Alexander Jones of the Royal Unites Hospitals, Bath, looks at resources available and outlines a strategy for success that trainees can utilise when undertaking the Primary FRCA
The Primary FRCA is a daunting task. The syllabus is broad, deep and requires a high level of understanding rather than just knowledge. The purpose of this article is to outline a strategy for success that trainees can utilise or supervisors can pass on.
What makes me qualified to give such advice? Well, as a trainee that took the long route to Primary FRCA success, I have had probably too much experience of the Primary FRCA exam. Trips to Red Lion Square came around with alarming regularity and not infrequent disappointment. This has given me a contemporaneous knowledge of the syllabus, exam and its content.
I got there in the end however and you or your trainees will too. It must always be borne in mind at times of low motivation or struggle, that success at the primary leads to genuine feelings of achievement, joy and overwhelming relief. Keep the end goal in sight.
During preparation for all parts of the exam, it would be sensible to bear in mind that a question on defining basal metabolic rate or describing anti-epileptic medication is worth the same as a question on propofol. I would therefore argue that it is an over-arching principle of this strategy that the whole breadth of the syllabus must be covered in sufficient detail. It is without doubt that practise is incredibly important for all components of the exam but a broad base of understanding is also of vital importance and should therefore never be underestimated.
Everyone learns differently and that can influence your strategy and which books and courses you like so please do bear this in mind when reading the below. As a disclaimer, this was only a way which worked for me. Despite having taken important exams every year since the age of 16, I had epiphany during my revision for the primary FRCA. I discovered that my understanding and retention of information was much greater if I had seen a diagram or video of a concept than if I hadn’t. There are some excellent “youtube” videos on subjects such as the clotting cascade or metabolic pathways which really helped me grasp these topics. I am not suggesting that everyone will benefit from this, but I feel it would help if you can establish which methods of learning give you greatest benefit at the start of your learning process. Some people learn better from audio or written word for example, it is worth experimenting with this early on in your journey as it will increase your understanding to effort ratio.
It is worth remembering that the exam really is matched to the primary syllabus. Therefore, the first thing I would recommend doing is downloading a copy of the syllabus. It is matched to the competencies for basic level training and is called Annexe B. It is available online: http://www.rcoa.ac.uk/CCT/AnnexB. When you are doing the written component of the exam, some of the more abstract concepts being examined may well test your faith that the exam is matched to the curriculum but for the OSCE and SOE there is no doubt that there is a clear link between the two and building a framework of knowledge around the curriculum will stand you in very good stead indeed. I would suggest that you should be able to tick off each part of the curriculum prior to sitting the exam. If you are able to do this, I feel that you are preparing yourself for success rather than failure.
The bulk of my notes came from The Primary FRCA Structured Oral Exam Guide 1 & 2, Second Edition (MasterPass) by Wijayasiri, apart from pharmacology which was learnt from Pharmacology for Anaesthesia and Intensive Care by Peck and Hill and the excellent pharmacology e-learning anaesthesia modules.
Physics I supplemented by reading the Physics in Anaesthesia book by Middleton and Stacey and adding to notes already made. I think this is an excellent book for those of you, who like me, are not natural physicists. It explains concepts clearly and logically in a way that a non-physicist brain can understand. For equipment, Essentials of Anaesthetic Equipment by Al-Shaikh was the go to book. The pictures and diagrams were brilliant for a visual learner like myself. The size of this book was intimidating at first but I was able to get through it quite quickly as it was readable and the pictures and diagrams took up a lot of the space.
Cross and Plunkett’s book Physics, Pharmacology and Physiology for the Primary FRCA, along with Dr Podcast Scripts for the Primary FRCA by Leslie, Johnson and Goodwin are both excellent gap fillers and explainers. Dr Podcast is very good at working through difficult topics or commonly asked questions and Cross and Plunkett has diagrams which often come up in the exam but are not found easily elsewhere and is therefore invaluable. Another excellent resource for visual learners that filled curriculum gaps in my notes was Graphic Anaesthesia by Hooper and Nickells. My copy is now torn to shreds as I went through my notes adding pages from the book to the relevant sections as the diagrams and explanations were so good, concise and coherent. I used these three books as the mortar around the bricks of my knowledge, consolidating and building.
It is worth remembering that clinical knowledge is also examined and this must be thoroughly at your fingertips, in particular for the SOE. Candidates often neglect systematically learning this as they feel they do it day-to-day. This is a big trap and don’t fall for it. You need to improve your clinical knowledge too as per the curriculum. I used the special patient group and critical incident section of the Wijayasiri book in combination with the clinical part of Fundamentals of Anaesthesia by Smith and Pinnock. I have to say I didn’t use Fundamentals of Anaesthesia for much else and I’m not sure why really. I had no problem with it, just didn’t pan out that way. Others have used it with lots of success.
CEACCP or BJA Education articles are also great. They are now curated in a collection on e-learning anaesthesia and there is a basic science section which is primary exam fodder. It would be worth going through these. If I was struggling to understand a topic or couldn’t find much info on it, I would google: BJA education CEACCP *Topic* and often the first hit would be a great article on that topic. They have some great ones on stats, thermoregulation and magnesium to name but a few.
The college’s guide to the primary book is also invaluable. It is worth knowing the answers to the questions that appear in that book inside out for the relevant part of the exam you are sitting. Lots of questions on the day will be very similar and there are only so many topics! Make sure you can answer these questions!
For the written section, I went on the Mersey Course and also did about half of the Onexamination question bank as I ran out of time. The question bank on e-learning anaesthesia was very similar in structure and content to the actual exam and I would recommend thoroughly going through this prior to the exam.
For the OSCE, I went on the Coventry course, which was excellent for this part of the exam. It is worth remembering for the OSCE that all questions have been asked previously. (New stations are introduced as a test station in a previous exam). Therefore, all OSCE stations are in the public domain. Work your way through the list on FRCA.co.uk against the two excellent OSCE books by Mendonca and Simpson and Frank. Anatomy features heavily in the OSCE and is often many candidates Achilles heel. Erdmann’s concise anatomy is small enough to not be too daunting and is also matched to the curriculum.
The Viva is a different challenge. I used my notes compiled from the above, with practice utilising the Anaesthesia Viva 1 & 2 books by Blunt and Urqhart, FRCA in a box and Blandfords Passing the primary SOE. The Blandford book was great for practising at the start as the knowledge was also in the text so this could be quickly corrected, meaning learning and practise could be done in the same session. FRCA in a box was great for theatre sessions and the Anaesthesia Viva 1 & 2 books were great close to the exam as they had some slightly niche topics not found elsewhere.
I hope the above is helpful and can help you get through the exam. Make sure you always book a fun and rewarding event or trip after your exam. It is important to give yourself something to look forward to and aim for. There is a lot of internal psychological motivation required to work for this exam and think about ways you can motivate yourself successfully. As with anything performance related, your headspace is equally as important as your skills and knowledge.
Alexander Jones MBBS MMedSci, Clinical Fellow in Anaesthesia and Intensive Care Medicine, Dept. of Anaesthesia and ICM, Royal United Hospitals Bath, UK, BA1 3NG