...is turning to joy and self-satisfaction! I’m pleased to report success in what will hopefully be my last exams ever. Many would say that I’m far too old to still be sitting exams, but the profession of surgery in the UK requires me to pass an ‘Exit’ exam before completing my training. Having passed, I can now add the letters ‘FRCS(Gen Surg)’ to my name in place of the basic MRCS qualification, but more importantly it means I can become a Consultant Surgeon when I finish in October later this year.
The Intercollegiate Specialty Examination in General Surgery has left me rather more stressed over the last few months than I would have admitted to myself. There are two parts – the first written part was in June 2009, consisting of a two hour multiple choice exam and a two and a half hour Extended Matching Questions exam. Having passed that, I was allowed to progress to the second Clinical exam.
I’m very much a General Surgeon. When I was in Uganda, that obviously encompassed every possible type of surgery. Here in the UK, most people choose to sub-specialise into Colorectal, Oesophagogastric, Hepatobiliary, Endocrine, Vascular, Breast, or Transplant Surgery. The exam tests both General Surgical knowledge (encompassing all of these sub-specialities) and sub-specialist knowledge. For me, sitting as a Generalist, I had to know all of the specialities to a higher level (!), although not to the full sub-specialist level.
The clinical exam itself was in Newcastle, held over two days. The Thursday afternoon had two exams – both half an hour long with two examiners, seeing actual patients. I had quite a mixed bag of conditions to discuss – a thyroid lump, a breast cancer, an incisional hernia, an abdominal aortic aneurysm, a large retroperitoneal tumour, and a post-op short bowel with ileostomy in the first part; obstructive jaundice due to retained gallstones, an incisional and an inguinal hernia, a male breast lump, an enterocutaneous fistula, a post thyroid cancer with an odd neurological syndrome, and some varicose veins in the second. You’re expected to be able to adequately speak to and examine patients, and then discuss the case in question in some detail.
The Friday exams were oral exams – an academic viva, a general surgical viva, and an emergency surgery and critical care viva. The academic exam requires an hour to read two published papers, before getting questioned for ten minutes per paper on your understanding of what the paper is trying to say. It’s all about the study design, appropriate methods, statistical tests, interpreting results and assessing whether the paper is worth taking notice of in clinical practice. The General exam was half an hour discussing Investigating anaemia, consent for hernia repair, pyloric stenosis in children and adults, bile leak after laparoscopic cholecystectomy, and clostridium difficile infection. The Emergency/Critical Care exam was a further half an hour discussing inflamed small bowel found at laparoscopy for suspected appendicitis, rectal bleeding and its investigation and emergency management, chest trauma with investigation and analgesia for flail segments, correction of coagulation after massive blood transfusion, and brainstem death.
I came away thinking I’d done well in the Academic and the Emergency/Critical Care vivas, but with no idea about the others. It’s an exam in which only about half of the candidates pass, so I was fairly concerned. Fortunately it doesn’t take them long to produce the results, and I had an email waiting for me when I got home on Monday. I can only say that I was relieved and exhausted. There was very little sense of achievement or joy at having passed, but that has developed through the rest of this week. Four of my colleagues in Edinburgh also sat the exam at the same time, and we all passed, which is a fantastic result. Another former colleague from another area of the country was unsuccessful on this occasion, but he’ll be able to sit it again.
Surgical Exams are an expensive business – the exam itself costs £1700; I went on a pre-exam course costing £1100; then there was travel and accommodation in London for the written, and in Newcastle for the clinical; Finally there’ll be an “election fee” to the Royal College of Surgeons to allow me to become a Fellow (FRCS stands for Fellowship of the Royal College of Surgeons) rather than a member (the basic surgical exam I passed ten years ago was the Membership exam). Still, it’s a hurdle that has been jumped, and I can now enjoy my last few months of training.
Of course, next up will be finding an appropriate Consultant job. There have been advertisements for posts in Elgin and Fort William, but both are a little too far away from the Central Belt of Scotland for me at the moment. I’m hoping that there may be jobs in Perth, Dumfries, Dumfermline or Forth Valley – a lot depends on other surgeons retiring. If nothing appropriate comes up, I may yet find myself back in Uganda!
