EDAIC Part 2 Clinical Viva Preparation: A Structured Approach

The EDAIC Part 2 clinical viva is a structured oral examination (SOE) that tests your ability to assess, plan and manage anaesthesia and intensive care scenarios under the scrutiny of two examiners. Unlike the written Part 1 papers, which assess factual knowledge through multiple true/false questions, the Part 2 clinical SOE evaluates how you think aloud, prioritise clinical problems and adapt your management as a case unfolds. Success depends not only on what you know but on how clearly and logically you communicate your reasoning.

This article outlines a systematic framework for preparing for the EDAIC clinical viva, emphasising the peri-operative continuum—pre-operative assessment, intra-operative planning and monitoring, contingency management, and postoperative care. The approach mirrors the structure examiners expect and helps you organise your thoughts under pressure.

Understanding the EDAIC Part 2 Format

The EDAIC Part 2 is a structured oral examination. Part II is offered in several languages, subject to demand and available places; check the language of your chosen sitting on the official ESAIC Part II page. You will face a series of guided clinical questions presented by pairs of examiners. Each station typically begins with a clinical scenario—a patient presenting for surgery, an intensive care admission, or an emergency situation—and the examiners will guide you through the case with targeted questions.

The examiners are not trying to catch you out; they are assessing whether you can safely and competently manage the situation. They want to hear your thought process, your awareness of risk, your knowledge of relevant guidelines, and your ability to adapt when complications arise. The viva is criterion-referenced: you are measured against a standard of competence, not ranked against other candidates.

Key point: The EDAIC clinical SOE rewards structured, verbalised reasoning. Examiners cannot award marks for thoughts you keep to yourself—speak your clinical logic aloud.

The Peri-Operative Framework

A reliable way to tackle any anaesthesia viva scenario is to work through the peri-operative continuum systematically. This framework ensures you cover all the domains examiners expect and prevents you from jumping to intra-operative management before addressing pre-operative risk.

Pre-Operative Assessment

Begin every case by gathering and interpreting relevant information. When presented with a scenario, mentally (or aloud) run through:

• History: What is the surgical pathology? What are the patient's co-morbidities (cardiovascular, respiratory, renal, hepatic, endocrine, neurological)? What is their functional capacity? Are there any drug allergies or previous anaesthetic complications?
• Examination findings: Airway assessment (Mallampati, mouth opening, neck extension, thyromental distance), cardiovascular and respiratory status, signs of difficult venous access.
• Investigations: Recent blood tests (haemoglobin, renal function, coagulation), ECG, imaging (chest radiograph, echocardiography if indicated), pulmonary function tests in selected cases.

Examiners will often provide investigation results if you ask for them. Do not invent findings, but do state what you would like to know and why. For example: "I would want to see a recent echocardiogram to assess left ventricular function and pulmonary pressures, given the patient's history of heart failure."

Risk Stratification and Optimisation

Once you have gathered information, articulate the patient's risk. Reference widely recognised frameworks where appropriate—ASA physical status, cardiac risk indices, frailty scores—but avoid quoting exact numerical thresholds unless you are certain. Instead, describe risk qualitatively: "This patient has significant cardiovascular co-morbidity and limited exercise tolerance, placing them at higher peri-operative risk."

Discuss optimisation:

• Can surgery be delayed to improve the patient's condition (e.g., treating anaemia, optimising heart failure, improving glycaemic control)?
• Is multidisciplinary input required (cardiology, respiratory, intensive care)?
• What is the role of pre-operative physiotherapy, smoking cessation, nutritional support?

Examiners appreciate candidates who recognise when a patient is not fit for elective surgery and who can articulate a plan to improve their condition.

Consent and Communication

Briefly mention informed consent. What risks would you discuss with this patient? How would you explain the anaesthetic plan in lay terms? Acknowledge the importance of shared decision-making, particularly in high-risk cases where regional or neuraxial techniques might reduce risk but carry their own complications.

Intra-Operative Planning and Monitoring

Once the examiners are satisfied with your pre-operative assessment, they will move to intra-operative management. Structure your answer around:

Anaesthetic Technique

State your preferred technique and justify it. For example:

• General anaesthesia with tracheal intubation for upper abdominal surgery in a patient at risk of aspiration.
• Combined spinal-epidural for lower limb orthopaedics in a patient with severe respiratory disease.
• Peripheral nerve block with sedation for distal upper limb surgery.

Explain why your choice is appropriate for this patient and this surgery. If there are alternative techniques, acknowledge them and explain why you favour one over another.

Monitoring and Vascular Access

Describe your monitoring plan:

• Standard monitoring (ECG, non-invasive blood pressure, pulse oximetry, capnography, temperature, neuromuscular monitoring if using muscle relaxants).
• Invasive monitoring if indicated (arterial line for beat-to-beat blood pressure in haemodynamically unstable patients, central venous catheter if large fluid shifts or vasoactive infusions are anticipated).
• Depth of anaesthesia monitoring in selected cases (e.g., total intravenous anaesthesia).

Justify your choices. For instance: "I would site an arterial line pre-induction because this patient has severe aortic stenosis and I anticipate significant haemodynamic instability."

Induction, Maintenance and Positioning

Walk the examiners through your induction plan. Will you use rapid sequence induction? What precautions will you take for a difficult airway? How will you manage haemodynamic stability during induction in a patient with ischaemic heart disease?

For maintenance, state your choice of volatile agent or total intravenous anaesthesia and your rationale. Mention ventilation strategy (tidal volumes, positive end-expiratory pressure, lung-protective ventilation in at-risk patients).

If positioning is relevant (e.g., prone, lithotomy, beach-chair), discuss the implications: pressure area care, risk of nerve injury, effects on ventilation and venous return.

Exam tip: Examiners often interrupt to ask, "What if the patient becomes hypotensive at induction?" or "What if you cannot intubate?" Have a clear, stepwise contingency plan ready.

Contingency Management

The clinical viva frequently tests your ability to manage complications. Common scenarios include:

• Hypotension: Assess cause (hypovolaemia, myocardial depression, vasodilation, surgical bleeding). Describe your immediate actions (fluid bolus, vasopressor, reduce anaesthetic depth) and escalation (invasive monitoring, inotropes, blood products).
• Hypoxia: Systematic approach—check the breathing system, increase FiO₂, hand-ventilate, assess chest symmetry, consider bronchospasm, pulmonary oedema, pneumothorax, aspiration.
• Difficult airway: Verbalise your failed intubation drill. State that you would call for help, maintain oxygenation, consider supraglottic airway, wake the patient if surgery is not immediately life-saving, or proceed to front-of-neck access if cannot intubate, cannot oxygenate.
• Anaphylaxis: Recognise the clinical features, stop suspected triggers, give intramuscular adrenaline, fluid resuscitation, call for help.

Examiners value systematic reasoning and safety awareness. If asked about specific drug doses, you can describe dose ranges qualitatively (e.g., "a small bolus of vasopressor") or state that you would consult a reference or local protocol if you are not certain of the exact figure.

Postoperative Care and Handover

Examiners will often ask where the patient should go after surgery and what postoperative analgesia you would provide.

Destination

• Recovery room for routine cases.
• High-dependency unit (HDU) for patients requiring close monitoring (e.g., epidural analgesia, significant co-morbidity, major surgery with anticipated fluid shifts).
• Intensive care unit (ICU) for patients needing organ support (mechanical ventilation, vasoactive drugs, renal replacement therapy).

Justify your choice based on the patient's pre-operative risk, the magnitude of surgery, and the anticipated postoperative course.

Analgesia

Describe a multimodal analgesic plan:

• Regional techniques (epidural, peripheral nerve blocks, local anaesthetic infiltration).
• Simple analgesics (paracetamol, non-steroidal anti-inflammatory drugs if not contraindicated).
• Opioids (patient-controlled analgesia, nurse-administered boluses).

Mention monitoring requirements (e.g., regular sensory and motor assessment for epidurals, respiratory rate and sedation score for opioid infusions).

Handover

Briefly state what information you would hand over to recovery or ICU staff: patient demographics, surgical procedure, anaesthetic technique, intra-operative course (blood loss, fluid balance, complications), current observations, analgesia plan, and any ongoing concerns.

Intensive Care and Emergency Scenarios

The EDAIC clinical SOE also covers intensive care admissions and emergency presentations. The same structured approach applies:

• Assess: Airway, breathing, circulation, disability, exposure. Gather history and examination findings.
• Investigate: Arterial blood gas, lactate, chest radiograph, ECG, blood tests, imaging as indicated.
• Resuscitate: Oxygen, fluid resuscitation, vasopressors or inotropes, source control (e.g., antibiotics and drainage for sepsis).
• Diagnose and treat the underlying cause: Septic shock, cardiogenic shock, acute respiratory distress syndrome, traumatic brain injury, etc.
• Organ support: Mechanical ventilation, renal replacement therapy, haemodynamic support.
• Monitor and reassess: Serial observations, repeat investigations, escalation if deteriorating.

Examiners will probe your understanding of pathophysiology, your ability to interpret investigations (e.g., a blood gas showing metabolic acidosis), and your knowledge of relevant guidelines (e.g., Surviving Sepsis Campaign, ARDS Network ventilation strategies). Describe these in general terms; do not invent specific protocol details.

Frequently Asked Questions

What is the EDAIC Part 2 clinical viva format?

The EDAIC Part 2 includes clinical structured oral examinations (SOEs), with the examination language confirmed for the chosen sitting. You will face a series of guided clinical questions presented by pairs of examiners, covering anaesthesia, intensive care, and emergency scenarios. Each station tests your ability to assess, plan, and manage cases systematically.

How should I structure my answers in the EDAIC clinical SOE?

Use a peri-operative framework: pre-operative assessment and optimisation, intra-operative planning (technique, monitoring, contingencies), and postoperative care (destination, analgesia, handover). For intensive care or emergency cases, follow an ABCDE approach, investigate, resuscitate, diagnose, and provide organ support. Speak your reasoning aloud—examiners cannot award marks for silent thought.

Can I quote specific drug doses in the viva?

Only if you are certain. Examiners value systematic reasoning and safety awareness over precise dosing. If asked, you can describe dose ranges qualitatively (e.g., "a small bolus of vasopressor") or state that you would consult a reference or local protocol. Do not invent doses.

How do I prepare for EDAIC oral clinical questions?

Practise verbalising cases aloud with colleagues or mentors. Work through scenarios covering the breadth of anaesthesia and intensive care—elective and emergency surgery, obstetrics, paediatrics, trauma, sepsis, airway emergencies. Use a structured framework every time. Familiarise yourself with major guidelines (difficult airway, sepsis, ARDS) in general terms, and refine your ability to adapt when the examiner introduces a complication.

Final Thoughts

The EDAIC Part 2 clinical viva rewards candidates who can think systematically, communicate clearly, and demonstrate safe, guideline-aware practice. By anchoring your preparation in the peri-operative continuum—assessment, planning, monitoring, contingency, and postoperative care—you build a mental scaffold that works for any scenario the examiners present. Practise verbalising your reasoning, seek feedback from senior colleagues, and remember that examiners are assessing competence, not perfection.

Start preparing for the EDAIC with AnesCORE →