Certain topics have a propensity to appear in the Final Examination. Some are topical, some are even newsworthy, and some have been done badly in previous exam sittings. Is it worth trying to spot some questions? Absolutely; we successfully managed to 'guess' 3-4 questions in the last exam, so I'm going to list a few topics which I think may come up for various reasons.
Previous SAQs done badly as highlighted in the Examiner's Report
- Preop assessment of a hypertensive patient (October 2007 SAQ paper)
- Management of twins (October 2007 SAQ paper)
- Air Embolus (April 2008 SAQ paper)
- Paediatric Fluid Balance (April 2008 SAQ paper)
- Neuromuscular Blocking Reversal + Sugammadex (April 2008 SAQ paper)
Other topics include issues of public interest and patient safety which were highlighted in the Examiner's report as being repeatedly done badly and therefore will continue to be represented in the examination, guidelines (including AAGBI, NICE, NPSA), and review articles from major journals.
-Awareness: continually remains in the public eye
-Healthcare-associated infections (VIP cannula scores/MRSA/C.Diff): huge at present also linked with recent publication by the aagbi on Infection in Anaesthesia
-CEMACH - easily repeated question
-Mental Capacity Act - has come into force in late 2007. This is the link I used previously, but for much more comprehensive coverage of both this and issues of Consent, EI has done a fantastic job putting togther some very simple explanations of tricky topics!
-LA toxicity +/- Intralipid use - it's going to come up eventually
-Malignant Hyperthermia treatment
-Blood Transfusion
-Perioperative Management of the Morbidly Obese Patient
-Prophylaxis against Infective Endocarditis: NICE March 2008
-Perioperative hypothermia: NICE April 2008
-Head Injury: NICE September 2007
-VAP: NICE August 2008
-CEPEX testing here
-POISE (Perioperative Ischaemic Evaluation) study: looks at beta-blocker use in non-cardiac surgery
-Amniotic Fluid Embolism: inexplicable rise in last triennium of CEMACH report.
-Obesity in Pregnancy
Journal Review Articles worth looking at
BJA
2007
August: Carotid endarterectomy
September: Perioperative platelet Rx
December: Gabapentin
2008
February: Prone position
March: VAP
September: Perioperative management of pts with renal failure
Anaesthesia
2007
October/November: Interpleural block parts 1&2
December: Remifentanil
Wednesday 17 September 2008
The Written Paper
SAQs
For candidates sitting the exam for the first time, the SAQ section can seem the most daunting of the two. This style of exam has not been approached or attempted before (except in my case - wry laugh at onesself!). Adam has highlighted in his recent posting on Exam Intelligence the importance of layout of your SAQs. As you can see from his jpeg examples, it makes a huge difference to the examiner marking the paper. One little tactic is to try and put yourself in the examiner's shoes: you have 60 or 70 copies of the same question to mark, you're probably going to get a bit bored after a while - it's human nature. It must be intensely irritating to arrive at a question that you can't read, or is squashed against the far margin (or is irrelevant!). So, here is some SAQ advice:
- Learn to write nicely - make it larger and well spaced-out. Start practicing now - don't wait until the day.
- Be relevant; answer the question asked. It sounds obvious but you'd be surprised. You only get approximately 10-12 minutes to write the question (plus two-three minutes planning). Don't waste time on lengthy definitions/introductions if not asked for.
- Use diagrams - as mentioned in a previous posting, an accurately-labelled diagram may save you a lot of time and gain more marks than a block of prose.
- Get your timing right - this section of the exam is time-pressured. Work out your strategy of answering questions i.e. do you work through the paper sequentially making a question plan then answering the question, or do you make plans for all questions in the paper, then answer them? You must have a game-plan thought out.
- If you haven't already started, time your questions...strictly! You have to complete all 12 questions in 3 hours; that's 15 mins per question. Anyone who has done the exam before will tell you it is exhausting and they're right. To write solidly for 3 hours is difficult, both on your hand and on your mind. Like running a marathon, you need to train for it, and build up your stamina in answering these questions. Start by answering 4, then 6, then 8, then 12 questions in a row...timed!
MCQs
A word of warning, ignore these at your peril. There is a tendency to concentrate on the SAQ section, thinking that past experience in MCQs will see you through. This is the mistake I made and I paid for it with a 1+ and that is part of the reason why I have the privilege of doing this again. I probably can't offer much in the way of new advice on how to be successful with MCQs - everyone has quite extensive experience. Do as many MCQs as you can lay your hands on. The only difference this time around is that negative marking has been removed and consequently the pass mark will increase. You should probably be aiming to achieve approximately 80% i.e. average of 4/5 on each stem.
For candidates sitting the exam for the first time, the SAQ section can seem the most daunting of the two. This style of exam has not been approached or attempted before (except in my case - wry laugh at onesself!). Adam has highlighted in his recent posting on Exam Intelligence the importance of layout of your SAQs. As you can see from his jpeg examples, it makes a huge difference to the examiner marking the paper. One little tactic is to try and put yourself in the examiner's shoes: you have 60 or 70 copies of the same question to mark, you're probably going to get a bit bored after a while - it's human nature. It must be intensely irritating to arrive at a question that you can't read, or is squashed against the far margin (or is irrelevant!). So, here is some SAQ advice:
- Learn to write nicely - make it larger and well spaced-out. Start practicing now - don't wait until the day.
- Be relevant; answer the question asked. It sounds obvious but you'd be surprised. You only get approximately 10-12 minutes to write the question (plus two-three minutes planning). Don't waste time on lengthy definitions/introductions if not asked for.
- Use diagrams - as mentioned in a previous posting, an accurately-labelled diagram may save you a lot of time and gain more marks than a block of prose.
- Get your timing right - this section of the exam is time-pressured. Work out your strategy of answering questions i.e. do you work through the paper sequentially making a question plan then answering the question, or do you make plans for all questions in the paper, then answer them? You must have a game-plan thought out.
- If you haven't already started, time your questions...strictly! You have to complete all 12 questions in 3 hours; that's 15 mins per question. Anyone who has done the exam before will tell you it is exhausting and they're right. To write solidly for 3 hours is difficult, both on your hand and on your mind. Like running a marathon, you need to train for it, and build up your stamina in answering these questions. Start by answering 4, then 6, then 8, then 12 questions in a row...timed!
MCQs
A word of warning, ignore these at your peril. There is a tendency to concentrate on the SAQ section, thinking that past experience in MCQs will see you through. This is the mistake I made and I paid for it with a 1+ and that is part of the reason why I have the privilege of doing this again. I probably can't offer much in the way of new advice on how to be successful with MCQs - everyone has quite extensive experience. Do as many MCQs as you can lay your hands on. The only difference this time around is that negative marking has been removed and consequently the pass mark will increase. You should probably be aiming to achieve approximately 80% i.e. average of 4/5 on each stem.
Sunday 14 September 2008
HCAI
At the beginning of August, I didn't know what HCAI stood for. I certainly do now: healthcare-associated infections. As mentioned previously, this is big business in the NHS. As usual, there are mountains of paperwork associated with this, including lots of webpages which, if you have loads of free time on your hands and not a lot to do, you could trawl through. However, we have exams, therefore we need a concise summary of what is important to us as anaesthetists/intensivists for the Final FRCA. Below is an account which summarises and provides links to important guidelines/publications:
Saving Lives - Clean Safe Care
- In a nutshell, the aim is to reduce HCAIs and provide safe, clean, reliable healthcare.
Important Publications
- Winning Ways (Chief Medical Officer, Dec 2003): strategy for reducing HCAIs in UK.
- Towards cleaner hospitals & lower rates of infection (DoH, July 2004) - 6 elements:
1) Being open with the public i.e. regular publication of infection data
2) Giving power to the patients e.g. cleanyourhands campaign.
***On September 2nd, the NPSA released a Patient Safety Alert 'Clean Hands Save Lives'. The four page document can be downloaded from here.***
3) A matron's charter - ten principles for delivering cleaner hospitals
4) Independent inspection to measure progress
5) Learning from the very best i.e. home & abroad
6) Harnessing the latest research & technology
-Saving Lives (June 2005): a delivery programme for acute hospitals to reduce HCAIs using Essential Steps to Safe, Clean Care e.g. reducing MRSA strategies, preventing inter-patient contamination, urinary catheter care, enteral feeding infection risk education.
- Also of relevance to anaesthetists/intensivists are: High Impact Interventions (or Care Bundles). Important ones include:
a) CVC care
b) Peripheral intravenous cannula care (also see later)
c) Care for ventilated patients
d) Reducing the risk of Clostridium.difficile
- Going Further Faster II (June 2008): applying the learning to reduce HCAI and improve cleanliness. A long document incorporating recent national guidelines/aims in infection control.
In my trust, there is a new policy which aims to ensure that all peripheral cannulae are sited in an aseptic manner. There is also routine use of Visual Infusion Phlebitis charts/scoring. Information can be found here and here.
Saving Lives - Clean Safe Care
- In a nutshell, the aim is to reduce HCAIs and provide safe, clean, reliable healthcare.
Important Publications
- Winning Ways (Chief Medical Officer, Dec 2003): strategy for reducing HCAIs in UK.
- Towards cleaner hospitals & lower rates of infection (DoH, July 2004) - 6 elements:
1) Being open with the public i.e. regular publication of infection data
2) Giving power to the patients e.g. cleanyourhands campaign.
***On September 2nd, the NPSA released a Patient Safety Alert 'Clean Hands Save Lives'. The four page document can be downloaded from here.***
3) A matron's charter - ten principles for delivering cleaner hospitals
4) Independent inspection to measure progress
5) Learning from the very best i.e. home & abroad
6) Harnessing the latest research & technology
-Saving Lives (June 2005): a delivery programme for acute hospitals to reduce HCAIs using Essential Steps to Safe, Clean Care e.g. reducing MRSA strategies, preventing inter-patient contamination, urinary catheter care, enteral feeding infection risk education.
- Also of relevance to anaesthetists/intensivists are: High Impact Interventions (or Care Bundles). Important ones include:
a) CVC care
b) Peripheral intravenous cannula care (also see later)
c) Care for ventilated patients
d) Reducing the risk of Clostridium.difficile
- Going Further Faster II (June 2008): applying the learning to reduce HCAI and improve cleanliness. A long document incorporating recent national guidelines/aims in infection control.
In my trust, there is a new policy which aims to ensure that all peripheral cannulae are sited in an aseptic manner. There is also routine use of Visual Infusion Phlebitis charts/scoring. Information can be found here and here.
AAGBI
The Association of Anaesthetists' updated guidelines on Blood Transfusion and the Anaesthetist in June 2008 are available now online. They are well worth a read and should be part of core knowledge both in clinical practice and for the forthcoming exam.
Guidelines from organisations such as the Association of Anaesthetists, as I have mentioned previously, provide excellent exam topics as they are current and relevant. In the interest of being thorough, the Association also published Standards of Monitoring in March 2007. Whilst this should be second nature to us as anaesthetists and, indeed, common sense, there are important clinical guidelines highlighted.
Guidelines from organisations such as the Association of Anaesthetists, as I have mentioned previously, provide excellent exam topics as they are current and relevant. In the interest of being thorough, the Association also published Standards of Monitoring in March 2007. Whilst this should be second nature to us as anaesthetists and, indeed, common sense, there are important clinical guidelines highlighted.
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