By now, your preparation for the upcoming vivas should be well under way. Here are some tips which you may find useful.
(1) Develop confidence with talking out loud.
Many trainees are surprised at how difficult it is to explain even simple concepts, when talking out loud. Drawing a graph while explaining it at same time can leave you tongue-tied!
Hopefully, you have engaged with a study group throughout the year, and pestered consultants with questions in theatre. If so, you are well on the way to performing well in vivas. Even so, much more focused preparation is now needed.
Try to have 2 vivas per day. This number enables you to remember and reflect on what was asked, and polish up areas of deficiency. A lot of the onus falls to you to ask for vivas – it is all too easy to withdraw to private study and avoid the uncomfortable experience of being grilled… but you avoid opportunities for practise at your peril.
As you develop more confidence, get someone to video some of your vivas. You can review these in private, and reflect on your answering style. Similarly, it is valuable to observe other registrars having vivas.
The self-confidence which develops during this process will pay rewards. One obvious example is managing an emergency situation, where you certainly need a calm, clear head, a confident voice, and the ability to solve a problem on the fly.
(2) “Go with the flow”
Each 20-minute viva will consist of 4 topic areas of 5 minutes each. The examiner wants you to score points, so they won’t let you go off on a tangent. This means the examiner might interrupt you, or redirect you, so that you keep answering the questions being asked. Similarly, when 5 minutes is up, the examiner will move to the next topic.
Please understand that these interruptions are in your favour. Hopefully you will get used to this during practise vivas.
(3) What if there’s a slightly “clinical” question?
Sometimes, a viva can include a question with a “clinical” flavour. For example “Your patient’s blood pressure is 70/30 post-induction. What drugs can you use to manage this?” This is not meant to be a segue into a scenario (like in the final exam). Do NOT embark on describing how you would treat this patient. We don’t want to hear “I would simultaneously diagnose and treat, firstly checking ABC…….”
To answer the above question, give a sensible list of drugs like metaraminol, ephedrine and phenylephrine. The viva will probably then proceed by focusing on the pharmacology of one or more of these drugs, and/or the physiology of hypotension.
Some candidates really seem to struggle with drawing graphs. This is almost always due to inadequate practise. However, here are some graph-related tips.
- Don’t draw a tiny graph – use the majority of the page.
- Label the axes, but don’t overdo it. You don’t need each axis numbered 0 – 100 and all drawn to scale…. this just wastes time. Consider the oxyhaemoglobin curve – you should be able to draw it accurately, with a few key points numbered, in about 15 seconds.
- Consider whether the curve passes through the origin, or does it cross the x or y-axis at a different point?
- Practise drawing and explaining at the same time. If you find this impossible, it is acceptable to draw it first and then explain.
(5) What if you slip up / say something silly?
Examiners realise how easy it is to say increase instead of decrease, etc. Commonly, we would allow you to re-state your answer if we think it is a small slip up. This can be done by asking the question again, but in a different way. Or, the examiner might just say “Are you sure?” The latter is never used to try to trick a candidate when they have said something correct. The examiner is giving you a chance to take a breath and re-think what you have just said so that you can correct your error.
(6) What if you don’t know?
Move on! Admit if you don’t know, and move on. There are marks to be scored with other questions. Don’t make something up.
(7) What if you never seem to be able to answer the last question?
Vivas tend to start with something easy / broad, and progressively drill down to test your level of understanding. Don’t panic if you never seem to be able to answer the last question! You may have well and truly passed the viva. The fact that you have progressed as far as a difficult question might actually be a good sign.
Additional viva tips can be sourced from a series of videos showing mock-vivas. This is available via Networks on the ANZCA website.