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The true VIVA examination is largely obsolete in modern medicine, although it may still feature in pass/fail and prize examinations. The majority of practical examinations involving communication are now OSCE (Objective Structured Clinical Examination) examinations.

OSCE's can have be purely practical, or involve a third party (patient, stimulated patient, resuscitation dummy) in which case you might not communicate directly with the examiner, but you will still be marked partly on your communication skills.

Important Points:

1. Speak clearly.
    
2. Speak at a good volume - not too quietly as it will annoy the examiner trying to hear your answer.
    
3. Try to use proper english - not slang or abbreviations.
   For Example:
   • "These ECG findings are in keeping with myocardial infarction and atrial fibrillation."
   • not: "These ECG findings show an MI and AF."
      
4. Speak confidently and don't let your voice become weaker if you are unsure (it will indicate uncertainty).
    
5. Be definite in statements made (even if you're not 100% inside) - examiners don't like doubt.
   For Example:
   • "This gentleman has mitral stenosis."
   • not: "I think this man has mitral stenosis."
      
   • "There is a macular erythematous rash on the forearm."
   • not: "It looks like there is a macular erythematous rash on the forearm."
      
6. If you do not understand the question, it is fine to ask the examiner to rephrase or repeat the question.
   For Example:
   • Examiner: "Why do inflammatory bowel patients get oral ulcers?"
   may become:
   • Examiner: "What is the pathogenesis of oral ulcers in patients with inflammatory bowel disease?"
      
7. Look into the examiner's eyes when answering the question.
    
8. Try not to exhibit mannerisms (like touching your nose a lot or using your hands a lot to describe things).
    
9. Try not to say umm or urghhh when thinking of the answer.
    
10. Don't have a long period of silence before answering the questions as it will seem like your brain is empty, but don't talk immediately for the sake of it and dig a big hole you cannot get out of either.
     
11. If you don't know anything about the topic being asked - say so and then maybe you'll be asked another question, rather than getting into all sorts of trouble by making it up.
     
12. Try to give answers in a structured manner. Divide causes into local and systemic, or into infectious, malignant, vascular etc.
    For Example:
    • "The causes of finger clubbing can be divided into respiratory, cardiac, gastrointestinal and others."
    • "Respiratory causes include: bronchial carcinoma, mesothelioma, cystic fibrosis and lung abscess."
       
13. Give the common things at the top of the list.
     
14. Try not to mention something wierd and wonderful if you cannot explain it if asked for details.
     
15. Don't let a bad answer to the previous station/question carry over so that you mess up the next question in which you would have otherwise done well.
     
16. And finally:
    • Look enthusiastic and interested.
    • Don't argue with the examiner (even if you think you are right). You want to pass the exam - just accept s/he is right and move on.

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BY: Ian Bickle, November 2005