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Check out this blog site for more thoughts on how to pass the Final FRCA - glad to see people sharing the pain!!

What next?

4 weeks to go.... it's difficult to know at this stage where to focus revision. I've got one more week at work, then I go off to Liverpool for the Booker course and have annual leave etc, two night shifts at work, then more annual leave and then the exam. So, I do have a fair bit of study time available, but what's the best way to utilise it? I need to 'cane it' with MCQs - literally try and do hundreds (maybe into the thousands if possible) - it's the only way, and it's worked before for me. The good thing about MCQs is that they can be done anywhere: in the bath, on public transport on the way to work, even (dare I say it, although couldn't possibly condone it) at work!!

SAQs: I've nearly finished working my way through the Past Papers on the College web-site. Incidentally, the majority of the questions from 1996-2000 can be found in the SAQ textbooks by Bricker, and Dashfield & Murphy, taken verbatim. There are many more SAQs to be answered from the AnaesthesiaUK website (also see one of my previous posts where I categorised all of them).

The RCOA kindly publishes a report on the previous SAQ paper which has some interesting content. Firstly, it would appear that recently, questions done poorly in one year are repeated the following year (but not six months later). Also, they emphasise the inclusion of hot topics. I have taken the liberty of "guestimating" my very own hot topics for the forthcoming exam!!

- CEMACH 2003-2005 - it's just too good an opportunity to miss, surely?

- Obesity in pregnancy was a hot enough topic to make the national news headlines.

- Amniotic Fluid Embolism deaths shot up in this triennium - a lovely little question!!

- POISE (Perioperative Ischaemic Evaluation) study: looks at beta-blocker use in non-cardiac surgery

- CEPEX testing: here and here

- Awareness - trendy topical subject. Has been in the headlines in past couple of months + ironically a Hollywood film is about to be released in the UK.

- Mental Capacity Act - has come into force in late 2007

- Association of Anaesthetists Guidelines in 2007
-LA toxicity +/- Intralipid use
-Malignant Hyperthermia treatment (already used in a question and answered well, so unlikely to come up)
-Perioperative Management of the Morbidly Obese Patient - THIS IS FAIR GAME FOR THIS YEAR!!
-Standards of monitoring during anaesthesia & recovery

- NICE Guidelines (2007-8)
-Venous Thromboembolism: April 2007
-Acutely Ill patients in hospital: July 2007
-Head Injury: September 2007
-Intrapartum Care: September 2007
-Ultrasound Guidance in locating the Epidural Space: January 2008

-New Ideas
-Advances on clotting pathways
-Sickle cell anaemia

I also think that it is prudent to read through review article from the big journals for the last year i.e Jan 2007 - Feb 2008. Bold highlighted articles are those which lend themselves to SAQs!

BJA: here & here

Jan Fentanyl patch vs post-op pain

Feb Statins in sepsis

Mar Neuromuscular monitoring

Apr Blood flow & ventilation in the lung / percussion pacing

May CA stents in non-cardiac surgery

Jun Diastolic heart failure

Jul Neuro ++! The whole post-grad issue is neuroanaesthesia/NICU reviews

Aug Carotid endarterectomy

Sept Perioperative platelet Rx

Oct Sciatica & epidural injections / contrast-induced nephropathy

Nov Cardioprotection with remote ischaemic preconditioning

Dec Gabapentin

Jan Sedation & Regional anaesthesia

Feb Prone position / epidural analgesia vs periph NB for knee surgery


Anaesthesia

Feb Simulators

Mar Temp. epicardial pacing part 1

Apr Temp. epicardial pacing part 2

May Systemic complications post-head injury

Jul Propofol-infusion syndrome

Oct Interpleural block part 1

Nov Interpleural block part 2 / new thrombotic agents & neuraxial anaesthesia for major orthopaedic surgery

Dec Remifentanil

Jan Oesophageal Doppler in abdominal surgery / Statins for non-cardiac surgery part1

Feb Statins for non-cardiac surgery part 2 / cardiac output monitoring


Happy Reading!!

Misery

Happy Easter to anyone who is reading this!!
Most of my posts have been pretty positive, and from a couple of the comments it sounds like some people are finding it difficult to get down to work -this is to make you feel better!

I feel utterly fed-up, miserable and bored today. I just cannot bring myself to work. I have just had annual leave for the last week, and have not done badly (apart from Thursday/Friday where I went to a wedding) trying to plough through SAQ from the College website. But I woke up this morning and felt totally lethargic and distracted. I'm sitting at my desk with papers in front of me but no desire at all to tackle them, and with the attraction of so many other inane activities seeming much more appealing!
After such a nice break post-Primary, I had forgotten the utter misery that exam revision is. The only consolation is that I am starting to feel a little cleverer!!

Sixth Gear

I've just finished nights and now have a full week off - the first day (yesterday) has already gone and I didn't work because I was too knackered and the body-clock was all over the shop. There are five and a half days of studying stretched out ahead of me, broken up nicely in the middle by an extremely posh wedding of a friend in London, for which I'm also playing the piano during reception drinks. I'm aiming to try and complete two SAQ papers per day, in addition to some MCQ practice. It's a tall order as I've only been managing one recently per day - I am very easily distracted!! But the time has come to be more serious and strictly time myself doing these papers. I also have my weekly tutorial tomorrow night where we'll go through a paper written last week and marked! Unfortunately, I was quite tired during last week's tutorial and wrote the wrong paper and dutifully sent it off to be marked. No big deal, but it undelines a rather important point of listening to and following instructions properly!!!
Thankfully due to some careful study/annual leave planning, I now only have 12 shifts left to work between now and the exam, giving me quite a lot of spare study time. I'm going to bloody need it all !!!

Progress

I've not had a chance to update this blog for a couple of weeks - mainly for positive reasons. My work ethic has changed and I've moved up a gear or two now. I find as the exam looms, I start putting more and more pressure on myself to work, and it drives me to put the hours in. The motivation comes from imagining that feeling of seeing your number up on the board in the College telling you that you've passed: I don't want it any other way! Don't get me wrong, I still feel like there's too much to do in too little time, but its now about playing the game.

There's no way around the MCQ paper: you have to practice and practice and get into it's mindset (sounds very psychological I know!). I think it's vital to complete all the College MCQs as there is a high chance that a couple will appear in the exam - free marks if they do. I've almost finished the 240 MCQs in the College book, and am averaging between 40-50% which I'm encouraged by at this stage.

The SAQ paper is all about structure: it is possible to pass a question without intimate details e.g. "How would you anaesthetise XYZ......?". Now, you may not know much about paediatric craniofacial surgery, or even seen it.......BUT you can answer the question. Write down what you would actually do: start with an introduction - shared airway, other potential congenital abnormalities, paediatric anaesthetics blah blah. The preop, periop, postop. Then you would go and see patients, rapport, consent, history, exam, investigations, +/- premed. Emergency equipment & drugs, skilled assistance, venous access, O2, monitoring (AAGBI), senior help, induction - drugs (+doses in mg/kg NOT actual doses) & airway, maintenance, analgesia, post-op etc. I know its a simplified version, but if there is a system which is the same for any question, you will not miss anything out......and you will pass the question. It is all about demonstrating to the examiner that you are structured, organized, and above all you are SAFE!

I've been working my way through the past SAQ papers published on the RCOA website. Interestingly enough, in recent years, there have been two questions repeated almost identically the year after. I believe in October 2005, there was a question about a 15yo having surgery for idiopathic scoliosis, repeated in October 2006. Same for NIBP measurements in May 2006 and May 2007. Obviously, I'm not advocating question spotting as a substitute for the work, but there is definite benefit from having been through these recent papers!

Further to my previous posting on review articles and SAQs, I think the value lies in trying to have a look at review articles from the previous 2 years prior to exam setting. Which means, for this April sitting, essentially all of the articles of 2006/2007, and possible the beginning of 2008. No mean feat! There are a lot of them! Reasoning behind this method of madness, confirmed to me again yesterday whilst going through October 2006 paper. There is a question on Awareness during GA, and in November 2005 there was a lovely review article published in CEACCP on......yes, it was Awareness.

PS/ don't forget to look at your basic sciences for the SAQs/MCQs as well. In May 2007, there is a question on Microshock, and the NIBP question.