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.



Study Tips: “I keep six honest serving men (they taught me all I knew); Their names are What and Why and When And How And Where and Who.” – Rudyard Kipling, The Elephant’s Child

The vivas are over for another year, which means that it is less than six months until the next written exam.

For those of you planning to sit the first exam in 2018 it is probably time to revisit your study plan to see how you are tracking.

For those aiming for the second sitting next year, it is time to put pen to paper and make a study plan and timetable.

Here is a list of  the types of resources you could include:

  • ANZCA Curriculum (Learning outcomes mapped to the primary examination) – here is great site
  • Online MCQ collections (a previous study tips post covered the Black Bank and also applies to newer collections)
  • Past SAQ papers (including examiner reports)
  • Operating theatre teaching – Rudyard Kipling can help with this one
  • Primary LO of the Day (a bit of recursive promotion)

  • Other internet resources (try googling ‘anaesthesia exam technique resources’)
  • Study notes from past trainees – bear in mind that the real benefit of study notes comes from creation not consumption
  • Exam technique resources
  • Psychology support – managing exam anxiety

If there are others you know about feel free to leave a comment below.

Tips for performing well in vivas


The viva invite emails were sent out this week. My commiserations to those who did not receive an invite, it’s a tough email to get. Different coping strategies work for different people but at least part of the right answer for most people would be to take a break to recharge yourself for a new approach to study.

For those who were invited, congratulations. You’ll find your knowledge, understanding and verbal fluency leaping ahead in this period – verbalising your understanding and being challenged on it is an incredibly effective learning technique. I think this is where the value lies in viva practice, not in gaining ‘viva technique’. Behind the scenes examiners become expert at ‘examining techniques’, you should become expert on the subject matter covered by the primary examination.

An ex-examiner colleague directed me to this reference the other day – Twelve tips for performing well in vivas – which I have shown to some other examiners and we all pretty much agree that much of the material is not relevant to a science viva as opposed to a clinical viva. Some may find some comforting tips in there though, and it’s worth while reading through to tip 12 which I think is very useful.


Evolution of a viva- Part 2

In Part 1 we formulated a viva and I ran through it with my shadow a few times. Now we need to properly ‘test run’ the viva. This entails doing it with trainees, candidates and other people preparing for the exam. I don’t test a viva that will be used in the next exam. But it is important to test a viva because you invariably learn things- eg. what you thought was a straight forward question may turn out to be ambiguous to candidates. You might find that your viva is too long (they are never too short) or too hard (God forbid). A really hard viva does no one any favours. I sometimes find that candidates consistently get a particular question wrong- I need to discern whether it is worth asking that point or not and often end up discarding that question. For example, I asked in a BIS viva what cells in the brain are responsible for producing the EEG waveforms. I wanted people to say ‘cortical pyramidal cells’ but no one did so I canned it. Getting bogged down half way through a viva because of one point is not a productive exercise.

There are other changes that result from testing. I often find I change the wording of my questions or prompts after test running a viva. The ultimate test is using it in the actual exam of course and a viva can even undergo changes during the course of an exam. Believe it or not we want to maximise the chances of the candidate demonstrating to us an understanding of a given viva topic. The challenge for the examiner is to find the best way to extract the desired information. Sometimes the exam experience is very different from that with my local candidates. I have certainly ‘decommissioned’ a viva after an unsatisfactory performance! It is always surprising and enlightening to see what aspects of a particular viva candidates find challenging. It is quite satisfying when candidates consistently do well with a particular viva. This doesn’t necessarily mean it is easy. Indeed the same viva may be done poorly in another sitting of the exam.

That is all I will say for now about writing vivas. But I will give you a little heads up. One of the disturbing  recent trends examiners have noted is that the vivas that were done poorly tended to be on core topics eg. core anaesthetic drugs, PK and PD, cardiac physiology, respiratory mechanics. This tends to reliably distress us examiners (“they should know that etc”) so there is a good chance these topics will be revisited in future exams.

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.