ANZCA Medical Vivas

From the 2020.1 final exam report:

Please find below an update regarding the new medical viva examination which will start with the 2021.1 sitting.

The medical viva component of the Final Examination has been redesigned to test the ability of a candidate to identify and assess the severity and stability of a specified medical condition without the involvement of a volunteer patient.

The medical vivas will continue in the format of two vivas, each around a clinical case. Each viva will have an opening stem followed by a series of questions asked by an examiner. Each viva will run for 15 minutes, with two minutes’ reading time for each stem. The medical vivas will contribute 12 per cent of the total marks.

The medical viva assesses the ability of a candidate to show an understanding of a medical condition and its impact on anaesthesia and surgery. It is set in the context of the preadmission clinic; however, routine anaesthesia questioning is not expected, for example, around airway assessment.

The stem will include information relating to the age of the patient, the system to be assessed and the patient’s medications.

Key areas to be examined within the viva include:

  • The ability to demonstrate an understanding of relevant history for the specified medical condition
  • A demonstration of the understanding of the expected physical signs and their relevance in the context of the specified medical condition
  • The ability to integrate this information to form a diagnosis, assess the functional status of the patient and to grade the severity of the disease process
  • The interpretation of several investigations in the context of the scenario
  • Integration of the investigations to stratify disease severity and to show an understanding of the medical condition and its treatment
  • Pathophysiology of the medical condition and the implications for anaesthesia and surgery
  • Medical optimisation in the perioperative period

At least one medical viva will have a patient scenario with a cardiovascular or respiratory condition. Other systems that may be examined include neurological, gastrointestinal or renal as well as multisystem disorders.

Examples of clinical conditions that may be in the viva include but are not limited to:

  • Valvular heart disease
  • Ischaemic heart disease
  • Cardiomyopathies
  • Chronic obstructive pulmonary disease
  • Bronchiectasis
  • Cystic fibrosis
  • Diabetes mellitus
  • Connective tissue diseases

Examples of possible investigations include but are not limited to:

  • Electrocardiograms
  • Chest X-rays
  • Echocardiograms
  • Pulmonary function tests
  • Blood tests

In order to prepare for the new medical vivas, candidates are encouraged to continue assessing and examining patients, particularly in the preadmission clinic. They should continue to ensure they have sufficient knowledge around a range of medical conditions and practise interpreting investigations.

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