I observed at the 2016A vivas in Melbourne. The examiners that I spoke to unanimously stated that candidates fail because of lack of knowledge/understanding and not because of poor presentation style. In all of the vivas that I observed, the examiners were very good at prompting candidates, pushing them along and trying to allow them to maximise their marks. The up-shot of this? If your knowledge is solid, you will be ok even if you are really, really nervous on the day and not sounding polished. Having said that, what strategies can you employ to maximise the marks you can get with the knowledge that you have?

Below is my advice, which is modified from something I posted on the Kerry Brandis website back in 2004 – and I see is still featured in the “How To Guides” section  🙂

Answer the question that is asked – no waffle

You get told lots of different - and conflicting - advice from various colleagues and bosses. Some will tell you to keep on talking until the examiners tell you to stop, to lull them into a hypnotized slumber; others will say to keep your answers short and to the point. Speaking to examiners, they much prefer someone who sticks to the point, answers the question, then stops talking.

Listen carefully to the question that is asked. This sounds straightforward, but with the increased stress during the viva, it is easy to hear only the general gist of the question, then go on to answer the question that you want to answer.

For example,

  • Q "How would you classify anti-thrombotic drugs?"
  • A "Antithrombotic drugs are drugs that inhibit the blood from clotting..."

The question did not ask for a definition of anti-thrombotics, you should launch straight into a classification system like antiplatelet drugs and anticoagulants, then the subgroups.

Maximise your time

You may be tempted to show off your knowledge to the examiners, to make them aware that the scope of your understanding of a particular topic extends beyond the specific question that they have just asked you. You might want to open your answer with a broad introductory statement to demonstrate this before getting to the point. This is a bad strategy. Why?

  • It may annoy the examiner that you didn’t seem to listen to their question
  • It does not answer the question asked, therefore will not earn you any marks
  • It wastes time that you could have used to answer other questions to get more marks

Structure your answer before you speak

If you are asked a question where your initial visceral reaction is “oh $h!t”,  nod your head, say "ok", take a deep breath - and use that 2 second pause to make sure you know exactly what they have asked for, and gather your thoughts into a coherent structure - before you open your mouth and start rambling out information that may be correct, but unorganized.

For example

  • Q "What is the body's response to 1L acute blood loss?"
  • A "Well, the high pressure baroreceptors located in the carotid body and aortic arch sense the drop in arterial pressure and sends signals via the vagus to the cardiovascular centre to increase sympathetic tone while the kidneys retain sodium and water and the shift in the balance in starlings forces causes fluid to shift from the interstitium intravascularly..."

Better answer:

  • Nod, "ok", deep breath
  • "The body has several responses to maintain cardiovascular homeostasis"

This statement sums up everything you are going to say next, and "homeostasis" is a keyword that conveys that you understand the essence of what all the responses are for

  • "These responses are aimed at firstly maintain cardiac output and vital organ perfusion, and secondly replacing intravascular volume"

Then go on to talk about the individual reflexes, etc. (Brandis has a very good answer structure for this)

Taking the extra 2 secs before you start is worthwhile because

  • The organised structure will help you to remember points you might have forgotten
  • You get across the most important points in the shortest amount of time (hence most marks in the shortest time)
  • If you talk about 3 out of 5 important points in great detail, then run out of time, they can't credit you for knowing the other 2 point even though you may. While if you come out first with the 5 important concepts, mentally the examiners are going "tick, tick, tick, they obviously knows all this, no need to question further, full marks, let's move on..."

Another tip is to avoid saying things like "there are x number of factors...". It'll throw you off your game if you say there are 8 factors that affect the size of FRC, then can only recall 4! Just list them out without prefacing it with a concrete number.

Drawing Diagrams

  • Draw diagrams large, to fill up an A4 page – make it easy for 2 examiners sitting across the table from you to actually see what you are drawing
  • Use the ACD approach to drawing diagrams (taught to me at the Kerry Brandis short course):
    • Draw the Axis, then the Curve, then as you fill in the Details, start talking about the curve. Don't waste time writing out "volume (ml)" and "time (sec)", just write "V" and "T" and say "this is volume in mls vs time in secs". Practice being able to draw and talk at the same time
    • Trust me, the examiners are mostly interested in just seeing that the shape of your curve is roughly correct. Don’t waste time with a long pre-amble, putting down all the numbers before finally drawing the actual curve. Also, if you’ve already put down the numbers, it makes it much harder to then draw the curve to make sure that it hits all the right points
    • Increasingly, it seems examiners are giving candidates a pre-drawn set of axes to draw on – presumably because many candidates waste too much time before drawing the curve otherwise
  • I would recommend going to Access Anaesthesia. There are some presentations on drawing graphs in the vivas which are really good, which seem to come from the Christchurch and Waikato Refresher courses

Practice Vivas

  • The first few times you do practice vivas will likely feel very awkward. You will trip over your tongue. Don’t let that discourage you from doing more practice because you feel embarrassed – everyone goes through that stage
  • Answering questions in a structured manner is a learnt skill, which gets better with practice. If it doesn’t come naturally to you, all the more reason to practice more!
  • If you are shy, start by vivaing yourself when you are alone – ask yourself a question, then answer it speaking out loud, that is essential. Then move on to doing vivas with your fellow trainees, then with bosses, then ‘scary’ bosses
  • If your hospital runs a formal trial viva, treat it as the real thing
    • Wear the clothes you plan to wear for the real vivas
    • Hype yourself up, trick yourself into thinking that your life depends on passing the trial viva! The idea is to simulate the stress that you will feel on the day of the real vivas. You need to learn to control the stress. If you are too stressed, you will decompensate. If you can control the stress, it will actually help you to focus and concentrate.
    • Most candidates find that they perform poorly in the first station, because of nerves, then settle down and can think more clearly after that
    • Mentally, if you can then view the real vivas as merely a continuation of the trial, then you can go into the first station already in the zone, having gotten over the opening nerves during the trial

The Real Vivas

  • The night before the vivas, I think the most useful use of time is to try to get into the right frame of mind for the next day - you want to be "in the zone", in a state of controlled stress. I think trying to do last minute cramming is not helpful - if you don't know it by now, you won't know it by tomorrow - it will just get you worked up into a state of heightened anxiety. Instead, I recommend going out to watch a mindless entertainment movie in the evening - something that will take your mind off the coming day - so that you can (try to) relax and stay calm. Indiana Jones and the Crystal Skull was a terrible movie, but I will always remember it as the movie we watched the night before the Part II vivas!
  • It's hard to sleep the night before. You may want to put some pharmacology into practice. I find melatonin and phenergan work for me. Personally, I wouldn't use benzos or beta blockers before the exam, but if you are gonna use something, make sure to trial it well in advance of the vivas so that you know what effect it has on you!
  • It is essential that after each viva station, you mentally regroup, completely forget about the previous viva station and start fresh for the next station
  • It is common for people to come out from the vivas thinking that they really bombed one or two questions out of the twelve, yet they still pass. You can make up for a couple dud questions. But if you let one poor performance affect your performance in all the subsequent vivas, it becomes difficult to recover from that