ANZCA Final Exam

The ANZCA final exam consists of a:

Timing

  • Read
    • Note eligibility requirements
    • Dates
    • Discuss with recent supplicants what is involved
  • Discuss
    • Mentors and supervisors
      • Am I ready?
      • When should I sit?
    • Partner, family, and friends
      Understand:
      • What is involved
      • The degree of sacrifice required
  • Assess
    • Is this an appropriate time?
      • There is never a perfect time
      • It will always be disruptive
      • Some times will be less-bad than others
  • Commit
    • Outsource what you can
    • Drop balls
      Many other professional and personal commitments have to be shelved until the exam is behind you.
    • Don’t equivocate
      Avoid dragging it out.

Written Exam

As with the primary examination, a structured answer format:

  • Provides a scaffolding to hang ideas off and prompt your memory
    • ↑ The chance you will deliver a complete answer
  • Buys you thinking time
    Your mind can think of content whilst you subconsciously outline the structure on the page.
  • ↓ Stress
  • Is less painful to read, and therefore more favourable to mark

Almost all questions can fit into one of five structures:

  • The Emergency
    A crisis of some kind.
    • “This is an emergency”
    • Immediate actions
    • Send for help
    • Simultaneous diagnosis and treatment
    • An ABC approach
  • Anaesthetic plan for a patient
    • Pre-op and induction
    • Intra-op and maintenance
    • Post-op and emergence
  • Anaesthetic plan for this patient
    Pre-operative management, use:
    • History
    • Examination
    • Investigations
    • Referral
  • Issues for this patient
    This is the Cluedo patient: The appendix, with the Fontan, in the regional centre.
    • Patient factors
    • Anaesthetic factors
    • Surgical factors
  • Assessment and management of a disease process
    Use a system based answer:
    • Airway considerations
    • Respiratory considerations
    • Etc

Additional structures for specific questions include:

  • Welfare question
    When answer a welfare question for the ANZCA Part II Exam; aim:
    • Protect the patient
    • Protect the doctor
    • Short-term measures
    • Long-term measures
  • Legal question
    • Identify the issue
    • State the legal and ethical principles that apply
    • Apply principles to facts of case & balance conflicting arguments
    • Make a conclusion
      • Seek help
    • Close the loop
  • Regional technique
    Use the PRECIOUS mnemonic:
    • Position
    • Risk
      • General
        • Infection
        • Bleeding
        • Local anaesthetic toxicity
        • Nerve injury
      • Specific
        e.g. Pneumothorax.
    • Equipment
    • Consent and block time out
    • IV
    • Oxygen and monitoring
    • Ultrasound
    • Sedation
  • Introduction of new procedure
    • Consult regulatory authorities
    • Set up local hospital group
      • Anaesthetists
      • Surgeons
      • Nurses
      • Administrators
    • Formulate local protocols
    • Policies for selection of patients
    • Dedicated/separate ward facilities
    • Equipment appropriate for task
    • Consultation with other hospitals for advice and review
    • Slow implementation
    • Ongoing formal review and audit

Oral Exam

The oral section aims to assess whether you are ready to matriculate from training and assume the mantle of consultant. This is far more a question of mindset than of knowledge. Therefore:

  • Embody the consultant
    • Decide the type of consultant you want to be
    • Be that person
    • Have (or fake) confidence
  • Engage with the consultant examiner as a respected equal
  • Immerse yourself in the scenario
  • Take some time to think of an answer
    But not too much.
  • Be authentic
  • Discuss balance of risks without waffling
  • If you are unsure of a course of action, then describe your rationale
  • Have some prepared statements phrases
    • “In addition to my usual anaesthetic assessment…”
    • Know what to say if you don’t know what to do

Pitfalls:

  • Attitude
    • Non-consultant like
    • Indecisive
      Using ‘could’ not ‘would.’
    • Inflexible
      • Refusing to be lead
    • Waffling
    • Too many lists
    • Does not answer question
  • Knowledge
    • Insufficient
    • Long checklists do not demonstrate understanding
    • Inaccurate
    • Not recognising knowledge gaps
      Demonstrates lack of safety.
  • Safety
    • Inappropriate drug doses
    • Does not know how to manage a crisis
    • Lacks insight
    • Refuses to accept guidance

Medical Viva

Anaesthetic Viva

Process:

  • A ‘realistic’ patient scenario which evolves overtime
  • Tests the candidate at multiple points with dilemmas and disasters
  • Examines depth, breadth, and integration of knowledge
  • Aims to assess judgment and decision making
  • A professional discussion with a colleague
  • Tests if you are ready to be a consultant
    Evaluates your:
    • Knowledge
    • Safety
    • Leadership
    • Patient advocacy
    • Collaborative approach
    • Professional

Dilemmas and Decisions:

  • Tricky situations
  • Not all unstable clinical situations requires the emergency buzzer
    But press it when you need to.
    • Failure to act safely is viewed very poorly
  • Patients will deteriorate irrespective of how you are performing

References