 Welkom dit eurse probleem op dit eurse probleem, dit eurse probleem op het internedie. Wat ik dacht, ek wil u te mentionen, dit is de gode van dit probleem om te starten. Wat ek van die volgende couple van weken wil, want we doen dit tot dit eurse eurse eurse eurse eurse eurse, jy heb genoeg tijd om het te doen, en we gaan nie genoeg wat die stof doen. is het om jou volledig te bereikersen, wat is hetle doen, wat is hetle doen, en even, of jogging, of sikeling, wat gaan we doen, ons praat nie. We gaan nie die dag op die rink en ons verkoop nie, en die intermediaal examen is een groot event. Je gaat praat nie, praat nie, praat nie. Dus die vaste melde van candidates die verkoop nie, en ze hadden geen preperatie, ze sat daar met hun boek en het uit en ze studeerde, studeerde, studeerde, ze gramd het alles en die get daar en ze wilde ek die dood, want dit is wat ek aan die dood moet doen, ek ek die dood jouw dood, maar die nie genoeg praat het daar nie om die dood in het op te gaan, in het om die dood te gaan in die dood, en u kan die kandaan zien, het is heel makkelijk, ek is ek die dood in die dood om iemand te pitsen op en want die dood die dood en is nie codein na het oud nie is nie goed gaan doen, er is nog geen manier die goed gaan doen en het is hetzelfde voor dit examen, er is een hele techniek behind te doen in dit examen en dat is wat je gaan learn hier dus het hele idea behind dit is nie te geef jou nog eentje dit is nie het tutorial en als jy ook op die naaie jy zeggen, ben jy die op die naaie gaan slapen ok, het is het simpel is dat als jy hoe oud jou is en ik ga nie op de tabel ask wat die oud is, ok. So, imagin je wens te gaan studieën wat scientifice dingen. You're going to become a physicist, four years BSc, master's degree, PhD by the time you're 25, 26. After that you're a postdoc student en by your age, you've contributed massively to your field because you've had a PhD for quite a while now. Yet here you are at your age, you're tiny little students trying to pass an exam and just feeling so sorry for yourself, you know. So inferior, you know, is this wrong? See yourself in perspective. You are very senior students when you come to university, extremely. You've got to realise that and act like that. So we are not here for me to give you knowledge, this is not a tutorial. Now I know sometimes we do put emphasis on becoming and jotting down, that's how a lot of your time here does work. I'm against that completely, this is not a tutorial. You are old enough to go study and need up yourself. I'm going to prepare you to be fit to walk into the exam. So you're walking there, nothing is unknown, nothing is unexpected. You know what questions you're going to get and you know how to answer them. You're going to be walking in there fully prepared and you know how well we've done with this programme. For the last two we've had 100% and for the majority of these we've had 100% pass straight. Here and there we've had one slipper. But the pressure is really on you now. Everyone just passes. It's because they walk in there prepared. They're all good candidates, it's not all up to this programme. They've all put in the hard effort but they walked in there and they knew what to expect. Nothing was foreign to them. It was easy for them to do in their respect. Ask them about it. So there's a whole science behind doing the oral exam. I can't prepare you for the MCQ and I'll say something about the MCQ because there's always lots of questions about the MCQ. I can't prepare you for that one. That's just sitting on your behind and studying but I can't prepare you how to attack the oral exam. There's a whole science behind answering or handling the situation. Let's go sit there and let things just happen and let me go through this. There's a way to do this. There's a whole science and the philosophy behind approaching answering those questions. It's not just your knowledge that comes out your mouth. There's a lot more to that. And as an examiner I experienced the way that you respond in that situation. And that response tells me a hell of a lot about you. But I'm going to tell you about that so that you know. I'll tell you what goes on inside the examiner's mind. Which gives you a hell of an advantage over someone who doesn't because you're going to presume a lot of things. And as with most things in life your presumptions are going to be wrong. So that's what I mean. You will be prepared after this so that you can walk in there and know exactly what the situation is. So one of the big things about this you're going to come in and I'm going to ask you a question of the question of the question. The whole idea, one of the big ideas is so that you hear your own voice. Going into the exams should not be the first time that you hear your own voice. Because there's a lot of knowledge in here but it's never come out here. That neuronal pathway has never been exercised. You can think about the answer in your mind and you can recite the 16 causes of whatever. But that's a whole bunch of different neurons that actually activate your larynx. And those neurons have to be exercised as well. They have to go a few Schwann cells around them so that they are well sort of oiled. And that is not the time to hear your own voice. Sometimes it's good to go sit in front of a mirror and answer questions to yourself. You laugh, it's a good idea to do. Just to see what you look like. I'm going to say something about what you look like when you sit there very short. Be familiar with what the examiner sees and what he hears. Record yourself and see how you hear what you sound like. In broad terms what is the goal of the exam because I think many people have a misunderstanding of what the goal is. So the examiners get there usually the night before and we get put up in a hotel and sometimes it's old colleagues which you haven't seen for a while. So there's usually one or two handshakes maybe one or two beers or whatever. You know the little groups fall and you can eat something and you go to bed because tomorrow morning you've got to be out of bed early depending on where the exam is you have to get into a little bus and be taken there. And it's getting up early and it's usually cold and it's not the nicest stuff. It's not as nice an experience for the examiners as you might think it is. So now you get there. You get together in a little group as everyone gets there and we get horrible coffee. We haven't had good coffee yet. And then tiny little sandwiches or something as is the supposed breakfast and that has never been a success either. But anyway the exam commissioner stands up and he gives a little speech and he reminds us what this exam is for. And the first words that are always said is this exam is to identify the candidate who is safe to carry on with further training and preparing for the final exam. Safe. So you just want to identify the guy or girl I'm going to say guy a lot by that I have used the genetic term for human beings is the one who paid attention and you can see he's actually done this before. And then the commissioner goes on to say so try and keep your questions situation based because all I want to see is this a safe person to carry on or could he or she just use six more months just to get bit more experience and be a way of what's going on around here. It is not a test of knowledge. This is a massively broad exam. There's no defined limits to what really can be asked. So we can make it very difficult. I can ask very esoteric stuff. And by the way once you get those questions relax because by then you've already done well when you get the real difficult questions. But it's about the principles of surgery. So we want to know have you been paying attention have you done this before do you understand what this is all about not specifically the metigrity of the knowledge. And as an examiner when we start asking these things we all human beings we actually we are then making mistakes as examiners. I can this for the fact that these exams should be recorded but we can listen to them again afterwards. Of course it's not done. But I'm a great believer that these exams should be because the examiner has a big responsibility during these exams to stick to the rules. And the rules are just to see have you been paying attention do you understand what this is about can you manage the broad principles of this. In your final exams you'll get to the metigrity. So really it's not a test of raw knowledge because if you can tell me the 16 causes of something I'm going to be very worried because you just memorize that to forget by next week. And that doesn't make you a good surgeon by any stretch of the imagination. Probably the safer guy is the guy who goes to look it up again and he's not going to miss anything versus you who memorize that and then can verbalize those 16 causes. There's something in that for me. So there's one big philosophy about this whole examination process to sign you off as a specialist one day. And that is a big misunderstanding that I feel that is on a registrar side because I experienced the same thing so long ago. Is that you think that forcing you to do 3 exams to become a specialist in sitting and studying is to force you to gain the knowledge. That's not what this is about. Remember knowledge is empowerment. It empowers you to actually go do your job. So this is not a test do you know your job. You should know this word because you've got a job to do. It is gaining knowledge for yourself, not for an exam. You're not reading up this so that you can pass in a couple of months time. You're reading this up for yourself because this is what you're going to do on a daily basis. You need this. You need to empower yourself to go treat the patient. That's why you're doing this. The exam is just this thing that human beings thought up a long time ago as some measure of do you actually know. An exam is the worst possible design. Exams are just silly in my estimation but we have nothing better and we've been carrying it for ages since when was the first exams. Hundreds and hundreds of years ago this is what human beings have and we think that's good. It's not good. You're not doing this for an exam. You're doing this because you've got to treat the actual patients. When you see it that way it becomes much easier to go up and read the stuff. If you don't see it, there's something that should just be done for the exam. You need to know this to be able to do your job. It's as simple as that. Two parts to the exams. You all know it's MCQ. A couple of years ago now it's changed to MCQ. I'm very vocal in the fact that I don't agree with MCQ. As soon as you say that people will refer you to the fact that there's a lot of literature that states that it's a good tester of knowledge. My counter argument to that is it's extrapolated from data on MCQs as a test for non-surgical disciplines. In other words, man-made things like law, commerce, that sort of thing, or undergraduate students where we teach them black and white. As a faculty, any medical faculty in the world, we've decided this is how we treat things and this is what we want our undergraduate students to know black and white. You see this, you do that. You're a postgraduate. It's different for you. You've got to understand levels of evidence. You've got to understand controversies. And you've got to understand the situation around which there's so many factors that you have to deal with. You're not an undergraduate student. You know we're in the war. It's not black and white. And MCQ for me is not designed for that sort of artful, experienceful form of knowledge. For me it's a poor thing and I want proper research, someone to show me proper research done on this type of topic, for instance. And the broad principles of surgical care. I do not. There's no way that I can believe that this is a good, but that's what we have. You're stuck with it and you've got to deal with it. I have seen people not pass it and I thought they were good candidates and I've seen people who I thought had a little bit more to learn and they just passed. For me it's really not always an indicator of your actual knowledge and that's what I'm fearful of. I want an exam that reflects the effort that you put in the knowledge and the innate ability that you have. Now you've got into med school so presumably the mental capacity is there although I reserve judgment on that one. But you've got into med school that you need something to get in, to start over. So the mental capacity is there but I'm not sure it's a fair reflection on the effort that you put in and the knowledge that you have. That's my fear of the MCQ. And I know that. I don't keep it a secret. That is my fear but that's what we have the MCQ and you've got to deal with it. It does require you to have a bit more, a bit finer level of knowledge. You've got to sit there and study. There's no two ways about it. For that matter there are a lot of British, I think, books out there that have examples of MCQs. I would advise against those. All the MCQ questions that you get are South African made for the South African context. For the local context. Local people sitting those questions with a local perspective. So you might run into difficulties if you look at the British ones. They are not sourced from outside the country or from some repository or some other textbook or online somewhere they are. Home made, home brewed by the people that are your examiners. It's as simple as that. So be very careful when you look at other MCQs. There are some, I think, on the college's website. They are not representative of the questions you can get. I think some work needs to be done there. I listened from the last time I saw them. There are some work has been done on that. I apologise for that. Have a look at them. But speak to the people before. The vast majority will tell you those on the website are not representative of the exam questions at all. And remember the exam questions we add to them all the time so that repository grows and so we move on all the time and it gets bigger and bigger for us to choose better ones from. It is kind of a new thing so the repository is not that big and we still have to learn which are good questions and which are bad ones and the college does go through that process. So with time I suppose it will get better and it is still failing you so there are still some issues about it. And then there is the oral exam and that is what this is all about. You are going to walk in there, fit athletes and you are all going to pass. If I think you are not going, I am going to stop you from going. I am serious. This is years we are going to find out that I am not a nice guy at all. So I will tell you if you are not ready. I will. And they all passed the time before I sent everyone in and they all passed and so it goes. If you do not attend this I will not have any judgement on you and I will just let you go and that is where we have the one or two failures that we have had over this long period that we have been doing this. That also reminds me of the fact if you cannot be here you let me know this is professional. I meet that for you. If you cannot be here and there is a user because I want to teach you something and I want to talk about it. So if you cannot be here you let me know that you do not just stay away I will not accept you. So what to study? That is a big question people want to know. Because this is a very big exam there are the topics all listed on there ask any candidate who has passed this exam people ask way beyond those topics that are on there. It is an ill-defined exam. So my suggestion to you pay attention every day that you are in the ward the same people who are your examiners are the guys that you do ward rounds with. And pay attention what's happening, how you treat stuff it's not that difficult. Most of the questions I say again we are told beforehand try and keep them situational. Doctor, have you treated a patient with a gun shot to the abdomen before? Yes. We handle quite a few of them. Tell me, when a patient like that comes in with this and this specific scenario what have you done? I can listen to you and I can decide have you done this before? Did you pay attention? Did you understand where the problems lie? It's a situational question. I do not ask you what are the 12 causes of this or that. It's wrong because it's situational. So it being the broad principles of general surgery the first few chapters the big famous surgical textbooks Greenfield, Sabaston, you know all of them the first few chapters are all about these broad how to resuscitate how to feed those first few chapters and all of these famous textbooks are excellent. Please do not do the mini menon thing I've got the greatest respect for those old guys they did enormous jobs but those textbooks are too old please go beyond them so the first chapter in any of the good textbooks is a good thing to do the most important thing though are review articles people put a lot of effort these day review articles are the in thing in literature people try and publish these things and there's a lot of effort that goes into review article it already puts together everything you don't have to go search for it you just have to find the review article don't use google don't use google scholar and for the life of me don't use wikipedia use pubmed or the cotton database any specific formal medical repository now if you go on to pubmed there's a little there's youtube videos you can do to teach you how to use pubmed properly and the best thing to use are the mesh headings and we'll have a session where actually I'll just show you the short cuts because you're going to type in a search code and what you get 1,152 results of which the best article is not on page 1 or 2 okay who knows how to use mesh headings to narrow down your search on pubmed that's just a a base knowledge that you should have everyone should know how to use mesh headings to narrow down your search okay there's videos on pubmed of how to do this or otherwise we'll have a session where I'll show you we've all got university numbers you must all be registered so that you can get the full text articles there's pubmed and there's pmc pmc is a part of pubmed that only has the that will only hand you back full text article references that won't have the ones that just have abstracts never ever just read an abstract then you might be just wasting your time chuck it away so pmc comes from the fact that a lot of research are done with public money so in the united states if your research done with public money within a certain set time period you've got to have the full text available so if you search not under pubmed but pmc it'll only give you the full text but you're all university registered students the university has most of the surgical journals that you're looking for as part of the university so you can get the full text anyway so you can use pubmed just to make your little list and then you'll go on to the UCT website and you'll get the full text articles then try and over read don't get 5 review articles on the same topic it's just useless for trauma you all know there's the east guidelines they very well and they try and keep them up to date so that's an easy website to get to a little list of guidelines for blunt trauma penetrating trauma head injury spinal cord injury they have all the guidelines easy to read and to use that being said you've all been to trauma it should be before you get to the intermediate exam and you all know how to deal with trauma trauma is a large part of this exam when it comes to critical care they have their prescribed text and I'm sure they tell you exactly what to read but a good textbook there I think a good modern textbook is a good thing to have and most of you should have been through there before the exam I think they put in a tremendous effort in teaching you stuff you just have to pay attention and memorize a little bit I do advise you to pay specific attention to recent controversies we all know there's a big thing about saline versus other crystalloids colloids versus crystalloids the controversies in resuscitation sepsis these are the common big things a lot has written about it a lot has been written about many of these things basically everything in critical care so just see what is in vogue at the moment fluid resuscitation just being this big thing about saline colloid massive blood transfusions these things are all in vogue so just watch out what the newest hottest thing is make a little list for yourself as a surgeon for the rest of your career so you go online you search for a list of surgical journals by what's the term I'm looking for suddenly the index of ok I'll remember the word shortly journals are ranked according to how well they do out there there's a term for it as I say I'll get to it shortly I hope my brain is still functional anyway so it lists the journals in an order of how important they are out there so make a little list of 5 or 6 journals for yourself and those are the ones whose index you'll watch out for you can subscribe to many of these things and come see on your emails this tells you the table of content for the newest edition and you quickly read through them just try and keep up to date with what people are publishing so there is the journal of general trauma in critical care for instance that will give you the newest stuff that is happening in trauma the British Journal of Surgery the New England Journal of Surgery the American all of those even if you don't read all of them just see the table of contents what is going on most common errors is what I've got listed next that I just want to tell you about that is from having seen a lot of candidates sit in front of me of the exam the first one is to give in to your anxiety once you've given in to your anxiety you'll do the craziest things suddenly you'll have all these weird arguments in your head is suddenly things that come out your mouth or you will see it in a good light or do the silliest things and see them in a good light and let us think that politeness and the pseudo humility and laughing about your answer suddenly somehow improves your standing you don't know the answer and you make a little joke about it or laugh about it your anxiety just takes over and you can clearly see what happens and you think making a little joke about it, smiling about it or doing some weird thing suddenly makes you appear better in the eyes of the examiner and that's this wrong don't give in to that anxiety never ever appear pathetic because what the examiner what I see is I don't see you sitting in front of me I'm seeing you standing in front of a patient and being all pathetic then go to internal medicine you know, you're doing surgery you cannot stand next to a patient's bed and appear all pathetic you know, that's what I see when I see a candidate completely giving to that anxiety that guy, a girl's got to do six more months before I think they should go to the exam so once you show that I'm going to be very unkind to your exam and I think most examiners are so don't one thing if you forget everything else about this whole program this is the one thing you have to remember you can forget everything else never ever guess you will never fail this exam from not having the best knowledge you will fail and the only reason why you will fail is if you guess and you guess wrong invariably you are going to guess wrong because you didn't know the arms because that tells the examiner you are prepared to take a chance with the patient and his disease that you pull out a red flag and you say I'm a chancer I don't know and I'll just guess and I'll just do some whatever I want so we're going to we're going to do that so many times in this prep where you're going to have a maximum of 5 seconds and then you are going to say I don't know and I'm going to force you to become so used to saying I don't know and be okay with it you're just going to be okay with it and I'm going to teach you how to be okay with it and move the topic move the questioning forward how to get the examiner then off of that topic so you can ask you something else you will say I don't know because as soon as the wrong answer comes out your mouth you are going to fail you will not fail for saying I don't know and that is very counterintuitive anxiety takes over and suddenly you have this massive pressure there's some part of your pine brain kicks in and you want an answer and you have to come out your mouth because you've got this fear of appearing that you don't know anything you will not fail because you say I don't know you will fail because you say the wrong answer and you're only going to say the wrong answer when you don't know and then you start guessing so that is the most important thing you will not guess at an answer the furthest that you will go say this is what I know about it I don't know anything else they're going to push you pressurize you and you're going to learn to say I don't know but say I don't know in a very effective way don't be afraid of saying that tiny little things don't come in and put out your hand and try to shake my hand you all know I shake no one's hand anyway but I'm not there for you to you're not improving your standing by putting out your hand and appearing all polite and formal of that that's not giving you any points and that's also forcing your wall you want to shake hands now you're forcing me to I'm not saying me, I'm saying me as an examiner I don't want to shake your hand and I don't want for you to dictate the process at all so if you put out your hand I'm not even going to take it other people might take it but you know who you irritate you're going to come in you're going to stand by your chair you're going to stand by your chair you're going to sit down I will show you how to sit how to hold your hands how to position your body forward and backwards what not to do with your body we'll go through all of those things never ever say my prof says at my institution this or that it tells the examiner two things number one you're a lazy bugger you didn't go read up yourself you didn't form your own opinion number two is about this you just do what someone else said you just gave over your critical thinking you surrendered your critical thinking to someone else now if that's not bad enough the second part of it is we surgeons we don't all like each other surgeons are not inherently likeable people we don't like each other it's just the way it is it's something about your personality that makes you choose this some of us are better, some of us are worse I don't like that guy and now I sit and I ask you and you tell me what he does and he says it's going to count against you it's human nature if no other examiner does that then I'm the only guilty one but I tell you now I am not so you're going to either piss someone off which is on a human level beware but the most important thing is it just shows me you might answer the right thing and you're still going to get marks for that you won't be penalized but it just tells me something about you if you just say well we do this it's not wrong and I think many people try for the prejudice to us to answer that but then you might as well be undergraduate students what's the difference I can give you a textbook you can study that and you can say on page 45 at the bottom the paragraph says this and this and this you're not a good doctor and I'm never going to trust you as a surgeon I want to know that you actually read up and formed your own opinion and you can understand the literature why this is a controversy what other opinions are and why you choose this opinion we need to tell me all of that and then you say I'm familiar with this because that's what we do every day fair enough but I want to know that you know the whole spectrum of the stuff your answer is not I do this because that's what we do that's not an answer that is called a logical fallacy and it's a lead up on this of logical fallacy this one is called an argument from authority and that argument is a false as a fallacy never ever say I just forgot I know this but I just can't remember well if you're standing by the patient's bedside what the hell does that help you that you used to know or you just forgot just now you're not getting bonus points for that oh okay you do know it even though if you don't know it I'll score it if you know it that's giving you into anxiety you're doing stupid things that's a good example of it don't do that you're not getting bonus points for it it looks silly you feel slightly some part of your brain that feels better because you said that that doesn't count for anything it counts against actually you are admitting to the fact that you forgot some knowledge that's bad it's a very natural reaction very natural reaction because you've given in to your anxiety you are not going to do that okay one thing I forgot we're going to talk about how to sit I'm also going to tell you what to wear you know there's a great tradition of everyone wearing black and you're going to continue with that tradition in this I'll tell women what to wear people from UCT pitch up their uniform and you're going to wear what I tell you to wear there's no negotiation okay there's a reason for that I'll keep it a secret that you're all going to appear in the clothes that I tell you to appear there's a subconscious effect on the examiner that I really believe in and you're all going to pass that but on okay so from a week to week basis we're going to prepare a topic because it's easier that way and we can try and get to most of the topics that are listed there and then you're going to be questioned we start on this side next time we start on that side I do prefer sugar free red bull so whoever brings me sugar free red bull amongst yourselves organize that out okay as simple as that red bull is the spice of life it makes everything better not the sugar free one sugar free I'm joking okay so by the end of it my energies are just as low as yours it's very difficult to come up with questions it's not that easy you've got to think about it being the last or second last or third last candidate you get tired your neurons can't work that long so what I try to do is for you to sit in the same order because I start from this side next time start from that side next time start in the middle because by the end you'll see my questions tend to deteriorate you can only ask them in questions and I don't want for the same candidate to be the last one in my list every time you're going to get the bad questions okay I want a nice mix so we're going to start off by teaching you how to construct an answer that's what I said there's a whole science behind attacking this thing and the science behind it is how to construct the answer in your head before it comes out because you've got 20 minutes to fill and you've got to create an impression in those 20 minutes and the best way to do that is not to walk in and answer questions you're all prepared you're all professional people you're sitting across from someone who's in the same profession as you one is not better than the other the one has slightly more experience than the other you actually should have more knowledge than an examiner especially on these topics because most of us the examiners haven't recently read up on this one guy is an HPB guy one is a vascular guy he's read up on his own stuff he hasn't read up on all of this you know much more so walk in there with a mindset of we are going to have a professional discussion if you can if you can trigger that in your mind the battle is won you are not going in there to answer questions you are walking in there to have a professional discussion there are going to be some topics on the table and we might as well sit at the cafeteria with a cup of coffee or repel in my instance sugar free and have a discussion about that's what we talk about when you go home when your spouse is a surgeon as well you are going to talk shop and you are going to meet your colleague in the cafeteria you are going to talk shop it's just normal and you are going to talk shop in that exam that's what then you have won and that's the candidate I am always looking for that's the candidate that's going to win the prize there's no prize and I was going to hang something but of course we get to see the marks afterwards and I like it if the UCT candidate is top of the line it just works that way and that's usually the candidate that's walked in and has had a good discussion about topics colleague to colleague not examine it to some pathetic 19 year old student so there's a way that you can appear as if you are there to have this discussion and that's by structuring structuring your answer so I said I'm not going to embarrass someone here comes the embarrassment in front of me you're going to get the embarrassment so I'm going to ask you a question you're going to answer just tell me about your use of prophylactic antibiotics prophylactic antibiotics should be carefully considered they should not be the antibiotics usually used to treat the specific infection because that might be supposed to overuse of those antibiotics and therefore they will not be successfully successful in treating the specific infection and there's a specific timing involved in giving prophylactic antibiotics depending for example on when you expect the infection to be set free in the the person what I mean by that is if you're going into doing an abdominal surgery of abdominal operation then there would be a specific timing in which the skin flora would be exposed to the person's tissues or the abdominal contents and you want the antibiotics to reach peak levels at that specific stage and then also continue them for the period that this person would be exposed to the organisms at peak levels we use a number of specific types of antibiotics for example the first generation keplosporins like kefsal in orthopedic operations that cover mostly skin flora and then for abdominal operations you want to add something that would cover the negatives as well sometimes anaerobes so you might want to use phantomisem and richen hydrosol depending on the part of the body accessing it would also make a big impact on the or have a big impact on the antibiotics you're choosing chased cavities obviously don't have the same type of organisms as abdominal cavities so there are specific antibiotics for each region of the body and we have to consider the timing and delivery of those okay so let's just critique this let's get to the good points first she used up a lot of time you have to fill up 20 minutes you take control over those 20 minutes the more you talk the less questions you can get job done goal number one the more you talk the less chance you give that examiner to have a few words the less questions you are going to get with all the added benefits of appearing that you know everything you can talk, you look relaxed, you look professional you have all the positive signs the more you talk the better let's get to the negative points she laughed and smiled that's pathetic it shows can you see what it shows can you see it from my side is it possible to see it looks pathetic it does not help at all Dr. Amsikam Dain are we going to do this for your end you know that's ridiculous okay don't do that smiley thing number two and probably more important you fell from topic to topic whatever came in your head was this what you said there she had no structure to the way she answered she said a lot of correct things but it came across as if she was grabbing at a lot of loose little pieces of knowledge that she had in between she said the wrong things okay we usually don't cover for gram negatives in prophylaxis that's usually not the case positives and anaerobes that's what we cover for prophylaxis we're prophylaxis antibiotics so we're going to learn here things that I call recipes there's no one recipe correct over another recipe and it's not always appropriate to use one of these recipes but the vast majority it is and a recipe is an example for this question would go something like this the examiner sets a situation or ask you a direct question the first thing that you're going to show the examiner I understand what you're talking about and the best way to do that is to define the topic at hand so this is prophylaxis antibiotics first of all define the topic prophylaxis antibiotics is the use of antibiotics to prevent infection in a setting between the two in a setting before all those things you said just define prophylaxis antibiotics just have a nice short summation of the definition of that and then you're going to tell the examiner what you are going to say about these things you could say something like now we're going to build a pyramid top of the pyramid I'm defining the problem first of all it's used up time and secondly it tells the examiner you know what this is all about now you're going to tell him what you're going to say say you could say something for instance there are various considerations in the use of prophylaxis antibiotics number one is indication number two is timing don't say I'm going to say 5 things because then you'll only get to 4 so try not to use number I'm going to talk about timing indication timing specific types of antibiotics what else can we add to this okay it's day number one we won't push it but then you're going to tell him what you're going to talk about that has structured your mind you've used up time but more importantly it has structured your mind now you're not going to grab for loose things because the big thing about getting for loose things obviously you seem slightly incompetent but you're going to miss stuff you know so much about it and now there's a few things that are not going to be said and I don't know that you knew it you lost that opportunity to show me everything you knew and by structuring your answer all the positives of it but you also get the opportunity to bring everything out so now we've defined it we're going to some things to consider is indication now we can talk about indication even that you can then break down I'm going to now under indication this and this so everything is this pyramid that keeps on being broken down and the more you can do that the less chance that you go to forget anything the more time you're going to use up the more professional you're going to look the whole thing is just beautiful and that's what we're going to do over and over and over and over again so I'm not going to yet do once or twice we're going to talk about the topic and there's going to be some dictatorial thing going on but the vast majority of this is going to be how to structure your answer so that day you're going to come you're going to come sit down there speak to the guys who've had this before to come in there and know I'm going to get this question and then I'm going to have this whole structure in my head as to how to do that that is really empowering and you can see the difference in a candidate who comes to sit and answer like you did that guy was never prepared at all versus this person who can sit structure this whole answer and can talk for ten minutes without stopping it's the most beautiful thing to see and that only comes from practicing there