Clinical and Procedural Skills for MRCS Part B

In the Intercollegiate MRCS Part B (OSCE) Examination, candidates are required to demonstrate competency in clinical and procedural skills that are relevant at the level of a junior surgical trainee. The stations are marked against a set of criteria that takes into consideration the four domains (broad content areas) - knowledge, skills, competencies and professional characteristics – which map to the General Medical Council’s Good
Medical Practice.

This component of the exam will test the candidate’s capacity to apply sound basic science/clinical knowledge in a practical context. It will also test the candidate’s ability to perform practical tasks related to surgery that requires manual dexterity, hand-eye coordination and visual/spatial awareness. In addition, this part of the exam will test aspects such as capacity, consent, theatre safety, WHO checklist and principles of safe
surgery. The clinical and procedural skills may make up to about 15-20% of the overall marks in the exam.

Each chapter in this book is laid out in a format similar to a station as tested in the exam. It provides a clinical scenario/setting, important things not to miss, talk through, equipment required, one accepted way to perform the procedure and a sample mark scheme. There are some relevant questions and answers at the end of each chapter, which will help the user to prepare with a colleague in the run up to the exam.

This book does not intend to teach the user to simply perform the procedures, as they are mostly common tasks junior surgical trainees carry out on a day-to-day basis. Rather, it is a resource that helps the user to be informed of what is expected of them in the exam and flagging up important points that should not be missed.

In the exam, the candidates are suggested to read the scenario carefully to understand the precise nature of the task. As a general rule, in stations that involve patient/actor interaction, introducing oneself with full name and position and obtain verbal consent are important. Most tasks may be simple to perform but the exam is about demonstrating to the examiner that one is safe, meticulous, has the required knowledge and skill, and able is to interact with the patient (actor) at the same time. If one is asked to perform a procedure on a patient who is already under general anaesthetic, introduction to the patient might not be relevant but it is essential to state that the person undertaking the procedure would like to confirm the identity of the patient, checks the consent form, inspects if the surgical site has been marked and carries out the WHO checklist. All of the above can be done with a well-rehearsed statement in a very little time, securing good marks and allowing to quickly proceed to the task at hand. This concept is reinforced throughout the book.

LIST OF CHAPTERS
Arterial Blood Gas Sampling
Cannulation of a High Risk patient
Consent
Capacity
Debridement of a Contaminated Wound
Electrosurgery (diathermy) and Tourniquets
Fine Needle Aspiration
Lumbar Puncture
Male Urethral Catheterisation
Organising a Theatre List
Theatre Safety and Design
Removal of a Naevus
Safe use of Local Anaesthetics
Scrubbing up for Theatre
Suturing Skills: Closure of a Wound
Knots and Tying at Depth
Transfer Documentation
Trauma Chest Drain Insertion
Writing a Discharge Summary