Example FRCS Plast questions

Ethics & Statistics: FRCS(Plast) example questions

Our coverage spans consent and capacity, confidentiality, candour and probity, through to study design, diagnostic test performance and the interpretation of trials and meta-analyses. Illustrated with the plots and tables the questions actually turn on, and referenced throughout to GMC guidance, statute and the primary literature.

Consent & capacity

Confidentiality & disclosure

Candour & clinical governance

Safeguarding & vulnerable groups

Probity & professional conduct

Research ethics & trials

Study design & levels of evidence

Diagnostic test performance

Significance, power and error

Systematic review & meta-analysis

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Question 1

Ethics & Statistics

A facial palsy fellow at a tertiary UK reconstructive centre is designing a prospective cohort study evaluating outcomes after free functional gracilis transfer for smile reanimation. For each patient, the following variables are recorded: 1. Age at surgery (years), 2. Sex (male / female), 3. Aetiology of facial palsy (idiopathic, iatrogenic, congenital, traumatic, neoplastic), 4. Pre-operative House–Brackmann grade (I–VI), and 5. Operative time (minutes).

Which variable represents ordinal data?

CORRECT ANSWER

Ordinal data consist of ordered categories where the rank is meaningful, but the intervals between successive categories are not necessarily equal.

House–Brackmann grade (I–VI) is the classic surgical example - Grade III is worse than Grade II, but the clinical "distance" from Grade II to III is not the same as from Grade V to VI.

Classifying the others:

Age and operative time are continuous (ratio) - measured on a numerical scale with equal intervals and a true zero.
Sex is nominal (dichotomous / binary) - unordered categories.
Aetiology is nominal (categorical, polytomous) - multiple unordered categories.

The practical implication:

Ordinal data should not be analysed with parametric tests that assume equal intervals (e.g. t-test, Pearson's r).
Appropriate methods include - Mann–Whitney U test (two groups), Kruskal–Wallis (>2 groups), Wilcoxon signed-rank (paired), and Spearman's rank correlation.

Other ordinal scales worth recognising include: Sunderland nerve injury grading, Gustilo–Anderson, Clavien–Dindo, and the Mathes–Nahai flap classification.

REFERENCES

Vrabec JT, Backous DD, Djalilian HR, Gidley PW, Leonetti JP, Marzo SJ, et al. Facial Nerve Grading System 2.0. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2009;140(4):445-50.Kirkwood BR et al. Essential Medical Statistics, 2nd Edition [Internet]. Wiley.

Question 2

Ethics & Statistics

A research fellow investigates whether autologous and implant-based breast reconstruction differ in patient-reported satisfaction. Using a national registry, on a single census date she sends the BREAST-Q to every woman currently under follow-up across UK plastic surgery units, regardless of when their reconstruction was performed. For each respondent she records reconstruction type and satisfaction score simultaneously, then compares the two groups. No patient is contacted again.

Which study design does this best describe?

CORRECT ANSWER

The defining feature is that exposure (reconstruction type) and outcome (BREAST-Q satisfaction) are measured together at a single time point with no follow-up - a cross-sectional design. It yields prevalence and permits group comparison, but cannot establish temporality or incidence. Don't be misled by the historical surgery or the two-group comparison.

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Ethics & Statistics: FRCS(Plast) example questions

Better questions. Better preparation.

Better questions.
Better preparation.