Evolution of a viva- Part 1

Before you get your hopes up I will not be revealing the intimate details of a viva but I will attempt to convey some of the thought processes that are employed in the creation of a viva. I can only speak for myself here but I suspect my colleague examiners do similar things.

It begins with an idea (as do most things) which is often formed during the actual viva exams. I think to myself, “Gee the candidates don’t know much about basic propofol pharmacokinetics.” Often this thought is engendered as I watch a colleague examine on a particular topic. I like to examine on topics that satisfy a few criteria:

  • I think anaesthetists should know this stuff
  • The topic is clinically relevant (hopefully these two aren’t mutually exclusive)
  • I have seen a knowledge deficit about the topic in my trainees (if they already know it then someone else can ask them that!)
  • The ‘answers’ or responses I want need to be in the set texts (this can be quite difficult and has scuppered a few viva ideas along the way)
  • Another person with a FANZCA would at least understand most of what the viva was getting at
  • The nature of the topic lends itself to being asked in a viva format

Once I have the idea I write down what the main points I want candidates to demonstrate an understanding of are. (I also need to make sure there is a learning objective pertaining to the viva!!) Each viva topic is only five minutes long so the path to pass responses needs to be direct and hopefully short. Next I hit the books and confirm that the topic is adequately covered. Occasionally I discover that my understanding of the topic is at odds with what the books say! Not uncommonly I may have to look at six different books and it is frustrating for all of us if they say six slightly different things. Next I need to formulate the questions to get the information I want. Each viva should ideally start with a simple and brief question to allow the candidate to answer the opening question correctly and begin in a good frame of mind. So, for a propofol PK viva I might ask “What is the induction dose of propofol for a healthy unpremedicated 20 year old?” Subsequent questions need to flow on naturally from the opening question. I like a diagram or two in a viva but it needs to be simple and easily drawn. Sometimes it may be better to provide a diagram. It may be deliberately incomplete. Lastly I run through the viva myself a few times to check the timing and make sure the flow of the viva is alright. Then the real hard work starts. Part 2 will elaborate.

Study tip: Answering SAQs – make the most of your unconscious brain, but don’t let it fool you….

Ok, that title is a little cryptic, but bear with me….

We have probably all had experiences when we are asked to recall something which we are sure that we know (for me this is often a person’s name), but seems impossible to drag up from the depths of our brain. We give up and then the answer just pops into our consciousness. Perhaps this is your unconscious brain at work.

How can you use unconscious brain to your advantage during the SAQs? As soon as you read the questions your brain will start working on them. Make sure that you read all of the questions carefully in the first 10 minutes. Spend a bit of time carefully checking to see exactly what the question is asking, as you want to set your brain off on the right track. I will assume that you have studied well and have a good knowledge base. In spite of this, some questions may initially seem tricky: perhaps the information doesn’t spring to mind; you may not be sure how to structure the answer. That’s ok – don’t panic! Panic is shocking for your memory. Send these questions to the unconscious mind and get on with answering the questions you feel more confident with. When the time comes to answer the questions that you have set aside, hopefully your mind will have worked on them in the background and that knowledge will be easier to access.

Now for your second part – don’t let the unconscious brain fool you. This part applies to your SAQ practice. I suspect, and hope, that all of you are practising past SAQs. How do you do this? Here are some options:

  1. Do you select 6 questions at the start of your study session to write at the end?
  2. Do you choose some questions the day before to attack the following day?
  3. Have you put a whole lot of individual past SAQs in a box, from which you randomly pick a selection to look at and answer straight away?
  4. Do you have a friend/colleague put a set of questions in a sealed envelope to open and answer under exam conditions?

If you picked 3 or 4 – perfect! You are receiving a true reflection of how you could answer that question in the exam. The results may be confronting, but it will show your where a brush up is needed.

If you picked 1 or 2, I would contend that you are giving yourself an advantage that you will not have in the exam. You are giving your brain extra time to work on these questions even if you consciously try not to think about them.

There are still a couple of weeks until the next written exam. It’s not too late to give yourself some good quality SAQ practise. Any holes that you find in your knowledge should be easier to learn as this information is likely to have meaning for you.

Good luck everyone!! I am not sure that I will be back on the blog until after the written, but I wish you all of the best…..

….and just to finish, I couldn’t leave you photo free.


“Brain” jellyfish, Mljet, Croatia

Study Tip: Describe, Explain, Compare, Discuss, Outline

I am sure you have seen these words at the start of short answer questions. Have you taken much notice of them? Do these words actually mean anything to you?

They are called action or reporting verbs and it is worth having a working knowledge of them.

Good answers to short answer questions usually have a structure. For example, an answer to a question about a drug might use headings like pharmaceutics, pharmacokinetic and pharmacodynamics. The detail under each of these headings will depend on the action verb.

The Anaesthesia Training Program Curriculum (v1.6) provides some definitions (p16) but there are other sources for example here and here that are more informative.

Having your own easy to remember definitions will help you in the exam. Here are a few to get you started:

Describe – What

Explain – How and Why

Discuss – Multiple Whats and Whys

Outline – An organised description, usually with big picture points

Taking more notice of the action verbs in questions can help improve the structure of you answers and earn you more marks.

Study tip: Remember information more effectively 

Why is it that some things stick in our minds forever and others we have to work so hard to retain?

The Ebbinghaus forgetting curve shows that new information is lost exponentially without revision. It looks terrifying….

The Ebbinghaus experiments were done on himself, trying to remember short sequences of unrelated letters – most of us would find that hard. It has no context and is not meaningful for most people ( except if you like remembering strings of random letters!)

We have seen previously on this blog, that one way to help with retention of information is to revise the information regularly. This is important and to be most effective must use  active recall

There are other ways that you can give yourself the best chance of remembering the information you are learning in the longer term.

  1. Add the new information to a frame of knowledge that you already have – try to build your new knowledge on to well established memories. This is not always easy to do if learning totally new concepts. This technique could be used to layer information into your brain. It is a technique used by at least one previous part one candidate (see the 5th comment)
  2. Make the information you are learning meaningful. This one should be easier to achieve. We remember things that we think are important much more easily than things we don’t (which may explain why Ebbinghaus’s curve looks so pessimistic). Find relevance in what you plan to study. Build up a list of questions during your day at work – why did the blood pressure drop on induction? what might have caused that dodgy sats reading? – and study to find the answers when you get home.  This technique has also been used with success (see comment 6 in the above link). You will be using the knowledge gained through studying for the Primary Exam throughout your whole career – it’s your job.
  3. Look after yourself. Good nutrition, regular exercise, plenty of sleep and some time to relax, will all help your brain to function at it’s best. Do not under estimate the importance of this

As promised  the flying frigate bird – it’s a bit hard to photograph a moving target, but I did my best!


AR_ME 3.2 Discuss everything which could be construed as being related to anaesthesia

AR_ME 3.2 Demonstrate knowledge and understanding of the procedure including indications, contraindications, anatomy, technique side-effects and complications

This follows on from AR_ME 3.1 which is not examinable in the primary:

Demonstrate proficiency with:
 Vascular access
 Airway management
 Central Neuraxial block
 Other regional procedures
 Invasive monitoring procedures

T/F The Primary examiners have developed a sudden passion for anatomy.

T/F You are now required to know all about regional blockade when you sit for the Primary


Whilst this is only my humble opinion rather than an official ANZCA publication:

Asking regional blocks would be a major change in the scope of the primary. A change of this magnitude would not be slipped into the exam without a clear announcement from the College. So I will go out on a limb, and say: You will not be asked about subjects which are not in the non AR_ME LOs.

The examiners do not write the LOs, but I believe that the two AR_ME LOs which relate to the primary have been inserted to make it clear that when you study for the primary you should consider clinical applications, and when you are practising anaesthesia you should understand its grounding in science. I think you would be quite safe to ignore AR_ME 3.2 & AR_ME 1.3 (Apply knowledge of the clinical and biomedical sciences relevant to anaesthesia), as long as you realise that you will be asked about the clinical implications of the subjects you have studied.

As I am accustomed to say, if you don’t know the dose of propofol in an anaesthetic pharmacology exam you are in the wrong specialty 😉



Another cool book that should be on the ‘Recommended Texts for the Primary’ list


Most people don’t find pharmacokinetics particularly palatable. This book is arguably one of the most enjoyable ways you can learn about pharmacokinetics. This book doesn’t just entertain but it also gives you a sound understanding of PK concepts as they relate to the practising anaesthetist. It is under 200 pages and can be read in a day. It is fairly non PC which accounts for half its charm. Nothing in there about TCI sadly.

Addendum by woundedwildebeest… I got to see this post when it was a draft and bought the book. I definitely second this recommendation. Funny, educational, with even a dramatic twist on the last page. I’d suggest reading a chapter at a time and applying it in theatre before moving on to the next.

Cool books that should be on the ‘Recommended texts for the Primary’ list #2


Mercifully brief, this is a great little book written by an American anesthesiologist. You won’t finder a better description of core physiological principles in any of the recommended texts. There are also cool little puzzles at the end of each chapter which I found strangely appealing. The chapter on cerebral perfusion pressure including a discussion of the applied physiology in the giraffe is a real highlight. In fact this is the book you should read first before embarking on Nunn et al.

Study Tip: Gain knowledge and understanding, not familiarity 

Have you been I the position where someone asks you to explain something to them? You think, “Sure, that’s something I’ve read up on” – you feel familiar with the topic and happy to talk about it. But then, the wheels start falling off – as you go to explain the concept to your friend, your familiarity is not enough, everything starts to fall away, you don’t have enough knowledge or understanding of that topic to provide an explanation. It has happened to me – it’s embarrassing😉.

Talking with many registrars who have failed the exam, familiarity with the material is an enemy. They have looked at the material a number of times, but have never actually learnt the material in a way that enables them to impart knowledge to others ( specifically in answering exam questions).

How do make sure that you have learnt (know) the information?

This article from UNSW, gives some good advice on active reading and note taking as a basis for learning. Make sure that you have understood the material, before your leave it for the first time, by questioning yourself and reviewing your notes.

It is vital that you practice imparting your knowledge, and checking understanding, many times, before you get to exam. You will have read about the importance of active recall multiple times on this blog, as it is the key. 

  • Go back to your notes and practice recalling as much information as you can before looking at your notes again. Highlight any areas of difficulty 
  • Explain something to a friend, colleague, student, pet, pot plant.
  • Practice past SAQs, without your notes in front of you – be honest with yourself
  • Get people to ask you questions 

Have a look at this post from January. It shows you how important revision is. 

Make sure your learning is active. Familiarity is an enemy – you want to gain knowledge and understanding…

So you’re sitting the primary in August…

Submitting an exam application on the closing date demonstrates commitment to a career in anaesthesia   TRUE/FALSE


The above is facetious but many candidates do apply on the final day that applications are open. One of my candidates missed the application date once, it was heartbreaking, not only did she have to study for another 6 months she also lost her spot on the training program and had to find a new job for a year.

It is now a month until applications close, if you are studying as if you will sit in August, then you should apply as if you will sit in August. The college does not deduct the funds from your credit card until after the closing date. Don’t take the risk of missing the application closing date because of personal circumstances or equipment failure.