By Vasu Thanthullu, M.B.B.S., M.D., D.N.B., F.R.C.A., F.F.P.M.R.C.A., Dip. Pain Mgt., et al ,
In recent years, the Royal College of Anaesthestists (the governing body of anesthesia in the United Kingdom) has switched from short answer questions to constructed response questions on their final Fellowship of the Royal College of Anaesthetists examinations. Constructed response questions are used to test one’s knowledge and how that knowledge is applied in a variety of topics.
The content covered in the book is very comprehensive. The authors, all of whom have taken the Fellowship of the Royal College of Anaesthetists exam, have meticulously researched the information covered by the exam. The book is broken into 20 chapters. Six chapters are devoted to mandatory units of training: neuroanesthesia (chapter 1), obstetric anesthesia (chapter 2), pediatric anesthesia (chapter 3), pain (chapter 4), cardiac anesthesia (chapter 5), and critical care (chapter 6). Four chapters then cover the following: perioperative medicine (chapter 7); regional anesthesia, orthopedic, and trauma anesthesia (chapter 8); other topics in general medicine (chapter 9); and optional topics (chapter 10). Chapters 11 to 20 provide answers to questions posed in the first 10 chapters.
Within a chapter, each field that is highlighted is then broken into several key subjects. In neuroanesthesia, examples of key subjects are status epilepticus, delirium, and intracranial pressure physiology. Each subject is then tested with an average of four to seven constructed response questions. You, as the reader, are expected to answer each question with the appropriate responses. There is a numerical guide next to each question as to how many answers the book (test) is expecting. As shown in figure 1, the topic of intracranial pressure physiology has several questions to be answered, and the “marks” or the number of answers the test requires. Once you have completed a section, you can check your answers against the provided answers in the second half of the book.
In going through this book, I found myself challenged as I progressed through the chapters. What makes it especially challenging is knowing the expected number of responses to a question and coming up with those correct responses. I love the breadth of topics and the ease of reading this review book. Neuroanesthesia is very comprehensive. The chapter does a nice job of covering major key topics with thorough explanations. Additionally, throughout the book, neuro topics are included within other chapters, such as Guillain–Barré syndrome and stroke in the critical care chapter.
Critical care is understandably a broad topic that is difficult to fit into one chapter. However, ventilator management is only briefly touched upon within the topic of acute respiratory distress syndrome. Manipulation of different ventilator modes or a scenario involving weaning from the ventilator is lacking. Given how much of our clinical practice involves respiratory physiology and the use of ventilators, it is an area that could be expanded.
Constructed response questions are associated with concise fragmented responses. In this review book, the answers to the questions are at times in sentence form rather than fragmented responses. While I personally prefer sentence or paragraph responses, they are not the typical answers one would see to constructed response questions. These pertain more to oral board answers in the United States. There are also scenarios in which the questions are open-ended, making it difficult to predict which specific answers the authors require. Overall, the content matter is comprehensive and well understood once the answers are read.
Ultimately, this book is intended to prepare trainees for the final Fellowship of the Royal College of Anaesthetists constructed response question examination. While it does have a specific niche, it may be useful even for those trainees outside of the United Kingdom. It appears that the book could be a good review in the United States, Australia, New Zealand, India, and other European countries. In the United States, the content covered in the book can be helpful, in conjunction with other resources, when preparing for the oral board examinations.