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.

Examiner musings on candidacy Pt I

Extracts from a messaging app conversation between some examiners…

How much time did you spend studying? I started a year before, but spent the first three months falling asleep at night trying to read Guyton’s chapter on cellular physiology. After this, I gave up and read West instead…

A couple of things I did which were effective. A few months out I decided to do 6 hours effective study per day on the weekend, and then go out. I made 24 checkboxes, and ticked each one off after I did 15mins of effective study. It is a lot easier to keep yourself focused for 15mins than 6 hours…

The other really useful thing was compiling a list of every viva opening question. I ranked them in order of frequency, and wrote a card on each one—the answer to the opening question, and what I thought the followup would be…  (The opening questions aren’t published anymore but there is a large bank of them to be found on older exam reports. WW.)

I think once you have read things once, re-reading isn’t very effective. You need to do something else to ensure you retain and understand the knowledge…

having to teach others is a good technique…

In my first run through the material, I was draconian about what I learned. If I came across something that I decided wasn’t core material, I discarded it. The stuff that was left, I made sure I knew backwards. Then on my second run through, I attached a bit more depth to the “core”. It worked for me, and was actually the first time I’ve studied this way. But I’d never recommend it to anyone else. It just might not work for everyone, and if you misjudge what is “core” you could come very badly unstuck…

The thing that made the biggest difference for me was working with anaesthetists who understood the material, and made it come to life in the operating theatre by using basic sciences to inform their decision making. This not only made the information ‘stick’ it also motivated me to study!

Preparing for the Primary

“You must read Nunn.” “You must belong to a study group.” “It takes 1000 hours of study.” “You must go to the Brisbane and Christchurch course.” “Just one course is plenty”………..

……… and so on and so on. A trainee preparing for the primary is inundated with advice – usually dogmatic, ranging from the erudite to the nonsensical and always (hopefully) well meaning. In more than twenty years of observing success and otherwise in the primary exam, I have come to realise there are nearly as many valid ways of tackling this exam as there are candidates. My advice below has no more validity than anyone else’s. But I have yet to regret dispensing it. Here goes.

  1. Listen to all the advice. It’s a gift. Listen, but by no means should you take it. Evaluate where every piece of advice fits into your own world view, and decide based on your knowledge and experience of yourself whether you’ll accept it. You know yourself and what works for you better than anyone else on the planet. There are no rules.
  2. Be honest about yourself. Although this is probably the toughest academic hurdle you’ve faced; you won’t change in anticipation of it. The way you’ve always *actually* worked (not how you’d *like* to have worked) all through Medical School will be how you work for this exam. If you’ve always been a relatively distractible, not terribly focused studier; that ain’t going to change. You’re just going to have to put more hours in. And if two hours at a desk was your limit at age 20, it’s likely it will still be. You’re simply going to have to come up with a preparation framework that accommodates this.
  3. Commit to a date and stick to it. Being non-committal about when you’re going to do the exam is a huge negative predictor.
  4. No big blocks of time off. When in official study mode (for most of us about a year) you will still have plenty of nights off and down time. But what you shouldn’t have, in my opinion, is big blocks (more than about a week) of time where the exam is right out of your consciousness – because if you’re not going forwards; you’re going backwards. Try to avoid major life events during prep time (easier said than done, of course).
  5. Some peer contact is essential. It doesn’t have to be a “formal” study group if that isn’t your style; but some kind of collegial relationship with at least one other person who is sitting the exam with you is hugely beneficial. Establishing this isn’t easy for some people; but this is the one area where I would urge you to push past any barriers and get yourself out there.

It’s worth it. It’s a fantastic career.

The primary exam does not define you

Over the next few days, we will be offering heartfelt congratulations to those who pass the exam and conversely, sincere commiserations to those of you who don’t.

Regardless of whether you pass or fail the exam, this exam will not define you. It is a means of ensuring that all future anaesthetists have reached a required depth of knowledge in the sciences underpinning our specialty – that is all.

Passing or failing is no reflection on your worthiness (for better or worse) as an individual, although it may not seem that way at the time, especially for those of you who fail. Those around you will feel happy or sad for you, depending on your result, but their underlying respect and love for you and compassion towards you will be unchanged. You will be intrinsically the same person in a week that you are today – the same doctor, colleague, partner, friend, parent.

Be kind to yourselves.

Having said that this exam won’t define you, let it shape you. How can you use this experience to improve yourself? When I was studying, one of the best and most generous teachers I had was a senior registrar who had sat the primary exam 8 times before passing! He had an encyclopaedic knowledge of the material and a compassionate heart. He knew better than most how gruelling the exam could be. We are not used to struggling academically and, even less so to failing. But we are fortunate.

Sometimes, when faced with a significant setback, it can be hard to look forward. If you find yourself in this situation, or are worried about a friend, please seek help. Talk to a friend, someone at work or your GP. Two other options which are also always available are:

Doctors’ health advisory service


You are worth so much more than this exam – do not let it define you!!