FRCS Experience Chesterfield Feb 2015 – AS

I owe a lot of my success in passing this exam to my long suffering wife Grace. We had a baby just a couple of months before my MCQs and without her support, I wouldn’t have been able to work enough to pass this exam. My son helped to keep some perspective on life and work as its quite easy to disappear from life in general.

This exam is just something that we all have to get past so accept that a part of your life will be difficult.

Prep friends & family for the time ahead…. Its not fun for them and it goes on for a long time.

Don’t have children around the time of exam like I did ! its hard enough as it is ! if you do have kids, put your picture in their bedroom so they don’t forget what you look like. Try and keep some balance, especially near the end, family and friends tend to get pushed to one side as you become single minded about the exam. Start an exam fund. I spent £3500 for exam, courses and a nice hotel.

Its important to find like minded people who you can get on with and work well with. They will become like a surrogate family for this period of your life and you will spend an inordinate amount of time with them near the end. We spent more time with each other than out families in the last few weeks before the part 2.

We all work differently so this is only my personal experience and is based on how I work. I took my MCQs in Nov 2014 and the part 2 in Feb 2015.

I am quite slow but tend to remember what I read for a long time so I started in March 2014 even though I had been thinking about it since the start of the year. To help me get motivated, we had a study group early on and would set 2-3 topics every week and then meet up one evening or weekend to discuss them and anything we didn’t understand. This really helped to get me started and every week there was a target to reach and so you make time to read. Nearer the time of MCQs we would only tend to meet to disucss topics that we didn’t understand quite so well as we were often just doing our own reading. Its not necessary to have study groups for the MCQs but I found it helpful.

Please bear in mind that It can take 2-3 months to understand basic sciences alone. Its not a topic we deal with every day and theres is a lot of it. Some of it took me a while to wrap my head round but it’s a big part of Part 1 and 2. Anatomy and approaches comes up more that you might imagine (especially in part 2 ! )

I only managed to read a 1/3 of Miller in total but did all the orthobullet questions and some MCQ books that you can buy. Ramachandran and Miller were very good for basic sciences. I suggest taking a week off before the exam and in that time I just did the UKITE exams and some more MCQs.

In hindsight, I could have done a lot more work for it but my son being born soon put a stop to it. Thankfully as I had started quite early, I felt that the momentum carried me through.

For the Part 2, put miller away ! Your knowledge has been tested but now its about how you apply the knowledge to clinical practice.

I used Banaskiewich for most of the topics. You cant get it all out of this book and its important to looks at things like NICE guidelines, BOAST guidelines, NJR and MHRA MoM guidelines.

I looked at the previous exam experiences that my colleagues in the North put on the Orthnorth website. Its very useful. Lots of topics come up time and time again and its easy to have prepared answers for them. Its gives you a very good idea of of what type of cases come up in the clinicals and viva topics that you may not necessarily think about ( such as theatre design! ). If you start early enough, you can collect a large set of answers but I ran out of time personally. Its also partly why I am writing this … to do my bit.

There is always some controversy over papers. You can get through this exam without knowing any papers or evidence. Strictly they are not allowed to ask about evidence unless you bring it up yourself but they sometimes sneak it in or ask in a roundabout way.

I like Emmets phrase – “from my understanding of the literature …. “ I used that a lot.

Initially I wasn’t going to learn any papers but I agreed with Warwick’s idea of knowing a few. It can raise a 5 to a 6 or indeed a 6 to a 7, or just get you out of a sticky situation. Learn them nearer the time and its usually easiest to get them into the trauma viva.

Don’t forget about the clinicals ! They make up 50% of the marks in Part 2. We tended to focus on the viva and this was probably because we felt under prepared for this aspect of the part 2. As a group we really didn’t do much clinical practice and potentially it can be an undoing. There are a lot of set scenarios you can almost predict so try and have a set routine for some of these ( such as the claw hand – plexus vs ulna nerve vs high or low lesion)

The clinicals are not like medical school or even MRCS exams, there is no please examine this patients hip … and then they watch. In the short cases, the instructions can be very specific and you only need to perform part of the exam such as comment on the gait, or perform a neuro exam. Interruptions are common and you need to not be put off by this and regain composure and flow. You also need to talk as you examine and be prepared to answer questions as you go along.

For the boys, ties tucked in and sleeves rolled up, no suit jackets.. be plain but well dressed. No audacious ties !

Go on a well recognised course but book early. The good courses are often not even advertised and are full very quickly. Find a course you might want to do and start making enquires about 9 months before they happen. We did the Oswestry course. It was a very good 3 days and we saw lots of pretty awesome patients and the weird and wonderful. Treat the course like the real exam and then you will still have a couple of weeks to polish up what you need to.

Stay in a really nice hotel before the part 2. You will need a good nights sleep. I had my exams on Sunday and Tuesday. There really isn’t much you can do in 24hrs and I just tried to looks through some anatomy and basic sciences drawings. You can ask what your colleagues had before, some topics do come up again.

UL Shorts

Cubits varus in a child. Examine elbow please, Check neurology. Previous supracondylar fracture. When would you correct the deformity

Hand rheumatoid. And dupuytrens on the other hand. Dropped fingers, are the extensor tendons intact. How to manage ?  Vaugn Jackson syndrome and where is epl in the hand.

Lump on shoulder superior aspect of acj. Ganglion ? where it it coming from? Test glenohumeral movement specicically, test cuff, xrays, how to manage ?

LL Shorts

Foot drop shown on gait of patient. Test muscles and establish deficiencies please. Root value of the lower limb nerves including deep peroneal and up peroneal. What tendon would you transfer with and test for it.

Pcl. Injury in a young male. Test ligaments, tests for pcl.  What Rehab. Who to operate on?

Lump under scar on wrist and multiple other scars in young female. Diagnosis – Multiple hereditary exostisis. Examine hips. Which lesions do you worry about. Where are that lesiosn that you need To keep an eye on.

Other ppl – scoliosis 14 yr old. Adam test. Arthrogryposis, nail patella syndrome, morquio syndrome, MHE, brachydactily,

Intermediate Cases

High chronic ulna nerve in diabetic. Been in hospital for an amputation and sedated for a long time ? cause, test neck and arm neurology. Now yrs old, ? how to test now, what investigation ? tendon Transfers for ulna nerve

23 yr old female with left DDH, operation at age 2, then ? later derotation osteotomy and removal of metalware. Now increasing left leg pain affecting quality of life. Examine gait, hip exam, ? what options ? what prosthesis ? what revise to ? NJR data

Hand and paeds

Peri lunate dislocation – when to theatre, how to reduce, what approach, with median nerve symptoms ? CTD

Anatomy of APB muscle, attachtment and origin, function, and nerve supply and its root level, how to tell C8 T1 and median nerve lesion

Rheumatoid hand – deformities, what do do about subluxed mcpj, operations for thumb deformities

SUFE – chronic severem, management, traction, osteotomy, indicaitons for fixing other side.

CTEV – idiopathic, what else to look for, parents don’t want ponsetti, what would you do ? ponsetti, pirani score, pt later develops a rockerbottom foot deformity ? what now. What surgical options

Distal tibia fracture Physeal injury very displaced, when to take to theatre, manipulate, ? wire ? now fracture 3 weeks old and displaced ? remanipulate or let it heal and osteotomy


Grade 5 acj dislocation ? options ? what surgery / physio.

Segond fracture ? what is avulsed? ACL investigations ? meniscal repair, ? who would you operate ?

C5/6 discitis with large abscess, how to approach, spine stability, how to operatively stabilize. Invesitgations for diagnosis, what to test for

Distal humeral severe comminuted fracture in 70yr old, ? what to do. Elbow replacement/ CT scan and orif. Types of elbow replacements. How to practically do it.

Open book pelvis ? how to manage in ane. Pelvic binder, ct scan, ex fix, BOAST guidelines, blood at meatus ? what now

Posterior hip dislocation with head (pipkin type) fracture and post wall acetablular fracture, management, priorities, sciatic nerve palsy how to assess, how to reduce, CT, what approach would you for definitve fixation

Adult path

55 yr old male with a massive cuff tear, delayed presentation, investigations and management, now same in a 70yr old

Bowed tibia in pagets disease, what is pagets, aeitiology, histology, medical management, painful knee ? how to do a TKR in this knee

Metastatic lesion in a humerus, differentials, mangament of a isolated renal met in humerus, mirels score.

Osteochondritis dissecans, pathology, management assessment.

Rheumatoid elbow – management, total elbow, NJR data of shoulders and elbow and wrist, medical management,

Basic Sciences

Infections in theatre, how to minimize, laminar flow, gowns, glove, personnel in theatre

Articular cartilage draw it, what causes osmotic force, why does OA cartilage grade 1 become softer. What happens for microfracture

MRI – how does it work, how are images created, different sequences.

Allograft – how is it attainted, sterilized, stored, how can you use it in theatre, how is it incorporated, what other factors can help incorporation.

Compartment syndrome, why sensory nerves affected first. Anatomy of cross section of a leg. How to do fasciotomy

Osteoporosis, T and Z scores, how to manage pts, changes to bone, differences with osteomalacia

Good Luck with the exam !

If you need any help, please get in touch.