Demystifying the Fellowship
Examination
Tom Wilson
Senior Examiner – General Surgery
GSA Trainees’ Dinner 2013
Structure of the Examination
• The exams are held twice a year with the
Writtens a month before the Vivas in May and
September.
• May exams are in Wellington & Melbourne (odd
years) and Auckland & Brisbane (even years).
• September exams are in Adelaide (odd years) and
Sydney (even years).
Structure of the Examination
• The Pathophysiology Critical Care and Clinical
Reasoning Viva and the Operative Viva are
usually on a Friday.
• The 2 Clinical Vivas are on the Saturday.
• The Anatomy Viva is usually on the Sunday.
The Content of
the Exams
• Details of the
Curriculum are available
on the GSA web site
www.generalsurgeons.com.au/e
ducation-andtraining/curriculum
The 7 exam segments
1. Written 1 – 25 spot questions
2. Written 2 – 8 short answer questions
3. Pathophysiology, Critical care and Clinical reasoning
(PCC) viva – 2 scenarios, 4 mini-scenarios
4. Operative viva – 1 scenario, 5 mini-scenarios
5. Clinical 1 viva – 2 long cases
6. Clinical 2 viva – 6 short cases
7. Anatomy viva – 5 images, 5 Wet specimens
Written 1 - Spots
• 25 questions in 2 hours
• Typically a clinical photo or image with 2-4 short
questions about diagnosis, investigation &
management
• < 5 mins per question
• Note form or dot point answers are appropriate
• Clarity, precision and legibility are important
Written 1 example
A 58-year-old woman presents
with fever, abdominal pain and
jaundice. This is the image from
her ERCP.
1. Describe the findings.
2. What is the diagnosis and
outline your management of
this problem?
3. What are the specific
complications of ERCP?
Written 2 – short answers
• 8 questions in 2 hours
• Greater detail expected. Usually 1 anatomy
question
• 15 mins per question
• Either written, note form or dot point answers
are appropriate
• Clarity, precision and legibility are important
Written 2 example
A 65 year old man presents with 4 months of
progressive dysphagia and recent weight loss. The
provisional diagnosis is oesophageal cancer.
• Outline the key points in establishing the
diagnosis (including clinical features and
investigations), staging and treatment options
for this man.
Pathophysiology, Critical Care &
Clinical Reasoning (PCC)
• 40 minute viva
• 2 x 10 minute scenarios
– 1 acute care (trauma, sepsis etc)
– 1 complex clinical reasoning
• 4 x 5 minute “mini-scenarios”
• Example …….
This abnormality was seen in the stomach in a patient who being
investigated for chronic anaemia.
• What is the likely pathology?
• What are the important
features to document on
endoscopy?
• How would you investigate
this further?
• What management would you
recommend?
Operative
•
•
•
•
30 minute viva
1 x 10 minute scenario
5 x 4 minute “mini-scenarios”
Example …….
This patient presented with acute large bowel obstruction.
This is a limited rectal contrast study.
• What is the diagnosis?
• If you are unable to decompress
this at sigmoidoscopy, describe
the principles of your surgical
approach.
Clinical 1 – long cases
• 40 minute viva
• 2 long clinical cases – 20 minutes each
• About 10 minutes for history, examination &
presentation
• 10 minutes for case discussion – discuss
investigations & imaging, management
What to expect?
• These are likely to be chronic illness type
patients
• They can be complex problems
• Be polite, respectful and professional
• Treat the encounter as a patient consultation
Clinical 2 – short cases
• 40 minute viva
• 6 short clinical cases (i.e., 6-7 minutes each)
• This exam particularly assesses clinical
interaction and elicitation of clinical signs
What to expect?
• These patients will usually have common clinical
signs
• The range of problems is predictable – hernias,
abdominal signs, skin lesions, head/neck masses,
breast lumps, vascular signs
• It is important to show skilled and practiced
examination technique
• Be polite, respectful and professional
Anatomy
•
•
•
•
25 minute viva
5 anatomy images
5 regions of anatomy on Wet specimens
The range of anatomy is “General Surgery” –
head & neck, axilla/breast, GI tract, diaphragm,
abdominal cavity & contents, pelvis, inguinoscrotal & femoral regions, etc
• Example …….
Use  to scroll
through images
First image
Last image
The marking system
• Each of the 7 exam
segments are equally
weighted
• The segments are marked
according to the “Close
Marking System”
–
–
–
–
9.5 = excellent pass
9
= pass
8.5 = borderline fail
8
= fail
• If you pass all exam segments
you will pass the exam
• If you fail 1 or 2 exam
segments, you can still pass
the exam if your performance
overall is considered
satisfactory!
• If you fail > 2 exam segments,
you are unlikely to pass
The “Expanded Close Marking System”
• Each of the 7 exam segments has defined “Marking Points”
that the examiners use to score the candidate’s
performance
• Each of the “Marking Points” in each segment are scored
according to the “Close Marking System” (i.e., 9.5, 9, 8.5, 8)
• Each candidate is examined by a pair of examiners in each
segment
• Although the examiners score their “Marking Points”
independently, they must reach a “Consensus grade” for
the candidate in each exam segment
The “Expanded Close Marking System”
Segment
Written 1
Written 2
PCC
Operative
Clinical 1
Clinical 2
Anatomy
Content
25 questions
8 questions
Scenario x 2
Mini-scenario x 4
Scenario
Mini-scenario x 5
2 x long cases
6 x short cases
5 images
5 Wets
Ex 1
25
8
2x3
4
3
5
2x4
6x2
5
5
Ex 2
25
8
2x3
4
3
5
2x4
6x2
5
5
TOTAL MPs
50
16
20
16
16
24
20
The marking system
• At the completion of the exams, the Specialty
Court meets to consider all the results
– Candidates whose total score is ≥ 63 (7 x 9) will
pass
– Candidates whose total score is ≤ 61.5 will fail
– Candidates whose total score is between 61.5 and
63 are discussed in detail and may still pass
An example of information assessed by
the Specialty Court
The results
• Candidates who pass do not receive feedback about details
of how well they performed (or how close they may have
been to failing!)
• Candidates who fail do receive feedback about which
segments of the exam they failed, but do not receive detail
about specific questions or topics that were not satisfactory
• The feedback is usually of a more general nature referring
to “lack of knowledge”, “inappropriate management
choices”, “poor examination technique” etc
Coping with the
examination
• The Fellowship examination is
a tough test
• It is expensive and stressful
• Make sure you come to it well
prepared, both mentally &
physically.
Preparing for the exam
• Study with your colleagues
• Practice written questions
• Treat the face-to-face vivas like an interaction
with colleagues rather than an interrogation by
the examiners
• See the clinical vivas like ward or outpatient
clinical encounters
• Be polite and professional with the patients
Don’t be intimidated
• Remember the examiners were candidates once.
• They understand what you are going through!
• Most of the time you will know more than the
examiner does!
• How you apply that knowledge is important!
• We are trying to pass you, not fail you!