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What’s going on in the mind of a FCPS Examiner while conducting Viva exam

Dr Siddque Akbar SattiDr. Siddique Akbar Satti, who is a part of the board of examiners of College of Physicians and Surgeons Pakistan, shares his views about “how examiners  conduct viva exam, how they scan the mind of the student and what type of questions they ask?” Dr Siddique Akbar Satti is Head of department of medicine, Capital hospital (CDA Hospital Islamabad). He is a gastroenterologist and a graduate of Rawalpindi Medical College. He shared his views while teaching his trainees in Capital Hospital Islamabad during a teaching session.

Dr. Satti, discussed with his students, a short case  of the FCPS – Part two exam of 2014. He said “there was a female patient in her 60s lying in the bed, she had absent radial and brachial pulses of both arms, right carotid was absent while left carotid was weakly palpable. Arteries of lower limbs were palpable, she also had a hyper pigmented rash below the eyes and on the forehead”. Now my command was to do the general physical examination of this patient. “See how simple the command was, general physical examination, a very basic thing had been asked to do from a doctor who was going to be a fellow said Dr. Siddique Akbar Satti. I wanted to know whether the candidate would be able to pick the absent pulses and the abnormal dark rash below the eyes”.

Out of the 8 candidates, 3 couldn’t pick the absent pulses. They told me, “Sir his pulse rate is 80”. Another said “It’s, 70 and irregular”. Maybe it happened because of the stress aur pressures of the exam , but it was a basic thing that had been asked. How could we make a doctor a fellow if he couldn’t tell the mere absence or presence of pulses. The 5 candidates that had picked the pulse were asked about the hyper pigmented rash that was preset below the eye. Some said it’s malar rash, others said it was butterfly rash of SLE. Then I asked “Does it really look like butterfly rash, does it have raised margins?” This made them think over it again and a few changed their answers to “no sir, it doesn’t.’ Two or three candidates identified it as melasma which actually was the correct answer. Those who couldn’t pick the absent pulses, of-course couldn’t go any further despite being asked easy leading questions. The candidates who had picked the absence of pulses and identified the rash were then asked that why did they think the pulses were absent. Those who said it was due to SLE were questioned about the kind of arteries involved. “What do you think, are large arteries involved in SLE?” The case, in fact, was of Takayasu’s arteritis. In Takayasu’s arteritis large arteries are involved while in MCTD like SLE involves small and medium sized arteries. “So be clear in your mind about what you are going to say, because the next question of the examiner will be ‘why’ or ‘how’” ,said Dr. Satti.

The long case was about a patient who had jaundice, dark colored urine and splenomegaly (4cm below the right costal margin). The case was of hemolytic anemia. “There was a candidate, who told me that the patient had hereditary spherocytosis. No matter what question he was asked he always ended his answer on hereditary spherocytosis. I don’t know whether he had been told by somebody that the presented case was hereditary spherocytosis but the candidate was quite confident about his diagnosis. There was another candidate who was told that the ALT level of this patient was raised, “How do you explain the raised ALT level if you think that it is a case of hemolytic anemia”, Most of the candidates nullified what they had said previously, there was one candidate who said, “Sir, there can be another underlying autoimmune process going on in the patient that has raised his level of ALT” and his answer was logical, we accepted that. The examiner doesn’t ask you difficult questions, he expects you to answer the basic questions, for example, there was a candidate who was asked, What do you think, is it direct bilirubin or indirect bilirubin that should be increased in this patient? He quickly responded, “Direct bilirubin sir..!” That again was a wrong answer, and we don’t expect such answers from a fellow candidate”, said Dr. Siddique Akbar Satti

“Remember…! We analyze the depth of knowledge of the candidate and we expect him to diagnose simple conditions and answer simple questions. An examiner doesn’t fail a candidate on the basis of a question that is about a difficult syndrome, Never..!”. He emphasizes.

This article is peer reviewed by Dr. Maham Abbasi


  1. well ideally, for each patient selected for the examination, a detailed findings list should be prepared by examiner ahead of initiating the exam and the objectivity of the questions be defined ahead of time. Once done, there should be video recording of the examination, so that if a result is challenged, a fair chance should be given. Also this will help review the capacity of the examiners as well. I agree with the above article, but honorable Prof. has mentioned his views only. Since he is a physician himself and not an expert in management or examination techniques, he needs to give space to new emerging trends and realities.

    1. Thank you for your comment, but i want to tell you here that before examination, each consultant/examiner examine the patient and write down his findings on a piece of paper. After this, all examiners sit and discuss their findings and with consensus a list of findings and their weightage is decided. then if a student picks those findings, then he is given number, and graded as fail, pass, good, very good, excellent, oustanding. So this is it.Although i agree with video recording option, this should be done.
      Thank you.


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