The operative surgery viva is often the section that causes trainees the most anxiety. Here is a structured approach to preparation and performance based on feedback from recent successful candidates.
Preparation strategy:
Start preparing at least 6 months before the exam. Create a list of the key index vascular procedures and work through each one systematically. For each procedure you should be able to describe: indications, consent (including specific complications and their rates), patient positioning, key anatomical landmarks, step-by-step operative technique, variations, and post-operative management.
The core procedures to cover are: carotid endarterectomy, open AAA repair, EVAR (including device selection and troubleshooting), femoro-popliteal bypass, femoro-distal bypass, below-knee amputation, above-knee amputation, fasciotomy, embolectomy, and creation of arteriovenous fistula for dialysis access.
Practice with a partner. The viva format rewards clear, structured communication. Practice talking through operations out loud — it is very different from reading about them silently.
On the day:
1. Listen to the question carefully. Answer what is asked, not what you want to talk about.
2. Start with the general and move to the specific. For example: I would position the patient supine, prepare the skin from chin to chest, and make an incision along the anterior border of sternocleidomastoid.
3. If you do not know a specific detail, say so and move on. Examiners respect honesty more than bluffing.
4. Describe what you actually do in theatre, not textbook descriptions you have memorised.
5. Be prepared for follow-up questions on complications and how you would manage them intraoperatively.
Common pitfalls: rushing through answers without being asked to continue; not consenting the patient when asked about an operation; forgetting to mention patient positioning or anaesthetic considerations; and being unable to describe what to do when things go wrong.