27 Examinations in ENT
An examination system in Otorhinolaryngology has been established in the United Kingdom for many years. The Diploma in Laryngology and Otology (DLO) was introduced in 1923 and preceded the specialty FRCS examinations. The Diploma in Otolaryngology, Head and Neck Surgery (DO-HNS) was instigated in 2003 to replace the DLO, under the auspices of the Royal College of Surgeons of England.
Surgical training has undergone significant change over the last decade and competence became the main focus of assessment. The latter led to the development of a new Intercollegiate FRCS in 2006 and revision of the MRCS in 2008. The current U.K. specialty examinations in ENT are the DO-HNS, the MRCS (ENT), and the FRCS (ORL). All of the U.K. specialist surgical examinations are now fully Intercollegiate between the Royal Colleges of Edinburgh, England, Glasgow and Ireland.
The European Examination Board in Otolaryngology, Head and Neck Surgery (called the European Board of ORL-HNS) was created by the Union of Medical Specialists ORL Section (UEMS-ORL) for countries that did not have a surgical examination system in place. The examination comprises two parts. Part 1 is a 100 question MCQ and only those who have passed Part 1 are eligible for Part 2. Part 2 is an oral examination. The first MCQ took place at the Academy of ORL-HNS in Mannheim in 2009, and the complimentary oral examination took place in Vienna in 2010. Those who have passed their home national board examination and are recognised as specialists in their home country and who pass the European Board examination are allowed to be called ‘Fellows of the European Board of ORL-HNS’. Other successful candidates, not yet certified as specialists in their home country, receive a ‘Diploma of the European Board of Otolaryngology’.
There are completely separate examination systems around the world that also award a surgical Fellowship qualification such as the FRCSC in Canada, FRACS in Australia and New Zealand, FCS (SA) in South Africa and FCSHK in Hong Kong. Further details of these examinations can be found on their relevant websites.
27.1 Examination Standards
The purpose of any examination system is to set and maintain a pre-determined standard of professional practice. The assessment therefore provides a sense of credibility and reassurance to both patients, the public and other professionals, that a standard of practice has been achieved.
While the standards to be achieved are set by the various examination bodies, in the United Kingdom these have to be accepted and agreed by the General Medical Council.
U.K. Trainees in Otorhinolaryngology are required to have either the MRCS (ENT), the DO-HNS or both in order to apply for a numbered higher surgical training post, commencing at ST3 level. The FRCS (ORL) is an exit examination that should be taken towards the end of training.
The Intercollegiate MRCS (ENT) and DO-HNS examinations both test knowledge to a standard that trainees should have reached 2 to 3 years after qualification, and includes domains such as clinical knowledge, clinical and technical skills, communication and professionalism.
Examiners who partake in the U.K. examinations all have to undergo a selection process after application and once successful, each examiner undergoes a pre-examination training course that also includes Equality and Diversity training.
Candidates should be aware that they are not allowed to memorise or copy examination questions, or pass these on to other parties such as revision courses. Mobile phones or other electronic devices are therefore not allowed in the examination room. Such activity is seen not only as cheating that leads to disqualification from the examination but also a breach of both copyright and probity that could lead to the candidate being reported to the GMC.
27.2 The Intercollegiate MRCS and MRCS (ENT)
The General Surgery MRSC, called the MRCS, is different to the MRCS (ENT) by having the same Part A but a different Part B.
To be eligible, candidates must hold a medical degree accepted by the GMC or Medical Council of Ireland for provisional or full registration. Overseas candidates must hold a medical degree acceptable to the councils of the four colleges. There are two components:
27.3.1 MRCS Part A
This is a General Surgery (including some ENT questions) MCQ section, that comprises two separate MCQ papers with a combination of single best answer (SBA) questions and extended matching questions. The first paper is a 3-hours paper that tests applied basic sciences; the second paper lasts for 2 hours and assesses the principles of surgery in general. To achieve a pass in Part A the candidate is required to demonstrate a minimum level of competence in each of the two papers and to have achieved the pass mark set for the combined total mark from the two papers. Candidates must have passed Part A to be eligible to sit for Part B.
27.3.2 MRCS Part B
This is an objective structured clinical examination (OSCE) that consists of 18 examined stations, each of 9 minutes’ duration, with each station carrying a maximum mark of 20 points. The OSCE tests candidates on applied knowledge of anatomy, surgical pathology, applied surgical science and critical care, and applied skills such as clinical and procedural skills, history taking and communication skills in both giving and receiving information. Actors/actresses take on the role of patients for the purpose of this examination.
Candidates are allowed six attempts to pass Part A and four attempts to pass Part B. The GMC has deemed that this must be achieved within 7 years.
Candidates who pass MRCS Part A and MRCS Part B may be awarded the MRCS, an examination required to enter higher non-ENT surgical training such as General Surgery and Neurosurgery. Some CT1 doctors who have General Surgery in their rotation but wish to be ENT surgeons may pass the MRCS then take Part 2 DO-HNS to be awarded MRSC (ENT) too (see further).