Primary FRCA: 450 MTFs and SBAs

364 Pages·2013·6.626 MB·English

by  Kariem El-Boghdadly, Imran Ahmad, Craig Bailey

Primary FRCA:
450 MTFs and SBAs

Primary FRCA:
450 MTFs and SBAs
Kariem El-Boghdadly MBBS BSc (Hons) FRCA
Specialty Registrar in Anaesthesia,
South East School of Anaesthesia, London, UK
Imran Ahmad MBBS FRCA
Consultant Anaesthetist, Guy’s and
St Thomas’ NHS Foundation Trust, London, UK
Editorial Advisor
Craig Bailey MBBS FRCA
Consultant Anaesthetist, Guy’s and
St Thomas’ NHS Foundation Trust, London, UK
London • Philadelphia • Panama City • New Delhi
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Foreword
If you are reading this then you must have some interest in the FRCA examination process,
whether as a candidate, a college tutor or an educator. In my opinion it is the most rigorous but
fairest test of knowledge of any medical specialty. The Royal College of Anaesthetists has in-
vested an enormous amount of time, money and expertise in ensuring that both the Primary and
Final FRCA examinations are robust, the results reproducible and the papers valid. It is a relevant
examination; after 18 years as a consultant, I find that the principles tested remain as important to
me today as they have ever been. However, the examination is in continuous flux, constantly being
adapted in order that it remains fit-for-purpose, and I am extremely proud and honoured to be one
of its examiners.
The Primary FRCA examination is, in effect, the gatekeeper to a career in anaesthesia: once
success is achieved then the world of anaesthesia opens up to the trainee and anything is possible.
However, acquiring that success necessitates serious preparation, and lots of it. The Primary
multiple choice question (MCQ) paper tests knowledge of a wide curriculum and no candidate
could ever ‘wing it’. The candidate preparing for the Primary examination will have spent many a
lonely night and weekend ‘hitting the books’, deprived of the company of friends and family. If it
is any consolation the rewards for passing are tremendous. I clearly remember the day I passed
the Primary examination – it felt like a huge weight had been lifted from my shoulders, I had more
energy and was eager to get on with the rest of my life as an anaesthetist.
The Primary FRCA MCQ paper
Preparing for and sitting the Primary examination is expensive (currently £310) so it is foolhardy
to attempt it without proper preparation. There are three sittings a year at various locations and a
total of five attempts is allowed. Once the MCQ paper has been passed it is valid for three years.
The MCQ paper itself consists of 60 Multiple True/False (MTF) questions each worth 5 marks
(20 in pharmacology, 20 in physiology and 20 in physics, clinical measurement and data interpre-
tation), as well as 30 Single Best Answer (SBA) questions each worth 4 marks for a correct answer
and consisting of any topics from the curriculum. This gives a maximum score of 420; there is no
negative marking.
At the time of writing the pass rate for the previous four sittings was 55% (February 2012), 61%
(June 2012), 49% (September 2012) and 51% (February 2013). There is a reason why there is such
an apparently wide variation in the pass rate. If a fixed pass mark is set, then all candidates who
obtain that mark or higher are passed. If the paper was easier than in previous years, then more
candidates are likely to pass. Conversely, fewer are likely to pass if the examination is particularly
difficult. On the other hand, if a certain pass rate is set, e.g. 60%, then a particularly good cohort
may put at a disadvantage the borderline candidate who would have passed if the cohort were
less competent. This is the reason the Angoff method of criterion referencing was introduced by
the College.
Angoff referencing
This is a method of setting the pass mark based on the professional judgement of a group
of experienced examiners. The Primary MCQ examination currently uses a modified Angoff
v
Foreword
referencing system whereby a number of examiners make independent judgements which are
then used to set the standard.
The principle of standard setting is to set the pass mark for an examination by determining the
minimum level of knowledge or skills required to pass that examination. In order to do this the
examiners are asked to decide for each exam question the probability that a minimally competent
candidate will know the correct answer. Minimally competent means a candidate who is of reason-
able intelligence, with an average amount of clinical knowledge and who has done a reasonable
amount of preparation. Such a candidate is often described as the borderline candidate, or one
who has performed just well enough to pass the examination.
Due to the relatively large size of the Primary MCQ paper, examiners are given a version with
alternate MTF questions and all the SBA questions. For each question the examiner gives a score
from 0 to 10 for the probability of a borderline candidate knowing the correct answer.
Impossible Probable Certain
0 1 2 3 4 5 6 7 8 9 10
These numbers are summated to give a total for each examiner. Inevitably there will be a range
of numbers across the ‘Angoffing’ group. Once all examiners’ totals are returned, the examinations
department calculates the average Angoff mark. Outliers are removed using a 1st and 3rd quartile
calculation. It has been agreed that 12 or more examiners in any Angoffing group are required to
give a reliable Angoff reference score.
Revision aids
There is a plethora of examination aids available, ranging from e-Learning to past papers pub-
lished by the College itself, but they are not always as helpful as they could be. How often have
you attempted practice questions, looked at the answers and not understood why ‘B’ was false and
then had to look elsewhere for the reason behind the answer? This book does not suffer that fault
because it provides comprehensive answers to all the questions, so you are left in no doubt as to
why the answers are as they are. Preparation for the examination relies on this sort of analysis and
on wider reading: there is no point in simply memorising answers.
The authors are young and their enthusiasm can be sensed throughout. Kariem El-Boghdadly
and Imran Ahmad have spent a huge amount of time writing this book, and I truly believe that it is
the best revision aid on the market. All the questions are closely based on the current curriculum
and the answers have been painstakingly researched for accuracy. I feel sure that by the time you
finish this book you will be in a fabulous position to take on the examination and pass.
You may want a career in our specialty but until you achieve success in the Primary FRCA exami-
nation you can never truly call yourself an anaesthetist.
Craig Bailey
July 2013
vi
Preface
The FRCA has always been a challenging set of examinations. The recent addition of the Single
Best Answer (SBA) format to the multiple choice question sections of both Primary and Final FRCA
examinations has added to their difficulty. In order to succeed, candidates must use all the tools
available to them to either increase their knowledge or improve their technique. We recognised
that for the new examination format there were few good resources to support them in this, and
our aim has been to provide the right resource to help candidates pass the rigorous Primary FRCA
examination
This work has taken a huge amount of time and effort to put together. We have ensured
that the full breadth of the syllabus is addressed and we have made every effort to write in the
College’s exam style. Detailed explanations reinforce understanding of the correct answers and are
accompanied by references.
The SBAs are the most challenging aspect of the examination. We have included a wide range
of science and clinical SBAs to assist the reader in improving exam technique. Again, references are
provided to facilitate more in-depth reading around the topic in question.
We hope this book serves its intended purpose of helping the reader succeed in the Primary
FRCA examination.
Good luck!
Kariem El-Boghdadly
Imran Ahmad
July 2013
vii

Contents
Foreword v
Preface vii
Bibliography xi
Dedications xiii
Chapter 1 Mock paper 1 1
Questions: MTFs 1
Questions: SBAs 11
Answers: MTFs 19
Answers: SBAs 56
Chapter 2 Mock paper 2 73
Questions: MTFs 73
Questions: SBAs 84
Answers: MTFs 91
Answers: SBAs 129
Chapter 3 Mock paper 3 147
Questions: MTFs 147
Questions: SBAs 157
Answers: MTFs 164
Answers: SBAs 200
Chapter 4 Mock paper 4 215
Questions: MTFs 215
Questions: SBAs 225
Answers: MTFs 233
Answers: SBAs 267
Chapter 5 Mock paper 5 279
Questions: MTFs 279
Questions: SBAs 289
Answers: MTFs 296
Answers: SBAs 328
Index 341
ix