FAICO Glaucoma Part 2

This was held almost 2 months after Part 1.   

I received an email (more than a month before the exam, so there’s ample time to make travel arrangements) which said that my centre would be at KEM Hospital, Mumbai. You also get the contact number of the person you are supposed to report to at the venue. 

You can contact the co ordinator on this number and ask regarding the arrangements for the exam (examiners, number of OSCE stations, if short cases are being kept for the exam, etc)

Timing of exam: 10 am to 3 pm. 

The email stated:

 “At each OSCE Station the candidate will examine a short case / a Photograph / a case situation / instrument etc. etc. of the concerned Specialty for 5 Minutes and answer the relevant questions placed along with it. This will be followed by Viva examination (10^th Station)”.

Please note that in the initial notification put out by the AIOS for the FAICO examination, it says that the OSCE is the second stage of the exam for which the cut off is 50%. This would be followed by the 3^rd stage which is the Viva. This notification also stated that there would be 2 examiners (1 local, 1 external).

But, in reality, there is no real cut off for the OSCE. Everybody has to go through both the OSCE and Viva. In fact, our OSCE papers were corrected right at the end of the day (after the viva), just before I left the venue. Also, there are actually 4 examiners instead of the 2 mentioned in the notification.

At the OSCE stations, there will either be a short case or a picture of a clinical condition/instrument/ printout of HFA, HRT, GDX, OCT/surgical implant with associated questions.

A short case can also be kept at OSCE stations. In our case, 3 stations were short cases. You are expected to take a short history and examination.

All instruments for examining the patient were provided (4 Mirror Gonioscope, 90D lens, even a direct ophthalmoscope for those who want it). But, to be on the safe side, I brought my own because I'm comfortable with my own instruments)

Initially, only the direct ophthalmoscope was kept in the exam hall.

Interestingly, although I didn’t have a problem with this, some of the doctors in the room got nervous when they saw this and confessed that they were not at all confident using the DO and asked for the 90D lens, which was finally provided.  (I found this a bit odd. All these doctors were fellowship trained in Glaucoma from prominent eye hospitals, but they couldn’t use a DO confidently. That’s something to think about.). Yes, I agree that binocular view with the 90D lens is vital for disc evaluation, but that's besides my point.

 Visual acuity (and IOP, if you ask for it) of the patients was provided to us. 

There was just one slit lamp with an applanation tonometer, so we had to wait our turn to examine the patients.

I felt sorry for the 3 patients who were kept as short cases, because there were around 13 candidates giving the exam. Ideally, each patient should have been seated at a separate slit lamp, which would have made things easier.

You are supposed to get 5 minutes at each station but they were lenient about this. We got more than enough time for the short cases. We don’t have to present the cases, just have to write a short history and examination findings. This is a part of the OSCE and is evaluated along with the other OSCE answers. No questions regarding these cases were asked to us during the viva (at least they were not asked to me or anyone who took the exam with me)

In our case, 2 of the examiners were late as they were stuck in traffic. So we had 2 vivas with 2 examiners each and the OSCE was held in between. (Normally, there’s just one Viva with all 4 examiners together).

I’ll be posting the questions that they asked me (what I can remember) during the viva shortly. The questions asked were less of theory and more of the practical/clinical type related to things that you would face in day to day Glaucoma OPD and also regarding latest developments in the field.

All the examiners were accomplished Senior Glaucoma specialists of the country and although overwhelming at first, it was an honour to be examined by them.

FAICO Glaucoma Part 1: How I prepared

 The following is a list of things which I did to prepare for the online exam

1. As the exam is open only to AIOS members, all those who give the exam will have free access to the AAO ONE network (details on the AIOS scientific committee website). This gives us access to some journals and also a lot of MCQs which are divided sub speciality wise. Make sure you attempt these MCQs as they are very similar to the type asked in the exam. (a couple of questions in the exam were directly rom here)
2. Search for and watch all videos of the latest glaucoma surgeries like the iStent, iStent inject, iStent supra,  Hydrus implant, Cypass, Aquesys implant,  and other MIGS, NPGS on You tube. (I especially recommend the videos and lectures posted by Dr Ike Ahmed and Dr David Richardson)
3. Try using Slideshare to read up on any topic quickly. This will save u a lot of time as u will be presented with just the important points u need... and u can sneak in some reading during OP hours.
4. Be prepared for questions on landmark trials in glaucoma (AGIS, CIGTS, GLT, OHTS, CNTGS, TVT, AVB, ABC,GLT, FFSS etc) 
5. Be prepared with epidemiology of glaucoma...stuff like total population affected by glaucoma, total blindness due to glaucoma, etc
6. Dont ignore Optic nerve blood flow and its measurement. Its a field where theres a lot of research going on
7. The AIOS website also has a downloadable PDF document called "Guidelines and curriculum for sub speciality programs in Ophthalmology (collegium of AIOS)". I used this as sort of guideline for preparing. This curriculum says that Studies about glaucoma conducted in India should not be ignored (VES, APEDS, WBGS, CGS, ACES, CEDIS, HRGS, CIEMS, INGOT) and they should be given due importance. But they did not ask any question from these Indian studies both during the online exam and viva. 
8. Anyways, keep browsing through IJO issues regularly to keep in touch with the Indian scenario and new Indian studies on glaucoma.
9.  For a good summary of these studies, I found Dr Ramakrishnan's Text book on Glaucoma to be immensely useful. But I also downloaded a lot of articles about these studies and made notes to revise later on. This is another area where the AAO ONE network is useful, as it gives us free access to full articles from prominent journals.
10.  Solve all glaucoma questions at www.mrcophth.com.. its not much but its still practice for the exam. They have some picture based questions too.
11. If u have access to the AAO Basic and clinical science course textbook series, try solving the MCQs at the back of each volume depending on your speciality. 
12. Download Telegram on your phone and get some one to add u to the shared Ophthalmology books group. U can download pretty much any Ophthalmology textbook from this group.

These guidelines and the questions i posted earlier should help u get through the Glaucoma exam easily. 
I need more doctors who have passed the exam in other specialities to post anything that could be useful to others who intend to give the exam in future.

Wish U all the best!