Preparation for the Primary VIVA Exam

 

Amazing work, you passed the written.. it’s not over yet.

The VIVA exam is where you put all that knowledge into practice, you now need to be able to synthesize that knowledge into verbal answers.

You have the baseline knowledge; you passed the written exam. However, this exam is different. You will be asking to articulate and synthesize that knowledge while answering clinical questions. It will still be based on the basic sciences but will now be scenario-led and involve clinical building blocks, with the questions on the 4 main topics being related.

Exam Format

4 stations – 10 mins per station.

Candidates move through the 4 stations consecutively.

There is a five-minute rest period scheduled between each VIVA and a quarantine period is usually required either before or after a candidate’s examination.

Each candidate attends the examination on one day only.

Each VIVA station is examined by 2 examiners marking independently.

All VIVA stations are video recorded – this allows for marking by an additional examiner, if requires, after the examination.

 

Each station

Will start with a Stem – this is usually a brief clinical scenario.

Eg. “a 63y.o. female presents feeling unwell with flank pain. Blood tests are performed” (2021.0)

 Or “a 2 y.o. presents to the ED with a diffuse rash” (2022.1)

Then moves quickly to ask 5 core topics – aiming for 2minutes per question.

1 station is a clinical building block (occurs at any point in the exam, not always at the beginning)

            The other 4 stations examine each of the 4 core topics, directly or vaguely related to the stem.

            Each topic, at least in the more recent exams, has 3 questions that need to be answered.

Before each of the 5 question the examiner will highlight what the question is about

            Eg. “Moving on to Pathology” or “we will start with the clinical building block”.

            Listen to this part – it gives you direction.

The examiner must ask you all 5 topics.

This means that they will move you on at 2mins, even if you haven’t answered everything, to ensure you have a chance to answer all 5 topics. The examiners will move you through the station at a pace that enables you to achieve the maximum marks available for the station in the 10-minute period.

The prompts are minimal.

            The examiners don’t hint. They may ask “tell me more” or anything else” but that’s about it.

In some questions, candidates may wish to draw their answer on paper, as an aid. This is allowed; however, candidates must describe their answers in words to the examiner.

A note about format, and how it has changed over time..

This may explain why older questions you see may not be exactly like the ones you now get in the exam.

In the early days each of the VIVA topics (Physiology, Pharmacology, Anatomy, Pathology) were all examined separately.

New format – with all 4 topics being examined together in the one station:

• Started 2013.2
• Initially without clinical stems - these were introduced in 2015.
• CoVID changes - no models – all props/clinical building blocks were in picture form.
• 2023.2 - back to models – these are mainly used for Anatomy
• 23.1 marking changes.

How the exam is marked

Marking

• Marks for each Viva station are scored out of a maximum of 30 marks with six marks available for each section (Anatomy, Pathology, Physiology, Pharmacology and the Clinical Building Block).
• You need a mark of 60/120 and to pass 2 of the 4 stations.
• There are bold statements – you need to say these to pass the question (subset of the topic)

• Since 2018.1 the VIVA pass mark has ranged between 82-94%

• From 2023.1 there is a new fancy statistical thing – the Borderline Regression Standard Setting method. I am not going to pretend to fully understand it. The consequence of this is that the generally high pass rates for this exam as expected to drop a bit.

How to Prepare

Resources

Refer to the “Preparation for the Written Primary Exam” document for a detailed list of resources.

 

Again – start with the:

ACEM Primary exam resources page

Most importantly

• Look at the Guide to the Primary exam.
• Look at the matrix – this tells you what is more likely to be examined, focus on these.
• Look at the syllabus with Level of Assessment (LOAs).

• LOA -3 topics are unlikely to be examined in the VIVA. Focus on LOA -1 and LOA -2 as a priority.

Also please look at the official ACEM document regarding the VIVA exam here

 

Past VIVAs

The main source for this is EDvivas.com

• This is a great resource of past VIVAs, which you can sort by category.
• Note that only up to 2017 is published on this site

The college website

• All published past VIVAs can be found here
• Note from 2018 they only released 2 sample VIVAs from the examined topics.

Extra Bendigo DEMT resources

• every past published VIVA had been printed out and matched with the relevant visual prompts. These are in folders in the DEMT office. You are welcome to use them anytime, just please try to keep them in order.

 

Examples of how to answer.

The Tamworth Primary VIVA page as several demonstrated ‘model’ answers. These are demonstrated by FACEMs and well worth a look.

Acemprimarypodcast gives several example topic answers. These are quite perfect – not necessarily what you will be able to pull out in the exam – but good to listen to on repeat.

 

Preparation courses / Practice Exams

We will always ensure that a Bendigo Practice VIVA is run for all Bendigo-based candidates.

From time to time, we can also help get our candidates in to some Melbourne Practice VIVAs (for example Kent Hoi, one of our FACEMs, has a link with the Sunshine Primary exam program). Chat to the DEMTs and we will do our best to get you in to what you can.

There is a course run by Tamworth – a 1 day course run over zoom.

We recommend you register and attend this if possible.

https://tamworthprimarycourse.com/the-viva/

 

Props/Clinical building blocks

Bendigo health has most of the standardised models that are used in the exams - get to know these!

There are also a few sets of bones in the DEMT office which you are welcome to get familiar with.

Know the common props and Clinical Building Blocks – these are common and easy to practice and should be your “easy” points.

Some examples of might you get on the day:

• ECGs: these tend to be relatively straightforward and reflective of the ECGs that we would expect a junior registrar to interpret. For example:
  • You may get a STEMI - and would be expected to understand the region (eg. Anterior, inferior). More complex ECGs such as Sgarbossa's criteria would not be expected on the exam.
  • Rapid AF
  • Simple heart blocks
• Bloods gases: again, looking for simple, single abnormalities.
  • You will be expected to recognise acidosis vs alkalosis, metabolic vs respiratory, the expected compensation and the anion gap
  • More complex gases - such as mixed respiratory/metabolic, delta ratios etc would not be expected to be examined.
  • Although in 2021.2 there was a mixed respiratory and metabolic acidosis – so this might be changing.
• Chest Xrays
  • Again, generally obvious pathology. Eg.
    • Lobar pneumonia - and which lobes are involved.
    • Round lesions and their differentials
• CT slices
  • Single slice only
  • Brain, thorax and abdomen.
  • Detailed radiology knowledge is not expected.
  • CT levels are most likely to demonstrate important anatomical levels, e.g. level of transpyloric plane, aortic arch.
  • Detailed neuroanatomy is not expected, but candidates should be able to describe lobes, ventricles and other gross structures.

• Other Xrays
  • head, neck, thorax, abdomen, pelvis, spine, lower limb and upper limb.
  • Limb #s - again often obvious and simple
  • Spine XR

Anatomy props

• As above, there are model props which you should be familiar with
• There have traditionally been a number of single images from McMinns – know the common ones eg. Femoral triangle, anterior neck etc
• Anatomedia – again this is new to the exam. Recent candidates have described being shown images that may have come from Anatomedia – how much these are used is unclear, but the college has indicated that as Anatomedia is part of the resources, images from it may be used.

Practice, Practice, Practice

This cannot be underestimated; you need to practice articulating answers.

Set up times with you colleagues who are sitting, those who have recently sat and practice.

All of the published past VIVAs have been printed out for you, along with the props, in the folders in the DEMT office. Please use these (and keep them in order please!)

It’s good to start by practicing the topics individually, but move on to doing them as stations as soon as you feel comfortable

Practice to time.

Talk out answers in front of the mirror.

Record yourself talking – this may be cringeworthy but can help to hear where you stumble.

On the floor

Think about the anatomy you are reviewing – XRs, CT scans, wound repairs etc. Talk it out loud.

Think about the drugs you are giving – indications, mechanisms of action, dosing, side effects.

Look at ECGs, VBGs, CXRs and describe them.

 

Final Tips – courtesy of Dr Kiran Veera

Try to save time on the Clinical building block – they’re are usually easier to answer, and you can use the time saved on the other questions.

Do not overcomplicate Clinical building blocks. The expectation is you should be able to state the basics. If you see something abnormal, say it. Creat of 115 might not sound like anything - but if you don’t say it is mild AKI, you will not score marks.

 

 Similarly if there is a picture of an ulcer - go all out in describing it - how big? how far it is from a joint? what underlying structures may be involved? etc. You have describe it like you are talking to someone over phone. Don’t assume because it is clear to see means you don’t have to state the obvious.

 

 If they ask you to interpret a gas or an ECG, state the diagnosis after listing the abnormalities. “The findings in this gas are consistent with partially compensated metabolic acidosis”. And do not confuse your acidosis from acidaemia.

 

When answering Qs in Gen pharm/path, stick to basics. If you remember some weird basic stuff like ‘cell contracting’, say it. 

 

There is always a lot to know about everything. But the pass mark is usually set at ~50% level. So even if you feel like you haven’t done well, it is more than likely you actually passed.

 

While some questions are common sense, most are knowledge based. If you don’t know the answer, do not waste time. You probably will need it for the next one you know really well.

 

Just request to come back if spending time without scoring marks (you will know when they stop ticking!)

 

Get to the point as quickly as you can. Don’t give a big spiel only for the examiner to cut you off because the 2mins for that Q is done.

 

And finally, try and don’t let one station affect your others.

Keep it all together!

 

The Exam Centre

*Please note this is a new change

The exam was previously run in Melbourne, from 2023.2 this will now be run at Clifton’s in Sydney. At the time of writing the primary exam website is being updated to give more details for these changes.

Your exam will have FACEMs, ACEM staff as invigilators.

Please book your flights and accommodation early. Don’t underestimate the impact of flying interstate for an exam – give yourself time to get there and settle in. Know where you are and how to get to the venue from you accommodation. Try to get a good night’s sleep the night before.

From the college guidelines:

On arrival at the examination venue, you are required to register, to show suitable identification and hand in your mobile phone (switched off), your watch and any additional electronic communication devices. These will be returned to you when you leave the test centre at the conclusion of the examination and of any required quarantine time. After registration you will be shown to a waiting room or the quarantine area to await the commencement of the examination. When it is time to commence the examination, you will gather in a briefing area and then proceed to the examination area to commence the examination.

When do you get the results?

• The ACEM document above says 4 weeks post the exam.
• This is often on a Thursday.
• You get a notice generally 24hrs before stating that it will be released around midday the following day. The DEMTs get this notice too. The DEMTs also get an email later that same day formally notifying them of their trainees' results.

Ok, that’s it. Please note I have done my best to collate all the information about this exam that I can. If you find any inaccuracies, please let me know, and let me know if there is anything else that should be added.

Prepared by Dr Yvette Bassin, FACEM, co-DEMT, Bendigo Health. August 2023

ybassin@bendigohealth.org.au