Aim to pass the exam rather than avoid failing it


UPDATE: I had linked to the wrong page in the first version of post this morning. All fixed now, although for those of you who were diverted to the recipe it will definitely help induce positive emotions (more on that below).

I have recently attended a resilience and wellbeing course where the concept of negativity bias was discussed.

I have mentioned the concept previously on this blog.

In the current course, the instructors discussed he research of Rozen and Roysman (2001) which showed we will generally be more motivated to avoid a negative outcome rather than to achieve a positive one. Hence our focus becomes on defeat (avoidance) rather than success. I often hear candidates say, “I really don’t want to fail the exam”. Less often do I hear, “I really want to pass the exam”

I propose that you actively counteract this tendency, when studying and talking about the exam, such that you talk about what you can do to pass the exam rather than what you can do to avoid failing.

Perhaps this seems like a very subtle change of reference and why does it matter because  the end result is the same – exam completed successfully.

The positive frame of reference enables you to capitalise on the benefits of using positive emotions to drive you. When we are driven by negative emotions we tend to become very singleminded and tunnel visioned. Our ability to problem solve and consider alternate approaches decreases. Perhaps single mindedness is a good thing for the exam. However the proposed benefits of reframing our experience to use positive emotion, is that we are able to “broaden and build” our thinking. When studying under a positive reference, you are likely to have greater mental flexibility, be able to consider more options and use more of your cognitive resources to achieve the task at hand.

Does this sound like something you would give a go?

Here is a TED talk given by one of the main investigators in the area, Barabara Fredrickson, talking about the benefits of operating under the effect of positive emotion.

I hope that all of you experience some positive emotion this weekend. It doesn’t have to be bliss (although that does sound good), but perhaps one of the others, serenity, interest, love, awe…

…and from now on when thinking or talking about the exam, talk about how you are going to pass!

See one, teach one, do one

The title of this post is not a misprint.
Many of us have grown up with the mantra “See One, Do One, Teach One” or even this one:  “Those that can’t do, teach” which is often used in a derogatory fashion to disparage teachers.  The quote comes from George Bernard Shaw but is usually taken out of context.
There is another interpretation for the Shaw quote, which says that before you can do something you need to be able to teach it.
What has this all got to studying?
You have spent hours getting the information into your brain, but how long have you spent getting it out? Probably far less.
What is the best way to get information out of you brain? Teach someone.
I recently came across a useful hierarchy:
Talking is more effective than writing which in turn more effective than typing and explaining is better than just talking.
So who to explain things to?
  1. Another person in person
  2. Another person over the phone
  3. Your dog or cat
  4. Your drink bottle
You might notice that the list doesn’t include “Explain it to yourself” – this is because it is important to talk out loud.
What has all this got to do with the Primary Exam?
Well, have a think about the various components of the Primary Exam and how much value is placed on each method of getting information out.

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.


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 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.


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.

Study tip – start talking!

Now that the written exam is over it is time to start talking. This the the best tip I could give you for the vivas.

Find people to discuss your knowledge with, as expressing concepts verbally is a great way of making sure that you actually understand them. If you can’t find another human to talk to, talk to the cat, dog, pot plant or mirror…

Find someone to ask you questions. Consultants are often worried that their Primary Exam knowledge isn’t good enough to help out candidates. Don’t let them off the hook that easily. A lot of people have a pet topic which they feel comfortable with and, if worse comes to worst, you can give them some of your notes on a topic and get them to quiz you on those. Two past chairs of the Primary Exam have an article in the most recent Australian Anaesthesia aimed at helping consultants prepare candidates for the vivas. Read it yourself, it gives a good insight in to the type of questions you might be asked, and print off some copies to give to those you will be working with.

Registrars who have recently sat the exam, are also a great source of help. Most people are happy to inflict the vivas they were given on others. Bear in mind, people will alsways remember the questions they couldn’t answer better than those they could.

I hope you all have a fabulous and relaxing weekend but, on Monday, start talking!

PS. When you are in Melbourne for the vivas consider visiting the NGV to view the Triennial exhibition. The photo above is a work exhibited there by Xu Zhen

Study tip : Capitalise on your freshness


Last week I hosted a webinar, through ANZCA, entitled “Tips for the Primary Exam”. For those of you who are registered with ANZCA, you can watch it via the College networks (it is a bit of a time investment, but the fast forward button is always available).

One of the other contributors to this blog, asked me whether there were any noteworthy points that could be highlighted here. A lot of what I discussed has already been touched in the previous study tips on this blog.

With the upcoming exam, there has been single, but significant change – the increase in reading time to 15 mins and the allowance for you to write on the question paper during that time. I discussed how to use this change to your best advantage in the webinar and that is the point I will focus on today.

The written portion of the exam is a real feat of endurance – 2.5hrs of MCQs in the morning, backed up with 2.5 hrs of writing the SAQs in the afternoon. Exhausting! None of us write for that long continuously these days. By the end of the afternoon, you will be very tired.

A the start of the SAQ paper however you will still be reasonably fresh – capitalise on your freshness in the 15 mins reading time:

1. Read the questions carefully – those that look like repeated questions may have had important changes made. The answer you have practised for the old question may not be able to be successfully transplanted into the new question

2. Highlight important words – this may include those important word changes, things you wish to define, anything that helps you ANSWER THE QUESTION

3. Jot down a couple of notes to help you structure your answer – your brain will be thinking quite well at this stage. If something great enters it, take 30 sec to write it down. This may be especially helpful for questions you plan to answer towards the end of the 2.5 hrs. To be able to refer back to your little notes, when your brain is fatigued, may provide that little spark that helps you through.

I suggest that you include “Reading Time” in any set of SAQs you practice (1 min per question). The more times you use that extra minute per question in practice, the more useful it is likely to be for you in the exam.

A bit of light relief – yum!

I thought we all needed (well I certainly did) a bit of light relief after a whole week of BT_PM1.3.

A bit of light relief is an essential component of any study programme.

This not particularly scientific article suggests a number of ways in which you can improve your concentration span, most of which seem quite sensible.

One of their suggestions is to take a break.  If you have been following the blog for a while, you may know that I need little excuse for a break.

One of my favourite things to do, if I just need a mental break, is to bake!

To me baking has numerous advantages:

  • the process itself is quite meditative
  • it requires no real brain power, just follow the recipe
  • it makes a bit of a mess – quite therapeutic in my books
  • you end up with something delicious at the end
  • the end product can be consumed on a future breaks, perhaps with a cup a coffee, to improve your concentration even more (see link above)

Below are a few of my favourite simple recipes. Believe it or not, I am not really one to photograph food, so you will have to use your imaginations. These recipes are pretty well bullet proof and very tasty (especially if, like me, you LOVE ginger and rhubarb).

The easiest of all, Chatter’s Crack, I have already shared with you here.

The next one Gingerbread, from my friend Eliza

  • 110g unsalted butter
  • 110g golden syrup
  • 110g treacle
  • 225g plain flour
  • 1 tsp bicarbonate of soda
  • 1 tsp mixed spice
  • 1 dessertspoon ground ginger
  • 60g caster sugar
  • 150ml milk
  • 2 medium sized eggs, beaten

Ginger syrup

  • 100g caster sugar
  • 100ml water
  • 5cm piece fresh root ginger peeled and grated

Preheat oven to 150ºC (not sure whether this is fan forced or not. I have tried both and didn’t make much difference, but I would go with fan forced if available). Grease and line a 900g loaf tin.

Melt butter, syrup and treacle together in a saucepan over low heat. Sieve the flour, bicarbonate soda and spices in a bowl, add the caster sugar and mix well. Add the syrup mixture, milk and eggs and mix.

Pour into the prepared tin and bake for 40mins or until cooked (Eliza says an extra 5-10 mins). [N.B This is a moist cake]

For the ginger syrup, dissolve the sugar in the water with the ginger over low heat and boil for 2 mins.

Remove the cake from the oven and drizzle with the ginger syrup whilst still hot. Allow to cool in tin before serving. Keeps for a week (so I am told – it never lasts that long at our place!)

Third, from David Herbert’s Best Ever Baking Recipes. Super easy, delicious and also pretty foolproof.

You can see that this one is a favourite (and that I am a messy cook!)

And last of all, this is the cake I think I have cooked the most of any, in the 22 yrs since the book it is in, Stephanie Alexander’s A Cooks Companion, was published. The oven temperature is for conventional, not fan forced (drop to 140C if using fan forced).

I will concede the current weather is not ideal for baking, but I encourage you to give one of these a go the next time you need a bit of light relief.