Having recently sat the OSCE/VIVA exam I have been asked to write a brief guide on how I went about revising for it. Below are some tips on what I found useful and some of the resources I found useful.
Everyone has their own way of studying, but this might help those who will be facing a Viva for the first time. It can be quite a daunting prospect – but honestly, the way I looked at it was an opportunity to show off your understanding and knowledge.
First up – what is the OSCE/Viva?
This is the final face to face component of the FFICM exam. It is usually held in the Royal College of Anaesthetists in London and there are normally two sittings a year. Exam days are spread over a week and you sit the full OSCE/Viva in one day with one exam in the morning and one in the afternoon.
OSCE
This is a 13 station OSCE. Each station is 7 minutes and there is 1 minute to move between stations. One is a tester station – and marks from that station do not count towards the overall pass mark. There are no killer stations – and this is key! If you have a bad stations it is really important to let it go and focus on the next. You can still pass the exam overall if you can perform well in other stations.
I sat this exam digitally due to COVID. But having sat the RCOA anaesthetic OSCES in person I can say that it is tiring. You are constantly jumping from topic to topic and being pushed for more – more differentials, more signs on the CXR, deeper interpretation of the ECG etc. The mark scheme is very didactic and essentially if you don’t mention what’s on the sheet – you probably won’t get the mark. Keep differentials broad, present findings logically, and have a system for everything. It feels a bit frustrating at times – but there are a lot of marks for being systematic and thorough.
Also- learn to be disciplined and look at all results they give you. MCV/chloride/eosinophils- all the little subtle things that they may present on one slide can play an important role in a question further down the line.
The OSCE format is familiar to most, and for the medical dual trainees or anyone who has sat PACES – the clinical stations feel familiar. The data interpretation and equipment aspect is different, but talk to people who’ve sat it and I’m sure we’ll all happily help with preparation.
It is easy to concentrate on the Viva – but it’s worth putting effort into the OSCE.
Be mindful- there will be a sim resuscitation style station, and there is a communication/breaking bad news station too!
The Viva
Four stations with two consultants in each – each consultant will take it in turn to ask and then mark a whole question/stem. In total you will have 8 questions at four stations. Again – questions can be from all realms of critical care. From the investigation of critically ill patients to more niche topics such as eye care in ITU.
The viva feels like a formal bedside teaching session in critical care. The questions explore the understanding of concepts, how you would initiate management, differential diagnosis and much more – but doesn’t feel as much of a “tick box” exercise as the viva. Generally, examiners will move you on if you are heading down the incorrect avenue – and if you say something controversial, be ready to back it up with evidence or physiology. In general 7 minutes is not long enough to debate controversial topics and its worth having neutral answers about rapidly evolving areas of practice such as “in my unit we have…”.
This covers most of the curriculum and is easy to navigate. It is an excellent book to have in your bag in the run up to the exam and throw to any unsuspecting victims to viva you with.
Towards the back end of the book it covers some of the more niche topics and can really help in squeezing some marks out of the tricky topics that can come up.
When it comes to marking the viva is marked in a 0/1/2 manner. 0 represents no understanding of the topic, 1 is some understanding and 2 means in depth knowledge. There is also a degree of global performance to these exams, so the take home is – PRACTICE YOUR VIVA TECHNIQUE. All the knowledge in the world won’t get you through these if you can’t present the knowledge in a concise confident manner!
Pass/Fail
The first time you sit this exam you must sit both in the same sitting. If you fail one component ,however, you only have to re sit that one. Another reason to stay positive on the day- an awful morning doesn’t mean you can still come away with 50% of the exam!
Preparation
In terms of knowledge, I think by this stage 80-90% of it will be there after the SBA. Most of the work now is translating the book knowledge into good verbal answers and making sure you have conceptual understanding.
For me- I found the Feynman technique really helpful. For those who haven’t heard of him, his method essentially involves grabbing an empty piece of A4, naming a topic and then trying to flow through the basic principles of that topic without aid in a way that would allow you to explain the concepts to a child.
I found by doing this I would find gaps in my own knowledge and also realise what topics I knew well and didn’t need to invest to much time in.
As well as the book work and paper work, I think its crucial with this exam to start the viva process from early on. Get in a group with the other trainees and start to viva each other.
There may be a big difference in style, knowledge and confidence to start, but that’s ok! It is better to start early and get comfortable not knowing things. If you get use to that feeling of having to think under pressure it will really help on the day.
In work – use ward rounds as vivas. If you make a decision on a ward round – get someone to challenge you on it. What’s the evidence? What Is the physiology? What are your differentials and so on.
Evidence – I found it hard to know how much evidence to learn. I think the honest answer is an awareness of the big papers in ICU. Know why we don’t trachy everyone at day 3. Be aware of the Rivers paper and why EGDT went out of fashion. ARDSnet and Proseva are another two papers that are probably fair game in terms of asking why we ventilate as we do. I don’t think personally that not knowing a paper’s name will make you go from a 2 to a 1, but I think not being aware of large practice changing RCT’s may lose you a mark.
Finally- time. Life is busy, work is busy and adding an exam doesn’t make it any easier. I think 6-8 weeks is long enough to prepare for this exam, but I am a crammer. For some it will feel more natural to give it more time. I think balance is important too – and as much as possible I think continuing hobbies whilst revising makes everything easier – but that could be just me.
The welsh FICM trainee group is growing all the time, and is a goldmine of experience. Use your colleagues for support and for practice. I am confident that all of the post FICM trainees will be happy to provide more information and exam practice (in person or online) if they can.
I hope this helps and good luck!
Ifan