The key facts to remember about essay based exams are:

1. It is difficult to fail them

2. It is difficult to do very well in them.

3. Essay exams are a good way of getting "points in the bag", to help you through the more difficult parts of the exam, such as the MCQ.

4. Marks are awarded on the basis of the presentation of a series of key points, and the overall approach to your answer.

5. Consequently, it is in your interest to structure your answer well, with clear headings, neat writing and emphasis on the key points that you are making.

6. Even if you know virtually nothing about the specific subject, a well constructed essay will probably get you a pass mark [because this is what you are really being examined on].

7. Each essay is awarded equal marks: it is very difficult to get more than 70% for any specific question. If you write nothing, you get zero. Make sure that you answer all questions and you set a rigorous time limit for the individual answers.

8. Give slightly more time for the first question: it takes a while to get into your stride. If you have to answer 5 questions in 3 hours, spend 45 minutes on the first question, and thirty minutes on the rest. The first question relaxes you.

9. The questions requiring short answers may take you slightly longer than the long questions: what you need is concise "to the point" answers, not comprehensive ones. Do not fall into the trap of spending too long on these. They, are, in fact, the easiest marks in the exam.

10. You must attempt all questions.

11. Set out your headings just before you start writing and follow the pattern through. I will give you some of my own structures later in this tutorial.

12. If you run out of time and you are only half way through an answer, write down the important points in bullet form [if it's not on paper, you won't get any marks for it].

13. Two things examiners hate is bad handwriting and waffle. Write clearly and concisely, sacrifice volume for clarity.

14. Always structure your answers using a variation of the following:

• Read the question: ask yourself what exactly are they asking me? e.g "define the role of lung protective strategies in ARDS and discuss its implications, both positive and negative". Virtually all essay questions involve definition and discussion; you must address both.
• Define what you have been asked about.
• Develop the essay by going into the scientific background of the problem.
• Look at positive aspects.
• Look at negative aspects.
• Look forward to future developments in this field.
• Summarise your discussion and draw conclusions.

There are five basic types of questions:

1. The anaesthetic management of a problem.

2. An anaesthetic / intensive care emergency.

3. A piece of equipment.

4. A procedure.

5. A drug.

These can all be answered using the basic template as stated above: I will broaden out each kind of question below.

1. Define the problem

2. Develop the discussion by going into the scientific background, why it's important a) to clinicians & b) to anaesthetists, and what the implications are for anaesthesia.

3. Discuss the anaesthetic [see below].

4. Discuss the pros and cons of the various interventions.

5. Discuss any new or future developments in this field.

6. Summarise and draw conclusions

1. The disease in question

1. Pre-op
2. Intra-op
3. Post-op

2. The preoperative visit

3. Formulate perioperative care plan

1. Venue [ward / HDU / ICU]
2. Monitoring
3. Analgesia
4. Fluid and nutrition
5. General care [DVT / stress ulcer prophylaxis etc]

4. The Post Operative Visit

Summary:

This may be in anaesthesia or intensive care. This is very much a question of your ability to construct a methodical plan of management. Remember you must be safe - following basic life support, and sensible - using thoughtful and appropriate interventions.

Follow the plan as above:

• Define what you have been asked about.
• Develop the essay by going into the scientific background of the problem.
• Talk about the emergency management of the problem [see below]
• Look at positive aspects of interventions
• Look at negative aspects of interventions
• Look forward to future developments in this field.
• Summarise your discussion and draw conclusions

The emergency management of any problem: anaesthesia, medicine, ICU.

1. ABC1
2. ABC2
3. Monitor and look
4. Differential Investigation
5. Background exploration
6. Investigate simply until stable

1. ABC1 Airway: Ensure that the airway is clear, the patient is breathing spontaneously, and administer 100% oxygen. If the patient is not breathing commence positive pressure ventilation. Call for assistance.

2. Breathing and Circulation: Feel for a pulse and check the blood pressure. If this is inadequate call for emergency drugs and start iv fluids.

3. ABC2 Intubate the patient and administer adrenaline if necessary.

4. Place monitors and look for an immediately reversible cause of the emergency.

5. If a cause is found, treat it, if not commence a "differential investigation".

5. Delegate someone to investigate the patient's background (read through notes, contact next of kin, obtain a collateral history).

6. If the emergency occurs during surgery and is not rapidly reversible, abandon the procedure.

7. All invasive investigations wait until the patient is stable to YOUR satisfaction. Investigations that can safely be carried out in most situations: Full blood count, Renal profile (looking for hyper/hyponatraemia, hyper/hypokalaemia particularly), blood glucose, ECG, CXR. You should also send cardiac enzymes, serum magnesium and phosphate, and alcohol levels & toxicology levels if indicated).

1. All patients who present unconscious have head and neck injuries until otherwise proven, they should be intubated with inline traction, head secured with a rigid collar and sandbags; spinal lifting (or equivalent) is mandatory.

2. Never remove a patient from the emergency area until you are satisfied that the patient is haemodynamically stable.

3. CT scans are rarely indicated in unstable patients (with the exception of ?intracranial haematoma).

4. Nevertheless, it is essential to outrule an intracranial space occupuying lesion in any trauma patient presenting unconscious.

Use the usual headings:

• Define what you have been asked about.
• Develop the essay by going into the scientific background of the problem.
• Look at positive aspects.
• Look at negative aspects.
• Look forward to future developments in this field.
• Summarise your discussion and draw conclusions.

Procedure:

You can happily use the template as used above to flesh out a long question

A useful template for regional blocks

In addition I find this a useful template for describing a regional block:

1. PREPARE your tray / equipment
2. CONSENT the patient
3. Check RESUS trolly available.
4. CANULATE a vein
5. POSITION the patient
6. LANDMARKS
7. NEEDLE (type, size, configuration, nerve stimulator attached)
8. ENDPOINT (bone, CSF, twitching, LOR, distance etc).
9. ASPIRATE to ensure extravascular placement
10. INJECT amount of local, opioid included, adrenaline added
11. WATCH for effects and complications

Preoperative [preop visit]

Preparation [preparation of patient]

May [monitors]

Decrease [D.I.S.T.I.L see mnemonic 2 below]

In [induction and intubation]

Theatre [transfer to theatre from anaesthetic room]

Problems [position the patient]

And [analgesia]

Post-op [post op care plan]

Visits [post op visit]

Mnemonic 2