Ausr. N.Z. J . Surg. 1991. 61. 878-879

SPECIAL ARTICLE

RECENT CHANGES IN THE PART II FRACS EXAMINATION

JOHN HAM'

In 1988, the author presented data summarizing details of the advanced surgical training programme and the Part I1 FRACS Examination.' A summary of proposed changes in the examination was also outlined. In this paper, recently introduced changes are discussed, together with a series of new proposals.

Organization of the Court of Examiners There is now a Senior Examiner in each of the eight specialities in which the Royal Australasian Col- lege of Surgeons examines (the examination in oph- thalmology is conducted by the Royal Australian College of Ophthalmologists, with a representative of the Royal Australasian College of Surgeons at the Court of Examiners' discussion of candidates). These Senior Examiners are elected by the Examin- ers in the appropriate speciality and serve for at least two years. Their duties include co-ordination of advice about the selection of new examiners, the development of banks of written and multiple- choice questions, the setting of the written papers in the speciality, organization of the examination in the speciality (particularly the clinical examina- tion), and advice about the exchange of examiners between Australia and New Zealand. In certain specialities, such as general surgery and ortho- paedics, there are Senior Examiners in both Aus- tralia and New Zealand.

The Council of the College has agreed that the Senior Examiner in each speciality in Australia is ex uficio a member of the appropriate surgical board; this ensures that there are appropriate links between the Court and the Boards in matters relat- ing to the curriculum, surgical training, and the examination. It is expected that the Australian Sen- ior Examiners have a close liaison with their New Zealand counterparts.

The Senior Examiners, together with the Chair- man and Deputy Chairman of the Court, form its

'Chairman, Court of Examiners, RACS

Correspondence: Professor John Ham. Department of Surgery,

Accepted for publication 28 July 1 9 9 1 .

Prince of Wales Hospital, Randwick, NSW 2031, Australia.

executive, and this executive meets at the time of each examination. There are also meetings of each speciality group, and a meeting of the full Court.

In October 1990, an extended meeting of the executive was held, together with senior examiners from New Zealand. At this meeting, a number of major changes in the examination were proposed. Summaries of the discussion and the proposals were circulated to all examiners, and to all surgical boards. After some modification, the proposals were then agreed to at meetings of the Court in both Australia and New Zealand, and subsequently ratified by Council at its meeting in June 1991.

The major decisions are summarized in the next section. It should be noted that there may be some changes in the details, and that the lead time for their introduction is not totally finalized, but the broad thrust of the proposals is agreed.

Summary of decisions

CORE C U R R I C U L A A N D COURSES FOR ADVANCED TRAINEES

Some specialities have well-defined core curricula, and some have courses for their advanced trainees - either a strand of formal teaching throughout the advanced training period, or a short intensive course, or both. It was recognized that specialities with the best developed courses (both short and long) also had the highest pass rate in the Part I1 Examination; the converse was also true.

It was therefore agreed that speciality boards that did not have well-developed training courses should correct this deficiency. Surgical boards were also encouraged to develop core curricula, perhaps based on the content of the courses. It was stressed that the development of a core curriculum would not define the limits of the examination, but would define absolutely basic knowledge.

SELECTION OF N E W E X A M I N E R S

New examiners are selected by a sub-committee of Council, on the advice of the examiners in the speciality, the speciality Board, and the speciality Society or Division. The co-ordination of this advice was previously carried out by the Chairman

of the Surgical Board, but it is now agreed that the more appropriate person would be the Senior Examiner of the speciality. As already indicated, the Senior Examiner is ex o$icio a member of the Surgical Board.

CHANGE IN THE TIMING OF THE NEW ZEALAND EXAMINATION

Currently, advanced surgical trainees in New Zea- land may sit for the Part 11 examination in Novem- ber of their penultimate year of training - about six months earlier than advanced trainees in Aus- tralia. It is now agreed that New Zealand trainees will sit in May of the last year of training. This change is linked to programming changes in the examinations outlined in the next section.

CHANGES IN THE PROGRAMMING OF THE EXAMINATIONS

Currently, the larger examination in Australia is held in May, and in four years out of five this is held in Sydney, with a rotation to Brisbane in the fifth year. The smaller examination is held in Octo- ber, and in four years out of five this is held in Melbourne, with a rotation to Adelaide in the fifth year. The following changes have been agreed:

(1) The May examination in Australia should alternate between Sydney and Melbourne.

(2) The May examination in New Zealand should alternate between Auckland and Wellington.

(3) There will be one examination at the end of the year (the exact timing is still uncertain) and this examination will rotate between Brisbane, Christ- church and Adelaide.

The effects of these changes are: (1) The work of those organizing the Sydney

examination will be reduced. (2) There will be a large examination in Mel-

bourne every two years. (3) The examination will be held more fre-

quently in Brisbane and Adelaide. (4) There will be a slight increase in the number

of examinations held in New Zealand, and a slight decrease in the number of examinations held in Australia.

There has been a marked increase in the number of exchanges of Examiners between Australia and New Zealand over the past four years, and the proposals stated here will further increase the num- ber of exchanges. This should have the effect of making the whole Court (i.e. both Australia and New Zealand) more cohesive, and will also ensure that the New Zealand members examine more frequently.

It is hoped that these changes will be introduced in 1993.

TIMING OF THE WRITTEN EXAMINATION

Currently the written examination is taken shortly before the clinical and oral examinations at the Examination Centre. It is now proposed that the writtens be held simultaneously in a number of cen- tres in Australia and New Zealand, but be marked by the examining group at the Examination Centre. This change will not affect the Examiners but will reduce the time that candidates have to spend at the Examination Centre.

For the past few years, certain of the speciality groups have agreed on ‘model’ answers (or examin- er’s guidelines) for all the written questions prior to the marking procedure. It is now agreed that this system should be used by all speciality groups.

BANKS OF SLIDES, PHOTOGRAPHS. X-RAYS ETC.

Such banks have been used in oral examinations for some years, and it is now agreed that they should be developed by all specialities. They are most appro- priate for pathology and operative surgery vivas.

FEEDBACK TO FAILED CANDIDATES

The principle of providing appropriate feedback to failed candidates has been agreed. There have been some practical difficulties with the large number of candidates in certain specialities, but all senior examiners are now providing a written report on candidates’ performances, both successful and unsuccessful.

OSCE FOR PATHOLOGY EXAMINATION

There are some differences of opinion about the potential for an OSCE-type examination for pathol- ogy, but it is agreed that it may well be appropriate in some specialities.

RELATIONSHIP BETWEEN THE PART I BOARD A N D THE COURT

There are several areas of overlap between the work of the Part I Board and that of the Court. Exchange of views is obviously essential, and it is now agreed that each should be represented at the other’s meetings.

REGULAR PROVISION OF INFORMATION ABOUT THE EXAMINATION

Members of the Court feel strongly that it is impor- tant that information about the current examination, and proposed changes in the future, be widely dis- seminated to Fellows and trainees. Such informa- tion is regularly available in the College Bulletin, but it is felt also that a paper such as this should be published from time to time in the Australian and New Zealand Journul of Surgery.

880 HAM

The future of the examination tion, or a series of multiple-choice questions,

A second extended meeting of the executive of the Court will be held in October 199 1, and this will be organized along similar lines to that of 1990. Dis- cussion documents and proposals will be widely circulated before submission of any new proposals to Council in June 1992. Some of the issues that are likely to be discussed at that meeting are:

(1) Definition of the relationship between the speciality examining groups and the whole Court Currently, the whole Court carries the responsibil- ity for passing or failing a particular candidate; the advice of the speciality group is almost always fol- lowed, but the whole Court does have the right to reject that advice.

(2) Specialization in surgery What is the impact of such specialization on the examination, and on the selection of appropriate examiners?

( 3 ) The clinical examinations Do these reflect

together with an oral examination. Should we take steps to ensure that the content is more closely related to operative surgery?

(6) Observers at the examination Currently, a small number of surgeons sit in on the examination as observers. These are often surgeons closely con- cerned with training, or surgeons who might be considering applying to join the Court. Should we consider co-opting more surgeons as observers in order to disseminate information about the examination?

It is clear that there have been many changes in the Part I1 FRACS examination in recent years, and that there are mechanisms in place for evaluating both the current examination and new proposals. The Court would welcome comment from trainees, Fellows, Boards and Surgical Societies on any as- pect of the examination.

practice in the speciality? If not, how might they be altered?

iners? Should we examine the examiners?

examination currently consists of a written ques-

(4) New examiners Should we train the exam- Reference 1 . HAM J. M. (1988) Advanced surgical training in Aus-

( 5 ) The anatomy examination The anatomy tralia and New Zealand and the Part I1 FRACS Examination. Ausr. N.Z. J. Surg. 58. 937-40.