Monday, 9 June 2008

The Exam

I’ve not written much over the last week or so because I’ve mainly been down the pub after sitting my first post-graduate anaesthetic exam last Wednesday. Now the hangovers have gone, I thought I’d write a little about how I feel about the whole process. I’ll warn you now that this post is probably not going to mean a fat lot to the non-medical readers, but it’s something that has taken a hell of a lot of my mental energy recently

On sitting it early.

Traditionally, the Royal College of Anaesthetists (RCoA), who set the exam, wouldn’t let doctors even attempt the paper until they had done a minimum of 18 months work as an anaesthetist in a recognised training job. The MMC shake up to post-graduate training has meant that they’ve relaxed the rules about this and now say that you can sit the exam once you have your “Certificate of Basic Anaesthetic Competencies” which takes about 3 months to get. They haven’t changed the examination itself, so by deciding to sit the exam early (after 10 months as opposed to 18) I was putting myself at a potential disadvantage.
Advice from the consultants and registrars who have passed the exam varied. Some strongly advised me to wait for another few months and sit it in September (13 months in), whilst some said that I may as well get on with it so it’s out of the way.
I decided to go for the early option because the exam is theory based, so passing it is more a matter of doing loads of book rather than practical experience. Also, should I fail, I can get another crack at it in September and still be on course so pass all parts of the exam by the end of 2008.
Whilst studying, it became apparent that experience IS important. For example, there’s lots of stuff about pregnancy, its physiological changes and about how regional and general anaesthesia is different in a pregnant woman. Now, I’ve done absolutely no obstetric anaesthesia, so I had to learn all the facts “dry” as I had no real experience to relate them to.

The run up

I worked really hard to study for this exam. I mean really hard. I was putting in 3 hours of study after a working day and up to ten hours on the weekends. The spectre of being stuck in New City for a whole year longer was more than enough motivation to keep me in my revision chair. In the last week before the exam I think I was starting to go a bit stir-crazy. I was having headaches all the time and found it really tough to concentrate. I think probably pushed myself a little too hard, but this exam is notorious for being the hardest post-grad exam of all the specialties so it was a case of “needs must.”

Negative Marking

The exam paper itself is a multiple choice paper that asks 450 True/False/Don’t Know questions. The paper is negatively marked, so you score 1 for a correct answer, 0 for a “don’t know” and -1 for an incorrect answer. The pass mark is about 55%.
This is the last time that the RCoA are using negative marking and good riddance is what I think. A pass mark of 55% on a negatively marked paper means that if you decide to answer all the questions, then you need to get just over 75% of what you’ve answered correct. If you decide to pass on some questions, the percentage of correct answers you need to give goes up too. So there’s a balance between answering enough questions to pass the paper and not guessing at questions and picking up negative marks.
Lots has been said about various approaches to negatively marked papers and how many questions is the “ideal” number to answer. To be honest, it was all too complicated for me, so I decided to keep it as simple as possible and answered just about every single question on the paper. This is a high-risk strategy because it means I’m more likely to fail if I haven’t done quite enough work, but it also means that I’m more likely to score very highly if I have - “Live by the sword, die by the sword.”
I based my study and revision timetable round doing as many practice MCQs as I possibly could. I borrowed books like QBase and the RCoA Blue Books and I went on websites like and In my opinion, some of these resources aren’t as helpful as they claim to be and were a bit of a waste of money. I was particularly disappointed with in particular as it is out of date, and gives far too much weighting towards the random minutiae rather than the core knowledge that you need to pass.

Pre-exam chatter

I really don’t like chatting to other candidates before exams and before interviews. The conversations you have are utterly pointless and talking to other people only makes me feel worse about my prospects for passing. I arrived as close to the exam start time as I dared to and took myself away from everyone else to sit on the floor in the corner. It’s not that I’m anti-social, it’s just that I think there’s a time and a place for chit-chat and the lobby to the exam hall isn’t it.

The exam itself

I think the exam itself was tough, but then again, I was expecting it to be very tough. What I’d say about it is that I thought the exam was fair. The vast majority of the questions were based around core anaesthetic knowledge and the drugs that you’d reasonably expect an anaesthetist to know about. There was very little in the way of random, irrelevant trivia, so I can’t really complain about the exam questions themselves. As always with these things, there were bits that I knew right of the bat, bits I had no idea about and those annoying questions where you can remember reading the information but just can’t recall the actual answer. I was thanking my lucky stars that I flicked through the section about skeletal muscle in my histology book but was kicking myself that I neglected to learn how ketamine is metabolised.

Post-exam wind down

It feels fantastic to not have to study anymore. I can come home and just do normal things like watch TV, go for a run and cook dinner without the constant incantation of “I should be studying, I should be studying, I should be studying” going round and round my brain.
I honestly have no idea whether I’ve passed or failed, but I really do think that I’ve probably worked as hard as I possibly could have done. Fortunately, the RCoA don’t hang around too long with the marking and I will get my results on Thursday.

In the meantime, my life has quickly reassumed a familiar pattern – and it’s back to work again tomorrow.


Elaine said...

Fingers crossed!

Jo said...

Keeping my fingers very tightly crossed for you :-)

Tazocin said...

It was only after four and a half years in medical school in the run up to my finals that I realised answering every question on the paper was the best way for me personally to maximise my score on "Negative Marking" MCQs. But then again, we were docked -0.5 marks for an incorrect guess!

I've also sat exams this year (MRCPI Part 1 and Part 2 Written) slightly earlier than used to be technically allowed and now I'm 9 days (one call and one Leonard Cohne gig) away from a shot at passing the Clinical (We're still old school, non PACES here in Ireland). The way I've looked at these exams; if I get them first time out and early well that's great. If not, I see them as dress rehearsals for a more serious attempt later. You've obviously put in a hell of a lot of work though. You can never tell with MCQs I guess, so all the best for Thursday!

Fingers, toes etc firmly crossed.

Oliver Smith said...

Hope the results reflect the amount of work you put in!