overview of all the areas of ENT. I read through topic by topic, highlighting things I thought were important. Everyone responds differently to different styles of books, and I would recommend asking your colleagues what they found helpful previously and going to look at a few of them in the library or sample them online, before buying one which you think you will like. You do not need a book that goes into intricate detail, this is more for an overview of different topics, some of which you may not have had as much exposure to in your training, and to jog your memory on those you have. Although most of the FRCS courses are aimed at Part 2, there are some available for Part ...