Exam Intelligence

One of the most disconcerting things about going to a viva is that (apart from having no clue about what you might be asked), is the possibility of coming across an examiner who is a complete, erm,…is very mean.

There are several ways you might choose to cope with this.

• Pray you don’t get one before you get to the exam.
• Like the Beautiful South, Carry on Regardless.
• Imagine them sitting naked in the chair in front of you with nothing but socks on, although this may make you feel slightly queasy (unless Jessica Alba was your examiner (substitute celebrity of choice) - Ed).
• Simply remember that you have worked very hard for the exam, know a lot (even if you think you don’t) and probably know more than the examiner what you are talking about.
• Practice before the exam with someone who you feel intimidated by, respect a great deal, or get one of your friends to be annoying and act all disinterested. Get them to interrupt, ask you “Oh really”, “Are you sure?”, “Do you want to start again?” and so on. Have them change tack rapidly and switch topics without warning.

We have been trying this technique in preparation for Monday/Wednesday. It can be quite disconcerting having a good friend turn into a “bad cop”. Sometimes though, if taken to extremes, it’s impossible not to laugh….

69 hours to go….

Do you waffle when telling stories?
Does your partner tell you to get to the point when you’re explaining about something that happened at work?
Do your family hold their heads and groan when you start off by saying “A funny thing happened the other day….”, or something similar?

Then you may be a waffler, and I’m not talking about someone who bakes light crisp battercakes in a waffle iron, rather, I mean the other type of waffler, who speaks or writes in a vague and wordy manner (The Free Dictionary).

You may not even realise you are doing it, unless some particularly harsh person in your vicinity tells you about it, or you do one of the things I will come to shortly.

To realise you waffle will take some getting used to. There will have to be acceptance on your part that you are using empty “filler” words as previously discussed, which simply waste your time, as you are not scoring points. Remember back to the SAQ. The key was to transmit as much information as possible in the most succinct, legible manner possible (A remarkable achievement you got a viva then - Ed.) Yes, thanks, I know my handwriting is terrible… Anyway, BACK TO THE POINT: in the viva, you have to do the same, but in the spoken word, so to speak (ahem).

To help you on your way out of denial, try doing one of the following:
1. Pop down to your nearest Lidl and buy yourself a £15 dictaphone with 15minute blank tape, or failing that, blow all your money on one of these dinky gadgets, and practice talking about, say, “What are the changes in physiology in a runner’s body from 30 minutes prior a marathon race, until some time after the race?”
2. Better yet, borrow a video camera and do the same.
3. Sit down with two really harsh consultants from your department and practice being viva‘d by them on the above topic, whilst recording the whole thing with one of the above devices, or just get them to feed back to you whether you waffle or not.

If it is the case that you harp on without going anywhere, then you only have a few days in which to hone your technique to eliminate waffling. Nil desperandum, as they say. It is all perfectly feasible.

The key is in practicing with yourself, in front of a mirror, with your wife/husband/boyfriend/girlfriend, with a dictaphone or video camera, or in front of pairs of consultants (or even one will do, at a pinch) in your department.

• Try using the Five Word Viva Game to cut out absolutely everything extraneous, then flesh out your answers a little bit to build up to a sensible answer.
• Don’t repeat yourself: “The main concerns are residual nerve block, excess opioid and residual narcotisation, incomplete recovery of neuromuscular function, hypoxia and metabolic/endocrine derangement, are the main concerns.”
• Try to cut out saying “Er, um, ar, ah, aer” etc. Try a pause instead.
• Elongate vowels in starts of sentences slightly “Weeelll”, “Theeeere aaaarre” and “Iiiiii wooouuullld” for example (you get the idea, I hope?).
• Be confident about your knowledge when you are sure about it, and make the examiners feel you are confident. Remember that you are not about to become a consultant (this isn’t an exit exam, as one of my consultants put it), but they are looking for someone who is a good Registrar (Specialist, Specialty or otherwise) to whom they could entrust a case in the middle of the night whilst they cosy up back to sleep, and not worry about it (unless worrying is really necessary, in which case they’ll probably come in anyway).

Keep at it: one way or another it’ll all be over bar the drinking in a 10 days time…

The statement:
“I believe this patient has rhabdomyolysis because they have raised CK, raised K+, renal failure, leg weakness”

versus:

“This is a classic case of rhabdomyolysis, with leg weakness as a result, demonstrating raised CK, raised K+ and renal failure”.

Unfortunately, my ISP has managed to cut me off from my web-server, meaning I can’t upload anything at the moment. However, some readers have expressed interest in some Past Viva papers I discovered in my filing cabinet at home, as mentioned in a previous post. If you are interested in seeing them, please email me. Eventually I will be able to upload them, but I don’t hold high hopes of that happening before the middle of next week!

Critical thinking and prioritisation is paramount in our
daily anaesthetic lives, and is one of the things that is
being tested when we are invited for viva voce exams. It
is, of course, also tested in the SAQ and to a certain
extent the MCQ as well. Our answers should be prioritised
to present those things which are most important, most
common or most life-threatening first. No zebras outside
the windows when we hear hoofbeats!

One way of practicing critical thinking and prioritisation
is to try and answer viva questions with only five
critical words (key words). You can try doing this for
either a big topic or a subsection of a question when you
are practicing. Obviously you will need a friend, and an
ideal answer or example of a very good answer laid out in
front of you.

By practicing this Five Word Viva Game, when it comes to
the real thing you will have an advantage. It will help
your exam technique in several ways.

Firstly, when you practice it will make you think very
carefully about anything you DO know about the topic, and
you will formulate an answer which at least gives an
overview. One of the most difficult things to do in the
exam is to get away from waffle. You start answering a
question and then end up using lots of filler words, which
take up time, but don't go anywhere near answering the
question. Suddenly the bell goes, and ooops… By
summarising down to five important key words you have
automatically got the main points in your head, you are
more likely to say those than waffle, and you can get away
with using filler words a bit more (but should still try
and avoid anything which is not relevant).

Secondly, if you don't know anything about the topic when
your…friend…asks you the really difficult question
about immunoglobulins, when you go off and read about it,
and then try and figure out "What are my five key points I
need to get across for answering a viva question on this?"
then you have to process the information you have read.
This makes your brain form associations using that
information. You "intra-integrate", so to speak, the
information within itself, and you also "extra-integrate"
with information you already know and have thought about.
This means that you are more likely to remember it at
another time, and will actually allow you to trigger off
more information at another time.

An example of five words:

Q:Tell me a little bit about the immune system.

A:Innate, acquired, lymphocytes, antibodies, complement.

Q:Tell me a little bit about the innate immune system.

A:Barrier (skin/secretions), non-specific, phagocytosis,
cytotoxic, cytokines

Q:Tell me a little bit about acquired immunity.

A:(Previous) exposure, lymphocytes (B&T), antibodies
(ADGEM), specific, T-helper

So hopefully you see what I mean.

Now obviously it doesn't have to be five words, it could
three or seven, but five is a nice number, and three is
really too few for some of the topics. The point is, that
you aim to slim down to key words. Better yet if you can
associate those key words with key images, but I'll talk
about that another time.