CANDIDATE INSTRUCTIONS AND GUIDANCE NOTES

General Information

These guidance notes are specifically for the Intercollegiate Diploma in Otolaryngology Head &
Neck Surgery (DOHNS). They are intended to provide guidance for candidates who are taking the
DOHNS Examination Part 2 OSCE. These notes will be updated periodically. This examination, both
Part 1 (written) and Part 2 (OSCE) DOHNS, have been approved by the Post Graduate Medical
Education Training Board (PMETB).

The purpose of the DOHNS examination is to assess the knowledge, skills and attributes required for
the completion of core ear, nose and throat surgery training for Trainees following the Intercollegiate
Surgical Curriculum Programme (ISCP) and to determine the ability and progress to higher specialist
training in ENT surgery. This examination is also designed to assess the knowledge, skills and
attributes acquired by doctors intending to follow a non-consultant career pathway in ear, nose and
throat surgery, for example, Primary Care Physicians and Associate Specialists, who intend to
practice ENT surgery at a Primary Care or Basic Surgical level.

Possession of the Intercollegiate DOHNS examination and the Part A Intercollegiate MRCS
examination can then allow an application for the diploma of MRCS which would then allow access
to the National Selection Process for transition from CT2/ST2 to ST3.

For ENT Surgery Trainees the MRCS examination comprises of 2 parts, Part A – Multiple choice
questions consisting of 2 papers each of 2 hours duration taken on the same day and including
aspects of surgery in general. The Part B part of the Intercollegiate MRCS examination for ENT
Surgical Trainees would include Part 1 and Part 2 of the DOHNS examination.

There is no limit to the number of occasions on which candidates may attempt to pass Part A of the
examination, however candidates are only permitted 4 attempts at passing the Intercollegiate
DOHNS examination should they wish to apply for the subsequent Intercollegiate MRCS Diploma.
Objective Structured Clinical Examination (OSCE)

Structure:

The OSCE examination will normally consist of 25 active stations and no more than 6 rest stations
which are inactive with no examination material used or applied at the rest stations. There are 5
stations assessing clinical skills, clinical examination and clinical history taking, as well as
communication skills. There are a further 20 stations which include assessment for anatomy and
physiology, pathology/histology, audiometry, otology, rhinology, laryngology, neck conditions,
written communication skills, radiology, ENT surgical/medical instruments and devices and
paediatric ENT surgery. The 5 clinical stations are normally manned with an examiner/observer.

Domains:

The DOHNS examination examines various areas of knowledge, skills, competencies and
professional characteristics of the competent surgeon and these domains map to the GMC’s good
medical practice, including the areas of clinical knowledge, clinical skill, technical skill,
communication, decision making/problem solving and organisation/planning and also to the year 1-2
competences and knowledge in the ENT curriculum on the ISCP website.

Standard Setting:

The pass mark for the overall OSCE examination is determined by the examiners attending the
examination and includes a modified Angoff process.

Duration:

Each station will take 7 minutes and the candidate should move to the next station once the bell has
rung signalling the end of each 7 minute period. The number of rest stations is usually less than 6 and
thus the examination will normally take approximately 3 hours 20 minutes or less.
Quality Assurance:

Each candidates paper is marked by 2 separate examiners and where there is discrepancy between
each examiner then the paper is marked by a third examiner.

Conduct of Examination

Proof of Identity:

Candidates must bring proof of identity to the examination. Proof of identity must be an official
document, such as a current passport or driver’s license that includes the candidate’s name, signature
and photograph.

For the purposes of visual identification, any candidate sitting the examination may be required to
remove any clothing and/or other item which covers all, or part of, the candidate's face. The colleges
will observe sensitivity in the visual identification of candidates.

Dress Code:
In line with modern infection control practices, and in view of the variety of stations and the limited
time available between them, it has been decided to adopt a standard dress code for all stations in
order to ease the pressure upon candidates who would otherwise be required to modify their dress
between stations. The dress requirements for candidates are as follows:
• Arms to be bare below the elbow
• No jewellery on hands or wrists with the exception of wedding rings/bands
• No tie.
An acceptable form of dress would be a conventional short-sleeved shirt/blouse, open at the neck, or
for a long-sleeved shirt/ blouse to have the sleeves rolled up throughout the examination. Tee-shirts
and polo shirts are not acceptable dress.
Candidates with religious or cultural reasons for not observing this code for all stations will be
expected to comply with the dress code for those stations involving the physical examination of
patients/actors.

There will be space provided for hanging up jackets etc. if required.

To facilitate the assessment of non-verbal communication skills and interaction with the examiner
and patient (or actor in the role of the patient as the case may be), the colleges reserve the right to
require candidates to remove any clothing and/or other item which covers all, or part of, the
candidate's face.

Briefing:
All candidates will undergo a detailed briefing by a member of the examination administrative staff,
and usually the Supervising Examiner, prior to the commencement of the Part B (OSCE)
examination. It is very important that candidates listen carefully to the information that they are
given at the briefing and also follow any instructions that they are given by the administrative staff
during the circuit. The briefing will cover the checking and issuing of candidate numbers, layout of
the stations, rest stations, the candidate’s starting position, timing arrangements and arrangements for
emergency evacuation of the centre. Candidates must make sure they are absolutely clear with how
the examination circuit is to be run at this stage. At the end of the circuit there will be a debriefing
session and candidates will be invited to complete a feedback form and can air any immediate
concerns that they may have about the conduct of the examination.

Equipment:
All equipment required for the tasks set in each station will be supplied. Candidates are not required
to bring any equipment for their own use.

Mobile Phones:
Mobile phones or any similar electronic device must not be carried on the person during the circuit.
They can be left (switched off) with other property. Any candidate who is found to be in possession
of a mobile phone or similar electronic device after the start of the examination will be subject to
disciplinary action.

Candidate Instructions:
Each station has specific candidate instructions. It is important to read accurately each instruction as
this will describe precisely the task(s) that each candidate should undertake at each station. For the
clinical stations where the candidates have an examiner observing their activity and where there is
either an actor or patient present, then should the candidate complete the task within the 7 minute
period he or she may then move back outside the station and sit on a seat provided until the bell rings
and can then move to the next station. In the clinical stations there will sometimes be a preparation
station outlining the task(s) required in the active station to follow. At the preparation station it is
important to read the instructions and guidance laid out for the candidate, such that they are fully
aware of the task required at the station following.

In stations involving the examination of patients or actors the examiner will usually watch candidates
conducting their acquired task. Candidates will not be prompted and will not be required to give a
running commentary. If the examiner judges that a candidate is not performing the task requested, the
candidate may be prompted to re-read the instructions for the station. Hand Gel is provided for the
use by candidates where contact with patients or other clinical material requires hand cleaning.
During the rest stations candidates may review their answer sheets from previous stations if required.

Examination Papers:
It is essential that where necessary candidates should mark their candidate numbers in the top right
hand corner as papers that have no candidate number allocated will therefore not be added into the
examination results.

Results:
Details about the release date for the results will be given to candidates at or around the time of the
examination.

Feedback:
Candidates will receive a breakdown of their marks for the content areas and the individual domains
with their overall result. No further feedback will be available.
Candidates who request feedback may wish a breakdown of their marks in 4 specific domains
including otology, rhinology, laryngology/head and neck and clinical/communications.

Discipline:
This examination will be conducted according to the disciplinary procedures published by the
ICBSE. If a candidate is suspected of any malpractice the Supervising Examiner may make
reasonable enquiries at the time and will notify the candidate of what the concerns are and how the
matter will be resolved.