Practice, practice and more practice. (or, GASTROSTOMY TUBE CHANGES. SERIOUSLY?)

The fellowshipexam.com team were bemused to hear some recent exam candidates (not our students!) speak about ACEM's second new fellowship examination. It seems that several of the questions were a bit out of left field.....

"In fact, we here at fellowshipexam.com were similarly outraged, until irony of ironies one of our faculty actually had to perform the procedure under question last weekend!"

In particular, several registrars were outraged by a question asking them for a sequence of steps to change a gastrostomy tube. The objections were vociferous:

• "It's not an ED procedure!"
• "I've never seen anyone do that in ED!"
• "Why would they ask us that, when they could ask about *real* emergencies!?"

And so forth.

In fact, we here at fellowshipexam.com were similarly outraged, until irony of ironies, one of our faculty actually had to perform the procedure under question last weekend!

Aside from illustrating that perhaps the exam wasn't completely unreasonable in asking the question, it's important to realise that fair or unfair, it doesn't matter. It's a question on the exam and you have to answer it.

This is where the element of practice, practice and more practice will serve you well. We doubt that there is a definitive "5 steps to changing a gastrostomy tube" type list that serves as the gold standard for the world. Unfortunately, many candidates get put off by thinking that:
                            a) there must be, &
                            b) they haven't read it.

Well prepared candidates will realize that there is no such answer ready to be copied from a textbook, and simply go back to first principles to answer the question. This is exactly what one of our FACEMs did in real life last Sunday.

For the record, translated into text our "real life first principle solution" was:

1. Use of aseptic technique
2. Deflation of the balloon and removal of the old tube
3. Lubrication of the new tube and insertion through the existing tract
4. If the tube passed easily, aspirate gastric contents and insufflate the stomach whilst auscultating to confirm the position.
5. Inflation of the ballon with 7-10ml of sterile water, and application of a secure dressing.

If a sixth point were needed we would have added: if there are any complications, consult on call gastroenterology.

When you look at the list above, it's pretty hard to believe that candidates for an emergency consultant exam couldn't write something that simple. At fellowshipexam.com we don't believe they couldn't. We just believe they hadn't prepared themselves to do so. We run our candidates through timed examination questions every week, to ensure that the all important element of surprise is overcome by practice, practice and more practice.