ANZCA Final Exam common mistakes
ANZCA Final Exam · Understand the traps and how to avoid them.
In the SAQ/viva, launches into management (dose, drug, next step) before stating a structured problem definition and differential, so the examiner has to prompt for 'what is your differential diagnosis?'
Under time pressure candidates default to action-oriented recall, and the ANZCA SAQ and viva formats reward a defined clinical-reasoning sequence; candidates who have only rehearsed lists of facts have no scaffold to fall back on.
What to do instead
Rehearse a fixed verbal scaffold for every stem: problem statement, severity, immediate threats, differential ranked by probability and lethality, investigations, then management. Practise aloud with a timer so the scaffold is automatic before content is added.
Answers pharmacology questions with a memorised dose but cannot explain context-sensitive half-time, effect-site equilibration, or why an infusion behaves differently from a bolus, and cannot apply it to a specific patient scenario.
Candidates learn numbers from tables rather than pharmacokinetic principles, and the exam deliberately probes applied kinetics (obesity, renal failure, prolonged infusion) rather than recall.
What to do instead
For each commonly infused drug, be able to derive the practical implication of context-sensitive half-time in a named scenario (e.g. prolonged propofol sedation then wake-up). Build a one-page comparison table and explain each row aloud without notes.
Describes a regional block or airway plan only by its name and landmark, without stating endpoint, local anaesthetic choice and maximum dose, expected block extent, contraindications, and the specific rescue plan if it fails.
Candidates over-learn technique names and under-learn the surrounding decision-making, and examiners probe failure and rescue because that is where real-world harm occurs.
What to do instead
For each core technique, write a standard template covering indication, contraindication, endpoint, drug and dose with maximum calculated, expected extent, complications, and the escalation plan. Practise delivering it in under two minutes.
Approaches pain questions by listing drugs in ascending strength rather than constructing a mechanism-based, multimodal plan that addresses nociceptive, neuropathic and central sensitisation components with explicit endpoints and review timelines.
The WHO ladder is over-rehearsed and simple, so candidates default to it; the exam expects mechanism-based reasoning, opioid stewardship, and awareness of the biopsychosocial contributors.
What to do instead
Rehearse a framework: characterise the pain mechanism, set a functional goal and review date, combine modality-appropriate agents, plan opioid exit or tapering, and address psychological and functional factors. Apply it to acute, cancer and chronic non-cancer pain cases.
Recommends escalating opioid dose for poorly responsive pain without first reassessing the diagnosis, considering opioid-induced hyperalgesia or tolerance, or documenting a review of benefit versus harm.
Candidates fear appearing to undertreat pain and equate dose escalation with compassion, and the exam specifically tests recognition of opioid harm and stewardship.
What to do instead
Before any dose increase, verbalise a mandatory checklist: is the diagnosis right, is there a neuropathic or central component, what is the current function and side-effect burden, what is the exit plan. Practise saying 'I would not increase the dose until I have done X' out loud.
Discusses perioperative risk using only the ASA physical status grade, without quantifying procedure-specific risk, functional capacity, and the patient's own values and goals.
ASA grading is easy and familiar, and candidates conflate a physical status label with a risk estimate; the exam rewards shared decision-making and calibrated risk communication.
What to do instead
For every preoperative case, state estimated 30-day morbidity and mortality in approximate terms, the patient's functional capacity in metabolic equivalents, and how the numbers change the decision. Rehearse explaining risk in absolute terms to a lay patient.
Manages a deteriorating postoperative patient by calling for help and starting empiric treatment without first committing to a structured primary assessment and naming the most likely diagnosis and immediate threat.
Candidates freeze into a 'call for help and treat' script because it feels safe, but examiners want explicit prioritisation and a working diagnosis before intervention.
What to do instead
Use a fixed ABCDE verbal structure with a stated working diagnosis and threat at each step, then interventions with doses. Practise deteriorating-patient scenarios aloud, always naming the diagnosis before the first drug.
Answers ethics, consent and capacity questions with general principles ('respect autonomy') but cannot apply them to the specific facts, such as an unconscious patient, a refusal by a competent adult, or a request from family.
Candidates treat ethics as a soft topic and prepare only slogans, whereas the exam tests application of capacity assessment, best-interests decision-making, and the legal framework to a concrete scenario.
What to do instead
Prepare a short applied framework: assess capacity against defined criteria, identify the decision-maker, consider advance directives and substitute judgement, and document reasoning. Work through ten short vignettes aloud, ending each with a defensible decision and its justification.
Ignores the structured communication and non-technical skills components of the viva, giving disorganised answers with no signposting, no prioritisation, and no explicit handover or team instruction.
Candidates focus entirely on medical content and do not rehearse delivery, but examiners score clarity, prioritisation and leadership explicitly, and disorganisation reads as unsafe practice.
What to do instead
Practise signposting ('three priorities: first, second, third'), explicit closed-loop instructions, and a structured handover using a recognised format. Record mock vivas and review for structure and brevity rather than content alone.
Treats the exam as a knowledge recall test and does not rehearse the specific assessment formats, so time is lost to over-long answers on early questions and later questions are left incomplete.
Candidates revise content but never simulate the format, and the ANZCA written and viva formats are unforgiving on pacing and on answering the question actually asked.
What to do instead
Run timed mock examinations under exam conditions weekly, including full-length papers and viva circuits with unfamiliar examiners. Review time allocation and question interpretation, not just factual accuracy, after each mock.