Cracking the MRCS Viva: A Revision Guide

Abstract

This new book sets itself the enormous task of helping surgical trainees through their MRCS viva. Three of its authors have recently been through the viva in London, Edinburgh and Glasgow, and, together with a senior examiner for the intercollegiate examination, have come up with a book that guides the candidate through what they could be faced with in the examination. This includes working through numerous possible viva topics, with commonly asked questions and their answers. The introductory section works through examination technique, giving memorable mnemonics and a surgical sieve to use while describing conditions and their causes. The importance of being methodical and logical is emphasised, starting with the basics. It also gives advice on how to say ‘I don't know’, and reminds the candidate never to lie. There is then a list of Important diagrams and equations that should be committed to memory, most of which are also found elsewhere in the text. It suggests that you can show you are well prepared for the examination by taking a pen and paper into the viva to recreate the diagrams as you answer questions. The rest of the book is split into six sections: applied surgical anatomy, operative surgery, applied surgical pathology, principles of surgery, applied surgical physiology and critical care. Each section is organised alphabetically, which does lead to much page flicking if you wish to revise, for example, the nerves supplying the arm. However, there is a very thorough cross-referencing system running throughout, linking the various sections and chapters, illustrating how questions in a viva may flow. At the beginning of each chapter there is a list of all related topics within the book, which saves referring to the index. The anatomy section is made up of 20 chapters, each 2–3 pages long, starting with possible viva questions related to the topic. The text goes on to answer these questions in succinct form, making the major points with the aid of further mnemonics. The subsequent sections continue in the same style, with possible questions, lists of related topics and the required Information presented as bullet points, tables and reproducible line drawings. Operative surgery covers the most common procedures that could be expected of a trainee and also some larger procedures such as carotid endarterectomy and renal transplantation. I was surprised to find that the only oncological surgery covered in this section is breast, and little attention is paid to bowel procedures other than appendicectomy and hernia repairs. There is, however, a section on the operative management of bowel cancer in the pathology section. Five pages are devoted to orthopaedic-related approaches and procedures, covering Colles' fracture, scaphoid fractures, surgical approaches to the hip, dynamic hip screw insertion and the approach to the knee joint. Applied surgical pathology begins with a very helpful A-Z guide of pathological terms. Infection, Inflammation, metabolic disorders and neoplasia in their many forms are worked through, including universal precautions and HIV. Principles of surgery continues along the same theme, looking at incisions, diathermy, stomas and tourniques, covered by bullet points and question and answer sections. Applied surgical physiology concentrates particularly on the kidney and successfully makes renal physiology seem simple over a few pages. Action potentials and effects at neuromuscular junctions bring medical school memories flooding back. Critical care receives over 100 pages and contains many important definitions, with some drawn from the physiology section. The criteria for entry into high dependency/intensive care units and the definition of various organ failures are clearly listed, with acute respiratory distress syndrome, respiratory failure and ventilation covered in some detail. This book is an excellent purchase for anyone about to sit the viva; it can give you confidence in what you know and is full of helpful ways to remember basic anatomy and physiology. The first edition does, however, contain a number of printing errors, particularly in the anatomy section. Its main potential pitfall is the uncertainty in the examination system within the new run-through training, which could leave its advice on technique obsolete. But even Modernising Medical Careers cannot change anatomy, surely?