Why candidates lose marks in the ANZCA exams

ANZCA examiner reports repeat themselves from sitting to sitting. Most marks are not lost on rare facts; they are lost on how answers are written and on the same core gaps. These are the themes that come up most.

Not answering the question asked: pages of unmarked material while the specific point the part asked for is missing.
Vague phrases such as "good pain relief", "gentle induction", "cardiostable technique" or "post-op ICU" earn no marks: name the drug, the dose, the target and the reason.
Ignoring the command word: "compare", "justify" and "evaluate" need a structure that does exactly that, prioritised, not a list of everything known.
Incorrect statements are penalised even when correct content sits beside them; illegible writing and non-standard abbreviations lose marks.
In the vivas, ignoring details in the stem (weight, age, comorbidity) and giving standard induction doses to a patient who needs different ones.
Any unsafe decision in a viva prevents a pass for that viva, however good the rest of the answer.
Gaps in core knowledge such as ANZCOR advanced life support algorithms, anaphylaxis doses and local anaesthetic systemic toxicity management; slow pace without consultant-level justification.
Primary: measurement and equipment answered worst; physiology and pharmacology recited without being applied to the anaesthetised patient.

What this looks like when it is marked

A FEx SAQ question, an answer of the kind examiners see every sitting, and how a point-by-point marking guide scores it.

Question · 4 marks

An 84-year-old woman with severe aortic stenosis (valve area 0.7 cm², mean gradient 48 mmHg) needs a hemiarthroplasty for a fractured neck of femur. Outline your plan for induction of general anaesthesia.

Answer

A gentle, cardiostable induction with careful titration of drugs. I would maintain her blood pressure with metaraminol and avoid hypotension and tachycardia. Post-op HDU.

✗Invasive arterial monitoring established before induction0/1

✗Named agents with doses reduced for age and fixed output (e.g. propofol 0.5–1 mg/kg titrated, rocuronium)0/1

✓Vasopressor (metaraminol or phenylephrine) prepared or running before induction1/1

✗Stated haemodynamic target, e.g. mean arterial pressure within 20% of baseline, heart rate 60–80, sinus rhythm preserved0/1

"Gentle" and "cardiostable" score nothing. The marker wants the arterial line before induction, the drugs and doses you would give this patient, and the target you are defending. Examiners flag these phrases in every Final report.

How to practise against these

Reading a list of mistakes changes little. What changes the score is writing or speaking answers under exam conditions and being marked against specific points, so you can see exactly which one you missed. Do that for every area, weakest first, and repeat the ones you got wrong until they stick.

Know the references examiners expect: ANZCA professional documents (PG/PS series, e.g. PG09 procedural sedation, PG15 perioperative care); Acute Pain Management: Scientific Evidence (ANZCA and FPM); ANZCOR / Australian Resuscitation Council ALS algorithms; Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) anaphylaxis guidelines; National Blood Authority Patient Blood Management guidelines; Therapeutic Guidelines and Australian Medicines Handbook; TGA scheduling; Consent law (Rogers v Whitaker) and state guardianship law; ANZCA Anaesthesia Training Program curriculum and handbook.

Where do you stand?

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