The 2002 Experience

© James Austin 2004

Setting the scene

I travelled in to London on the morning of the exam (from Reading), and since I am paranoid about being late for major events, I arrived at the Royal College of Anaesthetists ridiculously early. The gentleman at the door checked my name off against the list of candidates, gave me a numbered badge, and showed me to a waiting room. Other candidates arrived soon after, and we chatted (mostly about our dissertations and the dire state of ICU training - how sad!). At the designated hour we were all shown upstairs to a room divided into cubicles. Each of us was allocated to a numbered cubicle with a pair of examiners, for the one-hour viva on our dissertations. Most of the examiners were anaesthetic intensivists, but there were a few physicians and at least one surgeon.

The dissertation viva

My cubicle also contained an observer (one of my former consultants!), who played no part in the exam other than to give an encouraging smile when I left. My examiners were very friendly, and asked questions that were penetrating but not tough. The dissertation questions were not particularly content-related - I was not expected to recite facts and formulae from my dissertation - but rather analytical: "What were the weaknesses of this particular methodology?"; "Would it improve outcomes compared to alternative techniques?"; "How would I go about organising further research in this area?"; "What did I think of such-and-such a study?". I suspect this viva is placed first to help put you at your ease, as this is the one section where you probably know more about the topic than the examiners. Certainly I came out of it feeling more relaxed than when I went in.

The ETR vivas

We then spent twenty minutes or so in a waiting room, having tea or coffee, before each being issued with a sheet outlining the 'key domains' for the exam. This was to travel with us for the next four vivas, for examiners to mark off which areas we'd already been viva'd on. We were then each shown to a different pair of examiners for the first of our half-hour vivas on our educational training record. One of my fellow candidates had suggested that the ETR vivas might examine anything from your claimed training experience, but in my case these vivas focused only on the 10 case reports. Once again the examiners were friendly; once again I had the benefit of being viva'd on topics I had researched thoroughly beforehand. Many of the questions were more content-related ("You quoted such-and-such a study - what were their findings?"; "What was your rationale for using anti-oxidants in pancreatitis?"); but others were again analytical. At the end of the first viva, the examiners ticked off those 'key domains' that had been addressed by the viva, and we took the sheet on to the next pair of examiners. Somewhat to my surprise, the examiner looked carefully at my sheet and then proceeded to ask me the same topic from the same case I had just answered at the previous table. Perhaps this was to test inter-observer reliability, for things soon diverged from there, and after a bit more 'content' I ended up in a very enjoyable ethical discussion about whether it was right to inform the parents of a teenage girl in ICU as the result of a concealed pregnancy. Having started the exam feeling I would be lucky to pass, by now I felt the odds were more in my favour.

Note: in subsequent exams, one pair of examiners has questioned on the 10 case reports and the other pair questioned on the candidate's ICU experience as described in the 'tickboxes' of the ETR. I think maybe my examiners made a mistake............

The general vivas

The candidates all adjourned to Russell Square Park for lunch and further small talk (how the Australians were so much better at intensive care than us!), and returned in good time for the last two 'general' vivas. Again we were shown to a new pair of examiners for each viva. Topics were selected from the gaps in the 'key domains', and were generally much more content-based. Questions I recall included support strategies for ARDS; the rise of ICU outreach teams; renal support (shortcomings of dopamine and the pros and cons of CVVH, IVVH and dialysis); diagnosis of community-acquired pneumonia; definitions of SIRS/sepsis/MOF - all pretty core ICU stuff, really. The only surprise was the heavy emphasis on literature evidence - virtually every third sentence I was asked "Do you know of a study that supports that?", "What did that study show?" etc. Most of the time I could at least name the study they were looking for, but often I did not know it in the depth they seemed to want. There was little or no MRCP-type medicine or basic science, and I regret spending so much studying time on the official syllabus and less on the literature. The examiners were again friendly, although one was disconcertingly persistent with a question on which I had already exhausted my available knowledge.

The aftermath

I think most of us had expected to receive our results immediately after the exam, but we were then bid farewell and told the exam results would be posted within the next 48 hours. In fact they must have been posted that same afternoon, for mine arrived the next day. And may I wish you equal joy when yours arrive!