Final exam update and information

05 December 2024

Updates and important information about the final exam from the Final Exam Sub-committee.

The ANZCA final exams concluded on 2 November. Throughout the year, the court of examiners and more specifically the Final Exam Sub-committee (FESC) have discussed a number of issues and we want to share the progress that has been made in maintaining the exam as a robust, fair and reliable assessment of anaesthesia knowledge and its application.

Medical vivas

At the time of COVID-19, our old medical vivas were suspended due to the inherent risk of large-scale clinical interactions. This proved an opportune time to reassess the medical viva, and the in-person clinical assessment of a patient was removed from the medical viva.  

A new style of medical viva has been used for the past four years. It is an integral part of the final examination and is worth 12 per cent of marks. The medical viva focuses on the preoperative assessment of patients and their perioperative medical management. More detail about the viva is included in the Chair’s Reports – Final Examination.

At the time of the loss of the old medical viva (which included elements of patient interaction) it was decided that clinical medical assessment of a patient was still an important skill to be assessed in a competency-based framework. After significant work, the new patient clinical interaction assessment (PCIA) will be introduced as a workplace-based assessment (WBA) from next year. It replaces a previous WBA and is designed to allow trainees to demonstrate their clinical mastery.

MCQ – enhanced reporting and stem release

Please note that for the multiple choice question (MCQ) examination we have published the blueprint for the last two examinations and the current exam report contains an explanation of the process that is used to review MCQs to ensure that they are fit-for-purpose.
 
In late 2019, the Final Examination Sub-committee decided to release the stems of the MCQs for each sitting, starting with the chair’s report of the 2020.1 examination. At the time, this was seen by both the committee and later by candidates as reducing disadvantage to some trainees.

Since that time we have developed concerns with this process.

The release of stems was an attempt to address potential inequality of access to exam resources by candidates. However, there is significant concern that candidates are aiming to just know the answers to the MCQs, rather than understanding the topic. We are also aware that there are resources in circulation where the MCQs may have incorrect answers identified.

To provide the shared goals of providing for equal opportunity for all candidates as well as promotion of learning, we have decided that rather than releasing the MCQ stems verbatim, the subject matter for each question will be provided.

Exam feedback

In response to trainee concerns and in the best interests of trainee welfare and education, we've introduced a number of initiatives regarding feedback for trainees.

These include:

1. Enhanced notification to supervisors of training regarding examination results so that trainees can be more adequately supported, which started in exam 2024.1.
2. Enhanced feedback for unsuccessful candidates whereby the marks for all sections of the exam are provided, to assist in future preparation.
3. From exam 2024.2, written feedback provided for all candidates who have had a significant deficit identified in their knowledge, clinical reasoning or where they described unsafe practice. This feedback together with the chair’s report is a powerful tool for trainees to continue their medical education.
4. From exam 2025.1, all candidates will receive competency-based feedback for each viva and short answer question of the final examination. This can again be cross referenced with the chair’s report to provide a tool for trainees to progress their medical education.

The Final Exam Sub-committee has avoided giving pure quantitative feedback (i.e. a final score) for passing candidates. The final exam represents a performance hurdle that must be cleared but it is not the total representation of a trainee’s abilities and performance. As such we do not wish to release a quantitative score that could be used in a ranking process in areas where it was not designed to be used, such as job applications.  

Decoupling

In response to EEMC requests relating to candidate concerns regarding time, financial cost and life cost of examinations we have reviewed the final examination and the current provisions we make for candidate welfare.

We've recently released an updated Special Consideration Policy and Reconsideration, Review and Appeal of Decisions Policy which has had input from the examination sub-committees.

Most significantly, at the time of COVID-19, final examination allowed specific decoupling of the exam components in two situations:

1. Carry-over a written score for one sitting, if both sections of the written examination had been passed but the candidate failed overall.
2. Deferral for one sitting of the vivas for a medical reason or significant personal disruption (as assessed by committee).

Recently we have looked at scenarios to further decouple the exam namely:

1. Decoupling the MCQ from the rest of the exam.
2. Decoupling the written exam from the vivas.

In our assessment of these scenarios we have considered:

• Exam cost, and hence candidate cost.
• Resource utilisation and workload on a volunteer workforce.
• Candidate progression. 
• Attempts and passing.
• Awards.

It is important to acknowledge:

1. Standards are critical to our role in the community and cannot be compromised.
2. If the components of the examination are separated, then each element of the exam becomes a standalone assessment with a separate blueprint and a separate standard. This would mean that a pass would be mandatory in each decoupled examination element, whereas the current examination practice allows summation of marks across the elements.

The committee performed an analysis of decoupling options and determined that either of the decoupling options would result in a significantly increased number of candidates failing to meet the criteria for passing the exam. This would be a highly impactful change with significant effects on trainee progression as well as financial and personal cost. 

With our current decoupling initiatives, the committee believes the final examination provides the greatest benefit to our trainees in achieving the standard required in an efficient and timely manner.

Professional conduct

Finally, on a slightly discordant note, we have seen an increase in reported incidents where a trainee is less than polite in their dealings with college staff. Additionally, there have been a number of reports of candidates who have tried to gain an unfair advantage in the MCQ examination by marking their question papers with the answers during the prescribed reading time. This is a clear breech of the regulations and candidates risk serious penalty if this conduct continues. 

We understand that this is an incredibly stressful time in trainee’s lives and that our trainees have significant competing life events. However, these types of behaviours are never considered acceptable and a process will be initiated with the college to manage these behaviours as part of a professional practice review if noted.