ANZCA Final Viva: How to Structure Your Answer

A poor laryngoscopic view and falling oxygen saturation create a clear priority, not an invitation to recite airway devices. In an ANZCA Final viva, the first answer should identify the immediate threat and state what you will do about it. Your reasoning can follow, but it should not obscure the first safe decision.

ANZCA describes the Final Examination as testing whether candidates can integrate knowledge, judgement and skills in realistic anaesthetic scenarios. Responses should demonstrate prioritisation, judgement, integration and decision-making. A structured answer makes those qualities easier to hear; a long list of facts does not.

Start with the decision

A concise opening gives the examiner a route through your answer. State:

• The problem: What is happening now?
• The threat: What could harm the patient first?
• The action: What will you do immediately, and why?
• The reassessment: What will you look for, and what would make you change course?

This is a thinking aid, not a script. Keep the opening brief, then expand it to fit the question. If the patient is deteriorating, make the urgent action clear before giving background or a broad differential. If the patient is stable, you have more room to explain your assessment first.

Develop the answer in a useful order

Once immediate safety is addressed, assess the patient and the context. Give a prioritised differential, linking the likely causes to the findings in the scenario. Choose investigations to answer a clinical question, and say how the result could change management. Then explain the plan, important contingencies and how you will judge the response.

In a time-critical case, assessment and treatment may need to happen in parallel. Say what you will do while checking the cause, and delegate when appropriate. Do not imply that you will complete an exhaustive differential before taking an action needed to protect the patient.

Keep returning to the question asked. If asked for immediate management, lead with immediate management. Add pathophysiology or later care only when it helps answer that question. A useful test is whether each sentence changes your understanding of the problem, your action, your contingency or your assessment of response. If it does none of these, leave it for later—or leave it out.

Make new information change your answer

An examiner’s new finding is a reason to reassess, not a prompt to defend your first answer. Make the change audible: “That makes me more concerned about…”, “This changes my immediate priority because…”, or “I would now stop and move to…”. Then state your next action and what you will monitor.

When asked why, give the reason for the decision you have made. When asked what could go wrong, name the consequential complication and how you would recognise it. If the situation is beyond your resources or experience, say when you would call for senior help and what you would do while help is coming. Escalation belongs in a plan; it does not replace one.

Work through a changing airway scenario

Suppose an adult under general anaesthesia has a difficult first intubation attempt and the oxygen saturation begins to fall. The priority has changed from obtaining a view to maintaining oxygenation. A clear response would be: “I would stop laryngoscopy, call for help and prioritise oxygenation with face-mask ventilation. I would assess whether ventilation is effective and follow the airway plan if it is not. I would not repeat an unchanged attempt. Once oxygenation is restored, I would pause, review what has changed and agree the next step with the team.”

The Difficult Airway Society’s 2025 adult guideline emphasises continuous oxygen delivery, calling for help when difficulty is encountered and moving through the airway plan when an approach fails. The viva answer does not need to become a catalogue of devices. It needs to show that the deteriorating oxygenation has changed your immediate priority.

The same discipline applies to haemorrhage, bronchospasm, anaphylaxis or sudden cardiovascular instability: name the threat, act, explain your reasoning, anticipate what could go wrong and reassess when the facts change. The clinical content varies; the structure helps keep the decision visible.

Practise the reasoning aloud

A useful mock viva makes you speak and adapt, not just read cases. Ask a partner to introduce a scenario, provide findings when you request them and add a change that forces you to reconsider your plan. The partner can ask why you chose an action, what could go wrong and when you would escalate.

Have an observer listen for a few specific behaviours: Was the immediate threat clear? Did you state a first action and rationale? Were your differential and investigations purposeful? Did you identify a contingency, reassess and adapt when the scenario changed? ANZCA’s Final viva preparation courses include mock vivas and feedback; use the same practice-and-feedback cycle in your own sessions.

After each case, identify one thing that helped the answer, one consequential omission and one behaviour to change. Then repeat the difficult part with that change in mind. “Read more” is not useful feedback if the problem was that your first action came too late or you failed to respond to a new finding.

For exam dates, eligibility and published format details, use the ANZCA Final Examination guide. For further case rehearsal, use the Final/Advanced Anesthesia Structured Oral Examination (SOE).

Let the next safe decision lead

In the viva, make your reasoning easy to follow: name the threat, state the first action and its rationale, then say how you will reassess. When the scenario changes, let the plan change with it. That is how you turn stored knowledge into a clear, clinically useful answer.