"How you answer is almost as important as what you answer..."
So, candidates need to be very slick when it comes to answering “knowledge”/”list” type questions. Question 18 is a case in point.
After interpreting the arterial blood gas, candidates are asked to “list 6 therapeutic goals for resuscitation in the event of massive transfusion”.
Simple, right? Just rattle off a list from the core textbook (which doesn’t exist) of six well defined therapeutic goals (they aren’t) which are universally accepted as best practice (there is still a lot of debate).
Oops! So, in fact, there is NO readily accessible list for candidates to memorize and regurgitate (but then it’s not an undergraduate medical exam either). So, candidates will need to be able to come up with a sound list, at short notice to ensure that they complete the question, score maximum marks, and do not exceed their allotted time for the question.
The good news is most trainees sitting the exam should be able to come up with some sort of list, given enough time. The bad news is that time will be in extremely short supply.
Thus this question illustrates a very important principle of preparation for the fellowship exam course: you need to practice applying knowledge under time pressure, not simply read lots of books. This is a core tenet of the fellowship.com preparation course. Over 26 weeks we set candidates SAQs based on our curriculum, all designed to get you putting your knowledge into play for real on the big day.
And for the record, our list of therapeutic goals would look something like:
- Normalization of haemodynamics (SBP >90, HR 100)
- Capillary refill time approaching 2 seconds
- Urine output >0.5ml/kg.hr
- Lactate clearance of 50%/resolution of metabolic acidosis
- Maintenance of normal haemostatics (INR as close to 1 as possible, normal TEG profile if available)
- A normal clinical state, particularly normal mentation.
In a future blog we’ll talk a little about why we’ve structured our list the way we have. How you answer is almost as important as what you answer with. If you’ve got any suggestions about how we could improve our list, post them in the comments below!