Tuesday, June 3, 2008
Monday, June 2, 2008
A WORD ABOUT VIVAS
A WORD ABOUT VIVAS
A lot of us are inherently uncomfortable with the prospect of facing a viva. The thought of being in a “hot seat” with a film in front of us and a group of “all knowing” examiners behind us may be quite discomforting! This is true even for people who function absolutely normally in a day to day working environment. The fear of vivas has a lot to do with the fear of the unknown (I don’t know what will be shown, what if I can’t see anything, I don’t know the background of the patient etc.) and inadequate verbal skills (ask us to write a report and we are quite happy doing that, put up the same investigation and tell us to speak about it and we are quite likely to get all muddled up).
Unfortunately vivas covering an array of radiological cases and modalities are an important part of most exams ( FRCR part 2B viva segment and increasingly MD/DMRD/DNB vivas ). So what’s the solution? Can we become better at tackling the “hot seat”. The answer lies in practice. See as many cases as you can, speak aloud the findings even if it is an Aunt Minnie and get used to the sound of your own voice. Try and formulate a logical reasoning behind the diagnosis for every case that you see and run over a list of differentials. Practice mock hot seat sessions – sessions with a couple of colleagues are very helpful in terms of feedback and cross questioning
In the exam you will be expected to introduce an investigation (eg. chest PA radiograph of an adult male patient), describe the positive findings, followed by relevant negative findings, diagnosis and differentials. You may or may not be given the patients history and the onus will often be on you to take the case forward….ask for history/age/sex etc . esp if its relevant to narrow your list of differentials. Round up by listing further investigations ….imagine if the patient was in front of you, faced with the particular examination, what would you think of, what relevant history would you elicit and what further investigations would you do to confirm your diagnosis. At this stage the examiner may choose to show you more films.
A useful way is to approach a viva session the way approach clinical colleagues at the workplace seeking a second opinion. Treating the examiner as a colleague rather than an interrogator may be useful. Behave as you would in the workplace setting – list your findings, ask for relevant clinical details, think aloud, give your opinion and state your reasons. The aim should be to demonstrate a logical train of thinking based on findings and theoretical facts; rather than blindly groping for the correct diagnosis .Put another way, there are more chances of impressing the examiner with logical thinking and an incorrect diagnosis rather than the other way round!
Expect a mix of films – spots, films requiring a discussion of differentials, films requiring further modalities for a diagnosis and everyone’s nightmare – the film which looks normal and makes you feel like an idiot. We plan to take you through all the above categories and we will discuss how to deal with each type of film from an “Aunt Minnie “ to an “Ohmigod – I am clueless” type.
A lot of us are inherently uncomfortable with the prospect of facing a viva. The thought of being in a “hot seat” with a film in front of us and a group of “all knowing” examiners behind us may be quite discomforting! This is true even for people who function absolutely normally in a day to day working environment. The fear of vivas has a lot to do with the fear of the unknown (I don’t know what will be shown, what if I can’t see anything, I don’t know the background of the patient etc.) and inadequate verbal skills (ask us to write a report and we are quite happy doing that, put up the same investigation and tell us to speak about it and we are quite likely to get all muddled up).
Unfortunately vivas covering an array of radiological cases and modalities are an important part of most exams ( FRCR part 2B viva segment and increasingly MD/DMRD/DNB vivas ). So what’s the solution? Can we become better at tackling the “hot seat”. The answer lies in practice. See as many cases as you can, speak aloud the findings even if it is an Aunt Minnie and get used to the sound of your own voice. Try and formulate a logical reasoning behind the diagnosis for every case that you see and run over a list of differentials. Practice mock hot seat sessions – sessions with a couple of colleagues are very helpful in terms of feedback and cross questioning
In the exam you will be expected to introduce an investigation (eg. chest PA radiograph of an adult male patient), describe the positive findings, followed by relevant negative findings, diagnosis and differentials. You may or may not be given the patients history and the onus will often be on you to take the case forward….ask for history/age/sex etc . esp if its relevant to narrow your list of differentials. Round up by listing further investigations ….imagine if the patient was in front of you, faced with the particular examination, what would you think of, what relevant history would you elicit and what further investigations would you do to confirm your diagnosis. At this stage the examiner may choose to show you more films.
A useful way is to approach a viva session the way approach clinical colleagues at the workplace seeking a second opinion. Treating the examiner as a colleague rather than an interrogator may be useful. Behave as you would in the workplace setting – list your findings, ask for relevant clinical details, think aloud, give your opinion and state your reasons. The aim should be to demonstrate a logical train of thinking based on findings and theoretical facts; rather than blindly groping for the correct diagnosis .Put another way, there are more chances of impressing the examiner with logical thinking and an incorrect diagnosis rather than the other way round!
Expect a mix of films – spots, films requiring a discussion of differentials, films requiring further modalities for a diagnosis and everyone’s nightmare – the film which looks normal and makes you feel like an idiot. We plan to take you through all the above categories and we will discuss how to deal with each type of film from an “Aunt Minnie “ to an “Ohmigod – I am clueless” type.
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