Advice for the viva

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You will, of course, get lots of different - and often conflicting - advice from various colleagues and bosses. Some will tell you to keep on talking until the examiners tell you to stop; others will say to keep your answers short and to the point. The following is an approach which boils down the best bits of advice that I received while studying for the Primary:


Answer the question that is asked

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 antithrombotic drugs?"
  • A "Antithrombotic drugs are drugs that inhibit the blood from clotting..."

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

What is the harm of a short preface before getting to the point?

a) it shows you are not listening to the examiners and this may annoy them

b) it does not answer the question asked, therefore will not earn you any marks

c) it wastes time that you could have used to answer other questions to get more marks

Note that if you are asked an open question like "what can you tell me about propofol?" then you can answer in a way that you are most comfortable, just make sure it is structured (see point 2).

Structure your answer before you speak

When asked a question, 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 (see point 1), and gather your thoughts into a coherent structure - before you open your mouth and start rambling out information that may be correct, but unorganized. This is particularly important for topics that are huge, where your initial reaction is "OH SH!T".

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 they want to hear.

"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 refelexes,etc. (See Kerry's viva book)

Taking the extra 2 secs before you start is worthwhile because

a) the organised structure will help you to remember points you might have forgotten

b) you get across the most important points in the shortest amount of time (hence most marks in the shortest time)

c) 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, he obviously knows all this, no need to question further, full marks, let's move on..."

Once you have answered the question, shut up

I know that sometimes you want to show the examiners that not only do you know the answer to their question, but you know a lot more about that topic. But you must resist this temptation!

My rationale is:

1) once you answer the question asked, you get marks for it

2) if you add on extra info that they did not ask for, they may or may not give you extra credit, but you have definitely used up more time you could have spent definitely getting more marks

3) if they want to know that extra info, they will ask for it - and then you can impress them with your knowledge - otherwise they will assume you know, give you full marks, and move on (saving you time)

Don't mention anything you don't want to talk about

If there is something you don't know much about, then don't mention it - not even if you really, really want the examiners to know that you know about it.

For example,

  • Q "How is FRC measured"
  • A "There are two methods, Fowler's method and body plethysmography..."
  • Q "So tell me about body plethysmography?"

Fowler's method is much easier to explain, so even though you want them to know that you know about the other method, resist the urge and just say "One way is Fowler's method, which works like this..."

Another example from a mock viva I had:

  • Q "What can you tell me about the Valsalva manouvre?"
  • A "the Valsalva manouvre is a manouvre that increases intrathoracic pressure, and can be performed with the glottis closed or open. In fact, the first application was to express pus from the middle ear" (I remembered this interesting tidbit from Kerry's book)
  • Q "So who first did that and in what year?"
  • A Valsalva in 1770

  • I don't necessarily agree with this section. The vivas are very structured now, if they want to know about body plethysmography they will ask about it whether you suggest it or not. You don't get marked down for not knowing something, but if you avoid saying something that is on the marking sheet, you won't get the mark. Otherwise brilliant advise. Duncan 11:46, 17 Mar 2007 (EST)
  • I agree Duncan (both about the structure and the brilliant advice). One other piece of advice Kerry gave us was don't say 'there are x number of something (eg functions of lung, additives in propofol)' but just list them. That way you don't look as much of a goose as if you say 'there are seven dwarves' and can only remember three! It's how you play the game... Kara 17:35, 17 Mar 2007 (EST)
  • I found this piece of advice hard to swallow too when I first got it from Dr Alan Sexton at his trial vivas at Westmead (open to everyone and well worth going to btw). But it refers more to not saying less relevant/unimportant things. Probably the best example of what I'm getting at is: You get asked about the alveolar gas equation. You write it down. Fine. Then you mention that there is a small correction factor. If you know the formula for the correction factor, then that's a great move. If you don't, you are just baiting them to ask you "so what is the correction factor?" and you'll have to say "I don't know". You won't lose marks, but you prob won't get a bonus mark for knowing about the correction factor but not knowing the formula, and you have wasted time and unsettled yourself. Regarding Duncan's comment above, my take on it is exactly the same, if they need you to mention plethysmography to tick their sheet, they will ask about it after you talk about Fowler's method. "Do you know any other ways to measure FRC?". But why volunteer to go down that path, guide them towards what you want to talk about - while sticking to answering the question asked. Of course, not everyone will feel most comfortable with the same strategy. bee 12:57, 14 April 2007 (EST) PS cheers to whoever reorganized this page.
  • This may seem like the bleeding obvious but old exam reports contain lists of introductory questions. They get repeated over and over and over.... You must have at least a one sentence summary answer to every one of them. I covered a huge number of topics in my physiology viva simply by giving short answers to introductory questions. My thinking is that the examiners are not going to waste time on topics that you have (or appear to) a good handle on. You will be amazed at how much ground you can cover in 20 mintues. This is especially relevant to people who think they can neglect measurement or statistics.

Use Kerry's ACD approach to drawing diagrams

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" and "time", just write "V" and "T" and say "this is volume vs time". Practice being able to draw and talk at the same time.

Practice drawing the curves in theatre. I went through and made a copy of each of the curves I thought I could get asked and put them on one side of a card with 'spirometry' on the other and practiced drawing them in theatre during long cases.

(This approach is outlined at the May Brisbane Primary Course)

I hope you find this helpful. Bee

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