Exam Intelligence

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Written by Lorelle on Wordpress, who has been blogging for
some 14-15 years in various guises, including writing for
the Blog Herald, Lorelle has some
useful tips and tricks to share.

Do you have any useful tips/tricks/comments to make about
passing Primary or Final FRCA? If so please contact me by
using the comments page.

Time is running away fast now, with 12 days until viva week, so I need some help brushing up my skills as well as my knowledge.

When giving an oral presentation or answering a viva voce question, it’s important to appear organised with your thoughts. (See Classify Or Die part 1)
To that end, here are some suggestions as to how one should organise these thoughts:

• At medical school we are taught: History of Presenting Complaint, Past Medical History, Drug History, Social History, Examination, Investigations. It still applies that we do them in that order (well, obviously we know that’s not always true, but you should do First Things First).

• Pre-/peri-/post-operative management (includes history taking and examination)

• “The problems of anaesthetising/associated with disease x can be divided into patient factors, surgical factors and anaesthetic factors (order these by which ones you want to talk about first, or which ones are the most important)

• “Complications of performing procedure y can be divided into immediate, early and late“

• When presenting an answer to “How would you anaesthetise this 63y old obese patient with a BMI of 44 and a history of aortic stenosis for a total knee replacement?”, talk about the underlying principles (maintain SVR, maintain preload, avoid rhythm disturbances etc… ). The same is true for any of the other questions which could come up. It is important that they know what you are worried about. It’s important that you know what you are worried about too…

• Be concise and try to be precise. If you mean a vasopressor, don’t say “inotrope”.

• Remember:

• Blood Pressure = Cardiac Output x SVR
  
• Cardiac Output = Stroke Volume x Heart Rate
• Therefore Blood Pressure = SV x HR x SVR
• Stroke Volume is dependent on contractility, preload and afterload
• Heart rate is a function of rhythm.

James has some other tips.

In one of my better work-avoidance moments, I was reading
that we waste a lot of our time when studying (rather than
avoiding studying, like I'm doing).

I mentioned earlier that I like to try and sit down and
decide what I intend to learn from a particular study
session. What I hadn't thought about was that I should
define a period of time I am going to spend on doing the
learning. There appear to be a couple of reasons that
make setting a goal and a time limit a good idea.

Firstly, if we decide on what it is we are intending to
learn, we avoid meandering around a lot and ending up
becoming distracted by concepts or ideas that are not
central or essential to what we want or need to learn. If
you read an article and don't understand a concept, you
can usually read to the end of the article without
understanding the concept, and grasp the central tenet of
the article anyway. If each time you didn't understand
something you went off and looked it up, several things
would happen. You would waste time looking it up, and you
would get distracted from your main theme.

Secondly, there is something called the serial position
effect.
When asked to repeat back a list of things they have just
been told, people will usually (not always) start with the
last thing they were told (called the recency effect),
then more than likely some of the first few things they
were told (the primacy effect) and then those things in
the middle are least well remembered. By working
continuously without interruption for lengthy periods of
time, we don't give ourselves beginnings and endings
(primacy and recency) to recall from, and if we don't set
ourselves a time limit or a "learning limit" or "learning
goal", we are less likely to stop work. (This appears to
me to be a special application of Parkinson's Law, where
work will simply expand to fill the time available, and by
giving ourselves an indefinite time to finish, we could
give ourselves and indefinite and infinite amount of
work).

Thirdly, there is always the "fear of the unknown".
Imaging you want to learn the contents of e.g.
Fundamentals (Pinnock et al) or Miller's Anaesthesia, or
(my favourite) Hutton. How many pages are there in each
of those books? (963, 3376 and 1072, in case you were
wondering). A lot. Imagine sitting down and starting to
read at page ONE, only to read all the way through? Every
time you stop and come back, you still have "1072 pages
less whatever I read so far" to go. Or are you a glass
half-full kind of chap/chapess and think "I've read this
many pages, fantastic"? And how long is it going to take
to read (well you could work it out, I suppose)? This
uncertainty of the amount of time it will take is almost
certainly going to be a millstone around your neck.

So what am I trying to say here?
Well, basically it boils down to: when studying, set
yourself a goal, and set yourself a (realistic) time in
which to achieve that goal. Take a break when you've got
to the end of that goal to allow primacy and recency a
chance to exert their power, and then come back to your
studying. Which is where I'm going now.

My friend Tash showed me a neat little trick. Some of you probably do this anyway…

Take a sheet of A4, and divide it up into sections for History and Examination, Investigations, Bloods, Drugs, Main Problems and Implications, and if you have time add information about your possible anaesthetic technique.

Use this when going through any practice long case viva, so that you get used to the layout, and it becomes a bit like the Mersey technique for SAQs, where you do it the same way often enough you don’t get frightened of it.

When Tash showed me this I remarked that it seemed to be remarkably similar to the front side of the anaesthetic charts where I work…

For an example (obviously created in Paint):

Why do this? Well, it keeps everything neat and organised, and means you can easily refer back to your information “at a glance”.

I’m afraid I don’t have any magic answers on how to succeed in the exam, other than, “Study Hard”, “Practice Often” and “Study Some More”.

The thing is, that “Studying” is one of those ill-defined things that I say “I’m going to study”, but actually I’m not sure what I mean, and that’s what’s held me back, I think, from getting on with some proper work.

Now I hate “drawing up a studying plan” (or “study plan”, if you like), and I’ve never done that. What I do, however, is decide what it is I hope to learn by the end of my session of “studying”, whatever length of time that may be.

This morning I decided I was going to learn about principles of anaesthetising patients with cardiovascular disease, including hypertension, abnormal ECGs, valve disease, and congenital heart disease. That sounds like a big topic, and it is in some ways. However, by grouping it all together under the “Cardiovascular Diseases” heading, and not spreading them out over a few days, I felt I was better able to integrate the information. Whether it’s gone in for good or not is another question!

Let me explain a bit more: because I had in my mind to learn about CVS disease and the impact on anaesthesia/anaesthetic technique, I had a peg to hang things on. If I then read about some CVS, some renal, some hepatic, and then came back tomorrow to read about some more CVS, it would be kind of jumbled up. Comprende? Instead, because I read all about it in one go, I was able to take ideas from one bit and integrate them with another bit and it all makes (more) sense.

Anyway, that’s what I mostly do, try and have an idea of what it is I want to learn by the end of the session, rather than generically “learning something, anything!”

I did spend about one and a half hours with one of my friends doing some viva voce practice, but I can’t say I felt very positive at the end of it. I would like to excuse myself by saying I have just finished 5 nights, but that doesn’t really make me feel much better…..