Advanced ENT MCQs Training to pass the FRCS (ORL-HNS) Part 1

Review by L Flood
Middlesbrough, UK

This is the last of four books by these authors preparing the ENT trainee for the hurdles of the examinations to be faced before completion of training, whether the MRCS (ENT) OSCE, the FRCS (ORL-HNS) viva or now the MCQs of its Part 1. At 15 years since ending over a decade as an examiner, this reviewer well recalls the challenges of question setting. This usually involved a gathering in some major city where all that attended doubted each other’s attempts at MCQs and especially tried to curb some of the more memorably obscure ones. A lasting memory is of our Chairperson, an eminent Rhinologist, lamenting that we only had three Rhinology questions. It seemed witty to announce, louder than intended, that surely there were only three Rhinology questions. Now, Paddington Bear is famous for his hard stares but would have met his equal there.

The world has changed. In those days MCQs were of the True/False kind. Now they are the single best fit. Of 5 choices offered most are reasonable but the need is to apply “Higher order thinking”. The Foreword by Prof Claire Hopkins and the Authors’ Introduction make for essential reading, if this concept is unfamiliar to the candidate. It is a way of problem solving that is definitely new to a generation very unlikely to be on the candidates’ side of the table. The advice is to read every word of the question posed. For example, “the best FIRST treatment” may be very different from the “ best definitive treatment”. Gaining IV access for rehydration might just trump total pharyngo-laryngectomy and stomach pull up.

Now, to one who rejoices in quizzes, crosswords and Wordle, this book was irresistible and actually very enjoyable, but also instructive (once I had gone back and actually read the Introduction). Surprisingly a personal Head and Neck score suggested a prize candidate and Otology was proving “challenging” at best. Howls of outrage were a common response when comparing the five choices with the subsequent correct single best answer. For each there is a very well composed explanation, but one can still beg to differ. For Q16 we are offered a choice of prednisolone therapy, when the answer paragraph says there is no role for it. A hearing aid sounds better. As indeed it did not sound, although recommended, for a really nice image of a myringostapedopexy with a unilateral 10 dB air-bone gap. Granted, no Bone conduction threshold is specified, but “Reassurance and Discharge” earned no marks. Q98 on Usher’s syndrome, “It is the commonest cause etc” seemed right, as was confirmed by the text later, but not by the recommended answer suggesting it is to do with potassium channels (which it is not). These are minor issues, just read the text and maybe see that you were right after all.

The message to read the questions carefully is well illustrated when a double negative appears. “Which of the following is not a risk factor for etc” has a possible answer “lack of perineural invasion” is something that still baffles this elderly reader. Another message is to accept that some are easy and obvious. Any question starting with “A 32 year old woman from Southern China” must be about nasopharyngeal carcinoma. It was thus, as was equally obvious a question about a trombone player, although one must ask whether a laryngocele is commoner than chronic laryngitis in this musician. Equally “ A 70 year old retired furniture factory worker” must be leading up to adenocarcinoma of the ethmoids, but a paper by John Capper in this journal says High Wycombe has not seen a new case in well over a decade. The intention was to avoid the traditional eponym style question, and one must confess that Boyce’s sign for a pouch was unfamiliar, while a Luc’s abscess in Otology was correctly identified. Thankfully, for a journal Assistant Editor, the first ten questions on research methodology, in a very clever addition, an Evidence Based Medicine, Stats and Miscellaneous section proved satisfyingly predictable.

This is an essential read for any examination candidate, partly because it is packed with clinical information in the model answers sections, but more so for getting one into the mindset to face this style of questioning. It is very reassuring to be reminded that standard setting is still an important part of the examination process and that those questions that prove to be poor discriminators are excluded from analysis. The three authors, the section editors and the many contributors are to be congratulated on producing what should be yet another valuable resource for any ENT trainee. This reviewer, now six years retired, would be better coming back as a head and neck surgeon than a modern otologist, that is the take-home message.

Amazon Link: Advanced ENT MCQs Training to pass the FRCS (ORL-HNS) Part 1
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