Oral Examination: Structured Clinical Reasoning Under Questioning
What the oral exam tests
The viva assesses how you think aloud: structured history, focused examination, prioritized differential, safe investigation, and a defensible operative plan with consent and complications. Examiners probe depth by asking "why?" and "what if?" - so every statement should be justifiable. Expect clinical scenarios (a non-healing wound, a breast lump, a hand injury, a burn, a cleft palate, a skin cancer) plus ethics, consent, and complication management.
Structure that scores
Use a consistent scaffold: presenting problem → relevant positives and negatives → examination findings → differential ranked by probability and danger → investigations → management in stages (immediate, definitive, reconstructive) → complications and follow-up. Name the things you would not miss (the "can't-miss" diagnoses) to demonstrate safety.
Traps in oral stations
- Rushing to the operation without consent, capacity, or fitness assessment.
- Forgetting the multidisciplinary team in cancer and complex reconstruction.
- Ignoring the patient's goals in aesthetic and reconstructive discussions.
- Failing to mention complications and their management when asked about an operation.
- Being unable to justify a choice when the examiner offers an alternative - concede gracefully and reason.
Worked rule of thumb
When asked "what would you do next?", answer with the safest next step plus the reason, then state what finding would change your plan. This demonstrates contingency thinking, which is what separates a pass from a strong pass.
Handling uncertainty
If you do not know, say so and describe how you would find out (guideline, senior, MDT). Never invent a fact - examiners forgive gaps, not fabrication.