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  • Writer's pictureDr Sally Ayesa

Five quick tips to turn it around

What do you do when you are in a rut about a particular viva, or subject within a viva? We have all been there. Here are a few practical things I did to try and turn it around for me. If you are feeling emotionally down and frazzled, click here for my thoughts on picking yourself up.

1. Focus your reporting

Having trouble with detecting an abnormality on CXR? Wrangle yourself a reporting shift where you can report 30 CXR to get your eye in. The benefit is that you will re-orient yourself to normal cases and flick yourself out of viva mode when there is pathology everywhere. You will be less likely to dream up findings that aren't there if it is a standard patient. May sure you are picking up the microphone while you do this and consider every single reporting case a mini viva. Good viva presentations are just reports, with a little bit of your thinking processes thrown in.

2. Take a clinical or multidisciplinary meeting

Taking meetings is great for a few reasons. Firstly, you are presented with a suite of the most interesting cases from that week - a concentration of real world exam level cases. Secondly, preparing the cases with a knowledgable radiologist for backup is like a bonus tutorial. You can ask questions about how they work through real world cases and pick their brains on interesting pathology. And - it is completely one on one. Finally, the stress of presenting in front of a room of experts simulates the stressful situation of the viva. They will throw you questions and ask about specific findings, not because they are trying to mess with you but because it matters! Each case is a real patient, with a real problem and there will be real debate. The point of training is so you can be valuable in moments like these.

3. Flip through a short case book

Case books are great for bringing you back to high yield topics - reinforcing the most key knowledge and plugging the gaps. Case books are great because if you can just flick through, saying diagnoses in your head and checking your work. If you are way off the mark you can have a short summary to read through as well.

I have a textbook habit ... but borrow them if you can

4. Read a few chapters

Around four weeks out from vivas I was struggling with pulmonary nodules - how to quickly categorise them film, and how to present a sensible differential list which was relevant and not sounding like a shopping list. So I asked my boss and chest radiology mentor, who suggested reading a few chapters from one of his favourite books (Webb's HRCT if you are interested). The chapters took me through foundation level thinking, which I was then able to build and characterise. Because I understood the principles, my thinking became clearer and more logical.

5. Ask your colleagues how they do it

Humility goes a long way in this experience. You are not in competition with each other, and if you are all good enough there is no reason why everyone can't pass. I was lucky to have a wonderful support team of fellow candidates, two of whom were in my home hospital. We were running cases together most days. At one stage when I was struggling through retroperitoneal pathology, I asked my colleague/friend how he did it. He would glide through similar cases with a clarity I didn't yet possess. So we sat together for ten minutes and he taught me his approach, what he looked for and the relevant negatives - even giving me a few resources to look at. Within a few days I was much better at that particular breed of cases.

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