Debunking Trauma Myths and Pseudoaxioms

This is a copy of the slides I used during the Regional Anaesthetic SpR Teaching on 14/03/2014.

It essentially an extended version of the talk I delivered at the recent Trauma Anniversary Meeting run by the Royal College of Anaesthetists. 

The pdf of my presentation can be downloaded by clicking the link below:

STH Regional Trauma Day Summary

Primary FRCA Vist: Key Points

A colleague (Dr Martin Diacon, @Phatfishie) recently attended the Royal College of Anaesthetists to observe the Primary FRCA. Dr Diacon runs the very successful SCIPY Primary Course (@SCIPYCourse) and he has kindly provided his learning points and reflections from his observation of the OSCE/SOE, which will be very useful for candidates preparing for the examination and for those of you who provide viva practice.

SOEs (Structured Oral Exam a.k.a. vivas):

  • The required standard in the SOEs seemed to be very high.
  • There is very little time to get through the required detail so candidates cannot afford to waste any time.
  • There are two 30 minute SOEs on the day, each with two subjects:
  • Pharmacology and Physiology
  • Clinical Anaesthesia and Physics
  • Each subject consists of three questions of broadly five minutes each e.g. 3x five minute Pharmacology questions followed by 3x five minute Physiology questions – total 30 minutes.
  • There are two examiners in each SOE.
  • The candidates are invited in and allocated to a table in a booth.
  • If they know the examiner or vice versa they are asked to leave the booth and they are swapped with another candidate (this may sometimes involve three way swaps!)
  • There may be other people in the booth such as observers or auditors.
  • The candidate is welcomed and allowed to settle in by the examiners while waiting for the first bell to sound.
  • One examiner will ask the questions for the first three Pharmacology questions and the other examiner will observe and write copious notes.  At 15 minutes a bell will sound and then the examiners swap roles – the Physiology questions are asked by the examiner who had been observing and the examiner who had asked the Pharmacology questions now observes and writes the notes.
  • At the end of the 30 minute SOE a further bell will sound and the candidate leaves.
  • The examiners may then ask each other clarifying questions only e.g. did the candidate say such and such.  They cannot confer with each other about their marks.
  • The examiners then mark independently of each other and record their marks on an iPad.  The marks are saved on a central server and cannot be changed.
  • Each examiner gives the candidate a mark of either 0, 1 or 2 for each of the five minute questions (see attached “Primary FRCA Scoring Guideline” for descriptor of the marks).
  • There are a total of 48 marks available across both SOEs
  • (i.e. six questions in each 30 minute SOE, so 12 questions in total.  Each examiner can give up a mark of up to 2 for each of the 12 questions so as there are two examiners there are a total of 2x2x12=48 marks available over the two SOEs)
  • The pass mark is 37.
  • This means that the candidates must aim for marks of 5 out of 6 from each examiner for each subject i.e. they can only afford to drop one mark!

OSCEs (Objective Structured Clinical Exam):

  • There are at least 16 stations in the OSCE (for full details click here)
  • There may be an extra station or two if the examiners are trialling new stations.  These trial stations will not be apparent to candidates and do not count towards the marks.
  • Each station is five minutes long.
  • There is one minute change over between stations to allow candidates to rotate and read the information provided prior to entering the next station.
  • Each station is marked out of 20.
  • The OSCE pass mark is not fixed but is around 225 out of 320.
  • For the types of questions asked see the attached “OSCE in a nutshell” PDF.
  • Often candidates will finish a station before the five minutes are up – the examiners are used to this and are very good at making small talk.

In general:

The Primary FRCA Exam appears to be a very fair process.

Examiners are there to pass the candidates if they reach the required standard

For both the OSCEs and SOEs, if the candidates feel they have done badly in one five minute question or station, they must pick themselves up again and move on and do their best in the next question or station to be in with a chance of passing overall

The advice from the Chief Examiner was that when providing viva practice to candidates at their place of work it is best done in a formal, structured way mirroring what is done in the exam (i.e. not in theatre but sat across a table, ideally with two examiners asking three five minute questions each over half an hour).   He advised we should be honest with the candidate on how they have performed as most will know if they are underperforming.