Short-answer questions

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Chapter 3 Short-answer questions

The short-answer question (SAQ) section is regarded as one of the more challenging components of the exam. While it examines general knowledge of emergency medicine topics and scenarios, the format in which it is presented tests candidates’ ability to link multiple concepts as well as provide detailed knowledge for individual areas. Since it is difficult to judge the balance between the breadth and depth of information required to score good marks, the SAQ section can be quite draining. Well-structured answers showing a logical, systematic approach will be more successful than simply writing to exhaustion in an overelaborate manner.

Format

There are eight questions to be answered over a period of two hours, giving approximately 15 minutes to answer each question. In addition, 10 minutes of reading time is allocated at the beginning of the exam during which no writing is permitted. It is normal at the end of the SAQs not to be able to control your cramped writing arm!

Six questions cover the ‘core’ topics: administration, medicine, trauma, paediatrics, resuscitation/anaes thetics and surgery. Others may be sourced from the following topics: emergency medical systems/public health, ENT/eyes, environmental, obstetrics/gynaecology, psychiatry, toxicology and minor trauma (including orthopaedics). As with all sections of the exam, individual questions may cover more than one topic.

Questions can be posed in a number of different ways. The majority will involve a clinical scenario: remember that every word in the scenario has been specifically chosen for a reason and is important in answering the question. The remainder of questions ask you to write about a certain subject or how you would approach a particular situation.

Questions may comprise up to three parts, and each part will be given a specified percentage value of the total mark for that question. You need to reflect this percentage breakdown in your answer.

The College has produced a glossary of terms used in the fellowship exam, which is available for use in the exam room (see the glossary at the back of this book). Utilise this list when answering the questions: answering about treatment when investigations have been requested will not score marks.

Preparation

Questions can be taken from almost anywhere in the curriculum. Thus, general preparation in learning the curriculum goes without saying. In addition, most of the questions will address issues that present in your day-to-day practice. Working in an ED setting will greatly enhance your ability to answer these questions.

Although the range of topics that may be covered is almost endless, there are a number of recurring themes, many of which overlap. Practice questions can be sourced from your DEMT and other consultants, or you and your colleagues can write them for each other. Table 3.1 outlines the major topics that should be practised or at least considered. There is a significant overlap with lists of likely VAQ and SCE topics. This reflects the fact that certain core topics are consistently tested in one format or another during the examination process.

As with much of your exam preparation, practice in answering SAQs is vital. Every time you answer an SAQ, complete it in the required time frame (15 minutes) and ask someone (preferably a FACEM) to mark it. Over time, you can progress to ‘half ’ (four-question) and full-practice exams. Do them under exam conditions where possible, including a proportional amount of reading time.

During your preparation, it can be useful to develop some standard templates for answering certain types of question. Tables, flow charts and diagrams are acceptable as part or all of an answer and are particularly relevant for certain types of question. Table 3.2 provides some examples of answer templates for certain types of questions. The table is arranged as per the College’s glossary of terms for the fellowship examination. Some of these templates will be relevant for answering other question types, such as VAQs and SCEs, in a more structured manner.

TABLE 3.2 Sample SAQ answer templates

Question type Possible templates
Assessment

Discuss Disposition Interpret Investigations See ’assessment’ section above. List Management Outline Protocol Treatment See ’management’ section above. Other

The answer book for the SAQs is similar to that used for the primary examination. A sample is avail able on the College website (www.acem.org.au). Practise writing your answers in these answer books and using the templates given in Table 3.2. It is worth trying to write your answers on every second line, since this not only facilitates legibility but also gives you space to insert new material should you recall more information later.

We recommend writing a brief outline or ‘plan’ at the start of each answer. It is helpful if you can consider what this will be during the reading time. A good outline provides a structured, logical, sequential response and helps trigger recall of relevant material. If you run out of time to provide a full answer and provide only an annotated plan, at least the examiner will see your intentions and may reward you with marks you would not otherwise have obtained. Avoid writing excessively long plans, as this detracts from their purpose.

Th e aim of the SAQ is to impart as much knowledge as possible in a brief, logically structured and concise format. Point-form answers using standard abbreviations are preferred. ‘Essay-style’ answers can be a less efficient method of communicating information and are discouraged.

Using a template immediately gives your answers subheadings. This makes it easier for the examiners to read and mark your work, particularly if you lay out the sections in a controlled, legible fashion. A well-structured introduction and a concluding statement can link together the material for maximal impact.

For ‘treatment’ and ‘management’ questions in particular, it is oft en useful to consider the 3Cs (condition, cause and complications) and not just the condition when formulating answers. Try to tailor the template to the question by providing examples of the key relevant history, and what you would be looking for or expecting to find on examination or from specific investigations. A few examples for each subpoint are expected (e.g. in suspected renal colic, ward test urine for haematuria to support diagnosis and examine abdomen to exclude AAA if elderly).

On the day

Use your 10 minutes of reading time wisely. Read through the whole paper and decide which questions you are more likely to be able to answer well. Use this time to plan the format in which you will answer the questions and the order in which you will tackle them. Some people prefer to answer the questions in order, whereas others prefer to start with the question(s) they feel more confident with. The latter option has the advantage of your writing being at its best when you have the most information to impart.

Maintain your focus on what each question is asking using the definitions supplied by the College. Do not transcribe the question onto the answer book let before answering it as this wastes valuable time and is not necessary.

Be aware that by the end of the two hours, you will be both physically and mentally fatigued and can easily lose track of time. Have a reliable method of timekeeping and keep to your self-allocated time frame for each question. It may be worthwhile writing down the number of minutes you have to spend on the sections within each question (or the start/finish times) proportionate to the percentage value designated.

Ensure you answer all questions. The marking system rewards consistency above high scores on individual questions. Failing to provide an answer to a question will substantially reduce your overall mark. If you have time remaining at the end of the exam, you can go back and ‘fill in the gaps’ for those questions where you have additional relevant information.

Worked sample SAQs

The following worked examples show the types of questions that may be encountered in the exam.

SAQ 1: resuscitation/toxicology

Sample answer

(a) Initial assessment

(b) Immediate treatment

SAQ 2: resuscitation/surgery

Sample answer

(b) Immediate management

SAQ 3: medicine/resuscitation

Sample answer

Assessment

History

SAQ 4: administration/medical systems

Sample answer

SAQ 6: psychiatry/medicine

Sample answer

Assessment

Investigations

SAQ 7: surgery/administration

Sample answer

Investigations

SAQ 8: trauma

Sample answer

Management

Definitive therapies