Format of the Examination in Anesthesiology – Fall 2023/Spring 2024

*Note for fall 2024: Paper 1 and paper 2 of the written component will both be in a MCQ format.

About the Exam

Purpose

The purpose of the examination is to assess the candidate’s clinical competence and readiness to enter clinical practice. The exam is developed and reviewed by the Anesthesiology examination board, which is made up of practicing Canadian physicians who are recognized content experts. In addition, the exam is reviewed by a quality reviewer, a linguistic reviewer for translation accuracy, and a Royal College editor.

The content of the examination is based on a blueprint that reflects the Competencies in Anesthesiology and the depth of knowledge required for the examination National Curriculum to ensure that the examination reflects relevant clinical practice in Anesthesiology. All candidates are strongly encouraged to read the blueprint, the Competencies, and the National Curriculum thoroughly.

Passing the Exam

The Royal College examination in Anesthesiology consists of a written and an applied component. The written component of the examination will be taken before the applied, and only those candidates passing the written examination will be invited to the applied examination. The pass score is 70% for each component.

The examination is decoupled, and due to the standalone nature of each exam component, a candidate that is successful at the written component but not successful at the applied will not be required to retake the written component on their subsequent attempts.

Questions that were overly difficult, fail to distinguish between low and high scoring candidates, or for which new evidence emerged between the time of question writing and exam administration are reviewed. As a result of this review process, some questions may be deleted from the final exam score for all candidates. The exam scores are then reviewed by a panel of subject matter experts in a standard setting process and adjusted, if appropriate, to ensure the exam is set at a proper standard for candidates entering unsupervised practice. 

Overall Format of the Examination

The format of the examination is provided in the table below:

For more information on the breakdown of the station time (for example, if there is reading time) please consult the Candidate Information Session document for your specialty at Information on applied exams at hotel sites closer to your exam date.

Written Examination

Objective of the Written Examination

The written examination measures knowledge and application of knowledge necessary to function as a competent specialist in Anesthesiology. Most questions will concentrate on the Medical Expert role, but some can also assess the other intrinsic CanMEDS roles (Communicator, Professional, Health Advocate, Leader, Collaborator and Scholar).

Content of the Written Examination

The content of the examination is based on a blueprint that reflects the Competencies in Anesthesiology. The content is balanced to ensure an appropriate representation of the relevant domains. Typical areas of knowledge assessment and a range of percent marks on the examination are included in the table below.

*The ranges are approximate and may vary slightly

All questions may have associated visual or video material.

Scoring of the Written Examination

Each multiple-choice question is created with a single best answer. Scoring is an automated computer process through the online exam platform.

Each short-answer question is created with a list of model answers. This list is used to guide the markers as to the value of the responses when scoring the question. Partial marks may be allocated for some responses. Members of the Examination Board score short-answer questions, and discuss with their colleagues to ensure any correct responses outside of the anticipated model answers are given appropriate marks. If a candidate provides more responses than requested, only the first responses corresponding to the number of answers required will be considered in marking. Marks are only awarded for correct answers; no marks are deducted for incorrect responses. Be as brief and direct as possible.

All written examinations are combined to create one overall written score. In other words, you need a combined written score of 70% to pass the written component, but you do not need 70% on each paper.

Sample Questions from the Written Examination

Please note that this Sample Written Exam is not for the purposes of training on the exam interface functionality. It is recommended that you review the Information on written exams at hotel sites and access the Demo Exams to familiarize yourself with the different question formats and resources that you may encounter.

SAMPLE MCQ QUESTIONS

SAMPLE SAQ QUESTIONS

Applied Examination

Objective of the Applied Examination

The applied examination is designed to evaluate higher order thought processes and clinical reasoning compared to knowledge and application of knowledge assessed in the written component. Stations can assess different and multiple CanMEDS roles (Medical expert, Communicator, Professional, Health Advocate, Leader, Collaborator and Scholar).

Due to the number of candidates, the applied exam will be delivered on multiple days. The stations for each day will be designed to be equivalent in difficulty, based on the blueprint, but will consist of different clinical scenarios.

Examiners may interrupt the candidate to probe for answers, as well as to move the station forward so that the candidate is able to demonstrate their knowledge/clinical reasoning in the allotted time. Examiners may take notes during the stations and have been instructed to appear ‘neutral’ in their reaction to answers. They have been instructed not to provide feedback directly to the candidates. Observers may be present during some stations of the examination. These observers will not interact with the candidate or the examiners, or contribute to the candidate’s scores in the station. They are there to observe the conduct of the examination process.

The format of the applied exam allows candidates to be examined by multiple examiners across a number of stations. For this reason, you may be examined by an examiner from your center. Significant conflicts (e.g. a program director or mentor) are identified and avoided in scheduling your examination.

Content of the Applied Examination

The content of the examination is based on a blueprint that reflects the Competencies in Anesthesiology. The content is balanced to ensure an appropriate representation of the relevant domains. At each station, candidates may be asked to address multiple clinical scenarios. The applied examination may include stations that cover:

• Airway Evaluation and Management
• Obstetrical Anesthesia
• Pediatric Anesthesia
• Resuscitation and Trauma
• Perioperative Medicine and Medical Subspecialties
• Subspecialty Anesthesia
• Non-medical expert CanMEDS roles

Some of the issues that you may encounter in the exam include:

• Role-playing of a patient encounter where the examiner acts as a patient
• Providing counselling through an ethical issue
• Providing counselling regarding diagnosis, treatment, long-term management and prognosis
• Description of a focused physical examination
• Obtaining a focused history
• Visual recognition (laboratory reports, illustrations, scans)
• Videos
• How to come to a diagnosis
• How to choose the appropriate care
• How to prepare the patient, family, and institution for the appropriate care
• How to follow up on the appropriate care
• Technical aspects of care
• Ethical issues
• How to guide a patient/family through issues in a particular situation
• Interpret videos, diagnostic imaging studies, laboratory investigations or results of other tests
• Interpret results of a physical examination
• Demonstrate decision-making skills based on the case scenario and the interpretation of data
• Provide a diagnosis and differential diagnosis
• Demonstrate competency in communication with patients and health team members
• Others

Scoring of the Applied Examination

A global rating scale (GRS) will be used to assess relevant aspects of care demonstrated during the station. The GRS will be suited to the station and will focus on the candidate’s ability to systematically work through a case, with a focused, rational and efficient approach.

The domains measured in the stations may vary, but most commonly include a selection from the following:

• Data Acquisition (i.e. history taking)
• Data Interpretation
• Clinical Reasoning/Judgement (Synthesis/Integration of data)
• Diagnosis
• Differential Diagnosis
• Knowledge
• Investigations
• Clinical/Patient Management
• Patient Safety
• Organization, Logic and Flow
• Evidence Based Decision Making (Scholarly Knowledge)
• Intrinsic CanMEDs roles - Collaborator
• Intrinsic CanMEDs roles - Health Advocate
• Intrinsic CanMEDs roles - Leader
• Intrinsic CanMEDs roles - Professionalism
• Intrinsic CanMEDs roles - Communication – e.g. clarity of expression, rapport building and / or information delivery / counseling skills

To see the generic behavioural anchors for these domains, please see the GRS template. Note that the behavioural anchors for your specialty may vary somewhat from these.

Each station is weighted equally; station scores are combined and averaged to create an overall score for the applied examination.

Sample Station from the Applied Examination

SAMPLE STATION

Additional Information

To access examination dates, view Deadlines, dates and locations.

To access information on online exams, how exams are developed, exam format, pass rates, and tips on how to study for the exam, view Prepare for exams.

To access information on what to expect on exam day: FAQs, identification requirements, conflicts of interest, candidate conduct, and more, view Exam day.

To access information on results dates, how to access your results, data verification, and more, view Results.

Terminology used in the Examination

All candidates should be aware that regional differences in terminology may not be reflected in the exam. The terminology used in the exam has been vetted by the Royal College’s team of language professionals in close collaboration with a linguistic reviewer, who is a physician. It reflects standard terminology appropriate for your specialty.

Royal College exams routinely include abbreviation and acronym definitions. However, abbreviations and acronyms that are common knowledge to clinicians are not spelled out (e.g. MRI, CT, ECG, IV, BMI, HIV, CBC, etc.). The same practice applies for clinical trial names, with exceptions for when candidates are being asked to define or explain the trials themselves.

Below is a table that includes explanations of specific terms used in exam questions.

Reference and Study Materials

For sources with multiple editions, please refer to the most recent edition. In the event that a textbook or guideline has been published in the last 12 months before the fall written examination date, answers will also be accepted from the previous edition of the textbook.

The Royal College exams follow the Canadian and/or American “standard of care” for clinical practice, and clinical practice guidelines published in Canada and the United States. In the absence of Canadian or American guidelines and when relevant, candidates may reference guidelines from other international organizations.

Study materials include, but are not limited to:

Sample textbooks

• Barash, Clinical Anesthesia*
• Chestnut, Obstetric Anesthesia: Principles and Practice
• Coté, Lerman, and Anderson, A Practice of Anesthesia for Infants and Children
• Fleisher, Anesthesia and Uncommon Diseases
• Miller, Miller’s Anesthesia
• Flood, Rathmell and Shafer, Stoelting’s Pharmacology and Physiology in Anesthetic Practice
• Hines and Marschall, Stoelting’s Anesthesia and Co-existing Disease

*For the Fall 2023 exam, please refer to the 8th edition of Barash, Clinical Anesthesia.

Sample guidelines

• Canadian Anesthesiologists’ Society, Guidelines to the Practice of Anesthesia

Questions?

To ensure fairness to all candidates, all of the information that can be shared about the format of the examination is available in this document. If you require clarification on the content of this document, please contact credentials@royalcollege.ca.

Updated June 2023