Stress: A state of mental or emotional strain or tension resulting from adverse or demanding circumstances.

Is it a bad thing?

I recently attended a management course that concentrated on resilience in the workplace. Learning how to identify stress in your life and identify it in others is at the crux of this course. The above slide was put up and my mind immediately travelled to performance in the primary examinations. Examinations are stressful, but is this a bad thing?

The above graph looks different for everyone but displays some important points. The yellow section is where people perform best. It is called the “optimum stress” area and is where you want to be when you sit the vivas. You are tense yet motivated, your senses are heightened and you are prepared for the challenge ahead.

At the Olympics, what separates good athletes from extraordinary athletes is often their ability to perform in high stress situations. Most of the athletes are very similar in their fitness and physique, and it comes down to performance on the day. Two people with very similar skills and training can perform drastically different when faced with high-pressure situations.

Everyone has warning signs about when they are moving into the overload category, and when fatigue is becoming exhaustion. In this overload area, we tend to do less of our normal, healthy coping mechanisms (e.g. exercise) and our performance starts to decline. This overload of stress has been linked to impaired performance in military and in civilian populations.

Resilience: The capacity to recover quickly from difficulties; toughness.

The good news is that you can get better at identifying and managing the stress you inevitably feel when facing difficult and uncertain situations. Identification and management of stress, and building of resilience, is possible. The trick is to manage your stress and keep it within optimal levels in order to perform on the day. If you don’t have the tools in place to keep your stress in check, you’ll under perform on the day of the exam.

The key thing to understanding this is that you are indeed facing uncertainty—the outcome of your future has not been decided. It’s up to you to develop the beliefs and mental toughness that will get you through the next few weeks, and perform well on the day of the viva.


8 minutes….

With the exam rapidly approaching, I thought this would be a good time to address the 8 minute reading time. This is a time where you can read the questions and start planning your attack. You cannot write anything during this time, but you can have an internalised plan.

Easy things first…There are 15 questions to read during this time, read them well. There will be some repeat questions. Do not spend your 8 minutes thinking about the repeat questions. There may be questions that you think are repeats if you don’t read them properly so read them well!  There will be other new questions.  Some of these will be hard and one or two of them may seem impossible during the first read. Use your reading time to think about these new questions.

The things to ask yourself during this time are things such as “what are the key words in this question?” “WHY are the examiners asking me this question?” “WHAT about this topic is important?”. Vomiting an answer onto the page, without a plan or structure, does not fill the examiner with a feeling that you understand the topic. Whereas, if you have a structure to the question then the important points will hopefully follow. The better answers are often shorter than many of the other answers as they are efficient, and demonstrate that the candidate knows the topic well enough to know what is important.

When answering new questions, remember that this is an exam to enter anaesthetic training (more or less). Placing a whole bunch of random facts onto the paper will get you a few marks, but it won’t score you high marks. Stay calm, think about the question and have trust in yourself and the work you have done. Use the eight minutes to your advantage and think “structure, structure, structure (and handwriting!)”.

Good luck and stay strong!

Reading the examiner

How can you read the examiner during a viva?

Short answer: You can’t.

Long answer: Given that is not uncommon for the Renton Prize winner to believe they have failed the vivas, is there any way to actually know how you are going? This post covers some of the common ways people try to read the examiner, and ends with the test with the highest area under the ROC curve.

TRUE/FALSE If the examiners face is blank, you are failing.

Most examiners will avoid giving non verbal cues. A blank face only indicates that they are listening to your answer. Ask the people giving you trial vivas to give you practice at answering a question without non verbal feedback.


TRUE/FALSE If the examiner is smiling and nodding, it is a good sign.

This test has a high sensitivity but low specificity. It means that the examiner probably does not have Asperger’s syndrome.


TRUE/FALSE If the examiner looks at you over the top of their glasses it is a sign that you have made a mistake.

This test has both a high sensitivity and specificity. The examiner is longsighted.


TRUE/FALSE It is a good sign if the examiner is making a lot of notes.

Some examiners make notes whilst they are examining. Some examiners prefer to write their notes after they have finished doing their vivas. Either way, they are recording your answers, whether or not they are correct.


Your guess as to how you are going is worse than tossing a coin. There is, however, a test with a very high sensitivity.


Most people who are invited to the vivas pass. If you assume you are passing, there is a much better than even chance that you are right.

Viva tip: Reset and forget

I am sure most of you are aware of the format for the vivas, but just in case you are not, it’s:

2min reading, 20 mins viva (4×5 min vivas), 2 min reading, 20 min viva, 2 min reading, 20 min viva, done!!

Each of the sets of vivas will be conducted  by a different pair of examiners who have no idea how you have done in any other part of the exam – you are a blank canvas to them.

You have 3 chances to completely reset during the 66 mins. Make a conscious effort to calm yourself and refocus. Could you capture this feeling of freedom (not the sense of free falling)?

Leave the previous viva behind as you leave the little black cubicle.  Take it consciously from your mind. Only 3 people know what happened and the two of them who are still in the room, will be resetting themselves ready for the next candidate.

Within each 20 mins, there are also 4 separate and independent questions, each marked on their own merit. The examiners will mostly indicate when you are moving to a new topic ( it is a give away when the second examiner starts asking questions 😉). Take these transitions as another opportunity to reset yourself – perhaps have a sip of water.

You cannot alter the viva once it is finished. Undoubtedly you will have given it your best effort.

So when standing outside a black cubicle, with a bunch of other terrified looking individuals, in the second week of April, reset and forget…..

Exam Technique: Graph Drawing


The vivas are still a way off, but I will mention this now so you can think about how you will draw the graphs as you learn the material.

If you were studying maths you would be expected to know the formula, draw the graph, and describe it in prose. Lucky for you you’re studying for the anaesthetic primary and you only need two of these components.

Many candidates start by labelling and scaling the axes. Thirty seconds later, they still haven’t got drawn the curve, which means they haven’t gained any marks.

You should start with the most important part, which is the graph itself. Try to get in the habit of describing what you are drawing out loud. For example, “A log dose response curve has a sigmoidal shape, starting at zero, with a maximum of 100% effect for a full agonist”. This means if your graph is a slightly funny shape, the examiner will know what you meant.

The examiner will want to discuss the curve, so draw your curve in the middle of the graph. This will give you room to show what will happen when the curve changes.

Spend an extra second or two making sure the curve is accurate. If it starts at zero, draw it as such. This could easily save you a minute explaining that 20% of your patients are not actually unrousably unconscious on arrival at theatre reception.

If they don’t stop you, then go on to label the axes. Put in values for the important points only, and then start describing the factors affecting the curve.

Ideally you will speak while you are drawing your graph, but if this doesn’t work for you don’t worry – just draw the graph and then explain it.


Feel free to make suggestions as to what LOs you would like questions on next week.