World Anaesthesia Day, also known as National Anaesthesia Day or Ether Day, is observed annually on 16 October to commemorate the birth of anaesthesia. On 16 October 1846 at Massachusetts General Hospital, William T.G. Morton administered ether anaesthesia to Edward Gilbert Abbott (1825-1855) (Haridas 2017). Dr John Collins Warren (Hersey Professor of Anatomy and Surgery at Harvard Medical School, Boston, MA) was then able to surgically remove a vascular neck tumour painlessly. This first public demonstration of ether anaesthesia marks a significant event in medical history. This success led to rapid progress in surgical medicine because patients could now undergo surgical treatment without the pain associated with an operation.
‘Ether Day’ is celebrated annually by the World Federation of Societies of Anaesthesiologists (WFSA) with special events. This year will mark the 175th anniversary of the event. Around 134 societies representing anaesthesiologists from over 150 countries take part in the celebrations.
The WFSA uses this day to highlight a global shortage in the anaesthesia workforce, which translates into surgical operation, labour analgesia, and critical care gap (WFSA 2021). There is currently less than one anaesthesia provider per 100,000 population in most countries in Africa and South-East Asia, compared to 15–30 anaesthesiologists per 100,000 in North America and Western Europe (Firth and Evans 2021). Thus, there’s a deep disparity in the number of trained anaesthesia providers worldwide, along with an inability to treat surgical conditions where providers are unavailable. In the light of this ongoing neglect, WFSA celebrates global awareness days like World Anaesthesia Day since they can be a powerful advocacy tool to mobilise political will, educate the public, and showcase the achievements of the global anaesthesia community.
Some candidates are naturally good at exams. All candidates can be good at exams.
If you have learned the content and have rehearsed your technique, there is only one other thing that you need to remember. The examiner reports for exams repeatedly state that candidates who answered the question asked, scored better than candidates who gave general answers around the topic question.
Focus your energy on responding to the specific question asked by examiners and immerse yourself in the scenario. Remember to focus on “this patient” in the particular scenario described.
Best wishes to you all – I look forward to congratulating you soon!
Yes, it was epic. The annual ASA exam preparation weekend had a substantial re-work to accommodate a new exam format for those candidates who sat the written section in March (and who will not have medical vivas with patients) and a new boot camp format via Zoom.
The registrants were surveyed prior to the weekend to find out about their expectations, special requests and exam cohort. There was an approximately 50:50 split between those from 2020-1 and those preparing for 2020-2 and beyond, together with a number of International Medical Graduate Specialists.
PREPARATIONS AND LOGISTICS
Many hours were dedicated to the question of how to engage a group of close to 90 people via Zoom. Ultimately, the obvious choice was to create ‘Hollywood in the Home’. This allowed a combination of TED-talk style and screen-shared presentations. As always with Zoom, pants were optional but candidates were asked to try out the rest of their exam wardrobes on-screen.
An extended ‘arrival window’ at the beginning of each day was an opportunity to chat and meet individual participants and gave the weekend a personal feel. Candidates were encouraged to commit to the weekend as if they were in a lecture – without distractions or phones, and with Zoom cameras and exam-brains on.
PRESENTERS AND OTHER SUPPORTERS
Thank you to the examiners who participated in the exam panel. They answered candidate questions and provided commentary on the ingredients of good and great exam performances. Dr Steve Davies, Dr Nicola Meares, Dr Carmel McInerney, Dr Prani Shrivastava and Dr Sally Wharton volunteered their time, experience and knowledge of what appeals to examiners and what garners extra marks.
Sunday morning with the Final Exam Chair Dr Sharon Tivey was another opportunity to clarify the exam process for candidates. All participants gained insights into the diabolically difficult jobs of conducting exams, training, and studying during a pandemic.
The weekend would not have been possible without my co-hosts Dr Rod Katz and ASA office super-hero Kym Buckley. They co-ordinated chat responses, answered private questions and ensured the smooth running of the production.
Each exam section (MCQs, SAQs and Vivas) was addressed and ingredients for success outlined.
For multiple choice questions the tips were mainly straightforward. Since there is no negative marking, each question should be answered. Strict timing is important to allow review of all responses.
The short answer questions are a test of knowledge, reasoning and communication skills. This is a demanding section for which strict timing is essential and a construct is helpful. Writing less, writing legibly with all abbreviations explained was stressed. Practicing questions to time and having responses assessed is key.
Every year, examiner reports repeat the importance of answering the question asked. Techniques to ensure that the precise questions are answered were discussed.
Viva deconstruction, viva creation, practicing in sections, role-playing as examiners and video review were suggested techniques to improve viva performance.
It is important to systematically interpret investigations (for the exam as well as professional life). This demonstrates understanding and competence.
The examiners stressed that the entire curriculum was examinable in all sections of the exam including the vivas.
How to manage ‘viva-brain’: what to do and what not to do when a candidate is faltering or uncertain were part of recovery techniques discussed.
Most examiners are active clinicians. Candidates should not make the mistake of thinking that time spent in operating theatres and other clinical activities is not useful exam preparation.
The value of a range of techniques including individual and group study, a study plan that covers the entire curriculum and practicing past questions under exam conditions was stressed as an important part of exam success.
Details of EPIC participants were shared after the weekend. This is intended to help candidates in things such as forming study groups and developing and sharing practice questions. One of the points that was made through the weekend was that there is a real benefit to collaborating and no real downside. The exams are intended to test judgement and knowledge and
not designed to rank candidates. A higher success rate reflects well on candidates, examiners and teachers. Collaboration and working together will also be of benefit through post-exam professional life.
Professor Winston’s suggestion of an empowering promise was embedded in the plan for our weekend. All candidates were promised extra marks if they engaged and concentrated during the two days. Candidates listed what they learned that would most help them to earn those extra marks in the chat at the end of each day. That summary of what was meaningful to candidates also informed the lecture series for the future. However, we all agreed that we will never do it again… until next year.
These are extraordinary times. We will all serve to the extent that we are willing and able. Anaesthesia trainees and anaesthetists play important leadership roles in systems administration, surgery, resuscitation and critical care on ordinary days. During a pandemic, these roles will be crucial. Remember to stick to the facts, know the evidence (where that exists) and remain calm and caring.
…exam preparation – really?!
It’s up to you.
No-one knows how this situation will evolve nationally or regionally in the next weeks or months. When the exams will resume and in what format is to be determined. No-one intends to add to the misery of the unknown, but that is what we are dealing with at the moment. So why not take advantage of the time to keep up with your study.
Virtual tutorials and viva practice can serve as a forum for senior registrars to keep in contact and share their views. Continuing with a study program can normalise a part of our lives that is otherwise uncertain. It’s a bonus in extended study time for those candidates who elected to sit the first sitting in 2020!
So…EPIC BOOTCAMP IS ON! June 13 + 14, 2020
Bootcamp will be held via zoom. No current registrants have withdrawn (in response to my offer to refund rego fees) and trainees are still applying – so we’re on.
I did voluntary work with Mercy Ships for three weeks in February. This was just prior to recognition of COVID19 as a global pandemic and consequent lockdowns. The Africa Mercy was docked in the port of Dakar, Senegal in West Africa in September 2019 and was due to complete its mission there in May 2020. The port in Dakar is very calm and working on the ship is like working in a regular land-based hospital with no sensation of movement or disruption. During my 3 week stay I provided anaesthesia for plastic surgery, facio-maxillary surgery and removal of thyroid tumours. As a senior anaesthetist, I only occasionally have to do homework for a list. On Africa Mercy I spent most evenings researching topics such as anaesthesia for ameloblastoma, fibrous dysplasia and working out how to block limbs distorted by burns and contractures. If you are interested in more information on volunteering, the Australian Anaesthetist March 2020 issue is devoted to volunteering. While I was on Africa Mercy I worked with Mark Shrime, an ENT surgeon and an author of the Lancet Commission’s Report “Global Surgery 2030: evidence and solutions for achieving health, welfare and economic development”. The Lancet Vol 386 Aug 8, 2015 – it’s a great read for anyone considering volunteering. He delivered a fascinating lecture on board analysing the impact of the Africa Mercy and the provision of surgery and anaesthesia. I was motivated to work on the Africa Mercy to support Dr AJ Collins, one of the surgeons I work with regularly who also regularly serves on Africa Mercy. It also provided an opportunity to learn about different patterns of disease and injury to those we typically encounter in Australia. Both the different sorts of cases and the on board working environment encourage flexible thinking and an appreciation for the need to adapt systems to the situation. These abilities are important as we face new challenges with the spread of COVID19. The Mercy ship is a surgical service provider and aims to provide relief of suffering and tangible hope for its patients. It is also involved in capacity building. Mentoring local anaesthetists and surgeons was another activity for doctors on the ship.
The lessons learned during my recent time on the Mercy ship about conserving resources and being kind to one another have been very useful in this ramp-up to Covid-19 in Australia. The entire world is now potentially a low-resource setting as we scramble for equipment and supplies during this pandemic.