The primary Fellow of the Royal College of Anaesthetists (FRCA) examination is taken early in anesthesiology training in the United Kingdom. This examination sets a high standard and covers a great breadth of scientific and medical knowledge, which is matched by this excellent study guide. The two books are divided into five areas: physiology, physics, pharmacology, special patient groups, and critical incidents. These match the primary FRCA syllabus well, with the exception of statistics. This is a sensible omission because the statistical knowledge required is general and may easily be found elsewhere. The content is tailored to the remainder of the examination and anesthetic practice. There is a great deal of overlap with standard medical texts, but this guide manages to be concise and highly focused on anesthetic relevance of the concepts in each category.
Questions and detailed answers form the basis of the book, matching the style of the structured oral examination. The questions explore the full range of possible oral examination topics. In doing so, the questions at times focus on excessive detail: examples include defining pseudocritical temperature and the formal système international d’unités definition of the candela unit. These are of doubtful importance in passing the oral (or written) examination and divert the reader from the more important material. This is a minor criticism as much of the physics section is directed at useful parts of monitoring and anesthesia delivery equipment, and the physics is the furthest removed from the areas of medical knowledge most candidates will have.
The question and answer style drives the book toward clinical relevance, and the majority of the questions could realistically be asked by an examiner. The book becomes weaker when a large volume of facts need to be given, particularly in the pharmacology section. Here, the questions stop, and each drug is described in about 50 bullet points grouped into boxes, such as mechanism, metabolism, and chemical properties. There is no getting around the need to learn a large part of this mass of information. It is difficult to present this information to appeal to the majority of learners, but this section does struggle with this mass of disconnected information. Comparing and contrasting drugs within classes might have been preferable.
This guide covers the majority of topics very well. The answers are not presented as model answers but are comprehensive enough to explain the concepts to the learner. They also provide structure in order to tackle more open-ended questions. For example, “What are the problems encountered during massive transfusion?” This is a difficult and broad question in the setting of an oral examination, but the answer sets out the important points, sensibly grouped, with succinct explanations. The book becomes most clinically relevant and most superficial in the Special Patient Populations section. This reflects the target being the primary, not final FRCA examination. The whole of pediatric anesthesia is presented in seven pages of which four pages consist of the answer to one question. It is clearly a struggle to convey the variety and relevance of so much diverse information in sections like this. Unlike the more scientific chapters, the clinical sections suffer from lack of examples, unknown relevance, and relative importance of a slew of assertions. The authors do not cite any sources for the content of the book. With the good level of detail already given, the reader is likely to be more than happy without pursuing references. This is not a reference work, and the bulk of the content is not controversial or cutting edge, so the lack of references is acceptable. Despite the lack of references, sections such as Physics could be useful for a more senior trainee to review although the clinically focused sections would quickly be superseded by experience and deeper knowledge.
The examination is difficult and covers a great deal of material, which is matched well by the breadth and structure of this book. Preparation for an oral examination requires oral practice, and this book enables that by offering realistic questions and answers.