Advanced ENT Training: A Guide to Passing the FRCS (ORL-HNS) Examination

Review by L Flood
Middlesborough, UK

Now here is a book that is long overdue. It is the textbook that most of us, at whichever side of that viva table we once sat, really did intend to write one day (when time permitted of course). Preparation for an examination that allows oneself the label ‘FRCS (ORL-HNS)’ traditionally means ploughing through the major textbooks, attending one of many dedicated courses and a few seconds of desperately reading some pocket book, in the hallway outside the viva rooms.

What is so clever and novel here is the use of the typical questions and model answers format. As in the examination, this goes through the sequence of the simpler introductory questions, followed by the competency level one and finally the advanced questions, which pick up those extra marks. The bulk of the book is therefore ‘Common topics’, divided into the customary subspecialties. As in the viva, many topics are introduced with an image, all here in monochrome, but at a high resolution. Reproduction of the radiology images is flawless.

A review of this book could almost just be a series of quotes, many of which are true ‘pearls’. The art of this book is to present everything as a clinically based question, whether ‘what type of device is illustrated in this photograph’ or ‘describe the findings on this scan’. The text then continues as a conversation with the examiner, with repeated suggestions as to the style of the responses, as much as their content. (Trust me, after over a decade on the easier side of the table, by the end of a long day, a structured, fluent and spontaneous answer is so welcome). A great example comes with an image of a posterior retraction pocket and compromised incudostapedial joint. The boxed text is a masterpiece that concludes ‘There isn’t always one correct answer, but you need to be clear about the reasons for your answer in each case’. The text comes with boxed bullet points and references for further reading. The skill here has been to get a multi-author contribution (many former trainees of this reviewer!) to consistently concentrate more on how to deliver answers, across a table, to two stony faced individuals, than just listing what to actually say.

The book opens with really perceptive chapters on personal experiences of preparation for the two parts of the examination. ‘Advice for Part 2 Clinical Stations’ opens with ‘Another piece of crucial advice’. Who could resist that? In ‘Communication Skills’, there is the warning of some inevitable twist in the story. How well I recall the ‘patient’ reticent to tell that he would refuse blood transfusion, or the unfortunate individual facing major head and neck treatment who is told not to divulge his status as a carer for an invalid wife unless there was some specific enquiry as to his social history. If I had any reservation, it might have been that the coverage could have led to despondency in examination candidates. These are truly model answers, counsels of perfection, but again this is so well covered in advice as to how to continue if ‘stuck’, including ‘there are many opportunities to make up for one low score’. How very true this is.

I enjoyed this book immensely. It is a very easy read, nicely set out for browsing (which was indeed how I started), but better read cover to cover, well before the examination. I was, maybe, encouraged that I was doing better than expected in my attempts at answers, and those who know me will appreciate why I found Laura Warner’s chapter of ‘personal interest’ and with a very positive message.

Compare the price of this book with the costs of that ‘final examination’. Although focused on the British Isles, the advice is just as internationally relevant to others (e.g. those over the Pond) facing Board Examinations. Finally, I would stress again that this is not ‘Short Notes on’, ‘Key Topics in’ or ‘A Pocket Book of’, however valuable they undoubtedly are. Instead, this is a superb guide to the skill of presenting what you learnt from such preparation, in what is still a daunting environment.

Amazon Link: Advanced ENT Training: A Guide to Passing the FRCS (ORL-HNS) Examination
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