Format of the Comprehensive Objective Examination in Anesthesiology

About the Exam

Due to the COVID-19 pandemic, the Royal College is evolving the way we deliver the 2021 exams, while keeping the safety of residents, examiners, staff and the public in mind. We are committed to providing you with information as it becomes available. Please bookmark this page and check back often as information may change. Thank you for your patience during these unprecedented times.

Please bookmark this page and check back often as information is updated.

With comprehensive objective examinations, each component of the examination contributes to the final decision. The pass score on each component is 70%. If a candidate is unsuccessful on the whole, all components of the examination must be repeated within the period of candidate eligibility.

The content of the examination is based on a blueprint that reflects the Objectives of Training in Anesthesiology.  The content is balanced to ensure an appropriate representation of the domains relevant to Anesthesiology.

The objective of the Royal College Examination in Anesthesiology is to assess a candidate’s competence to practice at the level of a general consultant anesthesiologist entering practice in Canada. The examination subject matter is developed using a blueprint based on the contents of the Objectives of Training for Anesthesiology and the National Curriculum for Canadian Anesthesiology Residency. Accordingly, written examination questions and oral examination clinical scenarios are based on the knowledge required for the practice of general anesthesiology, and not on esoteric material.  It should not be expected that each component tests by itself the entire breadth of anesthesiology knowledge.  Material included in the different components of the examination should be seen as complementary.

Overall Format of the Examination

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

Component

Format

Number of Items

Total Test Time

Written

Paper 1: MCQ

~140-150

3 hours

Paper 2: SAQ

~30-40

3 hours

Applied

OSCE

8 stations x 15 minutes each

2 hours

Written Examination

Content of the Written Examination

Each paper will contribute 50% to the final overall mark of the written component. The broad domains and relative weights tested on the examination are indicated in the table below:

 

Domains

 Relative weight per component (range, %)*

MCQ

SAQ

Airway Evaluation and Management

0-5

0-5

Ambulatory Anesthesia

0-5

0-5

Cardiology and Cardiovascular Anesthesia

5-15

0-10

Complications

5-10

0-5

Critical Care and Resuscitation

5-10

0-5

Endocrinology and Metabolism

0-5

0-5

Otolaryngology, Head and Neck Surgery

0-5

0-10

Gastrointestinal, Genitourinary and Laparoscopic Surgery

0-5

0-10

Hematology and Transfusion Medicine

0-5

0-10

Medical Subspecialties (e.g. Geriatric Medicine, Clinical Immunology and Allergy, Infectious Diseases)

0-5

0-10

Monitoring and Equipment

5-10

0-10

Neurology and Neurosurgical Anesthesia

0-5

0-10

Obstetrical Anesthesia

5-15

0-5

Orthopedics and Trauma

0-5

0-10

Pain - Acute and Chronic

0-5

0-10

Pediatric Anesthesia

5-15

0-10

Perioperative Medicine and Risk Factors

0-5

0-10

Pharmacology

5-15

0-10

Regional Anesthesia

0-5

0-10

Respirology and Thoracic Anesthesia

5-10

0-10

Biomedical Statistics and Ethics

0-5

0-5

Surgical Subspecialties (e.g. Ophthalmology, Plastic Surgery, Anesthesia in remote location)

0-5

0-10

Non-medical expert CanMEDS roles

0-5

0-5

 *The ranges are approximate and may vary slightly

Both papers assess the candidate’s knowledge of the subject areas that are considered necessary for the practice of anesthesiology, namely clinical anesthesiology, internal medicine, and basic sciences. They are largely developed from the contents of standard textbooks (most recent editions published before June 30 of the year preceding the examination), syllabi from advanced courses (e.g. Advanced Cardiac Life Support [ACLS], Advanced Trauma Life Support [ATLS], Neonatal Resuscitation Program [NRP], Pediatric Advanced Life Support [PALS]), national and international practice guidelines including, but not limited to, Canadian Anesthesiologists’ Society (CAS), American Society of Regional Anesthesia and Pain Medicine (ASRA), Canadian Blood Services (CBS), Canadian Medical Protective Association (CMPA), and landmark journal articles.

Scoring of the Written Examination

Each multiple-choice question is created with a correct answer. Scoring is an automated computer process through the exam platform, Practique.

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 answers out of the anticipated ‘model’ answers that are correct are given appropriate marks.

Sample Questions from the Written Examination

[SAMPLE SAQ EXAM]
[SAMPLE MCQ EXAM]

Applied Examination

Due to the COVID-19 pandemic, the applied 2021 component of the examination for Anesthesiology will be delivered remotely through a computer-based platform. The format of the exam will include 8 virtual stations of 15 minutes duration. There may be more than one case covered in a station. The remotely administered stations will all have an examiner present in addition to any relevant material.  The material may include static images, videos or documents (e.g. handouts with lab results). 

Examiners may also role-play during the examination to simulate an interaction with a patient or colleague. 

In advance of the exam, we will provide candidates with detailed instructions about:

Content of the Applied Examination

In each of the stations, one scenario is presented to the candidate by one examiner. The scenarios are developed and reviewed by multiple examiners on the examination board to insure relevance and clarity. The scenarios are designed to assess specific objectives. They may consist of two or three parts in which the examiner provides information to the candidate, then asks the candidate a question. Some scenarios may be oriented at assessing intrinsic CanMEDS roles, such as Communicator, Collaborator, Health Advocate, Leader, and Professional, and may involve interaction with the examiner playing the role of a patient, a family member, a colleague or another health care worker. A brief clinical vignette with instructions will be presented to the candidate at the beginning of the scenario. The expected answers were identified when the scenario was written, and certain answers have been identified as critical features. Not every feature of a case is identified as a critical feature of the scenario.

The examiner may interrupt the candidate to probe for critical features not yet offered by the candidate, to seek additional information, or to advance the scenario in order to adhere to the allotted time frame for the station. The examiner will take notes during the stations and will appear neutral in their reaction to answers.  They have been instructed not to provide feedback directly to the candidates.  Some scenarios focus on patient assessment, and others focus on patient management; however, all scenarios fall within the domains related to the practice of anesthesiology (see above Blueprint and Content). Some of the scenarios may also have enhanced reality features (simulation) embedded within them. Examples of these features include vital signs, diagnostic imaging studies or other clinical information usually presented in a non-verbal format.

Below are two examples of Royal College Anesthesiology scenarios from previous oral examination sessions. The text in italic font is the information that the examiner would read to the candidate.

[SAMPLE ORAL SCENARIO 1 ]
[SAMPLE ORAL SCENARIO 2 ]

Scoring of the Applied Examination

A global rating scale (GRS) will be used to evaluate and document candidate performance on the oral scenario stations. The GRS will be used to assess relevant aspects of care demonstrated during the station, such as data gathering and clinical assessment, anesthetic considerations, organization, clinical reasoning and management plans, communication and collaboration skills, timeliness of care, professional and ethical behaviour.

Additional information

Candidates may NOT take any non-medical electronic devices (e.g. personal data assistant [PDA], cell phone, Blackberry, Apple watch, etc.) into the examination room. If candidates are found to have an unauthorized electronic device or they communicate with other candidates, this may be construed as irregular behaviour and may result in an invalid examination for the candidate(s), as well as potential denial of entry to future examinations. 

Note that some candidate groups will be sequestered (kept online) after their examinations to prevent them from divulging the content of the examination to other candidates preparing to take the examination. Please respect the registration times indicated in your candidate appointment letter to ensure the sequestering period is as short as possible for all candidates. Candidates are not permitted to use electronic devices during the sequestration period.

Also note that examiners will not provide feedback to candidates during the examination; candidates must obtain their examination results from the Royal College website.

Terminology used in the Examination

Within any of the examination components, when a clinical scenario is presented, the questions posed relate solely to that clinical scenario. With respect to specific terms, the following clarifies their meaning:

MOST likely: refers to the response most likely for that specific clinical scenario

INITIAL: refers to the first step you would select in that specific clinical scenario

 NEXT: refers to the next step you would select in that specific clinical scenario

 INVESTIGATIONS: refers to all testing procedures for that specific clinical scenario, and may include laboratory tests, diagnostic imaging studies, ECGs, etc.

TREATMENT: refers to all therapies for that specific clinical scenario, and may include pharmacological treatments, non-pharmacological treatments, nutritional therapies, education, counselling, and follow-up care/protocols

 MANAGEMENT: refers to the steps you would take in the clinical assessment, investigations and/or treatment in that specific clinical scenario

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 both a translator and a linguistic reviewer. It reflects standard terminology appropriate for your specialty.

References and Study Materials

Study materials include, but are not limited to:

Sample Textbooks

For sources with multiple editions, please refer to the most recent edition.

 

Revised on February 4, 2021