Board and Fellowships Exams

Introduction

The fellowship or boards of plastic surgery equivalent exams are the final trial by ordeal for most trainees, who will have faced exams over a large portion of their adult lives. Their respective examining boards put together the general structure of all four exams with the aim of presenting a safe surgeon who has adequately covered the entire plastic surgery curriculum. This is perhaps the most stressful academic period in a prospective surgeon’s training career. All exams have their own unique quirks of technique and reflect examiners’ habits or favorite topics. In recent years the various boards have attempted to provide a more standardized format to ensure reproducibility and fairness. As they begin to prepare for the final exam each candidate finds their favored study modality. Group study with a long-term timetable, regular tutorials from recently passed surgeons and more experienced senior surgeons together form the basis of most trainees’ approach to the exams. The structure of the FRACS(Plast), FRCS(Plast), FRCSC, the American Board of Plastic Surgery, and the European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS) exams is described below, with reflections by the authors on their personal experiences of their individual examination process.

FRACS(Plast)/EBOPRAS Exams

The Australasian College of Surgeons invites final year trainees from a 5-year specialist training program conducted by the Royal Australasian College of Surgeons to sit the fellowship exams. All candidates must have passed a PRSSPE (PRS Science and Principle Examination) multiple-choice exam usually as a SET 2 candidate. The final fellowship has the following components:

• (I)

  Two written papers: each of 2 hours’ duration, 2 questions in each paper and multiple parts in each question

• (II)

  Clinical – long cases: 2 cases, each of 30 minutes

• (III)

  Clinical – short cases: 6 cases, each of 5 minutes

• (IV)

  Surgical Pathology and Operative Surgery (SPOS) 1 – viva: 2 scenarios, each of 12.5 minutes

• (V)

  SPOS 2 – viva: 6 slides, each of 5 minutes

• (VI)

  Anatomy – viva: 25 minutes.

The scoring is a Closed Marking system – 8, 8.5, 9, 9.5. Support can be given in each of the marks: 9 is a clear pass, 8.5 is borderline fail, 8 is a clear fail. Any candidate can be failed on one critical error irrespective of the marks. Critical errors are considered those decisions that may be life- or limb-threatening. Although all seven segments are considered equal in value, during court of examiner discussions more emphasis is placed on clinical components, in particular long cases. These exams are held twice a year.

The EBOPRAS exam is divided into written and viva components. The written exam is a multiple-choice exam covering clinical as well as basic sciences. The viva component is divided into two 25-minute sections; clinical scenarios covering congenital, trauma, tumor management, esthetic and general reconstruction are conducted by two examiners.

As a candidate, I (Rostam D. Farhadieh) had the dubious pleasure of sitting three of the five exams discussed in this chapter (FRACS(Plast), FRCS(Plast), EBOPRAS). Each had its own strengths and weaknesses, however the common theme is that the examiners were not intent on failing the candidates, but to discover what their knowledge limits and more critically where their clinical limits lay. The FRACS is the most rigorous of these exams in terms of expected depth of knowledge, however it is not necessarily the broadest exam. The written form is significantly more detailed and in my opinion more in line with expectations of a specialist surgeon. The FRCS exam is the broadest exam; each candidate is assured that a series of congenital, trauma, esthetic and general reconstructive viva questions will be asked. The arrays of short cases were undoubtedly the best outpatients clinic not only I but also all candidates are likely ever to attend. The EBOPRAS exams similarly seek to cover the same broad base. The candidates are often, however, qualified surgeons and as such the exam format may seem more like a semi-formal discussion amongst colleagues than tutor to pupil format of the FRACS and FRCS exams.

The most pertinent advice for a prospective candidate is a broad formal clinical experience. This experience is best gathered in the trenches of interminable dressings and initial consultation clinics. Formal long case, short case practice and presentation is essential not only to success but also to a crisp and succinct decision-making process. This will become less formal, but nevertheless form the crux of your clinical practice for years to come. The examiners are destined to have more clinical experience than the candidates and this is where the candidate can compensate by depth and breadth of knowledge. The more a candidate reads and knows around a topic, the more confident and systematic they will become in replying to questions and putting clinical scenarios into a correct perspective. Review CME articles from the journals Plastic and Reconstructive Surgery , Clinics in Plastic Surgery , and Hand Clinics formed the basis of my own reading, in addition to the standard single-volume texts, although the latter I often found inadequate. Revision and complete command of surgical anatomy is mandatory in clinical practice of plastic surgery. Unfortunately, neither the FRCS nor the EBOPRAS exam stresses this component. This results in what is often perceived to be a deficit in many of the British and European candidates’ knowledge base.