Reading your feedback in 2018 – part 3

final result feedback

My hypothetical candidate was one of the 83.5% who passed the vivas at this exam. The vivas are in some ways easier than the SAQs as the examiners can prompt and rephrase questions to help you answer them, and in some ways more difficult as they test understanding. This candidate wasn’t able to compensate for their low SAQ mark, but should be very encouraged that they passed this component which requires both a breadth of knowledge and an ability to integrate the material. Not pass

This letter will have accompanying individual feedback sheets on questions/vivas that scored <40%, often with specific comments made by the marking examiner. It should be read in conjunction with the exam report too

This may be the first examination you have been unsuccessful in. This feedback, though difficult to read, can be a stepping stone to a successful attempt

 

Reading your feedback in 2018 – part 2

feedback SAQ

More personal opinions and interpretations, this time on the SAQ feedback.

All the SAQs are now marked or scaled to out of 5 so in this section you are given your score for each question and your total score. In this section you need 40% to be invited to the vivas, that is a total of 30, or an average mark of 2 (borderline). I would also define a 2 as ‘the candidate has not demonstrated that they are performing at the level required in a specialty exam but rudimentary knowledge has been displayed and the examiner feels, based on that performance, that the candidate is worth inviting to the vivas to demonstrate their knowledge and understanding further’.

My hypothetical candidate will be invited to the vivas based on their SAQ score but they have a lot of ground to make up in the viva examination. This will be difficult but it is doable. Study is often more dynamic, interactive and effective leading up to the vivas.

I suggest you classify each SAQ based on

  • topic
  • whether it asks for factual material only, or integration
  • whether it is clinically based

For example, question 7 in this exam asked to justify the dose of propofol used in different scenarios and requires integration of knowledge in a clinical setting, while question 8 in this exam just requires you to set down what you know about IV metoprolol.

Is there a pattern in your performance?

Question 15 scored 0 which suggests poor time management.

 

2018.1 SAQ 6

BT_GS 1.24 (Inhalational agents – pharmacokinetics)

Describe the washout of sevoflurane from a patient following two hours of general anaesthesia. You may wish to use a graph to illustrate the description.

Anaesthesia is unique in medicine for many reasons, one is our need to control offset of action of drugs as closely as onset. Desired effects become adverse effects once the patient is wheeled out of the operating theatre.

The scale on the abscissa (y axis) of this graph is logarithmic  T/F

This graph is modeled with a single exponential function T/F

High solubility drugs will wash out more quickly than relatively insoluble ones T/F

This graph takes into consideration metabolism of drugs in the liver  T/F

The initial rapid decline is due to washout from well perfused organs such as the heart  T/F

 

2018.1 SAQ 5

BT_PM 1.12 (Opioid receptors)

List the desired and adverse effects of opioids and the corresponding anatomical location of the receptors being activated

Opioids have multiple sites of action and many of their effects are undesirable. These should be considered in your patients, and other analgesic techniques used if harms potentially outweigh benefits.

Opioids can mediate analgesia through presynaptic primary sensory afferents T/F

Opioids can mediate analgesia in the dorsal horn of the spinal cord T/F

Opioids have no supra-spinal mediation of analgesia  T/F

Immunosuppression is an adverse effect of opioids T/F

Biliary spasm is an adverse effect of opioids T/F

Bonus question, definitely not core material in answering this question but interesting. First paragraph of the pethidine entry on wikipedia leads you to the answer but it’s worth considering why the Germans were trying to develop drugs of this class in 1939.

Pethidine can cause mydriasis T/F

Reading your feedback in 2018 part 1

mcq feedbackBy now those who weren’t successful in meeting the requirements of the primary examination will have received their feedback letters. A difficult read which I’d like to try and make easier by helping you approach logically. This isn’t official advice, just what I would recommend to any SOT or candidate who approached me for help. I’ll talk about looking at the MCQ marks today.

I’ll be including photos of a feedback letter I’ve created for an imaginary candidate. Here are their MCQ marks. The candidate passed the MCQ and I would like to take this opportunity to say well done to everyone who passed the MCQ. You’ve demonstrated a great breadth of knowledge covering over 300 LOs. This requires significant organisation and diligence. Even if you didn’t go on to be successful in the overall exam this is a great achievement.

This candidate has only just passed the component though, and I’d recommend people in the 75-84 range realise they have a good base but they should try to improve this component to safely pass in their next attempt. More ruthless organisation and diligence is the key here. Aids I would recommend would be The Primer for the Primary which I’ve recently recommended, and a new resource which will be released soon at mak95.com. I’ve spoken with registrars who have used a beta version of this and they have given glowing reviews.

Low scores in this component mean you haven’t demonstrated a foundation in the basic sciences in anaesthesia, and it may well be very difficult to build this over just a few months. If training requirements allow it might be best to build up to sit in 2019.

Mind games : recovering from a cycle crash

I was reading this article – Mind games: Getting your head back in the game after a crash  and found a box at the end of the article full of fantastic advice both for getting back on the bike and getting back to study after an unsuccessful attempt at the primary exam. Elite sport and specialist medical training have quite a lot in common.

Paraphrased…

Take your time

Identify what you enjoy about anaesthesia and use that to motivate you

Identify what’s within your control. And what’s not within your control.

Set successive challenges for yourself to get back into it under control

Recognise unhelpful thoughts.

Connect with other trainees and your family and friends outside anaesthesia.

 

A Primer for the Primary Examination

It can be difficult as a candidate without years of anaesthesia experience to appreciate the relative importance and clinical applications of different learning outcomes. One of the PLOOTD bloggers (who is of course incidentally an examiner) has therefore made this fantastic resource – A Primer for the Primary FANZCA examination. For each topic the depth of knowledge required is indicated, sources are recommended and some idea of the weighting in the exam is suggested. Many of the topics have useful musings from someone who has been an examiner for 12 years. Many of the topics also have links to some practice T/F questions with an idea of how difficult the writer feels they are.

This is going to be of most use to those who are sitting in August and beyond, but there’s a lot in there for those betwixt written and vivas too.

We think this resource is gold. Have a look and see what you think.

Carbon dioxide carriage in the blood

BT_PO 1.32   Discuss the carriage of carbon dioxide in blood, the carbon dioxide dissociation curve and their clinical significance and implications

Most of the dissolved carbon dioxide in the blood is in the erythrocytes     TRUE/FALSE

Carbonic anhydrase is found in erythrocytes   TRUE/FALSE

Carbonic anhydrase is found in pulmonary capillary endothelium   TRUE/FALSE

As temperature decreases, there is a lower pCO2 for a given mass of CO2 in the blood   TRUE/FALSE

Reduced Hb has a tenfold ability to carry CO2 over oxyhaemoglobin   TRUE/FALSE

Work of Breathing

BT_PO 1.10 Describe the Work of Breathing

1 Joule of work is done when 1 litre of gas moves in response to a pressure gradient of 1 kilopascal     TRUE/FALSE                                    This uses the SI unit of kPa, how many cm of water is that? So how many joules per breath? How many joules per minute? What is the efficiency of breathing? How many joules/calories are you expending on breathing? What % of your daily calorie use is that?

Breathing at rest is responsible for approximately 0.5% of the body’s oxygen consumption     TRUE/FALSE

Work is calculated by integrating a pressure volume curve     TRUE/FALSE

1/2 of the energy created in inspiration is stored as heat to be used for expiration      TRUE/FALSE

Bonus unexaminable question : Earth’s gravity accelerates a falling body at approximately 10 m/s/s and 1 Newton is defined as the force moving 1 kg at 1 m/s/s. Assuming that a 17th century apple had a mass of 100g, with what force would it have hit a man’s head if it fell out of a tree?

 

Pulmonary circulation

BT_PO 1.33 Discuss the difference between the pulmonary and systemic circulations 

The short length of the pulmonary vasculature contributes to its low resistance     TRUE/FALSE

Pulmonary endothelium synthesises prostaglandins     TRUE/FALSE

Parasympathetic stimulation constricts the pulmonary circulation     TRUE/FALSE

The pulmonary capillary bed is pulsatile     TRUE/FALSE

20% of foetal cardiac output passes through the pulmonary circulation     TRUE/FALSE