Ping! You look down to your phone and you have just received an email saying, “Congratulations, you have now successfully completed The Joint Committee on Intercollegiate Examinations section 1 of the Fellowship of the Royal College of Surgeons (Urol) exam.” A short period of initial elation will quickly be followed with dread as this means now you will have to prepare for section 2 – THE VIVA!
By this stage, all trainees will have already sat numerous undergraduate and postgraduate exams successfully. For the majority of us, this will be the last and most daunting exam we ever take on our journey to become a consultant urologist. By studying and passing section 1 of the FRCS urology exam, we should be brimming with knowledge. However, what is the art of delivering all this wisdom verbally, which is key for the viva?
Finance
By reaching this point you will have already committed your exams fees but it is wise to be aware of and prepare to pay additional costs which will surely mount-up. Attending the relevant courses, associated travel and accommodation for the examination venue can easily add another £2000 towards costs so austerity measures may need to be employed.
Format of the viva
The FRCS (Urol) viva consists of eight stations, each lasting 20 minutes. Each station is further divided into two 10-minute sections. These include the following categories:
- Paediatrics – Double station
- Oncology 1 – Prostate and Testis / Penis
- Oncology 2 – Bladder and Kidney
- Emergency Urology – Double station
- BPH and Andrology
- Neuro-urology and Female Urology
- Stones and UTI
- Technology and Imaging
Texts
We have listed in no particular order a select few of the revision aids that we found useful in preparing for the viva:
- European Association of Urology Guidelines (http://uroweb.org/guidelines/).
- National Institute for Health & Care Excellence Guidelines (www.nice.org.uk/guidance).
- Viva practice for the FRCS (Urol) Examination. Arya et al. Radcliffe Publishing.
- Oxford Handbook of Urology (3rd edition). Reynard et al. Oxford University Press.
- Imaging and Technology in Urology. Payne et al. Springer.
- Essentials of Paediatric Urology (selected chapters). Thomas et al. Informa Healthcare.
Note, you do not need to use any other bulky texts like Campbell’s Urology and do not believe anyone who says you must or that they did!
Virtual revision group
For most, this forms the cornerstone of revision sessions. Candidates who study in isolation are more likely to struggle with the viva than those who study in groups. Very rarely will there be enough candidates doing this exam locally to meet up face-to-face to practise viva topics. Consequently, setting up a virtual revision group with online conferencing programs is an easier and more efficient way to revise. We have found that having several people in one group and setting fixed times in the evening throughout the week works best. Not everyone will be able to make all the sessions due to other commitments but this way it ensures continuity and regularity. Work with people you get on with and do the vivas in a non-judgemental fashion – it is better to mess these practice vivas up than the real thing. Push each other hard but don’t be nasty in the practice sessions!
Viva practice
Asking a variety of consultants for viva practice will expose you to their own sub-specialist knowledge but also accustom you to the different questioning techniques that you may be faced with on the actual day. It is a big bonus to also ask the senior trainees who have recently been through the process of the viva as their knowledge and experience will still be fresh and contemporary in their minds.
It is important not to limit yourself to the world of adult urology. We have found when approaching our local paediatric urologists that they were more than happy to accommodate us in several of their clinics all of which were extremely useful. Throughout numerous stations in the viva you will be faced with radiological images. It is vital you prepare yourself in how to present these images in a swift and succinct manner and asking your departmental radiological colleagues to assess you is a great way to achieve this.
Candidates should be familiar in describing and interpreting non-invasive and invasive urodynamic tracings as these are very commonly used in the viva. Examiners become aware very quickly of those candidates who have not attended the relevant clinics and settings to gain knowledge in these investigations. Similarly, it is obvious if you have not been involved in treatment modalities such as extra corporeal shockwave lithotripsy and urological interventional radiology procedures such as nephrostomy insertions, urethrograms and cystograms.
Viva related courses
There are numerous courses tailored and targeted towards the viva throughout the year. These courses are not only great for their academic content but also provide a fantastic opportunity to meet up, discuss and share stresses regarding the exam with others who are going through the exact same feelings and concerns as you. It is also comforting to see and talk to familiar faces, and a certain comradeship and unity amongst senior urological trainees builds throughout these courses.
BAUS FRCS (Urol) Revision course: If you had to choose only one course then this five-day residential course would be the one. It has an excellent mixture of didactic teaching from leaders of their field in the morning session followed by practice vivas in the afternoon session. Interspersed are golden nuggets of short multiple five-minute micro-teaching presentations prepared by each delegate covering small but vitally important topics for the exam. This is an intense course with long days and the industry-sponsored dinner on the penultimate day is highly recommended to wind-down with other candidates and the faculty.
Rapid Revision Course for the FRCS (Urol) Exam: This intensive, very well structured two-day course will provide you with 32 10-minute viva sessions and you will also observe another 32 as candidates move along in pairs. Feedback is provided for all sessions and key pass / fail viva topics are also discussed throughout the course. Ensure you go having revised topics from the FRCS (Urol) Viva book as this will mean you have a meaningful dry run of the exam as the course organisers have structured the course to be very similar to the exam.
Northwick Park FRCS (Urol) Exam Prep Course: This one-day consultant-led course usually takes place a few weeks before the exam and by this stage it should be used to polish your viva answer delivery technique. The course is then followed by a well-deserved sponsored evening meal.
British Association of Paediatric Urology (BAPU) Revision Course: This two-day course takes place at Cambridge University and will cover most of the scenarios that could be encountered in the paediatric station. It also includes practice viva sessions led by paediatric urologists.
Andrology, Genital Oncology and Urethral Reconstruction (AGOUR) Course: This two-day course is fully sponsored by Boston Scientific with the faculty being prominent urologists and radiologists in the field of AGOUR. On-site accommodation in Hemel-Hempstead and a course meal is also provided by Boston Scientific.
Family and friends
It is unavoidable throughout your revision period not to sacrifice time spent with your family, friends and partner. Like us, some of the candidates at this stage will also have young children to look after. It is easy to fall into a trap and develop tunnel vision where you will base your entire revision period solely on exams. It is essential to spend your time on non-exam commitments which almost certainly will be more important than your career progression. Certainly on more than one occasion we have heard the saying “I felt guilty for not studying and taking a break” amongst our revision circles. For those who are active, sporting and fitness activities will also take a dip, however again it is not advisable to completely neglect these disciplines.
Deadlines
Your viva revision period is not a time to embark on new projects, research or audit. Consultants will be aware that your ‘free-time’ will be used to prepare for your viva. If possible delay or ask for extensions to deadlines with regards to academic activities. Now is an excellent time to delegate these duties to junior colleagues.
On the day of the exam
This day needs to be prepared for early. Ensure you have swapped out of your urology on-call commitments in the days / weeks leading up to your exams and requested your study leave months in advance. The most important time is the two weeks prior to the viva when one can recollect the information revised and discussed. Do not be afraid to use your annual leave alongside your study leave to free yourself up before the viva examination. There is an unwritten rule amongst trainees that on-call swaps for those sitting the viva exams are accommodated without hesitation as this should not lead to additional stress.
We would advise booking accommodation in the viva location as early as possible. This not only ensures competitive rates but also makes sure you are located close to your examination centre and ideally within walking distance. We found that arriving in good time the day before your exams allows you to settle into an unfamiliar environment and not be in a rush to check-in and grab some food before attempting to get an early night. Most people will do some form of reading the day before the exam but try and limit this as sometimes this can be counter-productive. Don’t engage in exam talk with anyone as this can be very distracting – beware the person who tries to give mini-vivas to everyone he / she meets! Equally, beware of those people who bring up bizarre rare topics or think they know what’s coming up in the viva.
On the day of the viva arrive in good time. Avoid talking about the viva to other candidates – you will only make yourself more nervous. Refreshments are provided throughout the day and each station has glasses of water for the candidates. Attempt to answer all questions in a structured and logical manner and ensure you maintain good eye contact with the examiner. Responses should be delivered with an enthusiastic and confident manner which should be well rehearsed and practised before you reach this day. Do not panic if one or two particular stations appear not to have gone as well as hoped. This may only be a perception, and anyway there are opportunities to make up and compensate for this at other stations. Also try not to over-analyse your performance in each station, as candidates tend to underestimate their performance in each station. The examiners will seldom show how well or poor your performance is and so trying to covertly look at your assigned marking sheet will reflect badly – don’t!
This viva is an examination for candidates to demonstrate that they have achieved the standard of clinical competence expected of a newly appointed urology consultant. Candidates need to appreciate that this viva is not only evaluating knowledge but is also assessing logical thinking and communications skills. The examiners are looking for candidates who not only possess theoretical knowledge but also those who practise in a safe and analytical manner. Remember though, that if the knowledge is lacking, a good viva technique will not take you very far. You must read, revise and frequently test yourself on your knowledge before the exam.
After the exams
The feelings of ‘relief’, ‘lost’, ‘exhausted’, ‘tired’ and ‘brain-drained’ are only a few phrases that we and our fellow candidates used to describe our state of mind immediately after our viva. All of us made getting home from the exam venue a priority and this was a good idea. The wait to receive the results email will require a full battery on your smartphone as you will check your emails at every opportunity!
Conclusion
Without doubt this will be one of the most stressful times of your training and one which entails dedication, a strong work-ethic and good planning. You will frequently feel very much alone when preparing for the exams and so your success will crucially depend on the help, support and assistance from your colleagues, family and friends. For all those who are planning to sit the viva soon – good luck!
Declaration of competing Interests: None declared.
