“The spoken word was the first technology by which man was able to let go of his environment in order to grasp it in a new way.” Marshall McLuhan
The dreaded viva voce
The viva voce, or oral exam, has declined in popularity over recent years but is still a part of many medical exams. It is generally the final hurdle of any particular exam and usually takes an interview-style format whereby the candidate sits opposite the examiners and answers questions posed in spoken format.
It is quite different from written exams, as there is less time to think and answers cannot be returned to or re-written. There is an even greater degree of unpredictability with these exams than there is with OSCEs, as there are no routines that can be practised and very little familiar territory for the average candidate to fall back on. As well as assessing clinical knowledge, they also assess the candidate’s ability to think on the spot and react under pressure, both vital skills for clinicians to possess. Even seasoned exam veterans have frozen up and gone blank in vivas. For this reason, the ‘viva’ is probably the most dreaded of all the different types of examination that medics are faced with.
Preparing for the viva
Just like any other medical exam, preparation should start early. Try to get a feel for the sorts of questions that come up by talking to colleagues and consulting any books that might be available. Get as many people as possible to ask you viva questions under exam conditions so that you can get used to the stress and anxiety that the viva can induce.
Being videoed can be a helpful way of picking up bad habits that you have and improving your general style of speaking. I did this before one set of exams and noticed that I had a tendency to excessively move my hands around and fidget, and it assisted me in stopping this before the viva exam.
It is very common to be asked to give definitions or give lists, and these should be a source of easy marks for you. These are often used as opening questions and should be second nature to you by the time you site the viva. When reciting lists, you should try to start with the commonest causes first. Think about writing flashcards with definitions and lists on them that you can practice.
How to approach the viva on the day
Just as in OSCEs, personal presentation is very important. You should dress the same way that you would for a job interview in smart but comfortable clothing. Avoid wearing outlandish ties and bright colours, such as orange and red, instead of sticking to safe ‘corporate colours’ like navy and black. Men should wear a conventional dark-coloured suit, conservative shirt and a dark coloured tie. Women should wear a conventional skirt or trouser suit and avoid low cut tops, very short skirts and excessive amounts of jewellery.
When you enter the room, make good eye contact with the examiner that greets you, shake his or her hand and then ask if you may sit down. Body language is very important, and sitting right back into the chair and leaning slightly forwards to send a message that you are engaged and attentive. Smile and keep your body straight and your head in a neutral position to project confidence and energy. Avoid crossing your arms and legs as this projects defensiveness. If there is more than one examiner, try to engage both of them, even if only one is asking the questions.
Listen carefully to each question that you are asked, and then spend a moment to think about your answer before you speak. A short pause is fine and may prevent you from blurting out the first thing that comes into your head impulsively. For example, if you answer a question about foot injuries and start talking about metacarpals instead of metatarsals, you will cost yourself important marks. By simply taking a moment to consider what you are about to say, these sorts of mistakes can be easily avoided.
Speak loudly and clearly but remain to the point and avoid waffling; the examiners are looking for a concise and logical answer and will become quickly frustrated by unclear answers that are difficult to hear. Above all, never bluff or guess an answer; the examiners are experts in their fields and will quickly spot this.
Be prepared to answer further questions about any answer that you give. If you are asked to list the commonest causes of finger clubbing, lead with a cause that you have a good understanding of. For example, it would be foolish to answer ‘pachydermoperiostosis’ if you know nothing about it, and you would be better off answering with a subject you are more likely to able to discuss, such as lung cancer or tuberculosis.
Never argue with the examiner, even if you are convinced you are correct, as many students have fallen down this way. The best-case scenario is that you are correct, but you have embarrassed the examiner in the process of proving it. The worst-case scenario is that you are incorrect and have made yourself look very foolish. Instead, remain polite, courteous, and try to find another angle to approach the issue being discussed that may enable the examiner to see your point of view. Remember that the examiners are human too and that the viva is also a challenging experience for them.
If you have answered a question badly, try not to dwell on it, as this will distract you and may affect your ability to answer subsequent questions. Answering one question incorrectly is not a disaster, but allowing it to disrupt your concentration and ability to answer subsequent questions may well be. It is also worth remembering that you may have misjudged how you answered the question, and you may well have done better than you think.
At the end of the viva, thank your examiners and leave the room promptly. The exam is over, and no more marks can be gained.
Understanding Vivas ‘do’s and don’ts’:
✅ Dress neatly and professionally
✅ Speak loudly and clearly
✅ Get as many people as possible to ask you viva questions
✅ Think about your answer before you speak
❌ Dress in garish colours
❌ Use defensive body language
❌ Bring up topics you know nothing about
❌ Dwell on answers you think were incorrect
❌ Argue with the examiners
Header image used on licence from Shutterstock
Medical Exam Prep would like to thank Dr. Marc Barton for permission to reproduce this extract from his book ‘How to Pass Medical Exams: A Survival Guide for Medical Students and Doctors’
About Dr. Marc Barton
Dr. Marc Barton qualified from Imperial College School of Medicine in 2001. Since that time he has worked in a variety of different medical specialities. He worked as a GP partner from 2006 until 2008 and more recently as a higher specialist trainee in Emergency Medicine.
‘How to Pass Medical Exams’ is available for purchase here.