The enigmatic title of this book comes from a toast to the four nations of Great Britain (I suspect some Welshmen might suggest the daffodil as their emblem, but it does not scan as well!), reflecting the various Colleges' role in maintaining our ENT exit exam. This book will obviously appeal to examiners in all surgical subspecialties, and will evoke memories in those who have survived at the receiving end. It may also carry a very useful message, internationally, to those seeking to establish local, validated examinations at the end of specialty training.

The author has served 18 years as Head of Intercollegiate Examinations, a period which has seen 13 000 candidates, of whom over 1200 have been ENT trainees.

The book starts with a very interesting history of surgery, especially the account of how our predecessors in the UK self-organised into guilds and then Colleges. There is much amusement here, and I have to reproduce the tale of the first surgical exam in Ireland, which cost the candidate a fee of one guinea, whilst the examiners gave their services for free. Well, at least the latter has not changed! The traditional FRCS was taken at a progressively earlier stage in training, until it became an entrance exam; hence the need for Specialty Fellowship examination on an intercollegiate basis. I had forgotten that the first ENT exam had been planned for November 1990 but had to be cancelled, as the only two candidates were ineligible. I do well remember the subsequent advertisements in the journals, suggesting to us all, even those safely in senior posts, that this optional exam was a worthy addition to our CVs. Revalidation may yet bring this, but, back then, the response was predictable. Happy days, when the optional exam only cost the candidate £230; however, by the mid 90s the exam had become essential for the, then, CCST.

There are great anecdotes, which future candidates will enjoy. The story of the sole candidate for the first paediatric surgery exam in 2007, the Close Encounter in Dublin, and the Close to the Wire incident humanise the whole experience.

Now, many of us will groan at Miller's Pyramid, the Angoff technique, Bloom's taxonomy and Cronbach's Alpha, but they do show the challenges faced in creating an exam that is ‘fit for purpose’ and will withstand scrutiny. The Secretariat of the ISB ultimately achieved the Investors in People Gold Award in 2009, something not lightly handed out.

The final chapter suggests how the process may yet evolve, with the Edinburgh College increasingly dominating its workings, greater employer pressure on examiners' time, and the challenge of establishing international equivalence. The appendices list the great and the good, who have run the show, and reproduce the invaluable advice given to candidates immediately prior to the exam. Read this now! My favourite is the statement that the examiners are not playing games so ‘leave any tactics taught on courses behind’.

Personal happy examining memories include Maurice and I hosting the exam in Middlesbrough. The panel left astounded at what a rural, tranquil place it had proved (little realising the effort we had taken to make sure accommodation and transport routes were planned meticulously). I fondly recall being booked into the same hotel room as ‘our Valerie’, an ultimately unfulfilled prospect of delight.

This book is remarkable value. At the price of a celebratory pint of beer in any pub on St Stephen's Green, the book is very professionally printed, and I would recommend it to those who have sat the exam, and even more to those about to do so. The examiners will recall with much nostalgia those entitled to wear the blue and red tie or the brooch, signifying examination success, and will increasingly prize what it all meant.