Visual Element: A diagram of the "SPAR" Framework (Situation, Problem, Action, Review), visualized as a cyclical process for answering viva questions.

The Theatre of the Mind

The Clinical Viva is the most feared component of the FRACS examination. Why? Because it is unpredictable. Unlike an MCQ, where the answer is on the page, the viva requires you to generate answers in real-time under intense scrutiny.

However, the viva is not a torture session. It is a job interview. The examiners are asking one fundamental question: "Is this person safe to be my colleague?"

This masterclass deconstructs the viva into manageable skills: Frameworks, Delivery, and Psychology.

1. The Examiner's Mindset

To pass the viva, you must empathize with your examiner.

• They are human: They are often tired, hungry, or bored.
• They are risk-averse: They are terrified of passing a "dangerous" surgeon.
• They want you to pass: Failing a candidate is paperwork. They want you to be good.

Examiner Tip: An examiner interrupts you for two reasons:

1. Good: You have nailed the point, and they want to move on to get you more marks.
2. Bad: You are digging a hole, and they are trying to save you. Always stop talking immediately when an examiner speaks.

2. The Frameworks: Your Safety Net

When the cortisol hits, your IQ drops. You cannot rely on raw brainpower. You need frameworks—pre-rehearsed structures that you can cling to.

The "SPAR" Framework (General Scenarios)

For any "How would you manage..." question:

• S - Situation: "This is a high-energy trauma presentation in a young patient..." (Sets the scene).
• P - Problem: "My immediate concern is the hemodynamic instability and potential pelvic binder failure..." (Identifies the priority).
• A - Action: "I would activate the massive transfusion protocol, re-site the binder, and..." (The solution).
• R - Review/Refer: "I would reassess the response and alert the interventional radiologist." (The safety net).

The "HUD" Framework (History Taking)

For the Long Case:

• H - History of Presenting Complaint: The details.
• U - Understanding/Impact: "How does this affect your life/work?" (Crucial for hip/knee/spine cases).
• D - Danger (Red Flags): "Have you had any night pain/weight loss?" (Safety check).

3. The Art of Delivery

The "Headline" Method

Don't bury the lead. Start with the answer, then explain it.

• Bad: "Well, looking at the X-ray, the bone is a bit osteopenic, and the fracture line is intra-articular, and it's displaced..."
• Good: "This is a displaced, intra-articular distal radius fracture." (Pause). "Features include..."

Thinking Out Loud

Silence is terrifying in a viva. If you are thinking, say so.

• "I am just considering the possibility of a pathological fracture given the transverse pattern..."
• This shows your working out. Even if the answer is wrong, the reasoning might be right (and safe).

Handling the "I Don't Know"

You will get a question you don't know.

• The Pivot: "I can't recall that specific classification, however, the principles of management would rely on assessing stability..."
• The Honesty: "I don't know the answer to that. I would look it up in [Source] before proceeding." (Safe).
• The Trap: Guessing. Examiners can smell a guess. It looks dangerous.

4. The "Angry" Examiner

Occasionally, you will face an examiner who seems hostile, aggressive, or dismissive.

• Don't take it personally: It is often an act to test your resilience under pressure.
• Don't fight back: Remain polite, professional, and calm.
• Stick to principles: "I appreciate that perspective, however, my concern for patient safety leads me to recommend..."

5. Virtual Viva Etiquette (Zoom/Teams)

Post-COVID, some exams may be hybrid.

• Eye Contact: Look at the camera, not the screen.
• Lighting: Front-lit. Don't look like a shadow.
• Audio: Use a dedicated microphone. "Can you repeat that?" breaks the flow.
• Lag: Leave a 1-second pause after the examiner finishes speaking before you start.

Conclusion

The viva is a performance. You are playing the role of a Consultant Surgeon.

• Dress the part.
• Speak with measured authority.
• Prioritize safety above brilliance.

If you can convince the examiner that you are safe, sensible, and pleasant to work with, you will pass.

References

1. RACS. "Fellowship Exam Reports." (Read these to see why people fail).
2. Bandiera G, et al. "The Verbal Viva: A communication skill."