The Joint Surgical Colleges Fellowship Examination

The first clinical or Section 2 exam of the “International FRCS” (more properly the Joint Surgical Colleges Fellowship Exam – JSCFE) took place in Kuala Lumpur on 23rd and 24th February. It was the culmination of several years of preparation, including five diets of the Section 1 (MCQ) exam. Thirteen examiners, an assessor, the Board Chairman and two members of the secretariat travelled to Malaysia a couple of days earlier to acclimatise and prepare for the exam. Local organisation and support were outstanding. The lead was Professor John Chan, previously a London trainee but presently Consultant Cardiothoracic Surgeon at Gleneagles Hospital in Kuala Lumpur. It was particularly gratifying to witness the enthusiastic involvement of numerous cardiothoracic colleagues from several hospitals across the city.

A refresher course for the examiners took place on the morning of 22nd February, followed in the afternoon by standard setting for all the next day’s cases. Several local surgeons attended the event to familiarise themselves with the processes and techniques, hopefully with a view to some of them becoming examiners in due course.

The first day of the exam proper - the clinical cases - was held in the University of Malaya medical examination suite. This is a remarkable purpose-built facility with almost limitless space and dedicated, helpful and experienced staff. Several problems were nevertheless anticipated and plans were made to manage them, but in the event none materialised. For example there was an awareness that many if not most patients would be unable to understand or speak English. Translators were on hand with every patient but also the very experienced examiners were more than capable of not dwelling excessively on history taking if this seemed wasteful of time. As with the previous day, several local surgeons attended as observers.

The final day - the oral exams - took place in the Hotel Majestic. Each candidate was questioned for one and a half hours at cardiac, thoracic and imaging/equipment stations. Again, several local surgeons attended.

Twenty eight candidates put themselves forward for the exam and the pass rate was approximately 60%, indicating, I believe, a generally very high standard amongst the young surgeons who had previously passed the Section 1 papers.

The universal feeling at the end of the visit was that the exam had been a great success and this was due to several crucial factors. Firstly, all the examiners were senior UK/ Ireland surgeons with immense experience who gave willingly and enthusiastically of their own time to support this project. Secondly, the local organisation and support were superb. This was not just because of the facilities, the patients etc., but also the cordial and warm reception we received. There is undoubtedly a genuine desire in Malaysia for the link with UK/Ireland cardiothoracic surgery to be nurtured and further developed. Thus, for example, the main dinner on the Friday night was attended by, amongst others, Tan Sri Yahya Awang (Chairman, Malaysian Board of Cardiothoracic Surgery), Professor Hanafiah Harunarashid (President, College of Surgeons), Professor Raja Amin (President of the Malaysian Association of Thoracic and Cardiovascular Surgery), Dato Hamzah (Head of Cardiothoracic Services, Ministry of Health) and H E Vicky Treadell (British High Commissioner to Malaysia). Last but not least, the ladies from the secretariat, Carolyn Mason and Amy Heaton, efficiently shepherded and organised examiners and candidates alike with their usual firm graciousness.

What about the future? Time will tell, but the perception is that the number of candidates presenting is steadily increasing, and my own aspiration would be to hold such an exam on a yearly basis. The next diet is being considered for February 2019. Should this go forward, it too will be held in Kuala Lumpur as all concerned were very comfortable and are now very familiar with the arrangements in Malaysia. Once the exam is more fully established it is possible that an additional venue in the Middle East will be considered. Very importantly, looking ahead, the Royal Colleges are keen to recruit ‘international’ i.e. non-UK/Ireland examiners. There are presently some minor obstacles with respect to suitable training, but such a development in the long-term is essential - to enhance engagement with the international surgical community, disseminate the skills that have been honed in the UK/Ireland exams, and not least of all to take some pressure off our own examiners who have to take annual leave to participate. n