Introduction

Intercollegiate exams are prerequisite for independent practice in UK. Recently these exams are open to those in non training posts. Individuals who have the skills and competence of a year four Registrar in the UK are eligible to take the exams. In the last two years the pass percentage in the ENT exit exams has been around 60%, however the number of individuals from the non training group passing the exams has remained around 5-10%.

Otolaryngology has been a competitive specialty in the UK. Individuals who are not able attain the all important seamless training post may end up training in other middle grade posts (LAT/LAS/Specialty doctor). An exit exam then is one of the important achievements to demonstrate competence. It is also one of the essential exams to have for those who plan to apply for consultant posts through Article 14, to apply for fellowship overseas, and also for those who intend to return to their home country with overseas qualification and some training.

This article should help guide all those trainees and non trainees in middle grade posts to approach the exams in a systematic way and get through the exams in the first available opportunity.

Planning

It is imperative to approach the exams with systematic preparation. Plan the preparation at least a year in advance. The cost of the examination fee is around 1700 pound sterling however the overheads like intercollegiate exam courses, books and special courses depending on individuals area of academic limitations may increase the cost to about 5000 pounds. Study leave is another issue as individuals in non-training posts and locum positions may not have the same amount of funding and access to study leave as trainees. This means you might have to use your annual leave for the courses. It is important to identify areas of weakness well in advance and book suitable course to improve your knowledge base. Keep an eye on free courses and CME’S as this would help keep the cost down.

MCQ Strategy

The first part of the exam is the multiple choice question exams. This tests your length and breadth of knowledge based on clinical scenarios and factual knowledge. The examination syllabus is generally around the prescribed topics on the ISCP website; however expect questions around other related topics like consent, statistics, basic sciences, clinical governance and research methods. The best strategy would be, to do a wide extensive study followed by some focussed reading around the related topics (Table 1).

Figure 1

Table 1: Resources for MCQ exams

The pass percentage of the MCQ exam is very good but it is important to be quick in answering the questions, as the time for each question is less than a minute and you might lose out on ‘not answering questions’ because of time constrains. Practising on a few mock papers is advisable.

Clinical component

The clinical component of the exam is more demanding and is best taken at the end of three to four years of middle grade training. With an overall pass percentage of around 60%, the results are significantly lower for individuals not in structured training, SAS, and overseas trainees. This exam takes longer time to prepare. Training and a working knowledge of UK health system is a must.

The exam lasts for two days with nearly 3:30 minutes of examination time (2 hr of Viva, 30 minutes of operative session, 40 minutes of clinical cases (4) and 20 minutes of communication skills). It is advisable to prepare for the clinical exam along with your preparation for MCQ exam. It is quite natural for those both in structured and non structured training to have limited expertise/exposure in certain areas. As a part of the preparation try and attend all the specialty clinics available to give you a wide overview of the current management protocols in particular areas (Head and Neck MDT, Vertigo clinics, Paediatric ORL clinics, Voice clinic, Skull base clinic). Identify areas of knowledge and experience gap early and address them with courses and attending sub-specialty clinics.

An ideal preparation for the practicals starts along with the preparation for the MCQ examination. A wide range of resources may be needed for the preparation (Table 2).

Figure 2

Table 2: Books and Web Resources for the clinical Component (B) =Book

Book your 1^st Inter-collegiate course before you attempt the MCQ examination. This helps you to understand the format and requirements of the exam early and helps you to focus preparation in a systematic way. Further it enables you to concentrate on areas of poor performance (from the course) and the 4 months period between the MCQ and clinical component provides sufficient time to rectify mistakes. The second course should be planned a month before the exam as a ‘dry run’. This enables you develop the examination mind set and helps iron out any minor flaws. Alternatively arranging viva sessions with Consultants or Registrars /SAS who have recently passed the exams would be helpful. This can be arranged in the region you work in but there are pros and cons to it (Table3).

Figure 3

Table 3: Paid courses vs Free Training

It is extremely important to examine as many cases as possible during this period and ask colleagues or consultants to critique your technique (Video/Audio recordings of consultation is a useful technique however patient consent is needed). The subspecialty vivas last for 30 minutes testing the candidate’s depth of knowledge, judgement and lastly whether the candidate is ‘emergency safe’. You will encounter common clinical scenarios of everyday practices and you are expected to identify the clinical condition, able to comment on appropriate clinical examination, describe relevant investigation and also discuss the broad outline of management. Speak as much as possible quoting recent evidence and also you should be able to be in position to explain why’s and how’s of your decisions .It is important to score as much as possible in each vivas as this would help you to compensate for any poor performance in any other vivas /or clinical scenarios.

The clinical cases are usually four in number .They are usually from different subspecialties of ENT .Most of the cases are chronic cases (HHT, septal perforation, neck swelling, Syndromal child ).As the time duration is just 10 minutes per case you would be asked to examines the case directly and come to the possible diagnosis and management plan .Again demonstrate that you are a competent ,confident , professional doctor .You should be able to formulate a management plan and be able to explain why’s and How’s of your decisions

Communication skills station is very important station .It lasts for 20 minutes with 10 minutes devoted to history taking and another 10 minutes to explain the diagnosis and management to the patient .It is important to have a consultation model (Calgary- Cambridge model, Macy model, MISCE).Remember to take a good history and explore patient’s ideas, concerns and expectations (ICE) .At the end of consultation you should be able to discuss this further and emphasis any important issues. Use common language (Cartilage=Grisel, vestibule-cochlear nerve= balance and hearing nerve) to explain to the patient rather than medical terms .It is important to go through the common websites which gives the patient information and quote figures from reliable websites (ENT UK, Cochrane) especially incidence of a clinical conditions, complications of a operative procedure, do mention about self help groups (BTA) etc. For overseas candidates Get English Diction, and Clarity Right.

Operative session includes temporal bone dissection, nasoendoscopy, prosections and bones. A recent ENT anatomy course or a temporal bone dissection course would be helpful .Alternatively consider temporal bone dissection in your hospital, to be familiar with cadaveric tissue .For bones and prosections; visit to anatomy lab in the nearest medical school or alternatively revision with a anatomy atlas is useful.

Last but not the least it is important to have determination and confidence in your abilities. A good combination of careful planning, hard work and methodical approach should help you pass the exams without difficulty.

Correspondence to

R Sachidananda 9 Hodder Close Chandlers Ford Eastleigh entravi@yahoo.com Phone: 07863203965