The FrCS (Tr & Orth) examination General guidance

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4                 Section 1: The FrCS (Tr & Orth) examination

Table 1.1Suggested marking framework

¹  History, examination and discussion.

²  Upper and lower limb sections.

Marking

The clinical short cases are divided into upper limb and lower limb sections with a minimum of three cases in each section. There are two separate pairs of examiners for the upper and lower limb cases. Each case is scored from 4 to 8 by each examiner to give a maximum total score of 24 from one examiner, 48 from one pair of examiners and a combined maximum total score of 96 from both pairs of examiners.

The long case is divided into three sections, which are history, examination and discussion. Each section is marked from 4 to 8 by each examiner to give a maximum total score of 24 from one examiner and a combined maximum score of 48 from both examiners. Orals are scored 4–8 with 6 a pass mark and 8 an exceptional pass and therefore extremely rare. Each oral is divided into two parts and each examiner marks each part separately. Therefore the maximum score for the four orals is 128 (8 × 4 × 2 × 2). Sections are “close” or “tightly marked” with most candidates obtaining a score around the pass mark unless exceptionally good or bad (Table 1.1). The aim should be for a steady consistent 6 all the way along. A score of 4 is a complete fail but I am not aware of it being a veto against allowing a candidate to pass the exam; in theory one can still compensate for this poor mark elsewhere.

It is now possible to still pass the exam if you fail your long case or short cases or even both provided that your overall score is a pass and has been compensated for elsewhere. In reality this scenario is very unlikely to occur, as it would be extremely difficult to make up additional marks elsewhere in the orals. The old examination marking system was easier to understand. It was not possible to pass the exam if you failed the long case. A marginal fail in the short cases could be compensated for elsewhere in the examination but not a poor fail. A fail in one oral could be compensated for elsewhere but not two oral failures.

Most candidates find the short cases difficult and so try to obtain a basic pass in this one. Likewise the children’s orthopaedics and hand surgery orals and applied basic science orals can be tricky so play it safe and attempt to obtain a basic pass in each rather than go for the gold medal.

Candidates will have up to three attempts to pass section II, after which candidates would be required to re­enter section I.

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Table 1.2 Old versus new exam

¹  Note: the first 12 questions in this paper will relate to the published paper.

²  Extended Matching Item questions (EMI) involve a list of possible answers from which the candidate must choose the

most appropriate answer to a series of questions.

The new exam

The final sitting of the current exam format took place in November 2006. The new format exam from 2007 has de­coupled the written examination from the clinicals (Table 1.2).

Eligibility to sit the new examination will be determined by three structured references, one of which must be from your programme director.

Written papers will take place twice a year and must be passed before attempting the clinicals on a later date.

Although the format is changing the standard and content are not. The techniques and information you need to pass the examination are therefore virtually unaltered. The content of this book is equally applicable to old and new format examinations.

NOTE:

These details should be checked by candidates with the Intercollegiate Specialty Boards (ISB) website since details may be subject to change during/following publication: .

The ISB issued the following guidance for SHORT CLINICAL CASES in May 2005:

The purpose of the Short Clinical Case Examination is for you to demonstrate that your observational and clinical examination skills, and your knowledge, are sufficiently well developed to make a relatively quick and accurate diagnosis for conditions that have typical clinical signs. For complex problems you may not necessarily come to a diagnosis but you should be able to list an appropriate differential diagnosis. The examination is rather like seeing a patient in the out­patient clinic and making a provisional diagnosis. Because of time limitations, the normal pleasantries of shaking hands on meeting the patient, taking a conventional history and carrying out a general examination of the patient are not expected of the candidate. Instead the examiner will give clear instructions about the part to be examined such as “Please examine this patient’s right hand and tell me what you observe”. There is no intention during this examination to trick the candidate and candidates are strongly encouraged to do exactly what is asked of them by the examiner. You should of course show respect for the patient and attempt to avoid inflicting unnecessary pain during the examination. The examiner will expect an answer like “I see a diffuse swelling over the dorsum of the hand and wrist which is soft on palpation and may be a synovitis of the extensor tendons”. The examiner may then ask the probable diagnosis.

6              Section 1: The FrCS (Tr & Orth) examination

Radiographs may be available for a number of the cases and these may form part of the examination if they are clinically relevant. The Short Case Clinical Examination will involve two separate 15­min examinations with two separate pairs of examiners. Although it is possible for one patient to have more than one clinical problem you will generally meet at least three patients during each 15­min part of the examination.

Marking: The examiners will allocate two marks – one for each of the two 15­min sections of the examination.