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.

Study tip : revision tactics



Inspired by PLOOTD we’ve started the creation of a local bank of TRUE/FALSE statements for revision purposes. At the end of each tutorial, each trainee writes 2 statements that they thought were important and/or interesting from the session, and we’re keeping them in a spreadsheet. Every couple of months we run a little quiz with 50 random statements and give the trainees the answers to mark themselves.


Study tip: sit the exam when you’re ready

That may seem like a ridiculously obvious statement.

However, speaking with registrars who have failed the exam, sometimes multiple times, they often say they should not have attempted the exam when they initially did.

I realise that there is an imperative, real or implied, to sit the exam as soon as possible in your training. For the majority of people it is completely feasible to prepare for, and sit the exam within the first two years of Basic Training. However as far as I can see in Regulation 37, which details the requirements for training,  you actually have at least 4 yrs to attempt it.

If you end up at a point where you really don’t think that you are ready to sit the exam, please think twice (or three or four times) before “just giving it a go”.

Now I am not talking about the feeling we all get, where you don’t feel 100% ready to sit the exam. However, you have: put in a very concerted effort with your studies; covered the syllabus; done lots of exam practice; had people review your questions and all the signs are looking good. It is normal to have the heebie jeebies.

I am talking about the situation where, for one reason or another, your exam preparation has been significantly compromised. Perhaps there was more work to do that you realised and you just didn’t leave yourself enough time. There are a myriad of other social and work related issues which can derail an attempt. You may have been avoiding giving people practice questions to look because you don’t want to look silly ( that to me is a sign you are not quite ready – much, much better to get the feedback which helps you improve before you sit the exam, not after you fail)

I would counsel you to NOT just give it a go for the experience. Wait until you are properly prepared.

We are all highly achieving individuals. It is not in our nature to fail and a lot of you will never have failed anything up until this point of your lives. Do not underestimate how psychologically devastating it is to fail something, even when you have convinced yourself you were not going to pass in the first place. I do not know one person who has felt ok with it….

Statistically, your first attempt at the exam is the one where you have by far the greatest likelihood of passing. Make it you best posssible shot – sit the exam when you are ready.

( A little birdie told me that the applications for the next exam open on Monday ……)

And finally, today’s photo is from my garden. Hope you have a lovely weekend….

SAQ perusal

Many candidates write unstructured text that doesn’t answer the question. It’s a known problem generally with the SAQ format that in the heat of the moment candidates will write down everything they think they know about the topic regardless of relevance.  It’s hard though when you’ve only got 10 minutes to answer a question to spend some of that time planning, not actually writing. And it’s hard, once you’ve (mis)interpreted the question, to get back on track.

So perusal time is changing! It’s longer at 15 minutes – 1 minute per question! And you can now write stuff! Not in the answer books, it’s not a default exam extension. But you can write notes on the question paper.

We strongly recommend you spend this time underlining all the key points and jotting down rough outlines of your answer.

Simplicity beyond complexity

Last week I advised a rather algorithmic SAQ approach of thinking of and writing relevant facts. Excellent candidates however are already writing and succinctly explaining relevant facts because they understand the material well enough to distil out what is important. Oliver Wendell Holmes coined the term ‘simplicity beyond complexity’ which is where you want to aim for – to understand the material well enough to know what’s important, sum it up and explain it. If you’ve not heard of Oliver Wendell Holmes before then read Letter to Dr Morton.

SAQ 2017.2 Question 6

Describe the effects of morbid obesity on the respiratory system.

The material to answer this is scattered through the recommended texts and most of it can be deduced if you have a reasonable general understanding of respiratory physiology. It’s also nicely summarised in Foundations on Anesthesia : Basic Sciences for Clinical Practice by Hemmings and Hopkins Chapter 71 if you can find a copy.

It’s Friday so instead of making this a TRUE/FALSE post I’ll talk about answering an SAQ using this question as the base.

One of the examiners gives the advice :


This is great advice. Unfortunately a lot of exam answers have step 2 omitted. Step 2 is very important, and in the heat of the exam it is easy to forget it. I have had a sneak preview of the exam report and for this question the marking examiner commented that ‘Notably there were no marks achieved for describing the metabolic, endocrine or cardiovascular effects of morbid obesity’.

I would build on his advice and say an even better answer would be created by :


For example with this question you could write : (note use of point form, common abbreviations and clear arrows showing direction of change – all acceptable and even encouraged by examiners)

  •  FRC ↓ or FRC ↓ so oxygen store ↓ esp with pre-oxygenation (does this decrease in FRC have other implications too?)
  • ↑ pulmonary blood volume or  ↑ pulmonary blood volume → ↓ compliance → ↑WOB   (this change in blood volume is also relevant to gas exchange, why?)
  • diaphragm displaced cephalad → why is this relevant to the preload of this muscle?





Evolution of an SAQ

A colleague wrote some evolution of a viva posts so I thought I’d give some insight on the development of an SAQ.

An SAQ is initially written by an individual and placed into a bank of questions. Once we decide to include that question in a paper a group of us will look at it and try to remove any ambiguity. An answer grid is then written (often not by the original author). An answer grid comprises the points we think address the question, with weighting to more important points and often with weighting towards answers which demonstrate understanding. Marks are allocated such that an excellent candidate could achieve full marks well within 8 minutes. Other examiners will then inspect and edit the grid – we are not expecting you to guess the thought processes of one individual. The grid is not set in stone, if a candidate writes correct and relevant points in their answer they will be given marks even if they are not in the final grid. The question is often re-edited at this stage to take out any more ambiguity or to to narrow or widen its breadth.