The Structured Oral Examination in Clinical Anaesthesia: Practice Examination Papers.  By Cyprian Mendonca, M.D., Carl Hillermann, Josephine James, and Anil Kumar. TFM Publishing Ltd., Shrewsbury, United Kingdom, 2009. Pages: 558. Price: $70.00. ISBN-10: 1903378680; ISBN-13: 978-1903378687.

While reading The Structured Oral Examination in Clinical Anaesthesia  by Cyprian Mendonca (Consultant Anesthetist, Department of Anesthesia and Pain Services, University Hospitals Coventry and Warwickshire) et al ., I envisioned sitting across from an equally motivated trainee and passing the book back and forth as we quizzed each other. According to the preface, this scenario is consistent with its intended use. The aim of the book is to help the reader assess his/her strengths and weakness in oral examination skills, including not only clinical knowledge but also organization and timing.

The book consists of 10 oral examinations, each of which has a clinical anesthesia section and a clinical science section. The clinical anesthesia component contains one long case and three short cases, whereas the clinical science section includes four distinct topics. The long clinical cases begin with a detailed stem followed by “examiner's questions.” Each question is followed by an organized and concise answer. The questions range from specific case management, procedural concerns to disease pathophysiology that are neatly broken down by organ systems. The answers offer a clear review and example of how to organize the spoken answer on the oral examination.

The text is easy to read and engaging. The cases realistically reflect common concerns in anesthetic practice and become enjoyable to reason through. However, questions in the oral board examination and in this book may have multiple correct answers. This book typically gives one answer and explanation, without offering alternatives. An explanation of why the given answer is the most correct may be helpful. In addition, trainees using this book outside the United Kingdom may be frustrated by frequent references to medications not available in other countries, including the United States. An alternative medication is not typically recommended; if the trainee does not already know a substitute medication, they must refer to another book.

Anatomic locations and procedures are well described in a concise and systematic approach. Although detailed and thorough, these descriptions may not appeal to visual learners who would benefit from pictures and diagrams. For instance, the section on insertion of chest tube is detailed but may benefit from a diagram. There are few pictures and diagrams throughout the book, and some of these have poor resolution because of black and white shading. The x-rays are well visualized within the case presentations.

The book is intended to give comprehensive answers for oral examination questions. The answers at times are not structured in the order followed during real clinical scenarios. For instance, in the case of umbilical cord prolapse, which is a fetal indication for emergent delivery, the first answer lists obtaining a blood sample for multiple studies, including electrolytes. In that critical situation, the examiners may be more interested in hearing the second and third interventions listed, which are maternal oxygen and manual umbilical cord decompression back into the vaginal vault, respectively.

Overall, this book accomplishes its goals of being a tool for oral board candidates to evaluate their strengths and weaknesses in both clinical anesthesia practice and general medical knowledge. The book is formatted similar to the oral board examination to provide familiarity. The answers are both concise and organized as they may be spoken during the examination. The book will be an excellent tool for individual learners or for a small study group. Parallel use of a reference book may be useful, especially to reference medications and pictures or diagrams as needed. I would recommend this book as part of an oral board preparation study plan and will use this book in preparation for my future oral board examination.

Mayo Clinic, Rochester, Minnesota.