Practical Orthopedic Examination Manish Kumar Varshney
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How to Approach Exams?2CHAPTER 1

 
WHAT IS EXPECTED IN EXAMS?
After the immense hard work at orthopaedic residency program and practical experience spree it's difficult to put forward the argument in favour of a one or two-day assessment of the candidate deciding his fate to procure degree. Everyone has to still undergo the same stereotyped manner of judgment deciding one's ‘fitness’ for the degree. Nevertheless it is a matter of fact that the examiners have also undergone the same course over the years making it easier for a candidate to pass exam if it is taken in its “true perspective” which is often unknown! Candidates often find it an ‘uphill’ task to ‘please’ the examiners in exams for want of understanding of the main purpose of exams and the “desired perspective”. The following points are projected to give an outline about what exactly is expected from candidate:
  • The way a candidate approaches the patient: This should ideally be reflected upon as a firm but sober and professional approach to the patient (always remember to be gentle and kind, be keen, be confident, be smart, be professional – it's not too much an ask!). Give patient enough time (from your stipulated time, don't be thrift – believe me it helps; sometimes you will find that the patient tells you the diagnosis!). Explain every procedure to the patient and confirm the doubtful points to streamline your ‘history taking’ part. Follow the basic norms like to examine the normal side first for comparative assessment etc. Always pay particular attention to the surroundings, e.g. footwear, assistive appliances and make a note of them before starting ‘your’ “probation”. This will tell the examiner that you know how to start solving the problem.
  • The way a candidate approaches the given problem: Perhaps the most difficult part in the absence of practical experience (good judgment comes from experience and experience from bad judgment). A hands-on experience in out-patient department which is often time constrained and theory and academic classes give excellent opportunity to present patients to ‘well-experienced’ consultants – who are surely examiners for 3others and possess immense experience – never flee away from them (Mistakes teach you the most – The biggest fault of life is to think that you have none). Ward rounds and patient work-up immensely help develop one's skills. Examination anxiety imposes a sense of hurry, and uncertainity about cases throws up disarray in approach which is often striven in the end by a quick fix solution that indeed jumbles up the problem turning on the vicious cycle. Always attempt to develop a unique but well-manageable and adequate approach for most common cases. Regular practice should make one comfortable in exams.
  • The way a candidate presents the problem and his viewpoint: After examining the case appears the ‘true’ encounter whereby you will be assessed as regards your capability to communicate with the examiner about the case. For this you should be a part orator, part clinician and part politician! You should be smooth and focused in presentation with tactful representation of the facts leading to diagnosis but not projecting at the same time to the examiner that you are biased by a diagnosis. Keep your mind open to anything and be unprejudiced for criticism.
  • The understanding about the given problem and possible solutions: Always answer to yourself in the following sequence of the problem and solution (What is the problem? → What can be done? → Why should it be done? → When to do it? → How to do it?; What, Why, When, How). Just making a diagnosis in a long case and particularly in a short case does not surmise the assessment. One is required to know the basic etiopathogenesis and management perspectives of the same. Particularly for some cases being a specialist in the field you may even be asked of the popular historical perspectives (so you also need to be a historian!). The treatment or management options you give require that you know fully about them and that it should fit the case. Don't beat around the bush, take your time. No one will fail you for being sloppy if your answers are correct, as even 4the best of clinicians are perplexed sometimes by simple problems in unusual circumstances!
  • Explanation of most common solutions: You should be the ‘boss’ of the most common procedures performed. Any question asked right-left or centre should be answered with the ease of cutting butter with a ‘spoon’ in summers.
 
HOW TO PREPARE FOR EXAMS?
This is the shortest written portion of this book specifically reiterating the fact that it's individual's way of learning, however, there may be some advice of help.
  • Refer and follow the standard practice.
  • Continuously practice and revise the important cases.
  • Be focused.
  • Develop communication skills! (Difficult; but of tremendous help, most candidates who fail are just unable to express what they actually mean although they are correct in essence).
 
DO's AND DON'Ts IN EXAMS
There are a few things that should be done and more importantly few that should not be done:
Do's
  • Be calm and patient!
  • Be tactful but considerate
  • Be clear in perspective
  • Be confident with apt knowledge
  • Be frank
  • Accept your mistakes if pointed out, be flexible, open-minded
  • Finish with a smile to patient and examiner.
Don'ts
  • Be in a hurry or anxious or overzealous
  • Try to be clever
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  • Try to jumble up problems or become a researcher with innovative ideas!
  • Mess up with facts or try guessing work!
  • Be overconfident and arrogant
  • Be dominative
  • Argue
  • Show disappointment or frustration over disagreement
  • Make hasty conclusions!
 
HOW TO READ THIS BOOK?
A concise yet comprehensive attempt to recreate the questions may make some aspects of the book difficult to grab! It is well accepted that basic concepts regarding the management and diagnostic perspectives differ depending upon the personal and practiced algorithms by various ‘experts’. You too may differ in various respects being amateur in the field (Information consists of differences that make a difference). The book definitely does not give a holistic approach to all the cases, but is a willful attempt to introduce the basics for revision with address to some intricacies of the cases that may need further refinement according to the local practice. It is imperative that at the important juncture of exams one needs support from the internal examiners who are basically ‘internal experts’ and would be able to better explain the ‘locally practiced’ protocols. I would appeal the readers to go through the book as-it-is once and then practice the cases. Mutual/group discussions over particular problems make fundamentals clear and easy to grab. Don't be in an illusion by ‘illegitimate’ concepts that are unacceptable. The book has been prepared after considerate and careful analysis of the various standard texts (more than 21 textbooks) and review papers (more than 650) that are acceptable to most by and large (the acceptability threshold may however differ!). The concepts given are standard for orthopaedic practice, but personally I will prohibit quoting of the text or concepts or guidelines given herein, one should adhere to standard textbooks or reviewers to this rescue. I feel here to reiterate the fact that what is written in this book is not 6a hypothesis or personal research work, to give a sense of security to the readers. You will gradually come to know the source for manuscript while reading your textbooks. The read times are calculated approximations depending upon the general practice and exposure of graduates, complexity of topic, importance of topic and compactness of information provided. This, in general holds true but ‘exceptions are a rule’ so one may diverge considering his own knowledge and exposure and the local prevalence of particular topics (e.g. shoulder may be omitted fully while hip may be read twenty times!). General flow of questions in exams not necessarily follows the pattern given herein and in a “virtually-realistic” exam it is bound to differ, but one is always questioned of the reasons for giving a particular diagnosis, possible differential diagnoses (with reasons), management protocols, etc. That is primarily stressed upon in this compilation. Some stereotyped questions are oft repeated like ‘What will you do next’, the answer to which is often wrong in an anxious environment! And will hence be found in most of the chapters so that it becomes a habit of the candidate to correctly reply the same as it is the watershed between the diagnosis (considered less important part by the candidate) and management (more stressed part).
Try reading the chapters from beginning unless revising particular concepts as continuity has been specifically dealt with, otherwise some concepts may be overlooked. Teaching notes or text in italics is often ancillary and sometimes includes controversial and unsettled issues needing individual judgment for acceptance. Lastly, where a large amount of knowledge is presented with alternative procedures, the underlined text serves as the standard or most commonly followed method, but is again subjected to individual assessment for want of standardization.
In spite of the best efforts one may not accomplish the desired. The disheartening fate dictates some lapse in fundamental approach which all cannot be laid down in a narration and entails experience – remember hair don't just turn 7grey in sun (Experience enables you realize a mistake when you make it again!). I surely do not mean that one needs to ‘fail’ to understand the cause of failure but it should be emphasized that prevention by a masterly carved approach pays rewards. There is no short-cut to success and exhausting effort with indelible persistence is required to become a specialist. Destiny is not a matter of chance but of choice, and the choice is still yours till you have to face exams. You can achieve what you want with a good strategy. Strategy building is not just a subject of fighting wars or winning elections – remember those times you devised time to see a movie or attend friend's marriage by quickly shuffling day's work – that's also strategy.