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Viva
Run over 2 days with 4 different sessions in total (morning and afternoon)
– the topics and questions changed each time so we couldn’t cheat.
I had the following
PM1 – retinal tear, detachment discussion about management
PM2 – Granulomatous uveitis and weird FFA – most people said VKH –
discussion about steroids etc
Attitudes/Ethics/Responsibility – Odd discussion about how to look after a
blind woman in clinic (i.e. giving her your arm when walking her in), then
CVI questions
Audit/Screening/Research – Discussion about screening services, diabetic
programme. Glaucoma trials chat – OHTT mainly
Investigations – Hess chart, 4th nerve
Communication skills – Monovision and unhappy patient after cataract
surgery
Overall in this viva there is no time whatsoever and the examiners rush
you through trying to get all the tick boxes ticked to get you the most
marks. However you feel they want to pass you and its over very quickly.
I suspect however the viva is the source of poor pass rate for non-UK
trainees – as they either
a) Didn’t realize they might be asked about Caldicott guardians, European
working time directives etc
b) Havent gleaned ways to answer those kinds of questions after years of
crap in the NHS and at medical school
OSCE
A pool of 10-15 patients for each station so
you end up having one or two shared over the two days but mainly cant tell
whats coming up.
Glaucoma/Lids – Cupped disc and chat about glaucoma, BCC on lid .
Cataract/Ant Segment – DSEK post-phaco, Macular dystrophy,
Crocodile Shagreen.
Posterior Segement – nanophthalmos/uveal effusion, optic disc pit
and macula SRF, retinal coloboma by indirect.
Orbit/Strabismus – Simple left exotropia discussion about Botox/Sx,
Brown’s syndrome.
Neuro/Medicine – cerebellopontine angle patient – cranial nerve
exam, Adies pupil, inferior quadrantanopia fields, Parkinsons upper limb
neuro exam.
Overall there was very little time per case and the examiners were once
again nice basically saying – look at the disc/macula/cornea for 30secs-60
secs describe as go along and then discuss for 2-3 mins.
However the Strab/Orbit station was more
difficult – apart from the fact its strab/orbit you are left on your on
free rein and have more opportunity to dither, which I did. The Medicine/Neuro
station was difficult and stressful, partly because the examiners have
more time so can just leave you to get on with it and hang yourself with
poor technique and partly the personalitys involved – your friendly cornea
surgeon is impressed you can identify Macula dystrophy and the adnexal
surgeon just wants you to say you won't operate on his Browns patient. But
the neurologist is more likely to do what he did with me….
Enter room….patient sitting there next to couch which had entire plethora
of neuro testing equipment on it. “Imagine your called to see this man on
the medical ward because he is complaining of a headache…off you go” Me –
"can I ask him any questions" – “No, and don’t talk as you go along”.
Frankly I felt this was unfair, I have been in such a situation many times
on the ward and completed a full assessment taking my time but under
extreme pressure with a 5 minute time limit this was a nightmare and if I
do fail it will probably be down to that one station and one examiner who
decided to put us under unnecessary pressure.
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