The journey of a medical book – from concept to completion….

Book Binding

Weekend Book Binding. Photo: Nate Steiner. Used under CreativeCommons.

Since our book has been published, colleagues, friends and family have been intrigued as to our journey to publication. For us, it is immensely satisfying to see, and feel, the final product. It is also a good time for us to reflect on how we got here…


As with many of these things, the book’s concept was spawned during a chance conversation between operating theatre lists. We were colleagues at a busy DGH and in the midst of our FRCA exams – Ned lining up for the primary written, and Marc for the final written. ‘Wouldn’t it be great,’ Ned mused, ‘if there was one book where all the equations for the exams were collated, explained and made sense of’. A quick Google search revealed no such texts, and thus we returned to our revision relying on the time-honoured tradition of thumbing through dog-eared text books and trusting our sage superiors’ tuition. This initial conversation had however planted somewhat of a seed for an idea and following a quick straw poll of our colleagues, we surmised that equations were one of the aspects that really exorcised FRCA candidates.


The next stage was to articulate our thoughts, and we decided that the best way to do this was to use a publisher’s guidelines. Having both used, and been thoroughly impressed with Cross & Plunketts’ Physics, Pharmacology and Physiology for Anaesthetists, we approached Cambridge University Press (CUP) with the opinion that our text could be a natural bed-fellow to said text.

Having browsed the FRCA curriculum, and documented every equation we came across in our revision texts, we collated the list of all the equations encountered, wrote a number of example chapters, and submitted our book proposal to CUP. A swift and very positive peer review ensued, and we were delighted, though somewhat surprised to have our idea accepted.

One important caveat had been proposed, the suggestion that we used a well-established senior colleague to both edit the text, and mentor us through the writing stages. One such colleague independently sprung to both our minds, Dr Wynne Davies. Having both worked under Wynne’s clinical guidance, his immense knowledge and ever enthusiastic willingness to teach made him the ideal candidate. This was bolstered further as Wynne had also previously been an examiner for the Royal College of Anaesthetists, such that he was ideally placed to provide ideas and opinions from ‘the other side of the table’. Thankfully he accepted, and we are both extremely grateful for all the hard work, mentorship and friendship that he has provided us with over the months of writing.


With the proposal accepted and contracts signed, the hard work started. The submission deadline clock had started ticking, with completion some 18 months away. Our approach to writing was to do quasi peer-review. Together we formatted a page template, decided on the format of each chapter, and subsequently divided the topics and started writing. Dropbox (other internet clouds are available) was used to store the drafted pages, thus enabling the other author (Marc for Ned, Ned for Marc) to review and edit each person’s initial endeavours. Following the undertaking of these preliminary corrections, Wynne edited each page in turn, before once again returning each to us for universal approval.

Ensuring accuracy was a top priority, as was making the book readable, relevant and clear. Arguably the most time consuming part of writing was providing the applications of each equation to clinical practice. However, this, apart from having all the equations necessary for the examinations in one place, is what we feel that the USP of our book is. Knowing the equations is one thing; understanding them and being able to derive them another. Being able to apply the equations to medical and anaesthetic practice is vital in order to negotiate the examinations, particular the oral ones, and also arguably to stay sane whilst revising and questioning the need to learn and memorise some rather obtuse concepts.

Once the text was prepared and bounced between us until we were happy with it, we sent it to Cambridge University Press for proof-reading and type-setting. It was fascinating to be involved in these processes and again, an eye for detail was mandatory. We also had our non-anaesthetist partners look over it which was invaluable.

At last the text was ready and we waited in anticipation for the final product: it was a great feeling of satisfaction when it fell through the letterbox and made all the hard work worthwhile.


Whilst neither of us were deluded enough to think that writing a book would be easy, one should certainly not underestimate the amount of time, effort and sacrifice required. Writing, reading, editing and re-revising comments was somewhat time consuming, especially alongside a PhD (Ned), and HEMS & NHS England Fellowship (Marc).

Moving forwards, we eagerly await peoples’ feedback. Undoubtedly as medicine and anaesthetics progresses, there will be corrections and clarifications required in future editions. We very much hope that readers will enjoy it and find it useful and we would welcome any comments and feedback.

In the book, we have tried hard, and hopefully succeeded in the majority of cases to tick all the boxes which will give readers a head start, whether they are preparing for the examinations themselves, helping others to do so, or even, dare we say it, examining!

Top tips amassed from 18 months of toil…

  1. Know your audience and write for them, not you.
  2. Choose a mentor that you trust and can reply on.
  3. Know your market and spot the gaps. They may be very obvious such that one assumes someone else has already filled them.
  4. Don’t underestimate the amount of work involved, and ensure that your nearest and dearest are supportive of your project!
  5. Detail, detail, detail…edit, edit, edit.

Dr Marc Wittenberg and Dr Edward Gilbert-Kawai are co-authors of Essential Equations for Anaesthesia (out now).

Essential Equations for Anaesthesia


Advertisements, the new online testing resource for the Primary FRCA exam, includes Single Best Answer questions…

‘I love the two levels of reading you can do if you get a question wrong. And, importantly, it’s made by anaesthetists for anaesthetists…a brilliant resource.’ Alan Race, anaesthesia trainee, the new online testing resource for the Primary FRCA exam, is the only website offering SBA (Single Best Answer) questions.

Why are SBAs important?
SBAs are included in the Primary exam from the 13th September 2011 onwards. Are you taking the Primary FRCA exam after 13th September 2011, or do you know someone who is? If so, find out more about

What does the Primary FRCA MCQ paper consist of?
We can say with some certainty what the MCQ paper will consist of in September 2011 and for a few cycles thereafter. In the exams prior to and including the June 2011 exam, the paper consisted of 90 MTF questions to be answered in three hours. This gave 450 knowledge point tests.

From September 2011, the College will replace 30 of the MTF questions with SBAs. This will provide 300 knowledge point tests from MTF and 30 from SBAs. The two styles will run in a combined paper for some time while the College gathers data comparing performance across the two paper styles. This will allow a standard to be created for the SBA question bank.

How do I answer SBAs?
Hints and Tips to help you in the exam…
This will sound like an echo from your earliest days of education, but it doesn’t hurt for us to say ‘make sure you read the question carefully‘!

A good tactic is to read the stem and lead-in, cover up the options and ask yourself what the correct answer would be. If you are 100% confident of the answer and this answer appears in the options, it is most likely to be correct.

If you are not in the lucky position of definitely knowing the answer and are trying to work it out, it is very important to not just settle on the first option you see that looks correct. Read all the options against the lead-in and ask yourself: ‘Which one fits best?’

In trials of SBAs with trainees we have noticed that they often find that two of the options can be discounted immediately, leaving two or three options to whittle down to one. If this happens to you, go back and read the stem, looking to see if there is anything within the detail that will allow you to reduce the options further. It may end up with a wild guess between two final options, but at least your odds of guessing correctly have increased from 20% to 50%.

Even if you only have the vaguest notion about the subject area, apply any knowledge you have and make an educated guess. Do not leave a blank. It is also important to state that only one mark per question should be made on the answer sheet. More than one mark and the candidate will score zero for that question.

Make sure you have the edge in your exam…
Try a free demo of FRCAQ
Subscribe to FRCAQ

New dynamic self-testing website for trainee anaesthetists from Cambridge

Cambridge Medicine has launched a dynamic new self-testing website for trainee anaesthetists –

What is
It is an online revision resource of over 1,450 questions, answers and explanations in anaesthesia for trainees preparing for the Primary FRCA MCQ exam. Four different test options give you the flexibility to tailor your exam preparation to your specific needs, and detailed reports allow you to monitor your performance over time and against your peers.

Tell me more…
The site contains questions in both SBA (Single Best Answer) and MTF (Multiple True False) format. The Editors have analysed very component of the Primary FCRA syllabus and written questions on every topic you will encounter in the exam. Each question contains a short and long explanation, giving extensive background information to enhance your anaesthetic knowledge.

Which countries is the site relevant for?
Due to similarities in exam content and structure, the questions and answers on are directly applicable to the Irish Primary FCARSCI exam, the European Diploma in Anesthesia, the Australian and NZ FANZCA Part 1 exam, the Hong Kong HKCA Intermediate exam and the South African FCA(SA) Part 1 exam. Trainees preparing for these exams will find the site an invaluable revision resource.

Who are the Editors?
The FRCAQ editors, James Nickells and Ben Walton, are not only highly experienced anaesthetists and intensivists, but also expert medical educators who run the highly regarded Frenchay Final FRCA Crammer course. Members of their writing team are recent successful Primary and Final FRCA candidates or recently appointed consultants, so is written by anaesthetists for anaesthetists!

What next?
Try a free demo of FRCAQ
Subscribe to FRCAQ

Which other resources will help with Primary FCRA preparation?
Check out the following bestselling books:
Fundamentals of Anaesthesia, 3rd Edition Edited by Tim Smith, Colin Pinnock, and Ted Lin
Physics, Pharmacology and Physiology for Anaesthetists: Key Concepts for the FRCA Matthew E. Cross, Emma V. E. Plunkett
Pharmacology for Anaesthesia and Intensive Care, 3rd Edition Tom E. Peck, Sue Hill
Dr Podcast Scripts for the Primary FRCA Edited by Rebecca A. Leslie, Emily K. Johnson, Alexander P. L. Goodwin
Concise Anatomy for Anaesthesia by Andreas G. Erdmann

Treating radiation injuries in US travelers returning from Japan

March 22, 2011 — In response to the crisis in Japan, the US Centers for Disease Control and Prevention (CDC) hosted a conference call for clinicians to answer questions about treating radiation injuries in US travelers returning from Japan.

During the hour-long Clinician Outreach and Communication Activity call yesterday evening, Jeffrey Nemhauser, MD, who is a captain in the US Public Health Service and a medical officer in the CDC’s Radiation Studies Branch, answered questions from healthcare providers about radiation exposure and treatment.

Dr. Nemhauser stressed that the CDC is not aware of any US travelers returning from Japan who have been “contaminated with material at a level of concern.” If a traveler is contaminated, the CDC will recommend decontamination, collect data, and follow-up with the traveler, he said.

Customs officials routinely screen travelers (and their luggage) entering the United States for radiation contamination, he said. Because of the radiation leaks in Japan, however, the CDC is creating extra screening protocols for airports. Dr. Nemhauser said that these protocols should go into effect this week. Read more of this post

Medical Resources Strained in Japan

 March 17, 2011 — The devastating magnitude 9.0 earthquake and tsunami that occurred in Japan’s Miyagi prefecture on March 11 have caused a cascade of health and safety problems for survivors, including possible exposure to radiation from the region’s damaged Fukushima Daiichi nuclear plant. The disaster has strained medical resources on the ground, but it is unclear how many resources will be needed in the future.

“This is a very complex disaster, and it’s an evolving, ongoing situation,” Kristi L. Koenig, MD, director of the Center for Disaster Medical Sciences at the University of California–Irvine, told Medscape Medical News.

“The recovery phase of this disaster is going to be years and years and years,” she said. “They need people over the next many months to years to help, because the whole public health infrastructure is disrupted.”

Japan’s experience has been very different from Haiti, where a magnitude 7.0 earthquake struck in January 2010 and created a vast need for medical help. “In Haiti, the existing healthcare infrastructure was basically nonexistent,” Dr. Koenig said, “and the building codes for earthquakes were not anywhere near what they are in Japan.”

Unlike Haiti, Japan has well-organized civil defense teams that helped victims immediately until outside help was available, Dr. Koenig pointed out. These factors likely mitigated the injuries and deaths from the earthquake in Japan.

“Japan has significant emergency management capacity — one of the best in the world,” Margaret Aguirre, director of global communications for the International Medical Corps, told Medscape Medical News in an email.

Future Clinical Assistance May Be Needed Read more of this post

Neuroanesthesia and anesthesiology

Blog Post by George A. Mashour MD, PhD, Director, Division of Neuroanesthesiology and Assistant Professor of Anesthesiology and Neurosurgery,  University of Michigan

Neuroanesthesia is a subspecialty of anesthesiology that focuses on the perioperative care of patients undergoing surgery of the brain, spine or peripheral nerves. Because the drugs routinely used for anesthesia have their therapeutic action at all of these sites, anesthesiologists and neurosurgeons must “share” the nervous system during the course of an operation. This becomes particularly important at the end of surgery, when the assessment of neurologic function is a major priority. If, for example, a patient has suffered a stroke or has brain swelling, it needs to be recognized and acted upon rapidly before permanent damage occurs. Read more of this post

Non-invasive ventilation for acute cardiogenic pulmonary oedema

Blog Post by Mr Tim Case MPhil MA (Cantab) Medical Student, Hughes Hall, University of Cambridge, Cambridge, CB1 2EW, UK, and Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

Acute cardiogenic pulmonary oedema (ACPO) is a life-threatening consequence of acute heart failure that affects more than 17000 patients in the UK per year[i].  As the left ventricle fails, increased hydrostatic pressure causes fluid to leave the pulmonary capillaries and fill the alveoli.  Clinical features of ACPO include dyspnoea, tachypnoea, wheeze, pulmonary crepitations and hypoxaemia.  Read more of this post

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