The Exit ! exam Jason Lee National Oncoplastic Fellow, RMH
Applying - “Where to start” • On line - www.intercollegiate.org.uk • Need to give: – 3 structured references - 1 must be PD – CV – Logbook – Completed application form – £1795 (!) - upfront for whole process • (£520 for Section 1 / £1295 for Section 2) • Must be “in good standing” with college
Timetable • Section 1 – 3 times a year – 11th June 2013 & 5th Nov 2013 – At approved test centres (choose early) – Notified a few weeks after if eligible for next section • Section 2 – 29th May 2013 (Sheffield) & 11th Sep 2013 (Cardiff) & 5th Feb 2014 (Coventry) – No guarantee that you will get the next direct sitting after your section 1 (apply early) 3
Format of the exam Section 1 • WRITTEN – ONLY 2 YEARS OR FOUR ATTEMPTS ALLOWED - no re-entry • Covers the WHOLE curriculum • 2 papers in one day – Paper 1: 2 hours SBA 135 questions – Paper 2: 2.5 hours EMQ 45 stems (3 questions/stem) 4
Format of the Exam Section 2 • CLINICALS & VIVAS - ONLY 4 SITTINGS ALLOWED - no re-entry • Takes 1.5 days either: – Weds all day vivas then Thurs AM clinicals – Thurs PM clinicals then Fri all day vivas • VIVAS – Academic (20 mins plus 1hr prep time) – Emergencies & Critical care (15 mins each) – General Surgery & Sub-speciality (15 mins each) 5
Format of the Exam Section 2 • CLINICALS – 2 examiners take you through at least 3 stations – 1 general & 1 sub-speciality (each 30 mins) – These are basically more vivas • Not really interested in ability to elicit signs • More interested in patient rapport & management 6
What to Learn?? - Section 1 • Curriculum available on the iscp website - useful starting point - but 237 pages! • There is a PDF version of topics on the jcst website from 2001 • Sample questions available on intercollegiate website • Questions banks on “OnExamination” and “Pastest” • There are a couple of books too. 7
Emergency Surgery Core Curriculum CRITICAL CARE Hypotension Haemorrhage Assessment of the acute abdomen Haemorrhagic and thrombotic disorders Biliary tract emergencies Blood transfusion and blood component therapy Acute pancreatitis Septicaemia and the sepsis syndrome Swallowed foreign bodies Antibiotic therapy and the management of opportunist infection Gastrointestinal bleeding Gastro-intestinal fluid losses and fluid balance, including in Appendicitis and right iliac fossa pain children Abdominal pain in children Nutritional failure and nutritional support Peritonitis Respiratory failure Acute intestinal obstruction Renal failure and principles of dialysis Intestinal pseudo-obstruction Fluid overload and cardiac failure Strangulated hernia Myocardial ischaemia Intestinal ischaemia Cardiac arrythmias Toxic megacolon Multiple organ failure Superficial sepsis and abscesses Pain control Acute ano-rectal sepsis Cardiac arrest, respiratory arrest and brain death Ruptured aortic aneurysm Organ donation Acutely ischaemic limb Hypo and hyperthermia Acute presentations of urological disease Diagnosis of brain death Acute presentations of gynaecological disease Legal & ethical aspect of transplantation Scrotal emergencies in all age groups Cardio-pulmonary resuscitation Chest drain insertion Central venous line insertion Insertion of peritoneal dialysis catheter Primary vascular access for haemodialysis 8
Emergency Surgery Trauma Assessment of the multiple injured patient including children Laparotomy for large bowel obstruction Closed abdominal injuries, especially splenic, hepatic and pancreatic injuries Laparotomy for perforated colon Hartmann’s operation Closed chest injuries Colostomy Stab and gunshot wounds Arterial injuries Appendicectomy Drainage of ano-rectal sepsis Injuries of the urinary tract Initial management of head injuries and interpretation of CT Laparotomy for abdominal injury Laparotomy for post operative complications scans Initial management of severe burns Urethral catheterisation Drainage of superficial abscesses Suprapubic cystostomy Exploration of scrotum Tracheostomy Emergency thoracotomy Reduction of paraphimosis Embolectomy Diagnostic laparoscopy Closure of perforated peptic ulcer, open and laparoscopic Fasciotomy Endoscopy for upper GI bleeding Organ retrieval for transplantation Operations for GI bleeding including partial gastrectomy Emergency cholecystectomy Splenectomy for trauma Emergency hernia repair Laparotomy for small bowel obstruction Small bowel resection Ileostomy 9
Elective Surgery Pathology, diagnosis and management of skin lesions, benign and malignant Wide excision of breast tumours Basal and squamous cell carcinoma Axillary dissection with other breast operations Malignant melanoma Neoplasms of the upper GI tract Other skin cancers Gallstone disease Diagnosis & management of neck lumps Jaundice Physiology & pathology of:- Gastro-oesophageal reflux and its complications Thyroid Hiatus hernia Parathyroid Peptic ulceration and its complications Adrenal cortex Radiation enteritis Adrenal medulla Infantile pyloric stenosis Management of :- Diagnostic upper GI endoscopy Thyrotoxicosis Laparoscopic cholecystectomy Adrenal insufficiency Conversion to open cholecystectomy Hyper and hypo thyroidism Exploration of common bile duct Carcinoid syndrome Biliary bypass Anaesthetic and pharmacological problems Gastrectomy Imaging techniques for endocrine organs Splenectomy Excision of skin lesions Ramstedt’s procedure Excision of skin tumours Physiology of pneumo-peritoneum Split and full thickness skin grafting Informed consent for laparoscopic procedures Node biopsy Pre and post operative management of laparoscopic cases Block dissection of axilla and groin Port complications Surgery for soft tissue tumours including sarcomas Technology of video imaging, cameras, insufflator etc Thyroid lobectomy Laparoscopic instruments, clips, staplers and port types Retrosternal goitre Management of equipment failure Thyroglossal cystectomy Recognition and management of laparoscopic complications Submandibular salivary gland excision Use and dangers of diathermy Parotidectomy Anaesthetic problems in laparoscopic surgery Carcinoma of the breast External and internal abdominal herniae. Anatomy, presentation, complications Benign breast disease Hernia in childhood Hormone therapy for benign and malignant breast disease Undescended testicle Histo-/cytopathology Development and natural history of the prepuce Mammography Diagnostic laparoscopy Ultrasound Closed and open techniques of port insertion Adjuvant chemotherapy: Laparoscopic biopsy Chemotherapy for advanced disease Laparoscopic appendicectomy Radiotherapy Laparoscopic adhesiolysis Counselling Thoracoscopy Hospice care Laparoscopic suturing and knotting Treatment of breast abscess Control of laparoscopic bleeding Fine needle aspiration cytology 10 Surgery for all abdominal herniae, using open and laparoscopic techniques Trucut biopsy Repair of childrens’ herniae Excision of breast lump Orchidopexy Mastectomy
Elective Surgery (cont) Adult circumcision Neoplasms of large bowel Vasectomy Inflammatory bowel disease (inc medical Atherosclerosis management) Ischaemic limb Diverticular disease Aneurysmal disease Irritable bowel syndrome Venous thrombosis & embolism Haemorrhoids Hyper-hypo coagulable state Anal fissure Chronic venous insufficiency Rectal prolapse Arteriography Fistula in ano Vascular CT scanning Diverticular disease/fistula Magnetic Resonance Angiography Colostomy complications Vascular ultrasound Ileostomy complications Varicose veins Pathology of the scrotum and its contents Mesenteric ischaemia Male sterilization, including counselling and Critical appraisal of the surgical literature informed consent Scientific method & statistics as applied to surgery Proctoscopy/rigid sigmoidoscopy Informed consent Flexible sigmoidoscopy & colonoscopy, Ethical aspects of surgical practice diagnostic and therapeutic Genetic aspects of surgical disease Outpatient haemorrhoid treatment Vascular suture/anastomosis Haemorrhoidectomy Approach to/control of infra-renal aortic, iliac and femoral arteries Procedures for fistula in ano Control of venous bleeding Right hemicolectomy Balloon thrombo-embolectomy Left hemicolectomy Amputations of the lower limb Sub-total colectomy Fasciotomy Resections for rectal cancer, restorative and Primary operation for varicose veins excisional Abdominal aortic aneurysm repair, elective and ruptured Illeorectal anastomosis Femoro-popliteal bypass Panproctocolectomy Closure of Hartmann’s procedure Femoro-femoral bypass Rectal injuries 11 Operations for hydrocoele, epididymal cyst and varicocoele
Breast Surgery Genetics related to surgery Reconstruction Immunocyto-chemistry Myocutaneous flaps Clinical trials Tissue expanders Neo-adjuvant therapy and Complications and re-operation related surgery Breast reduction Epidemiology Screening programme Stereotaxis Needle localisation biopsy Mammary duct fistula Breast duct excision Microdochectomy 12
What to Learn?? - Section 2 • Nothing fancy or clever • This is about being safe, conventional and able to justify practice - GUIDELINES • Some papers/trials if you like - but NOT really necessary • General & Emergency Surgery dominates • Critical care has a clinical focus - some basic science needed but this is FRCS • Criticial appraisal needed for academic viva 13
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