FRCR 2B Viva (‘orals’)

Speak clearly

• Speak clearly during the viva, for example as you would whilst talking on the phone.  For most this is second nature, however many candidates develop ‘pressure of speech’ or find themselves mumbling under pressure.  To find out how you sound you can either record yourself or ask your colleagues to give you feedback during teaching sessions.  If your colleague doesn’t think you speak clearly, then it is likely others (including the examiners) may think the same too!
• If you talk constantly, barely pausing for breath, then you do not give the examiner the chance to assess your depth of knowledge by asking additional questions or guiding you summarise/discuss patient management, potentially gaining you extra marks.
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You are marked separately for each modality

• If you are shown a plain radiograph, an ultrasound and an MRI scan during a single case, you will be marked as if you have seen 3 cases.  Don’t lose marks by just giving the diagnosis when a new modality is presented to you – be sure to describe it appropriately.  For example if you are shown a plain chest radiograph initially and after presenting this you request a CT scan to confirm your findings, the CT scan will be marked separately to the plain radiograph (as if it was a new case).  If you perform poorly on the chest radiograph, don’t let that ‘phase you’ as you can ‘start from scratch’ with the CT scan, even if it is just to confirm a diagnosis.
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All cases/modalities carry equal weight

• There is no such thing as a ‘starter’ radiograph.  All cases/modailties are marked equally.
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Extract as much information as you can from the modality first presented

• This will usually be a plain radiograph so get as far as you can before requesting another modality.  You should also try to build on the information obtained in the first modality when making observations and interpreting any subsequent modality.  Don’t forget about ultrasound!  Candidates often favour CT or MRI even though US is the most appropriate next investigation.
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Auntminnies

• An auntminnie is a case with radiologic findings so specific and compelling that no realistic differential diagnosis exists.  If you get an auntminnie, go for it and get the full marks.
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If you don’t see the anomaly within 5-10 seconds, systematically look through your ‘review areas’

• Ensure you have a list of ‘review areas’ in your head for each modailty / body part you may get in the exam.
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Never point or touch the screen! (unless specifically asked to do so with the mouse)

• Pointing and guesturing are very bad habits that local radiology teaching should have ‘kicked’ out of you.  If you find yourself doing this during practise sessions or mock exams, you must find a way to stop.  It is annoying for the examiner and if you struggle to describe an abnormality using words alone, then you are not ready for the exam.  Touching the screen is like touching an old plain film.  Just don’t do it!
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Do not continuously scroll up and down CT/MRI scans

• Do not look at CT/MRI scans as you would in your usual daily practise as this continuous scrolling up and down is annoying for the examiners and makes you seem unsure about the scan in question.  Instead, just look through the whole scan once and spot the obvious abnormalities.  If you need to look at a particular area in more detail (e.g. a hernia) then it is ok to scrool back through this area slowly (e.g. to look for, and confirm a transition point in the hernia), but make sure you tell the examiner why you are doing this and specifically what you are looking for.
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Have a good posture

• Try to project a confident image.  Sit up straight and don’t slouch or lean into the film.  Try to sit still and do not fiddle with clothing or jewellery.
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Listen carefully to the examiner

• Often there is a short clinical history given at the start of a case which may help you when giving the diagnosis / differential diagnosis.  Sometimes the examiner will direct you to a certain area of the radiograph.  This is not a trick.  If anything the examiner says or asks is unclear then it’s ok to ask for clarification.  More importantly do not argue with the examiner.
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Presenting technique

• – Start all images with a brief description e.g. ‘frontal chest radiograph’ or ‘unenhanced axial CT images of the head’.
  
• – Give a brief description of the findings.
• – Do not say ‘obvious abnormality’ (what is obvious to you may not be obvious to the examiner).
• – If the abnormality is obvious, describe it and not the normal areas around it.
• – Use radiological terminology, not lay terminology.
• – After giving a brief description you may ask for previous imaging, past-medical history, investigations etc however be specific and always qualify them with the reason e.g. ‘does the patient have diabetes?’ is perfectly acceptable when given a case of emphysematous cystitis.
• – When giving further management of a patient, you should go beyond referral to an appropriate MDT and provide the advice that would be given to that MDT.
• – Only give negative findings after describing the abnormal area and only if related to the primary abnormality.
• – Do NOT use acronyms or abbreviations!  If you use CBD or SMA you are potentially throwing away marks.  Many clinical errors have arisen from the use of acronyms and what is common in one institution may not be common elsewhere.  If you are referring to the common bile duct, then for gods sake SAY common bile duct!
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Always have a finishing statement

• Probably the most important skill you will learn when practising for the viva is learning how to ‘finish’ a case.  This can be done in a number of ways and a few examples are given below:
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  • 1. Giving a conclusion and brief summary of findings, followed by the next step in the patient’s management then looking at the examiner.
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  • 2. Putting down the mouse and looking directly at the examiner.
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  • 3. If you are struggling or have no idea what is going on, don’t waste time starring at the images.  Take positive action by briefly listing any abnormalities you can see then telling the examiner you are unable to reach a diagnosis.  Stop talking / mumbling at this point and look at the examiner.  They will move onto the next case where you will hopefully do better.

   

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