Hello everyone!  I am  Mohd. Javed Ali from Hyderabad, India.  I passed my FRCS at the first attempt!  Believe me I had prepared only for a month because of my oculoplasty fellowship that ended a month before FRCS. My great friend Maaz Mohiuddin (an excellent phaco and corneal surgeon!), who also appeared for it for the first time and passed, was a great support during the exams! My experience is as follows:

DAY 1:

Essays:  Always remember to get all the past and model essays from Dr Muthu! (www.mvupgo.com ) . Thankyou Dr Muthu, You were of great help as a teacher and a great friend!!

I was exempted from MCQ’s part!

DAY 2: 

Always keep smiling during all these stations. Appear confident, walk confidently towards your station, shake hands with the examiners and introduce yourself. Wait for them to ask you to sit down! Say thank you when they do so! Be in apt attention when they ask you questions. Every word they speak has a meaning! Never bluff if you don’t know the answer! Say you cannot recollect or you do not know, so that the examiner shifts to another question. Never start digging without knowing where to dig!!

Dr Ayman’s FRCS group and their files are very important for both viva and clinicals.  THANKYOU DR AYMAN FOR THOSE GREAT PRESENTATIONS AND ALL THE HELP YOU GIVE TO ASPIRING CANDIDATES!!

 

Ophthalmic Medicine: 

I think it is immaterial to know who the examiners were and what was their race!

The examiner began with giving me a paper that had a dendritic pattern with 52 written beside it! Asked if this is the clinical picture and 52 is the pressure, Give me the prescription. I gave the prescription and supported with HEDS studies!

Examiner that showed a photo of  Fuch’s uveitis  without heterochromia! Asked for the management. Than asked how would you manage the other eye if pressure is 24 mm. I replied that the other eye has nothing to do with fuch’s! the examiner smiled and than asked me whether I would treat a pressure of 24 mm of Hg in an otherwise normal patient! I asked him what is the CCT, he said it is 470nm, I than asked him how did he measure the IOP! He said goldman’s. I told him that I would look for fundus for peripapillary changes and RNFL defects as well as C:D ratio before deciding! The discussion than went on to OHTS study!

 

The other examiner than showed photos of graves ophthalmopathy! (Seeing Orbits and Oculoplasty cases gave me so much relief in this examination. Anybody would be happy if they get their respective subspeciality cases!)

Discussion went into details of management of compressive optic neuropathy. (All managements should start with history, clinical approach, investigations and treatment. Never Jump onto treatment from the beginning!)

Told the examiner about the management, involvement of the internists, medical management and at the same time preparing the patient for investigations as they may require surgical intervention.

The examiner than showed me the photograph of Cherry red spot and the discussion went into DD and management of CRAO.

At the end of it both the examiners appeared happy and pleased! This was my best station!

 

General Medicine and Neurophthalmology

The general medicine examiner was very interested in pulmonary emergencies!  ( I believed I did general medicine better than neurophthal! My fellowship in emergency medicine came very handy in this part! Nonetheless always study Oxford handbook of emergencies! Never speak anything that you have not done or not sure in emergencies. Always involve your internists in the answer as much as possible to be on the safe side!)

 

The emergencies discussed were pulmonary embolisms, acute exacerbations of COPDs, DVT.

The examiner than showed a picture of a tongue with deep furrows and grayish patches! Could diagnose it as thrush only after examiner gave a clue!

Discussion went towards IVDA’s (intravenous drug abusers) and AIDS. Lastly he asked me does HIV spread through mosquitoes? I replied there is speculation like these but have not yet been proved convincingly!

The neuro-ophthalmology examiner discussed a lot about anisocoria , horner’s, adie’s, ARP’s, 3N palsy and was not appearing happy with some of my answers. As I was sinking , the best part began as he started discussing the use of drugs by other specialists like cardiologists, pulmonologists, dermatologist, rheumatologists and their ocular significance. I love pharmacology and did this part really well to neutralize examiner’s initial negative mood.

 

Ophthalmic Surgery and Pathology.

Never comment upon surgeries that  you have not seen or not done! Rehearse the pathology slides from Kanski well!

I did not do the ophthalmic surgery part well! The examiner was really getting irritated!

The examiner began by asking me squint surgeries, giving clinical scenarios of Eso and Exo and asking how much recession/resection you would do in each eye! I just knew what kanski had given for squint and not these! I told the examiners frankly that I do not know much of squint and have not seen them very often! I thought he would change the topic and guess what! To my surprise he began asking difficult squint surgeries like how would you do IO transposition! I could not answer much and I knew I am failing, just when god came to the rescue and the examiner probably wanted to make my life difficult by asking Wiess and Quickert’s procedures for lid malpositions!

I told myself quietly: Wow! He does not know that he is in my house now! I discussed them well to his satisfaction and it was so nice to see the frown on his face becoming more and more aesthetic!

The pathology part went well! (There was a dual advantage to me: one being in oculoplastics, where a lot of pathology is in air and secondly my wife being a pathologist, made me rehearse all important and real slides in the comfort of my    house!!!)

Will you believe what slides I got:

1) Retinoblastoma

2) Thyroid myopathy

3) Squamous cell carcinoma.

I came back to my house after this and did not go to see the results personally, as I was worried by neurophthalmology and ophthalmic surgery that I neither performed to my satisfaction nor to the examiners! Lots of comments by my friends that I should not write with only a month’s prepration came to my mind. Told myself that ‘I should have listened to them’. ‘Wasted my Dad’s money!’ ‘I will never write these exams again’! so on and so forth! 

When my friend revealed the results and that I was allowed to go forward, a relief dawned and immediately the batteries were recharged and geared up for one last time-CLINICALS.

 

DAY 3:

CLINICALS: Always read WONG thoroughly along with Dr Ayman’s presentations on FRCS groups. Practice all the common clinical techniques fluently as the state of mind won’t be such that we can think and do them on spot!  Most of us have a habit of doing I/O’s with the patient supine. Practice with patients sitting upright as that is what you need to do there! Keep all instruments in working conditions many days in advance! Keep spare batteries for your torches and scopes! Try to be quick in examining! The more the number of cases you do, the better it is!

 

CASE 1:

90D of a 10 year old boy!  There was an irregular, mild grayish scar with pigmented borders in the macular area! Asked about DD and discussion of toxoplasmosis briefly.

 

CASE 2:

20D of a patient with resolving Vit H’ge, PDR, isolated fibrous bands and fresh laser marks. Discussion went into CSME, macular grid, further management of the patient!

 

CASE 3:

A teenage girl with exotropia! I did not do this case well as usual because squint is my graveyard! The case actually had a trauma with a stick 5years back and there was a corneal scar as well! The examiner was asking many things, that I know could have been simple to answer but my brain stops ticking when Squint arrives specially in exam situations! Both the examiners were not pleased and neither I with myself and I was feeling I am going to let down my well wishers! My ordeal was not going to end here as my next assignment was same graveyard:Squint’ God save me!

 

CASE 4:

Was asked to examine ocular motility. Did the technique well but again the questions were going above my head! The examiners did not persist with this, thank god!(God was on his way to my rescue!) They were O.K with what I did, the technique.

 

CASE 5:

A case with marked enophthalmos! (God finally brought oculoplasty for me!) Discussion went into blow out# , was asked to see with direct ophthalmoscope, started right away on the job (when the examiner switched off the lights by himself, realized my mistake that I should have asked for the lights to be dimmed off. Corrected myself immediately by saying the examiner thankyou for switching off the light! Thankgod , he did not switch off my pass light for this!) The fundus showed traumatic optic neuropathy. The examiner appeared pleased that I quickly handled this case. The time was running out when a final case was given.

 

CASE 6:

Guess what I got! OSSN. Described quickly all the findings and how I would manage this and post excision cryo techniques and post surgical mitomycin and followup! The examiner appeared pleased.

 

RESULTS:

Clinical session was over in the morning and had to wait till evening! Was tense but chalked out plans for both the eventualities of the result! What lonely spots I would visit if I fail and how I would celebrate if I pass! How I would convince my loved ones and friends if I fail! ( I would tell them see with first attempt and less preprations, at least I have reached till final stage and so have at least some face,though atrophic to show you all!)

 

The results were favourable! I rejoiced! Thanked God, all my teachers with a special thanks to Dr Subrahmanyam, who brought me into plastics, Dr Santosh Honavar (Who is an infinite inspiration for me!) for the moral support throughout and believing in me that I would pass. Dr Ramesh Murthy for always being there for me! Dr Ramesha.K , whose great smile soothes during the exam time!

 

If anybody needs my help (although I passed by luck) kindly do not hesitate to contact me at drjaved007@gmail.com .

Thank you all.