I thought this was an updated version of an earlier release by these publishers, namely Advanced ENT Training. A Guide to Passing the FRCS (ORL-HNS) Examination, by Manjaly and Kullar (CRC Press, Taylor and Francis Group, 2020), but this proves very different and both texts are of value. The earlier was almost unique in teaching examination ‘survival’ skills, while this is more in the traditional ‘Short Notes on’ format, with most of the chapters concentrating on specific clinical disorders, whether Grave's disease or pharyngeal pouch. That is invaluable for revision and makes this a useful revision text for any trainee, however remote the examination seems at the time.
From personal experience of 12 years on the easier side of the viva table, the questions posed, however, tend to focus on clinical issues; for example, ‘A patient presents with a chronically discharging ear and a facial weakness. How will you manage this?’. Once the candidate has managed to diagnose cholesteatoma, then this book nicely kicks in. The authors clearly have only recently been on the receiving end and I suspect none were invited back in six months, so their personal insider knowledge may be limited. Fortunately, there are some very experienced examiners listed amongst the contributors. The Foreword is written by Prof Quraishi, whose course in Doncaster has prepared candidates for the Fellowship of the Royal College of Surgeons qualification for decades. I was amused by the Introduction, which lists abbreviations used in ENT, all seven pages of them. Am I alone in obsessively looking at car number plates for ‘OAE’ (otoacoustic emission), ‘SMR’ (submucosal resection) or ‘PMH’ (past medical history), for example?
The text emphasises structure in the answers, which does help when under stress or in sheer panic, and, of course, each of the four traditional viva stations merits sections that comprise the bulk of the book. My interest was most concentrated on the final two sections, the clinical examination and communication stations, surely the most dreaded for the candidates. The former merits 10 pages and I assume the paediatric station is no more. That was a nightmare for the organisers, the candidates, let alone the subjects and their families, and, if so, it will not be missed. The temporal bone drilling exercise, equally, did seem like a good idea at the time. I liked the model response to the inevitable question, ‘Is there anything else you would like to do?’, but would love to have seen this whole section expanded.
Finally comes the communication skills station and this proves the highlight of the book. I was worried that a patient with a cocaine habit and septal perforation also proved cytoplasmic antineutrophil cytoplasmic antibody positive, with no further comment. Much earlier on in the book I then read that this is due to the preservative levamisole that accompanies the drug. The things that an old dog can still learn.
I was particularly grateful to the publishers for a paper copy of this book, as, like so many now, they tend to solely offer e-books to reviewers. I would concede that the format of this book would lend itself to reading off a screen, as it is more a dipping-into than a read-cover-to-cover exercise. It certainly does not replace, and is in fact very complementary to, Manjaly and Kullar's textbook, and, of course, has a value well beyond the exit examination.
