Viva Pitfalls: How to Fail (And How to Pass)

The Oral Board (Viva) is not a test of what you know; it is a test of how you think. You can know every fact in the book and still fail if you present yourself as unsafe, erratic, or arrogant. Conversely, you can pass with gaps in your knowledge if you are structured, safe, and logical.

This guide analyzes the "Archetypes of Failure" and provides the antidote for each.

The Archetypes of Failure

1. The Dangerous Cowboy

• Behavior: Jumps straight to surgery. "I'll fix it." Doesn't check if the patient has a heart condition. Uses the biggest implant available.
• Examiner Perception: "This person will kill someone."
• The Fix: Slow Down. Always mention patient factors. Always mention non-operative options.

2. The Erratic Scattergun

• Behavior: Lists 20 differential diagnoses, from "Bruise" to "Ebola." Orders "FBC, UEC, LFT, CRP, ESR, MRI, CT, Bone Scan" for everything.
• Examiner Perception: "They have no clinical judgment. They are just reciting a list."
• The Fix: Hierarchy. "My differential is structured into Common, Dangerous, and Rare." "My top 3 differentials are..."

3. The Silent Statue

• Behavior: Stares at the X-ray in silence for 45 seconds. The examiner gets uncomfortable.
• Examiner Perception: "They don't know it. Or they are frozen."
• The Fix: Think Out Loud. "I am looking at this X-ray, I can see the soft tissues are swollen... I am looking for a fracture line..." Even if you see nothing, keep talking.

4. The Argumentative Lawyer

• Behavior: The examiner challenges them ("Are you sure?"). The candidate argues back. "Well, actually, the 2024 paper says..."
• Examiner Perception: "Unteachable. Arrogant. Will be a nightmare colleague."
• The Fix: Humility. "I recognize there is controversy. In my hands, I would prefer..."

5 Phrases That Fail Candidates Instantly

1. "I would do an MRI." (Before examining the patient or looking at the X-ray).
   • Why: You are skipping steps.
2. "I'm not sure, but I guess..."
   • Why: Never guess. Deduce.
3. "This is an Osteosarcoma." (Without describing it).
   • Why: If you are wrong, you are dead. Describe first.
4. "I would fix this immediately."
   • Why: You didn't consent the patient.
5. "I don't know." (And stopping there).
   • Why: It's a dead end. Say "I don't recall that specific fact, but applying first principles..."

Rescue Strategies: How to Save a Station

You have made a mistake. The examiner is frowning. You are panicking. Stop.

1. The Pivot

• Situation: You went down a rabbit hole of rare diagnoses.
• Action: "Stepping back, the most common cause for this would be..."

2. The Safety Net

• Situation: You don't know the answer.
• Action: "While I cannot recall the classification, my priority would be to ensure this is not an infection / tumor / compartment syndrome..."

3. The Senior Call

• Situation: You are totally lost.
• Action: "This is a complex case outside my routine practice. I would stabilize the patient and seek advice from a specialist in this field / my senior colleague." (This shows you are safe).

Body Language Hacks

• Sit Forward: Show interest.
• Hands on Table: Don't hide them (looks deceptive) or fidget.
• Eye Contact: Engage the examiner.
• Smile: It releases endorphins for you and the examiner. They want to pass a nice person.

Conclusion

The viva is a performance. You are playing the role of a "Safe, Competent Consultant." Stay in character. Be boring. Be safe. Be structured.

Clinical Pearl: If the examiner interrupts you, STOP. They are trying to help you. They are steering you away from a cliff or moving you to the next scoring point. Listen to the hint.