ANZCA PRIMARY EXAMINATION
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1 ANZCA PRIMARY EXAMINATION The Primary Examination Sub-committee and all primary examiners strive to conduct an examination which is fair, valid, and reliable, and that continues to assess the basic sciences with a relevance to safe conduct of anaesthesia. We hope this information will be of benefit to both trainees and those who are helping trainees prepare for the coming examination. The broad aim of the primary examination is to provide an integrated approach to learning. While the candidate will be learning about individual topics via the reference texts, the examination process, especially with regard to the oral examination, will not examine individual subject areas in isolation. Rather the examination will aim to present candidates with a broad range of questions covering the scope of the major topics. Below is a brief outline on the MCQ, SAQ and Viva examination process to provide you with an understanding of how the examination is managed and operates. MULTIPLE CHOICE QUESTION PAPER Content The multiple choice question (MCQ) paper consists of 150 Type A (select the best answer) questions, to be answered in 150 minutes. Question selection The College maintains a question bank that contains several thousand multiple choice questions. All questions must be related back to a learning outcome, and have a reference to a textbook or reference on the reading list in its most up to date edition. Prior to setting a question in the exam, the reference from which it is written is checked. When setting the MCQ paper, the examiners work to a template to ensure that questions cover a large proportion of the learning outcomes. Examination reports document the allocation of questions to topics. Marking The questions are marked and summary statistics are produced for each question in the examination, detailing the response rates for each of the five possible answers (A to E). Questions with few or no correct responses are reviewed to determine if there has been a misprint or potential ambiguity. Such questions may be removed. SHORT ANSWER QUESTION PAPER Content The short answer paper consists of 15 questions. Question selection and marking
2 Similar to the MCQ bank, the college has a bank of short answer questions (SAQ). Prior to being selected for an examination, the question will be checked back against the learning outcome and the most current prescribed reference texts. There is no set template for selecting SAQs by topic. The SAQ paper consists of both old and new questions. All questions are set and reviewed by a group of examiners who agree marking templates prior to the exam. The marking guidelines ensure that it is possible to get 25 marks out of 25 in the 10 minutes allotted to each SAQ, even if the question seems quite broad. The range or questions is assessed to ensure that each paper has a balance of both straightforward and more complex questions. An example of a short answer question with its marking grid is in Appendix A. Each SAQ is marked out of 25 marks. All marks are collated and a total mark out of 25 is awarded. SUMMATION OF WRITTEN EXAMINATION RESULTS Candidates need to score 60% or more in the MCQ and 40% or more in the SAQ papers to be invited to the oral examination. THE ORAL EXAMINATION The oral section of the exam consists of three viva sessions of 20 minutes each. There are two examiners at each session. Each viva session consists of four topics (two asked by each examiner) during a 20 minute period. Appendix B has an example of a sample viva. Each examiner will have their own bank of oral examination questions. Prior to each oral examination, an examiner will submit their questions to the court of examiners for that examination. For an oral question to be approved for an examination, it must not relate to a topic that has already been significantly assessed in the SAQ paper, it must be directly related to a learning outcome, and the answers that are required must be found in a textbook from the reading list. When presented, the examiners will discuss what standard is required to achieve a pass. There will also be discussion as to the content of the opening question for each oral examination topic. There is a controller who will assess all the oral questions that will be asked of a candidate to ensure that there is an appropriate spread of topics, and that a candidate is not assessed on the same material more than once. Marking Candidates are marked out of 25 independently by each examiner without conferring. In most circumstances, examiner marks usually differ by no more than one to two marks. It should be noted that examiners have no knowledge of a candidate s performance in the written examination. The scores of all three vivas are added up to give a final mark out of 50 for the oral component of the examination. SUMMATION OF FINAL MARKS After verification, marks are entered into a computer program, and a combined score for the whole examination is determined. A score of equal to or greater than 50.0 is a pass, and a score of less than 50.0 is a fail. Marks are not altered or scaled in anyway. EXAMINERS Examiners are also being constantly assessed for fairness and performance, and as such there may be a senior examiner who may be present during the oral examination. Examiners are given feedback as to their performance with suggestions as to how they could improve their technique. As mentioned at the beginning of this note, The Primary Examination Sub-committee strives to conduct an examination which is fair, valid, and reliable, and that continues to assess the basic sciences with a relevance to safe conduct of anaesthesia.
3 ADDITIONAL LINKS 2013 Curriculum and Learning Objectives Reading list Candidate information sheet
4 APPENDIX A SAQ Question Marking Grid Question Number Topic: Nutrition and Metabolism Author: Question: Outline the components of parenteral nutrition and explain the rationale for the use of each component. Suggested Answer: Definition: providing partial or total nutritional support either to increase caloric intake, or to provide total nutritional and fluid support to prevent complications of prolonged fasting (2) Water approx 2.5 Litres per day (2) Caloric approx 8000 kj or 2000 kcal or 100kJ/kg or 25 kcal/kg per day (2) provided as CHO glucose solution (1) Lipid - to include essential fatty acids (1) Protein to include essential and non essential AA (1) (prevents catabolism of muscles) (1) Different amounts of protein according to reason for TPN e.g. different states of catabolism postop, burns etc Ratios may be adjusted to change RQ value in certain disease states (1) Electrolytes and minerals to replace obligatory losses (1) Na approx 1.5 mmol/kg/day (note: different references different have values any reference value acceptable) K approx 1 mmol/kg/day (1) Ca and Mg (1) allow normal nerve and cellular function (1) Vitamins and trace elements for normal body processes (2) Insulin also given, adjusted to the glucose tolerance state of the patient (e.g. may be altered in critically ill). Altered caloric requirements with physiology (age, gender, pregnancy) and pathology (sepsis, trauma and burns). Global marks (1) (1) (1) (2) (3) Syllabus Reference: Textbook References: Oh, edition p Section K; 2.d To explain the physiological principles of parenteral nutrition Guyton, edition pp
5 APPENDIX B A number of vivas, written by members of the Primary Examination Sub-Committee have been designed to give candidates some practise in the type of vivas that will be used in the primary examination. In order to gain maximum benefit from these vivas, it is suggested that they be used under examination conditions, with questions being asked by a consultant or other suitable member, after they have given some thought to the appropriate level of response for each question. The vivas have been constructed to allow or practise of technique. They are not designed to be given over a six-minute period; some may take longer. Sample viva 1 1. Let us assume you are passing a spinal needle in order to undertake a spinal anaesthetic what layers of tissue do you pass through? 2. You enter the CSF, and note that CSF flows from the end of the needle. Why? 3. What is normal CSF pressure? 4. How is CSF manufactured? 5. Local anaesthetic is injected into the CSF. What is the mechanism of action of local anaesthetic drugs? 6. Immediately afterwards you notice that the blood pressure has fallen to 80/50. What are the mechanisms for this response? 7. Where do these sympathetic nerves arise from? 8. What drugs could you use to treat this response? 9. If you choose metaraminol, what is its mechanism of action? Why is its administration accompanied by a bradycardia? 10. The patient feels no pain, but still has a small amount of movement in his toes. Why is that? 11. What types of nerves are affected by the local anaesthetic? Why do they have different sensitives? Sample viva 2 1. You see a patient preoperatively and wish to assess his renal function. What tests will you order? 2. Why are these tests used to assess renal function? 3. Can they be used in an equation to better estimate GFR? 4. What are the variables in the Cobcroft Gault equation? 5. The surgery requires that a muscle relaxant is used. How do you classify non-depolarising muscle relaxants? 6. Which relaxant might be suitable for a person with renal failure? 7. Let us say mivacurium is selected (but viva could be modified for any agent). Why is this drug suitable? 8. How is it metabolised? 9. Mivacurium is presented as a number of isomers. What is an isomer? 10. What is the significance if the isomers that go to make up mivacurium? Sample viva 3 1. What is your usual fluid of choice in adults? 2. What are the components of Hartmann's solution? 3. Why is this fluid ideal? 4. What is the value of calcium in this fluid? In plasma? 5. When we measure serum calcium we also measure something else? Why do we measure albumin? 6. What determines the plasma concentration of calcium in the blood? 7. What is the role of calcium in the body (outline)? 8. We can also give calcium as a drug. In what forms do we give it? When might we give it? 9. If we give it for hyperkalaemia, have does it exert its effects 10. How do calcium channel blockers exert their effects? 11. What are the effects of calcium channel blockers? 12. In what way do nimodipine and verapamil differ? 13. What are the clinically important side effects of calcium channel blockers? 14. How do we treat an overdose of calcium channel blockers?
6 Sample viva 4 1. What are the properties of the ideal drug to administer as a pre-operative anxiolytic medication? 2. What is an example of a drug used for premedication? 3. If a benzodiazepine is used as an example, what is margin of safety? 4. Draw a dose response curve explaining concepts of margin of safety with both wide and narrow margins 5. What effects do benzodiazepines have on the control of ventilation? 6. How is ventilation normally controlled? 7. What effect may benzodiazepines have on MAC? 8. What changes in the EEG do you see with increasing MAC? 9. How can we measure depth of anesthesia in the operating theatre? 10. What is the principle of operation of these machines? 11. What other drugs may cause a MAC sparing effect?
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