Phew!

I've deliberately not written anything for about a week to try and forget about the written exam last week.
It was an exhausting day, but I'm really glad it's done for now. I thought that with a couple of exceptions, the SAQ paper was reasonable - it could have been a lot worse. The MCQ paper was an absolute nightmare - more about that later.

SAQ
1) Thoracic paravertebral space: either you know it or you don't. Despite having performed a couple of these blocks in early SHO-days, I couldn't recall the anatomy as I hadn't revised it - simple as that. I tried to make it up as best I could. The indications and complications were fairly generic answers for all nerve blocks.

2) CEMACH - one of my predicted questions came up, so the risk factors and causes of death were hopefully recalled verbatim. The next bit about Early Warning Scoring Systems was the usual lists of stuff making up PAR scoring/APACHE or whichever system is used.

3) Air Embolism - standard question seen before in similar guise in Bricker. I think there was a review article in Anaesthesiology about this subject.

4) 4yo appendicitis, dehydrated - fluid management. This question was about paediatric fluid management with specific reference, I think, to NPSA guidelines on avoiding hyponatraemia in children post-operatively. I thought that the NPSA website was a bit of a nightmare to navigate around, and had not found these guidelines pre-written paper. So, consequently had not read them, so probably missed out some quite important points - typical the only bloody guideline I do miss comes up!!

5) Pre-oxygenation. The lucky people who went on the Booker Course and did this question almost verbatim up there will be happy with this one

6) Complex Regional Pain Syndrome. As for 5) I'm afraid - congrats to Dr Booker!

7) Rocuronium - the 'topical' question. Fortunately I used to have a boss who was fascinated with Sugammadex, so was at least able to give a basic description of this. Unfortunately, I had a complete blank about neostigmine and was only able to write some pretty basic stuff about it - c'est la vie.

8) Asthma/Acute Bronchospasm - waffling plus some standard clinical emergency management.

9) Elective paeds - child not cooperating. The first part of the question about decreasing pre-op anxiety was a chance to be very touchy-feely etc. The second part was much less structured, and perhaps was touching upon consent in paediatric patients ?Gillick competency. I don't think I answered the second bit very well, but hopefully did enough on the first bit.

10) AAA - emergency. So much to write, too little time. A recent CEACCP article on exactly this topic.

11) Needlestick injuries. Very unusually for the College they have repeated a question from just six months ago - I assume it was done fairly badly last time out.

12) Acute Pancreatitis - again repeated from six months ago. So much to write, too little time.


MCQs
I honestly don't know what to say about the MCQ section. I normally go through the paper fairly quickly to start with, just answering the stems that I definitely know. By the time I got to Q.45 and a lot of stems were unanswered, I started to get that feeling of desperation. You know, six months of hard work, thousands of practice MCQs - utterly pointless in trying to do this exam!!
I recognised a few questions from the college book. There were also a few questions from Elfituri & Arthurs MCQs (which incidentally I would have tried to do more questions from had there not been so many dreadful errors in it). But the rest of them......

There were obviously quite a few new questions, as the exam had to be halted numerous times to make corrections for the paper.

The only consolation was the fact that everyone else found it exactly the same!

So, onto viva practice - A senior registrar has grilled me today on the exam he got. Subjects include: phaeochromocytoma, pacemakers, N2O cylinders, tetanus, foetal circulation, and adverse drug reactions.

Last minute

Well, I'm off to London shortly to spend an uncomfortable 18 hours or so waiting to get this little test out of the way!
I hate the weekend before the exam - there is a lot of frantic reading done, which is completely pointless as I'm sure none of it goes in. My gastrointestinal autonomic system is doing its usual pre-exam malfunction and I can never eat properly! I hope I echo many other people's thoughts out there.
The problem is that you tend to concentrate on all the stuff you think you don't know or have forgotten, rather than the considerable bulk of material that you have managed to assimilate into your completely overloaded brain!

My advice, for what it's worth at this late stage, is:

-Try not to panic - part of this exam is keeping a cool head. Remember what you need to pass - usually 12/20 on each question (sometimes lower, sometimes higher) to get a '2', and minimum 6 1+'s and 6 2's to pass the SAQ paper.
-Get nice pens, plus a spare or two
-Arrive early & bring photo ID as told.
-Read the questions (properly).
-Write nicely and space answers out - make it easy for the examiner! 10% of marks can be gained here!
-Don't overrun on questions
-Eat and sleep well tonight!
-Look through RCOA MCQs
-Look through some guidelines/protocols/past papers.

-Have some luck !

All the best
James

Psychological imbalance

Is it psychologically acceptable to swear at a computer screen?
During QBase I reckon it is. I am ploughing my way through QBase 2 at present on the computer - it feels marginally less like doing work if you're clicking a mouse every so often. But the MCQs can be so frustrating. They contradict answers in different MCQ books and unfortunately a small proportion of questions are out of date. But, the standard is reasonably high and the more the merrier etc etc. I've been getting between 42-49% on QBase 2 - which allowing for stupid errors (often!) and not reading the question/stems properly (occasionally!), I think, is OK. I'm sure some of you will be feeling smug on reading this if you're getting higher marks - so this portion was to make you feel better!!!

Well, I've just come off two of the most hideous night shifts on Neuro ITU ever. That'll learn me for taking in books to read/MCQs to do. It reminds me of a week of nights as a surgery house officer where our first three nights were so quiet. So, on the third night my SHO at the time decided to bring in his Playstation for the mess......the rest is history - Tits Up!!!!

Four and a half days to go - so how best to make use of the time?
-I'm still trying to get through as many MCQs as I can - in fact I wish I'd spent more time on them earlier as I may not finish all the books I have. I generally try and do at least two papers a day (usually take about 2 hours to do each), one first thing in the morning and then one later when I'm really tired, exactly like the real thing!!
-Today, I'm concentrating on sexy topics, review articles, guidelines etc, and hopefully if there's time, to finish going through some physics.
-I think the time has come to stop trying to learn new things now, so over the next few days I shall be rereading all the SAQs I have done from the Mersey Course, College papers, and SAQ textbooks (especially Bricker and Dashfield & Murphy).
-Over the past few months, I have been transferring some of my Basic Science notes from Primary into the Bricker Basic Science Viva Book, hopefuly leaving myself with one definitive but concise Basic Science text for both this written part and any future vivas (fingers crossed). I'll also try and go through as much of that as I can in the next few days.

I'm going to buy some really nice pens that are comfortable to write with - preferably ones that I don't have to press too hard onto the paper with. Hand cramp 90 minutes into the SAQs would not be desirable.

I have pledged not to take part in the dangerous pre-exam sport that is A-Z word-chasing. This involves reading a topic in A-Z, then seeing a bold word highlighted in the text that you have forgotten about, and going to that entry, and so on. It wastes a lot of time, and induces sphincter-loosening panic (?sympathetic or parasympathetic).

I am taking the exam in Central London but live about half an hour outside. Rush hour trains or traffic i.e. M4 are not conducive to good mental preparation. Therefore, a four star hotel overnight and a good breakfast, for me, is a prerequisite. So I've booked a nice room at the Park Inn Hotel on Southampton Row about ten minutes walk from the Exam hotel.

Nice!!

Exhaustion

I've just returned back from the European City of Culture 2008 where I attended the Booker course. I am shattered!
It was really encouraging to speak to a number of people who actually read this blog - thanks for your support and please leave comments and your advice/tips etc.

About the course:
I still reiterate that I think these courses are so valuable in preparing you for this type of exam. I found it pretty tough-going, but it has completely fulfilled it's purpose i.e. enforced writing of a range of SAQs under time pressure (I think we did 44 SAQs altogether including one full 12 question paper), some even more time-pressured MCQs (not easy standard either). The standard of candidate on the course was really high, and I found it quite daunting at the beginning of the week, but as the week progressed there were encouraging signs.
My MCQ marks gradually got better!

My SAQ technique i.e. timing, layout, and handwriting has really improved - mostly thanks to the 'Mersey Method' (unfortunately I don't think it would be fair to divulge it on the www!). There was a couple of sessions where we marked other candidates' SAQ answers - eye-opening the difference between handwriting and layout.

My tips at this point would be:

-MCQs MCQs MCQs (do the college book again the day before!)

-Hone your SAQ technique: make sure you have written a full 12 question paper in 3 hours a) to get your timing right, b) to practice handwriting/layout, c) for stamina!!

-Think of some sexy topics (the exam was set at the beginning of March!)

-Don't forget anatomy (it comes up in all parts of the exam!)

With a little help from my tutor!

Continuing on the spotter theme.....
I mentioned in a previous entry about the SAQ tutorials I have been attending with some friends, which are run by a consultant we have worked with previously. I cannot understate the value of enforced MCQ practice and group discussion about the answers. At this week's session, we ventured briefly onto the subject of question spotting and our tutor raised a highly valuable point regarding a potential question.
I'm sure he won't mind me passing on his advice: a question on pain in some form or another. Two potential reasons: one, there hasn't been a pain question recently in the SAQs, and secondly (and most importantly), the setting up of the Faculty of Pain Medicine in April 2007 may lead to a request for pain representation within the SAQ questions.