• Dr Sally Ayesa

Hierarchy of learning - vivas

Updated: Apr 6, 2019

There are many ways to prepare for exams - where should you be putting your energy?


There is no way of getting around that exam preparation requires a lot of work, and there are a lot of different textbooks and word documents and PowerPoints and pieces of paper and offers of teaching that are thrown your way in the lead up. It is very easy to get bogged down in everything.


In that tumultuous time between the RANZCR Part II written and viva exams, it is hard to know where to start. For two weeks after my written exam I could barely pick up a case book, and summoning the energy to drag myself to a tutorial was exceptionally difficult. I was mentally exhausted and I was worried that I wouldn't be able to turn around and put in a good show for vivas. I slowly eased myself back into the groove and managed to get going.


This is my idea of the hierarchy of learning opportunities. You need contributions from all levels, but should try and stack more towards the top of the pyramid if you can. Everyone does (however) learn differently and you can tailor what works for you.


1. Top of the pyramid - practice vivas

Practice vivas don't come along every day. Most states now have one or two formal practice vivas which will allow you to site all seven stations in a day under exam conditions. Some other conferences, such as Radiodiagnosis Review, simulates high stress exam conditions by having 200 colleagues listening to your viva over the microphone. Scary stuff, but character building.


If you come across a radiologist who you know is a good teacher and has a good set of practice films, jump on the opportunity. Simulating the viva environment is an important tool in your learning. While nothing will truely emulate the viva experience, it is advantageous to get as close as you can get. With a stopwatch, exam level cases and a stone-faced examiner you will be getting valuable experience.


2. Small group tutorials

Most public hospital radiologists will have a stack of films, collection of DICOMS or list of medical record numbers ready to show some eager candidates. Start conversations with the bosses at your own hospital if they aren't rostered for regular tutorials. Ask kindly and try not to be demanding. They will be giving up their work or private time to work with you - so it is best to be grateful for the sake of yourself and future generations of candidates.


Asking for help from consultants at other hospitals can be sensitive. Study groups are often made of candidates from a few different hospitals to expand the learning opportunities. Some hospitals will offer a trade system - if you help our candidate we will help yours. Once again, try not to be demanding of you are approaching a radiologist. Be grateful and humble and remember to thank them for their time.


Around viva time, build on your strong foundation of knowledge with practice vivas, teaching sessions and group films

3. Large group learning sessions

Some states may have the opportunity for candidates from different hospitals to come together for a tutorial or formalised teaching session. These are great for a few reasons. Firstly, you have the chance to form a support network with those around you. You are all in this together - a team rather than in competition with each other. I hope to be be able to write a bit about this soon. Secondly, you can learn from what other candidates do well and not so well, so that you can build your own technique and learning. Did she have a succinct way of characterising that liver lesion? Did his description convey that he had a solid understanding of the diagnosis or was it more of a guess?


4. Small group study sessions

I would run cases with my study partners between tutorials, before work, after work and on weekends. We were lucky enough to have an extensive film library at our home hospital with some good quality film sets which we worked through relentlessly. I saw my study group more than I saw my family some weeks. When studying with others, it is important to remain humble. Everyone is learning together and there are things that you can learn from them and they can learn from you. I used to ask my colleague all the time how he managed to formulate a diagnosis from a finding and he would do the same - we were good enough to learn from each other.


There is also value to working with candidates outside of your core study group. Radiology trainees from other hospitals will have different ideas and strengths than your own and it is useful to tap into that.


In these small sessions, we would have StatDx and Radiopaedia.org handy, as well as a textbook or two, to look up concepts on the go if we found a knowledge deficit. We were constantly finding the holes and plugging them as we went along.


5. The bottom of the pyramid - textbooks

Don't get me wrong, textbooks have their place but if you spend too much time reading textbooks instead of speaking through cases, you will be less practiced and polished on the day. I have worked with candidates whose book knowledge is outstanding but they can't read the film correctly.


I would use casebooks predominantly in my downtime, when I was waiting for someone, catching a bus, between bites of my lunch, flicking through on the couch or in bed. They highlight high yield topics and get your eye in for pathology. Also, if you find you don't know much about a topic there is usually a bit of description accompanying the case which allows you to reinforce the learning. I would have an iPad loaded with pdf case books, or a hard copy in my work bag.


Thick, text heavy books should be used if you are struggling with a specific concept e.g. pineal lesions, interstitial lung disease. I would note down issues I had in tutorials and spend some time reading about them later in the day or evening if I needed to.



And then videos on YouTube of people decorating cakes when my brain was completely fried out.

Here is one to start you off if you are interested

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