John HillThe four surgical Royal Colleges in the UK and Ireland have joined forces to deliver a quality assured fellowship examination with the aim of promoting safe standards and surgical excellence worldwide. We caught up with John Hill to find out more. 

(Image: John Hill)

Can you tell us a little about your involvement in surgical examinations?

My first experiences were as a candidate sitting general surgical and ENT fellowship exams in the late 80s. I was initially unsuccessful at both, so I carry plenty scars from those days. In 2000 I became one of very few ENT surgeons on the Member of Royal College of Surgeons (MRCS) panel; I thoroughly enjoyed working with surgeons from other specialties and basic scientists. It was also much more interesting and enjoyable than being a candidate. In 2001, I was co-opted onto the Diploma in Otorhinolaryngology (DLO) exam, at the time we were transforming it into the objective structured clinical examination (OSCE) based Diploma in Otolaryngology Head and Neck Surgery (DOHNS). In 2007 I became an intercollegiate examiner and question writer. Constructing a good, pertinent multiple-choice question is surprisingly difficult! From 2014-17 I chaired the exam board and complained regularly to the Joint Committee on Intercollegiate Examinations (JCIE) that ENT was disadvantaged by not having an international version of the UK Intercollegiate FRCS. General surgery, orthopaedics, cardio-thoracics, urology and neurosurgery have had international versions running for the last few years. I was delighted that the college presidents agreed last year and then asked me to get on and organise it. 

Did this experience inspire your work on the International FRCS?

Absolutely, but I also have an appreciation of the difficulties involved in providing examinations worldwide. I worked for a year as a lecturer in Hong Kong in and am now the lead external examiner for their exit exam. I have also been lucky enough to have been an external examiner in Sri Lanka, Kolkata, Kuala Lumpur and Singapore over the years. I have a deep understanding of how to create and run a reliable, consistent exam that is fair to candidates. I also appreciate the difficulties of maintaining a reliable, valid exam, particularly in countries with a small number of candidates and a small pool of examiners. 

What are the main aims of this initiative?

To provide a respected exam open to ENT trainees around the world. The exam will be the same standard as the UK Intercollegiate exam, an exit exam aimed at trainees that have had at least four years of registrar level training. It will also have the same format: a section one of multiple-choice questions, and section two with vivas and clinicals. The UK exam has a communications bay that would be difficult to replicate for candidates from different cultures so that is not included. Section one can be sat online in designated centres in most countries. The first sittings are in 2020. We’re aiming for the first section two in Kuala Lumpur in 2021. Applications are through the Joint Surgical Colleges Fellowship Examinations (JSCFE) website: 

How have examinations changed since you sat your own FRCS exam?

Colossally, thank heavens. These exams are still difficult and cover the breadth of the specialty, but questions are now planned in advance. The performance of each question and examiner is measured and fed back. For examiners this, feels a little claustrophobic but for candidates modern exams are much fairer and more meaningful. 

Do you have a favourite question to ask in the FRCS-OLHNS examinations?

The best questions are those that make a candidate stop and think, putting together knowledge and experience to sort out a clinical problem. My favourite questions are the ones where I learn something new, either from my fellow examiner or the candidate. Medicine means lifelong learning, even for examiners.