I Want To Be A Surgeon

Moving Shop!

2012-03-10T22:39:00.002+00:00

Hi everyone,

I've moved this blog onto www.iwanttobeasurgeon.com which I have also given a little makeover! Hope you like it and let me know what you think...

Amel

February Journal Club

2012-02-09T23:31:00.001+00:00

Firstly, congrats to everyone who has finished CST interviews. Its not to much longer before you find out the good news (fingers crossed). Anyway, I have decided to choose a systematic review on Negative pressure wound therapy ("Vac dressings") for this month's journal club. I find this subject incredibly interesting and have been working on a review of my own after being inspired by Dr Paul Liu who was the Chief of Plastics at Rhode Island Hospital where I did my placement last summer. As always, the article details are below and I will put up my comments in the next few days. I would be interested in what every one else thinks.

J Plast Reconstr Aesthet Surg. 2012 Jan 9. [Epub ahead of print]

The methodology of negative pressure wound therapy: Separating fact from fiction.

Glass GE, Nanchahal J.

Core Surgery Applications - Part II The Interview

2012-01-17T20:04:00.000+00:00

So, interviews have started this week for CST and sorry this post maybe late for some of you. The interview can be split into two parts which need to be prepped for:

a) The hard portfolio
b) The actual interview

The hard portfolio is a very important way to demonstrate all your skills, achievements and also your organisation. Its upto you whether you use a lever arch file with dividers or a book. Either way there are principles that you must follow and some tips to make your book look impressive:

Have a contents page and ensure dividers correspond with this
Organise your book in logical sections
Avoid bunching up lots of pages in one pocket, your portfolio should read like a book so that interviewers can quickly flick through
Include a recent copy of your CV after the contents
Ensure that you add any certificates for courses as well as your MBBS certificate etc...
Don't forget your GMC certificate, copy of your application form and anything else they mention on the website
Organise printouts from your e-portfolio into CEXs in one pocket, dops in one pocket etc with the most recent and flattering first! Also don't forget the minipats/msf print outs
If you can print copies of presentations/posters in colour then please do to make them stand out
Don't forget teaching achievements!!!
If you have a record of the operations you have helped in/done so far that will also be impressive. As a non trainee you can register and use the Intercollegiate Surgical curriculum Portfolio "ISCP" (www.iscp.ac.uk). I recommend this as it shows that you are already familiar with the programme that they will use for all surgical training. It is also a very nice way to display your operative rcord (if you have one). Do not worry about absolute number of surgeries as they know that not everyone has had much exposure to surgery.
Be comfortable and prepared to reply to any question on anything in your portfolio!!

I have included pictures of my portfolio below to give you an example of how you can set one out if you're not sure where to begin.

The next bit is the actual interview. There are many books to help you prepare, the one I recommend is "

Medical Interviews: a comprehensive guide to CT, ST and Registrar interview skills - Over 120 medical interview questions, techniques and NHS topics explained". It has lots of good examples and basically goes through how to structure answers to questions. Also, this WEBSITE has some good free content.

First of all, turn up looking smart and clean as well as early. Make sure you have brought your portfolio as well as all the necessary paperwork including photocopy of front cover of your passport, photo ID, passport pics etc... Try not have a smoke (or drink) before hand ;)

My interview (in 2011 for the London Deanery at Lions court) was split into three sections:

CLINICAL STATION:

please note. This is the most important station and weighted the most. I had two examiners and each gave me a scenario to answer.

The first scenario was of an elderly woman post anterior resection 1 day ago. You are called to see her as she has a low urine output. It is important with this question to say you would firstly ensure that basic ALS principles are applied by ensuring patient was stable ie ABC... Then I said I would take a history and examine the patient to look for evidence of bleeding, infection, peritonism (think anastomotic leak) etc... Then look at the obs chart and look at trends for urine, fluid balance, BP, PR, temperature as well as latest bloods esp post-op. I would ensure patient is stable and let registrar and consultant know. You need to mention what possible differentials are going through your head and how you would exclude...
The second Scenario was of a patient who rolled over in bed and came to A+E with a fractured humerus. BE ACREFUL AND LISTEN TO QUESTION AS I APPROACHED THIS AS A TRAUMA AS THOUGHT HE FELL BUT ITS NOT! Basically, on xray he ad luscent areas. You need to say you would suspect pathological fracture and screen for malignancy through history, exam and then can possibly send off tumour markers/myeloma screen etc... make sure you show them you know which tumours metastasise to bone and how you would check for them.
Some of my friends got asked how they would manage a kid who came in with a supraconduylar fracture (must talk about risk of neurovascular compromise if displaced) as well as abdominal tenderness after falling off tree. In both these scenarios ATLS principles are important and ensuring you tell seniors early on (the latter point goes for everything)

MANAGEMENT STATION:

This station was a tad disorganised. I was again given two scenarios to talk through.

The first was that one of my F1's tells me that he felt persecuted by the Consultant. You have to show that you would be understanding and caring toward your colleague but also resepctful of the right channels to pursue. You would ask them why they feel bullied. If its because they don't have enough knowledge maybe you could offer to tutor them etc. Otherwise you would encourage them to discuss with their supervisor/pastoral mentor to get advise. You would act in a supporting role. Whatever you do, don't say you would tell them to "man up" - it doesn't go down well no matter how tempting...
The next was how would I ago about organising the rota - snooze fest! Basically you need to balance adequate training in terms of clinic, study leave, operating time with annual leave. I spent a lot of time talking about annual leave, THEY WERE NOT IMPRESSED!! Basically rota also needs to be EWTD compliant so other ways you can ensure people get adequate training is by using simulators etc...

PORTFOLIO STATION:

By far, this was the nicest station although it is less weighted than the others. I had a panel of 4 judges and they had looked through my portfolio before-hand (you hand it in before your other stations start) and asked questions about my teaching (including plans I had for developing this blog and website :)). I was also asked:

What speciality I want to do and why? (I mentioned plastics and also let them know that I am aware how competitive it is by rattling off some statistics on past numbers etc)
How will I develop my CV to increase my chances of getting a number in plastics?
Other people where asked: what in their CV shows a dedication and commitment to medicine, teaching, why they chose that particular deanery...

Anyway, I hope some of this is useful and I will try and get some more info on his year's interviews to help next year's applicants. Good luck and remmebr to be confident, relaxed and know your porfolio/CV.

Core Surgery Applications - Part I (the form)

2011-12-09T20:32:00.001+00:00

So, most people will be finishing off their forms by now and I thought I'd thrown in a few last minute tips on completing your applications.

1) Firstly, brevity is essential! Most of the questions are limited to 65 words!! Ensure every word counts but write in clear and concise sentences. Bullet points look scruffy and unprofessional. You do not have space to list every achievement so highlight the most impressive and quickly mention the others.

2) Be honest. Whilst its important to "big up" your achievements, lying will only hurt your chances at interview as they can be very thorough with questioning. Also this is a probity issue and can lead to referral to the GMC.

3) Teaching is a very important part of being a surgeon. Don't just list your teaching experiences. If you have organised teaching then explain this, mention any feedback you have received and any plans you have to build on your experiences. Also, if you have had any training or attended a course to help with teaching then also state this.

4) Audits. Be honest and explain how you contributed to each audit. Also, whether outcomes were implemented and if re-audit has been done (state this as that's key to finishing the audit loop). If the audit has been presented or published then state this too. If you have done tons of audits then state how many and highlight a few examples rather than listing everything.

5) Commitment to speciality. This is very personal and I think you need to show how long you have been interested in the speciality and how you have explored it further. Mention electives, courses, placements, research, if you have sat any exams etc...

Anyway, I know this is brief but just wanted to give a few ideas out there. Please note, I am only posting my opinion but I do not know what the Deaneries are looking for and how they mark these questions. This is just advise based on experience of having applied last year and as such should not be taken as anything more than this. I do not accept any liability for any unsuccessful applications (sorry).

Good luck!!!

Amel

Hand Surgery and so much more!

2011-11-10T21:12:00.001+00:00

For anyone interested in hand surgery and/or working in developing countries and/or anatomy and/or art:

www.donaldsammut.com

I went to a talk he gave at the RSM on tuesday and it left me very impressed and inspired. In fact the whole evening was a great start to the Plastics section.

Journal Club - November

2011-11-10T20:55:00.001+00:00

Hi all,

I was very impressed by the response to the first journal club paper. This month, I have chosen a paper that is very clinically relevant and addresses a common problem but management is often fraught with controversy. So this month's paper is:

J Bone Joint Surg Br. 2011 Oct;93(10):1362-6.

The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture.

Wallace RG, Heyes GJ, Michael AL.

I will pot my assessment in a few days time and would appreciate any input from you guys. Also if you would like to suggest any papers for next month, please go ahead! I would welcome input. FINALLY, I shall be putting up some posts on core training applications soon as well as more MRCS advice...

MRCS Part B - Stations from yester year

2011-09-09T23:12:00.000+01:00

Now please note, these stations are just to help give you an idea of what kind of topics could come up in the exam. There is no guarantee that they will come up again or even if they do the format maybe different as the exam structure has recently changed. MRCS OSCEs are designed to test your core surgical knowledge and ability. If you revise the theoretical stuff and ensure that you get experience in going to a variety of outpatient clinics as well as scrubbing in regularly in the OR then you should not have any problems.

Hope these are useful and good luck!

Clinical Skills and History Taking

1. Examine this ladies neck I started peripherally with a thyroid status exam, but the examiner prompted me to go directly to the neck. She was an afrocarribean lady with what I thought was bilateral parotid enlargement:

Q's
• Causes of symmetrical bilateral parotid enlargement
• What is most likely cause in her (sarcoidosis)
• He asked me about other manifestations outside the neck

2. Examine this lump on a man's back:

Large lipoma- I examined including assessing for fixity to muscle, transillumenence, draining lymph nodes etc

Q's
• What muscle was it overlying
• What is blood supply and lymph drainage of that muscle (was Lat Dorsi)
• To describe how you would excise this lipoma
• Consent patient for procedure

3. HISTORY:

Very simple history for likely colorectal Ca,

Q's
• RF for colorectal ca
• Difference in presentation for IBD and colorectal ca --> why is this change in bowel habit Crohns or UC
• How you would investigate him
• Why CT pneumocolon is inferior to colonoscopy (you can biopsy with latter)

4. CVS Exam:

Patient had AS

Q's
• Other causes of ESM --Hypertrophic cardiomyopathy
• How to investigate to see if fit for surgery- ECHO to look at EF and gradient across valve
• Any important considerations for anaesthesia? No epidural, cause hypotension which can be compensated in AS due to fixed output state

5. Hx and brief resp exam

Completely normal exam, history of long-standing panic disorders

Q's
• Would you pass this lady in pre-assessment for an elective cholecystectomy
• What are the ASA gradings? - what would she be?
• Can you think of ways to optomise her- SSRI trial

Anatomy (3):

1. Upper limb, prosection, live patient and skeleton all in one: Rapid fire 20 questions e.g- where is the insertion of supraspinator, (demonstrate on skeleton), demonstrate pronation and supination (live pt) point out long head of biceps (pro-section)

2. Unmanned prosection of mediastinum and thorax in saggital section. Lots of flags- just had to identify the structures - was v hard !

3. Manned station- very easy, lower GI/ Hepatobillary -prosection of bowels- asked blood supply, significance of water shed area and marginal artery of drummond. Also was given a colonoscopy picture of bowel ca and asked to identify it. Then asked dukes classification. Then hepatobillary anatomy on another prosection Skills

(2): Taking blood cultures Important points: patient was there- there were marks for interacting.

If you spoke to her, she told you she was IVDU and Hep +ve, so u had to take appropriate cautions-eye protection, and noting it on the form for the lab. Change needles before you fill bottles, and fill aerobic first. Offer to label them.
Also they had an obs chart and it said she was Pen allergic.
They said she had a new murmur, and was spiking on obs chart and asked for a differential. I said that I wld query infective endocarditis, they asked organism, I said staph, and they asked me if I want to write up Abx- I did, VANC--> she was penn allergic which was the trick of the station.

Scrubbing Self explanatory

Other stations:

Critical Care: Definitions of sepsis, septicaemia, septic shock etc. Asked for intepretation of a HDU chart, and generally where and how to ressucitate a patient in shock, ABCDE...

Comm skills- Calming an eratic mother whose son had been in accident in playground and was on the table for an emergency splenectomy. Had to tell her risk and complications, long term e.g immunizations. and she was questioning why he was taken to surgery without consent, so u had to to know the legislation that the doc act in interest of child if no consenting adult is available in an emergency Comm skills- Discharge summary.

Information Giving- Polytrauma patient, needed to read notes in prep station and call trauma surgeon at home who is on call. He just asked questions to see if you knew the ATLS guidelines, and about management of open fractures.

Information Receiving (written stations)
ECG: AF with fast ventricular response- asked to inteprate rate/ rhythm, about reversible causes, and treatment
CT- Bilateral pleural effusions in a pancreatitic- asked about ARDS, and glasgow scoring
Erect Chest X-Ray- Perforated viscus

There and back again (almost)

2011-09-09T22:53:00.000+01:00

Ok so massive hiatus from the blog and website, I know and I apologise profusely. Its not that IWTBAS is not a huge priority for me, but I have had a lot of work to clear. So now that I managed to get into Core Surgery in London, passed USMLE Step 1 (and revising for 2CK), finished a Plastic Surgery Observership in the USA, completed 3 audits, implemented a DVT pathway at West Middlesex University hospital, written two case reports and finished off a meta-analysis, I am READY to get back to what's important! I will be regularly updating this blog and finishing www.iwanttobeasurgeon.com. So as a treat, the next post will contain some old stations from friends who sat the exam a couple of years ago and I will also scribble a few words on Core Surgery applications. Again, let me know what you would like to see more of in this blog and also on the site. Amel

Journal Club

2011-02-18T15:02:00.001+00:00

We are starting a monthly online journal club to try and stimulate discussion about the latest research in surgery. We will pick one article per month and post it a few days before we post our appraisal of the paper. Then we hope this will stimulate debate amongst our readers. If there are any particular papers you wish to submit then email us and better still if you would like to contribute to journal club then we would also love to hear from you. The reason we are doing this is it is difficult to keep up with what's happening in research on top of all the clinical and extra-curricular activities. We hope this will help in some small way.

The article I have chosen for this month is:

Eur Arch Otorhinolaryngol. 2011 Mar;268(3):405-14. Epub 2010 Sep 15.
Laryngeal transplantation in minipigs: vascular, myologic and functional outcomes.
Birchall MA, Kingham PJ, Murison PJ, Ayling SM, Burt R, Mitchard L, Jones A, Lear P, Stokes CR, Terenghi G, Bailey M, Macchiarini P.

You can find it on pubmed and sign in via athens/institutional login to get the full text.

Amel

Website Renovation Part deux...

2011-02-13T12:26:00.000+00:00

Hi all

So sorry but moving the website along has proven much more time consuming than I initially anticipated. I can however give you a sneak peak on www.iwanttobeasurgeon.com. There is still so much content to move over including anatomy and videos of clinical skills. However it will all be so much easier to access once its all up there :) You will note that we have added a new research skills section which will contain articles on how to conduct research, how to write up papers and how to get published. We will also be introducing a monthly journal club onto this blog and I hope you will be able to partcipate by adding your comments :)

Anyway, good luck everyone sitting exams and especially those who have been emailing questions to us. Please write back and let everyone know how you get on.

Amel

Website and more

2011-02-01T21:08:00.000+00:00

Thanks Amel for improving the website. More contents will be added in the next few weeks.

Good luck to those sitting the MRCS exams, it's a very passable exam.

Few tips to get through the exam:

1. If you don't know the answer to a question; ask the examiner to move on, and come back to that question depending on time. This is because, the marks are allocated per questions, and you do not need to get the questions correct in the order of being asked to progress through the station,

2. Some examiners take your first answer, where as others will permit a few attempts to allow you to get to the correct answer before moving on.

3. Basic finals standard examination, and history taking skills is enough to easily pass the exam.

4. Make sure you are familiar with dry skeletons, and all the points where any significant muscles or bone attaches.

5. Prepare from previous stations as they are likely to repeat stations. At least half of my stations were examined in the previous 2 years.

Good luck, hope you find this useful.

Keep tuned for more updates.

Romesh

Ps: click here for an interesting case report.

Website Renovation

2011-01-31T16:37:00.000+00:00

As I have been promising, www.iwanttobeasurgeon.com is getting a makeover. I've reformatted it and there is a lot new content now including a research skills section. The old website will be down for the next few days and the new site will be relaunched on FRIDAY! So watch this space and let us know what you think of the new look...

Amel

PS
Good luck to everyone sitting Part B this February and I hope you found some of the blog posts relevant.

Application form

2011-01-25T22:03:00.000+00:00

In general, most application form for all the specialties are similar. ACF application form consisted of
1. Listing academic achievements
2. Courses
3. A brief paragraph on audits.
4. Brief paragraph on teaching experience.
5. Brief description about my research projects, and then the next question asked to write in detail about one of the mentioned research projects.
6. Brief description about why I wanted an academic job.
7. Brief paragraph on my commitment to the specialty I am applying for.
8. Extracurricular activities

However, in my interview, I was asked to talk I'm detail about my academic achievements, research projects, and my interest in academia. There is not much emphasis on audits, however it is advisable to have one completed cycle as it is essential to be shortlisted for an interview.

I was lucky enough to have worked in a reputable hospital during my F1 year and with my interest in surgery and research, I was able to undertake a few research projects. Although it was very hard work, during my F1 year I was able to successfully pass MRCS part A exam, nationally present my research project as first author, as well as publish 3 papers (2as first author, and the second as 2nd author). Furthermore, I am in the process of writing 2 further papers for publication.

My advice for aspiring surgeons and academics would be to start early. It requires a lot of hard work, but show your enthusiasm to the consultants in your hospitals, and you will have opportunities to undertake useful projects which will help boost your CV to be successful in your choice of job.

Next post will be about setting up portfolios in preparation for interviews.

Contact me by email iwanttobeasurgeon@gmail.com for further information, or via this blog, and I will aim to answer any queries as soon as I can.

Romesh

Core surgery recruitment and Academic Clinical Fellowship

2011-01-17T15:18:00.000+00:00

With the interviews for core surgical training underway, there's a lot of tension at work place.

Having secured an academic clinical fellowship, I have the luxury of sitting back and enjoying the rest of my foundation year 2 training. Sadly I'm not particularly enjoying the care of elderly attachmet as most involves countless paperwork and a lot of babysitting patients while they wait for nursing/residential home placement.

So what is academic clinical fellowship? Many have asked me this and it's surprising how little people know of such oppurtunity.

It is essentially a specialty training programme with protected time for research. Most candidates will spend the first 3 years doing a pre-pilot research with the aim of applying for an externally funded pHd or an MD. On completion of the pHd/MD the candidates will slot back into higher specialty training. It is essentially a run through training in which all candidates entering ST1 training is almost guaranteed a CCT (Certificate of Completion of Training).

Now you may think, then why don't many people apply for it?
The same reason I mentioned above; not many are aware of such opportunities, and it is also only suitable for those who are interested in research and academia. Competition is fierce with less than 10 ACF in surgery available in the whole of UK at ST1 or ST2 level.

My next blog will be about how to prepare your portfolio for ACF/ core surgery, how to fill out applications, and how to utilise the time to get the most out of foundation training.

Stay tuned.
Romesh

MRCS stations October 2010

2011-01-06T22:06:00.000+00:00

MRCS Station October 2010

I will be briefly talking about the stations I had in my MRCS part B OSCEs. I will Mention them in the order I faced each station.

My first station was scrubbing. There were two examiners inside the station, and one was acting as the nurse. The description stated that you can ask the "nurse" for anything you want him/her to do. The examiners check the hands under the UV light at the end to see if you had covered all the areas during scrubbing. During the scrubbing, I was quizzed on the advantage and disadvantages of chlorhexidine and iodine, and when I would use one over the other in surgery.

Critical care: essentially the same station described by Amel. I was quizzed on TURP syndrome. As I managed to get through all the questions, the anaesetists quizzed me further on pharmacology of furosemide, and Mannitol, the mechanism of action. They also asked about the indication for intubation in a patient (all covered in Kanani's critical care vivas).

Communication skills. 10 minutes to read some notes about a patient who fell down some stairs after a drunken night out. He sustained a splenic haematoma, and the plan mentions that he needs to stay in the hospital for few days. The task is to convince the patient not to self discharge. The patient is very adamant that he wants to leave. Just had to make sure that he was not under the influence of alcohol, and has capacity to make decision. No one in my circuit managed to convince him to stay.

Pathology: scenario of a patient who presents with fever, new onset cardiac murmur, and has a previous history of rheumatic fever. The discussion was around major and minor criteria of endocarditis, most common organism, and treatment. The discussion then went onto cardiac transplants, and side effects of immunosuppression. Very straight forward station.

Critical care: scenario of a patient who was trapped under collapsed building. Discussion was around ATLS management of trauma, rhabdomyolysis, hyperkalaemia(potassium from muscle getting into the circulation).

Anatomy (specialty). Trunk and thorax. Dissection specimen of abdomen. Asked to point out stomach, duodenum, and pancreas. The different parts of stomach, blood supply. The arteries that bleed in duodenal ulcer. Parts of pancreas, blood supply, function of pancreas (exocrine and endocrine). Blood supply to the colon.

Anatomy 2. Live model present. Asked to point out tibialis anterior tendon on person. Point out Achilles tendon, Extensor Hallucis Longus, and digitorum. Dorsalis pedis and posterior tibial pulse. Show what happens when tibialis andterior and posterior contract together (inversion of the ankle). Point out where peroneus longus attaches. Nerve supply of tibialis anterior, and peroneous longus. Show me where you would test sensation of superficial and deep peroneal, and sural nerve. Demonstrate ankle and knee jerk, and the nerve roots.

Anatomy 3. Dry skeleton. Asked to point out the different parts of the humerus, and sites where nerves can be damaged. Asked what lies around the radial nerve in the radial groove (lateral and medial head of triceps). Origin and insertion of rotator cuff muscle. The examiner pointed to the ASIS and asked me what that point is called, and asked what attaches there (sartorius). Asked which nerve gets compressed around there and what is the pathology called (meralgia paraesthetica). Asked about origin and insertion of quadratus femoris.

Clinical skills: catheterisation on a plastic model (with a live patient sitting on the other side). Quizzed on what I would do if I can't get the catheter in (try bigger size, in experienced hands introducer, or SPC if still can't catheterise. Then quizzed on management of a patient who presents with abdo pain, and tachycardia.they were describing a ruptured AAA case, and how you would manage the patient.

Round 2.

Cardiovascular examination. Patient had a pacemaker. Asked about what precautions I should take; ppm check, careful use of diathermy.

Comm skills2. 10 minutes to read notes about a RTA victim with pulseless leg. Task was to call the trauma consultant to come to hospital. Quizzed about ATLS, management of open fractures, compartment syndrome.

Comm skills 3. Assess cognition of a patient awaiting elective hip replacement. Patient has AMTS of 2/10. Asked what I would do; collateral history from family, GP etc. If new, then investigate cause for confusion. Postpone surgery for now as needs investigation of confusion.

Examination 1. Knee exam of a patient with relatively new arthroscopic ports. Tender medial and lateral compartments, and patient had crutches hidden behind bed. Differential diagnosis: OA, and rheumatoid, tests I would do (weight bearing x-rays, bloods). Finally management of knee pain.

Hernia and scrotal examination: patient with bilateral inguinal hernia, and a hydrocoele. Simple question on differential diagnoses of lump in groin/scrotum, and management of hernias.

Head and neck examination. Examine a patient who has pain in submandibular region pain on eating. I performed normal neck exam, and then bimanual examination of submandibular glands, I wasn't able to feel any abnormalities, and was a but worried that i may be missing something. The examiner then said to me "I appreciate this is a normal patient...but what would you find in a patient with similar symptoms" I breathed a sigh of relief and talked about submandibular calculi. Asked about what nerves can be damaged in submandibular gland surgery, and quizzed about anatomy of parotid gland.

History. Take a history of a patient with increased urinary frequency, hesitancy, and dribbling. Basic questions on management of BPH.

Critical care 3. Scenario of a patient who had a reversal of ileostomy 3 days ago, now has abdo distension, spiking temperatures. Asked about bowel obstruction, and anastomotic leak. Differentiating true obstruction from pseudo obstruction (no bowel sounds in pseudo, and tinkling In true obstruction).

History. Patient with back pain, and numb great toe. Probable disc protrusion and compression of nerve roots. Quizzed about cauda equina, and how I would manage this patient.

Overall, very fair and straightforward exam. The examiners are generally very nice and will help you work out the answer. There are lots of staff that take you from one floor to the other, so no chance of being lost. The exam however is very long and tiring.There is a break between each 9 station where you get coffee and biscuits.

HAPPY 2011

2010-12-31T23:12:00.000+00:00

Happy New Year to everyone, and hoping 2011 will bring all your wishes true. I am quite sad to be leaving 2010 behind, as it has been a successful year for me. Ranging from a successful research project which i presented at a national conference (BSET) on the use of iliac conduits on ameurysm repairs, passing the MRCS examination, as well as successfully obtaining an academic run-through fellowship in general/vascular surgery.

2010 has been a busy year, but has been very fruitful. I am looking forward to starting my surgical training in August 2011, and I am still in shock that my next job interview will be for a consultancy post. :o.

In the coming weeks I will be updating the blog/website regularly, so stay tuned.

Romesh

Happy Holidays!

2010-12-24T19:33:00.000+00:00

Merry Christmas everyone (not that I can be too cheerful as I am on nights all this week :( ). I have enjoyed blogging about exams and all things surgical this year and hope everyone who has stumbled across our humble blog has found some useful info. Congratulations to Romesh for becoming a member and good luck to everyone else who is planning on sitting the exams soon.

With core surgical applications sent off and interviews obtained, I will try to blog about the experience in the hope that it may help others planning to apply next year.

As for our blog and website, I will be making some changes after interviews. Firstly, I want to re-design the website so that navigation is easier and avoid flash to make it more accessible. In addition, I will be uploding much more content and have designed a quiz generator for practice questions.

So change is coming to IWTBAS - watch this space. As for anyone who has used this blog, I would be very useful if you could let us know how you got on in the exams/what more you would like to see on our blog.

With that Merry Christmas and Happy New Year!

Amel

MRCS OSCE October 2010

2010-11-13T11:45:00.000+00:00

After spending every minute of yesterday refreshing the Royal College of Surgeon's website between each theatre case, I found out that I have indeed passed the OSCE from the October sitting.

I will post the stations i had, and tips/tricks in passing the exam in the next few days.

I agree with Amel's advice on the usefulness of the Applied Basic Surgical Sciences for the Intercollegiate MRCS OSCE course.

Rom

More MRCS Exam stuff!

2010-09-29T21:16:00.000+01:00

Sorry but it has been brought to my attention that I forgot to post the two clinical skills stations which
I received. They were both single examiner and 9 minutes in length.

1) The scenario was someone was involved in an RTA and you needed to put in a cannula and write up fluids. Things to remember are confirm patient ID, correctly insert cannula and write up drug chart. After this it becomes an ATLS viva where thy quiz you on management of trauma. Its not a difficult station if you stay calm.
2) The second station was to excise a benign appearing lesion as your consultant was going to do it but he had to run to theatre. You have to pick the blade and suture you need to use and mount the scalpel (I found this the trickiest bit as my hands were shaking). Remember to check consent form, infiltrate with local and give advise as to when to remove stitches, how long to leave dressing and when histology will be back. Also give follow up details.

Hope this helps!

MRCS Stations - Efficiency Of Time Critical

2010-09-25T20:27:00.000+01:00

With the next sitting of MRCS rapidly approaching, I thought that I would post what stations I got in the exam in May to help give you an idea of what the exam was like. Obviously, you need to prepare for the probability that anything can come up but this may help give you a flavour of what to expect.

So the exam is done at the Royal College of Surgeons HQ in London if you're sitting at the English College. The exam is split over two floors with chaperones escorting you between stations. There was also a 20 minute break half way through the exam with tea and biscuits which I must admit was very welcome!

On the day, you register and put your things in a locker (do not forget to put away your mobile otherwise its an instant fail!). You are then split into two groups and do a circuit of 9 stations then a break followed by the second circuit. Here were my stations:

Rest station

Head and neck: asked to examine a neck. On exam patient had enlarged left lobe of thyroid. I examined her neck and then I said I would like to examine the rest of her thyroid system. So I looked for proximal myopathy, exophthalmos, lid lag, AF, myxoedema etc… when I was done I said that she was euthyroid but with an enlarged left lobe. I was asked for differential diagnoses, investigations and management plans. Then I was asked to talk about different cancers of thyroid (so I did the whole epidemiology, pathology, investigations and management of each…). Good station, I finished early and had a nice chat with examiner and patient.

Investigations station: I got a CXR which showed NG in bronchus as well as the patients notes and asked to comment (basically SHO did NG tube then left at 17:30 without handing over for anyone to check. Patient then NG fed erroneously and ends up in ITU with respiratory distress). The examiner was an anaesthetist who was very quick with questions so you had to answer quickly. Asked what management of patient was (obviously remove and replace tube immediately). Second was a CT abdo slice of px and blood results. Diagnosis was acute cholecystitis and gallstones in gall bladder. Asked about management. Simple station but it was rushed and you have to think fast.

Examination of Resp system: patient needed elective inguinal hernia repair. I immediately looked around room and spotted inhalers. He had hypo-expanded chest and expiratory wheeze. I diagnosed COPD and was asked how this affects his management. So I mentioned getting pulmonary function tests, optimisation of his COPD treatment, informing HDU as although it is normally a day case procedure he may have difficulties, let surgeon and anaesthetist know. I also mentioned consider use of regional anaesthesia.

HISTORY 1: Back pain in a gardener. Toe is numb. Pain radiates to right leg and increased urinary frequency. She was constipated but was using dihydrocodeine for back pain. My differential was L5/S1 herniation of disc or sciatica. I said I needed to thoroughly examine and exclude cauda equine (MRI if necessary). I said if suspect cauda equine admit immediately, otherwise MRI as outpatient, analgesia, physio and discuss scans with spinal surgeon in case needs decompression if disc prolapse.

HISTORY 2: basically woman with panic attacks. Asked to give a string of differentials so I said asthma, heart failure, vasovagal syncope, angina… For management I said investigate by doing bloods, CXR, echo, PFT and inform anaesthetist, surgeon as well as relatives as she may need support prior to surgery.

Abdo Exam: Asked to examine abdo of patient with abdo pain but patient kept refusing to let me see her abdo so I examined her by piece meal. I also forgot to look at obs chart first so examiner got upset at that (even though he had it hidden in his hand). Handed a piece of paper with urine analysis. There was bilirubin in her urine though she was not jaundiced. Pain was epigastric. I said cholecystitis, pancreatitis, gastritis as differentials and ran ourt of time. Everyone else said they had a tough time with the patient and examiner as neither were helpful. Examiner didn’t ask clear questions.

HISTORY 3: primary school teacher with change in bowel habit, LIF pain and mucous PR. She is adopted and does not know her biological family. So I gave IBD, hereditary bowel ca and said if she was old I may hink diverticulitis but she was only 30!. I would investigate with flex then colonoscopy if needed, barium enema/CT depending on scope results.

EXAM Ortho: hip exam of someone with pain in left hip, has scar on right hip, reduced flexion of left hip, fixed flexion deformity on right and small leg length discrepancy (I asked to measure his leg length so examiner got a tape measure out of his pocket). Tested trendelneberg which was normal. I gave differential of OA and then he asked what else so I said RA reluctantly. I said I wanted to do an xray of his hips. Asked about management so I said analgesia, physio, hip replacement if indicated but he wanted to know what else (think he wanted me to say bisphosphonates and calcichew which slipped my mind despite orthogeris).

TELEPHONE: 10 minutes to read patient notes investigations etc in one room then asked call the trauma consultant). Scenario is RTA of 23 year old male. ?free fluid in left paracolic gutter and absent pulses. ?compartment syndrome/critical leg ischaemia and possible head injury. Asked what I would do and said CT head and abdo if stable. Asked how to investigate leg. I said I would also consent patient for laparotomy, fasciotomy and possible leg amputation. Then ran out of time.

REST

Anatomy 1: examiner pointed at bladder, vas deferens, seminal vesicles etc… asked about blood supply and posterior relations of bladder. Also types of bladder cancer (yay shistosomiasis!)

Anatomy 2: surface anatomy of ankle. Asked to point out peroneus longus, brevis and tertius. Where do they originate and insert? What happens to foot if tibialis anterior and posterior contract together? Where is EHL and EDL (Surface marking). What are the roots fof the knee and ankle reflexes. Demonstrate knee and ankle jerk. Demonstrate foot pulses. If patient had crush injury what is he at risk of? Sensory distribution of deep peroneal, saphenous, sural and S1?

Anatomy 3: Abdomen. Asked to find ascending colon on cadaver. Where is appendix, caecum and ileum. Demonstrate internal and external oblique. Nerve supply to external oblique. What makes the conjoint tendon and the nerve supply? Which nerve gets damaged in inguinal hernia repair and how does it present? Asked to name all the positions that the appendix can lie in. why does pain refer to RIF?

CRITICAL CARE 1: 2 examiners, both anesthetists. Given vignette of patient who had TURP and is now confused, hypotensive and hyponatraemic. I said Trans uretheral resection of prostate syndrome likely diagnosis but differentials maybe sepsis, hypovolaemic shock and explained why it was not these things. Asked why TURPS occurs, so I said due to the osmotic actions of glycine the asked what glycine is. I said an amino acid. Then asked why confusion? So I said that glycine breaks down into ammonia and causes confusion. Asked what other conditions this occurs in and I said hepatic encephalopathy. Asked management so i said in ITU/HDU and went through how to carefully manage his acute issues.

PATHOLOGY: vignette of someone with gastric ca. asked about epidemiology, pathophysiology, investigations and management. Shown another vignette of patient at 6 months post op now with swollen abdomen so I said ascites likely die to peritoneal mets. Asked how to investigate and overall management in light of all this.

COMM SKILLS: given ten minutes to read patients notes and investigations. Then to explain to patient with obstruction and perforation why he needs surgery. Also explained stoma formation, complications, how long he needs it for…

CRITICAL CARE 2: 2 examiners and 20 minute station. Vignette on someone who had accident, swollen leg, renal impairment etc… discussed that problems due to crush syndrome and resulting rhabdomyolysis. Talked about acute management of his rhabdomyolysis.

1) All in all a fair exam in that examiners do give you a chance to prove yourself but you effectively only have 6 minutes to examine/take history and present findings in order to be able to answer as many questions as possible to score points. Most people have the knowledge but you need to compose yourself and be professional at all times! I hope this helps a little in preparing for the exams and I wish you all the best of luck.

Books etc to prepare for MRCS OSCE

2010-07-02T09:48:00.000+01:00

When preparing for my OSCES I asked my friend Essie who had already sat and passed her exams for advice on which books to revise with. Although I didn't use al the books she recommended due to time limitations, here are the books I did use:

Instant Anatomy: great little book for brushing up on blood vessels, nerves etc... to be used as memory aid rather than for learning from scratch. The free podcasts from the website are also really good.
Netter's anatomy atlas. Excellent for learning anatomy from scratch.
Get Through MRCS: Anatomy Vivas by Simon Overstall. This book is amazing. 96 pages of anatomy vivas and model answers which really help with structuring answers for exam. It was the one book I couldn't have done on demand.
Master Pass: MRCS Picture Questions Book 2 by Tang and Praveen. This book covered Trauma and Orthopaedics, Transplant, Vascular, Paediatric and Breast surgery. It has amazing pictures and excellent explanations. Can be used as a learning aid.
MRCS clinical question book by Catherine Parchment Smith. This book was good for structuring your clinical examinations and useful for anticipating questions around each topic. I dipped into it occasionally but did not use it very much as I was happy with my clinical examinations. Good for targeting weak areas or checking your examinations are in good shape.
Rafftery's MRCS book. I used this book for Part A and the pathology section for Part B.

In addition to books I also bought 2 apps on my iphone. Netter's flash cards were useful but I did not learn much from them and it was an expensive app (£20). Rohen's anatomy app is excellent (£15) as it uses dissections and really handy for exam practice as you get dissections in 2 of the anatomy stations.

I also bought the OSCE Cases online course from Pastest as it was on offer for £69. Although they need to do alot of work on the format and increase the content, I thought that Prof Ellis' anatomy lectures were amazing and the OSCE tutorials on the different examinations were excellent. I would not pay more than £69 for the course as it is but if they improve it (Alot of improvements need doing) then it may rival more expensive courses.

Internet wise, the following free website was absolutely amazing. It allows you to create your own anatomy quiz and uses dissections. The link is http://ect.downstate.edu/courseware/haonline/quiz/practice/u7/quiztop7.htm . Definitely worth trying out. I also discovered Acland's atlas of human anatomy which is a video atlas. You can download/view on University of Warwick's website and youtube. I thought it was very useful as a break from books.

As for critical care, I used the notes I made from the RCS Course that I went on instead of a book. However, if you don't go on the course, these two books cover everything you will need (we got given them free for the course):

Surgical Critical Care Vivas by Kanani
Applied Surgical Physiology Vivas by Kanani and Elliot

Anyway, I may have gone a little OTT with learning resources but I managed to use all of the above materioals in one way or another to target my weaknesses and it seems to have worked. The trick is to not use everything at once but to start with one or two books and add other learning materials as needed because your weak spots will become evident. Closer to the exam you can start whittling down the books you need.

MRCS OSCE RESULTS OUT TODAY

2010-06-25T12:43:00.000+01:00

So after 4 hours of pressing refresh screen and trying to take my mind off MRCS results by reading some biochem revision book (yes I did say that), I found out that I passed MRCS Part B and thus am now Miss Ibrahim. I can't describe how amazing it feels for all that hard work to pay off and thought I'd share some of the good news with you guys.

So after I'm done elebrating, I'll upload more info about the stations I got.

Amel

Change is coming to IWTBAS

2010-06-23T17:47:00.000+01:00

Great news y'all. We have launched the website finally! Although it is still far from finished there are a few pages to keep you occupied for the time being.

Amel

MRCS Courses

2010-06-13T18:39:00.000+01:00

Enjoying watching the soccer this weekend but thought I'd give you the low down on the course I went on.

I found it super difficult to pck a course as very little info is available and because they are so expensive I felt more apprehensive about making a bad choice. AFter much debate and searching, I wittled it down to 3 course:
1) The St Thomas' 7 day course costing £1200. So ths course was highly recommended by my Reg because he said they got you to practise stations on real patients. However, as it is very popular, I couldn't get a place on he course.

2) The PASTEST MRCS revision course. Costs £799 and you also get the online revision course for free. This course is run over a weekend so its only 2 days. I didn't go as I wanted something longer. A riend went and said it was excellent. Apparently you get grilled all day as the course is mostly in OSCE format and you go around in circuits. He felt it was very useful.

3) The Royal College of Surgeons' Applied sciences for the MRCS course. This is a 5 day course at the Royal College in London and costs £1000. I went on this course and thought it was fantastic. They explained what the format of the exam would be like, taught anatomy on cadavers in small groups and gave lectures on pathology and critical care. There were also lectures and an opportunity to practise comm skills stations. I think the highlights of the course were the lectures on critical care (very comprehensive) and the anatomy demonstrations. You also get critical care viva and a physiology viva books for free. The two problems with the course is that it didn't cover clinical examination or neuroanatomy.

I don't think you need a course to pass the exam but the royal college course really helped me prepare as I was most concerned with anatomy and critical care. Much of the stuff covered on the course came up in one way or another on the course. Hope you found this useful and if you have any experiences of the other courses please share with us.

Amel

Post MRCS Part B

2010-05-30T20:30:00.000+01:00

So I finally sat the OSCE on thursday and it was a very passable exam although I think I screwed up 2-3 of the stations and thus may lead to my failing the exam. However, results aren't till the end of June so I can still try and be mindlessly optimistic.

Anyway, for all those considering sitting the exam this winter (which will very likely include my self), I shall endeavour to give you as many tips and advise as necessary using my experiences. Over the next few weeks, I shall blog about the format of the exam, the level of detail questioning required as well as books, courses and other revision aids.

Firstly, the exam involves 18 stations in addition to two 10 minute rest stations whereby you sit by yourself in a cubicle and one twenty minute rest station separating the exam in two and during which everyone who has sat the same stations gathers and has tea. Of the 18 stations these are divided as follows:

1) Anatomy and pathology:
1x speciality anatomy station
2x generic anatomy stations
1x generic pathology station

2) Communication skills:
2x history on speciality topics
1x generic history
1x explain something to patient/relative (also has a 9 minute prep station whereby you read the notes)
1x communicate with a colleague over the phone (also has a prep station whereby you have 9 minutes to read notes and prepare)

3)Clinical skills and patient safety:
3x speciality topics- physical exam
1x generic system- physical exam
2x procedure e.g gloving/cannulation/blood cultures/excision of lesion

4)Critical care and physiology
1x manned station with imaging/results for interpretation
1x 2 manned station with a scenario and viva on critical care
1x manned station and viva on physiology and critical care

Ok so that's me done for now but watch this space for further info in the coming days and weeks.

Amel