Examiners
Mr. Ivan Connolly
Prof. Fraser McDonald
Mrs. Laura Mitchell
Mr. Julian O’Neill
Mr. David Tewson
Mr. John Turner
There were three pairs of examiners, each pair examined on two clinical and two management scenarios. All candidates were asked the same questions by the same examiners for the same scenarios in both the management and clinical sections
Feedback
“I felt that it was a very fair exam for an FTTA. The questions were appropriate for the training I had undertaken and the post that I hope to undertake in the future.”
Research Section (Written Examination)
This involved the critical appraisal of six abridged scientific paper in two hours
The 6 papers were abridged and comprised of between 3-5 pages, including text, graphs and diagrams. All six were orthodontic papers on a range of topics including materials, appliance types and surgery. The author names, journal title and date of publication were not included as the papers were abridged.
There were six questions relating to each paper. Professor Burden gave valuable advice to read the questions before reading each paper. This was the key to time managing the exam. Questions have different marks with the more difficult being worth greater marks, the marks were written at the end of each question.
Topics of papers were:
- Extractions & profile assessment
- RCT on analgesics and pain with separators
- Lab based study on force decay of intra-oral elastics
- Effects on vertical cepahalometric measurements with 2 treatment techniques
- Orthognathic surgery and 2 differing methods of fixation
- Another RCT- can’t remember the topic!
Questions generally related to the study design. Some examples:
Extractions & profile assessment
Comment on sample selection
Scientific and clinical validity of using sample with differing extraction patterns
Benefits of using a VAS for profile assessment
Summarising the results form the graphs in the papers
Using the tables to list significant results
RCT on analgesics and pain with separators
Benefits of an RCT
What does blinding mean
Interpretation of results presented
Clinical implication of results
Lab based study on force decay of stretched intra-oral elastics
Interpretation of results presented
How the lab design could be improved to simulate the intra-oral environment
Listing those result that are significant at differing significance levels
Effects on vertical cephalometric measurements with 2 treatment techniques
Commenting on recruitment of sample
Any limitations of method of sample recruitment
Commenting on the results presented
Commenting on the efficacy of either treatment modality on control of vertical dimension
Other questions
Sample size calculation
Sources of Bias
What is anova
What is a chi squared test.
Explain how ANOVA works (in simple terms!!!)
Summarise what certain graphs/diagrams show or the findings of the paper
Merits of method criteria mentioned in the paper
Why use a certain statistical tests
Clinical merits/advantages/disadvantages of some of the methods
How to do a power calculation
Feedback
“6 excerpts* from orthodontic journals (*seemed to be whole paper bar references). 20 minutes per paper with 6 questions of varying weightings per paper. Some questions did not require the full 20 minutes, others required a lot longer – there was a lot of material to go through!”
“My time management was poor and I had only 10 mins to answer the last paper, so try to be a bit more organised that I was.”
“General understanding required of study design, sample recruitment, sources of bias, hierarchy of evidence, inferential statistics, basic statistical concepts. Some recommended reading:
- How to read a paper, Trisha Greenhalgh
- The pocket guide to critical appraisal, Ian Crombie
Although the candidates felt that insufficient time was allocated, because everyone did well on this section, the time element is currently not planned to change.
Preparation using the books above is an excellent start as well as participation in journal clubs. Statistics is a small part so a basic understanding of concepts and commonly used tests for inferential statistics will suffice. This section was not difficult, it just required you to stay calm and read the questions and refer back to the papers as necessary. Some questions required more time than others but best to not spend too much time per paper.”
Management Section (Viva Examination)
There were six scenarios, with each one being of 10 minutes duration followed by a 10 minute assimilation period, during which you were allowed to make notes. Total examination time of 2 hours.
Each scenario is given to set the scene and although the examiners are in pairs, only one of the examiners asks the questions for their scenario, with the other examiner makes notes.
Each scenario is developed from an initial question, if your response does not completely meet the answers which are required, the examiners would ask further appropriate questions get that information.
Scenario 1 - You are a newly appointed consultant and inherit a lengthy waiting list for both new consultations and treatment
What do you do?
Establishment of managed clinical networks?
How you would manage the 18 week target?
Validate, prioritise etc. PCT consultation and service level agreement, staff required
Scenario 2 - Your first year SpR informs you that his wife has been diagnosed with a serious illness and he requests 2 weeks leave as of next week, he also informs you that the prognosis for his wife is poor
What do you do?
What kind of leave is SpR entitled to?
How long is each type of available leave?
Maximum length of time SpR entitled off without effecting CCST date?
If SpR takes extended time, how would you go about managing training?
How you would deal with his patients within the department?
Which bodies would you inform regarding the SpR’s situation?
RITA, Appraisal, training program director, post grad dean, health etc
Scenario 3 - Your SpR’s refuses perform to the work-load and is unable to use the computer system for patient appointments or Clinicians do not want to work with an older nurse who they complain cannot keep up with the number of patients on the clinic and the new computer system
What do you do?
Why might there be a problem?
How do you identify poor performance?
How do you manage poor performance?
How would you manage conflict?
Identifying training needs?
Leads onto Appraisal, key skills framework, capability procedures, motivation, disciplinary procedures, who is involved in these procedures, timeframes for procedures
Scenario 4 - You have been asked to undertake a 10% cost saving plan in your department
What do you do?
How you would identify where to make cost savings ?
Cutting staff costs e.g. use of orthodontic therapists?
Cutting consumable costs?
How you would argue your case for not making a cost saving?
Staff and consumables, cutting consumable costs, ordering, staff freeze, locum cost, PBR – under or over achieving, budgets, managers etc
Scenario 5 - You are a newly appointed consultant and find the sterilisation equipment and protocol is unsatisfactory
What do you do?
Infection procedures for staff, equipment, central sterilisation
How you would go about putting together a business plan, who would you consult?
You still cannot get the money for instruments form the trust, what are you going to do?
How you would calculate equipment needed for CSSD / local sterilisation?
How you would manage a nurse who will not conform to recommended sterilisation protocol?
An old consultant orthodontist is happy with equipment being washed in the sink what are you going to do?
Scenario 6 - You have been asked to put together a consultant job plan and timetable for a new orthodontic consultant
How you would identify / justify case for a new consultant?
How you would set up timetable, who you would consult?
Who needs to be informed regarding the job plan / timetable?
Appointments process?
Job plan, business plan, discuss with whom, other staff needed, selection panel, short-listing process, criteria-required and desirable, RCS Eng , canvassing, informal visits, interview panel, references process
Feedback
“All the above scenarios were real life situations so good to have discussions with your trainers in dealing with issues such as business plans, poor performance, complaints handling etc. It is useful to have awareness of your trust policies, although you do not need to know the exact details, it’s important to know the general process.”
Clinical Section (Viva Examination)
This comprises of six scenarios of 10 minutes duration with a 1 minute assimilation period in which you are given records (incomplete, with no study models). Total examination time of one hour.
Although the examiners are in pairs, only one of the examiners asks the questions for their scenario, with the other examiner makes notes. Each scenario is developed from an initial question, if your response does not completely meet the answers which are required, the examiners would ask further appropriate questions get that information.
Case 1 - Young boy in the mixed dentition with hemifacial microsomia.
Were given his pre-treatment photos and x-rays
Asked to briefly describe the case and diagnose what the condition was
How you would manage his case? why and when?
Have you treated a case like this and what did you do?
Treatment options / surgical options?
Which specialities would you involve in his management?
Classification of HFM, aetiology and cells involved, sequelae for occlusion?
Case 2 - Adult male with CLP and severe class 3 skeletal pattern.
Were given his pre-treatment photos and x-rays
Asked to briefly describe the case
How you would manage the case? Options fro treatment?
Which specialities would you involve?
Advantages and disadvantages of Distraction v single osteotomy, vectors and problems, types of midface distractors?
Have you treated a case like this and what did you do?
Case 3 - A radiograph of an ectopic canine having severely resorbed the UC1 and UC2
Asked to describe the xray
How you would manage the patient?
What you would tell the patient and the parents?
Setting up managed clinical networks and how you would go about educating your referrers?
Treatment options with advantages and disadvantages of each?
Section 63,referral guideline, audit etc.
Case 4 - Adult female with Class II div 1 malocclusion, severe skeletal 2 base and reduced vertical height with a deep overbite
Were given his pre-treatment photos and x-rays
Asked to briefly describe the case
How you would treat the case?
Any preliminary surgery?
Mechanics that you would use for management of the OB?
Complications that could occur and warnings that you would give the patient?
Risks, benefits, would you treat, condylar problems, surgery , orthodontics for surgery
Case 5 - Intra-oral pictures of a young child with BCLP
Asked to briefly describe what you see
How you would manage the case?
Which specialities would you involve?
How you would treat the case?
Why and when would you undertake ABG?
Orthodontic treatment pre- and post-ABG?
How you would monitor success of ABG clinically (types of indices) and radiographically?
Case 6 - Periapical of upper central incisors, one with an RCT and external root resorption, the other with pulpal sclerosis
Asked to briefly describe what you see
Likely aetiology of radiographic appearance
Management of an avulsed tooth / trauma management?
Treatment options for missing UCI and advantages and disadvantages of each?
Prognosis, options to replace, implants, criteria for implants?
Problems with the orthodontic management?
Feedback
“This section was relatively straightforward. Good exposure to syndromes, orthognathic cases, cleft patients is important as the questions were not complex, however if you had not had the exposure it may have made for a slightly tricky viva. Advice would be to attend interdisciplinary clinics and look at case records and discuss management with colleagues / trainers.”
“I must admit the quality of the print outs was not great however they are the starting points for the discussions/questions.”
“Each examiner asked one “describe what you see” and questions followed on from there. I found this part of the exam a bit disconcerting as one is interrupted to either expand on an issued mentioned or to stop one moving onto the next question. The examiners are looking for specifics for one to answer before moving on to the next question and will redirect one regarding this.”
