The Home Straight

Well, the last month has been agonizing. So difficult to motivate one's self to get viva practice with the unthinkeable potential that it might all be in vain. I am pleased to say that so far my extremely public humiliation has not occurred and that I passed the written SAQ/MCQ paper. I'm absolutely delighted and it has given me the emphasis and boost to keep going for these last couple of weeks.
Congratulations to everyone who has passed (including my esteemed colleagues whom I work with - all eight of us passed).

So, the hard work begins again. Our hospital very kindly runs a nightly viva session for 90 minutes, where consultants and senior registrars put us through our paces in true exam style. It has been intimidating (five seconds of silence can stretch to eternity!), frustrating (I really did know the Alveolar Gas Equation but could not reproduce it), and sometimes just hilarious (yesterday I tried to convince a cardiothoracic anaesthetist that I would perform a fibreoptic intubation somehow combined with RSI - thanks to my guru Dr B who suggested I would attempt it nasally as well!!). The eight of us have formed an excellent bond and friendship during preparation for this exam which has been most welcome.

It's time to talk......and talk. You need to pester consultants and senior registrars and get them to viva you - at least twice a day. You need to be selfish with your time and if your list is not fruitful then excuse yourself and find somewhere that is.

Practice your technique of talking about drugs; I use the setup from Sasada & Smith:

-Uses
-Chemical
-Main Action
-Mode of Action
-Routes of Administration/Dose
-Effects (CVS, Resp etc)
-Toxicity/Side Effects
-Kinetics (ADME)
-Other

You need to be adept at reading and presenting ECGs (a notable area of weakness by candidates in recent exams as stated by the College itself). You need to be able to identify common problems on X-rays and CT scans e.g. CT head.

Similar to the SAQs, you need to be uptodate with current topics and guidelines (see previous postings).
Additions include:
-Recent advances in thoughts about IHD in non-cardiac surgery including dual antiplatelet therapy and stents
-POISE Beta-Blocker RCT (www.thelancet.com May 2008)
-Updated Surviving Sepsis Campaign (Intensive Care Medicine 2008 34:17-60)

Also, keep up to date with BJA/Anaesthesia Review Articles and, of course, the beloved CEACCP articles.

AND DON'T FORGET BASIC SCIENCES!!