Cheers to MSA – H.I.P. H.I.P. hooray!

The Mersey School of Anaesthesia is a stalwart supporter of Lifebox®, putting hands in pocket to raise more than £15,000 in personal contributions and core funds the last four years.

We’re enormously grateful for the support – and pleased to pass the mic to Director Dr David Gray as he explains, in his own words, how it came to be.

“”Dear Lifebox,

The Mersey School of Anaesthesia (MSA), a registered charitable company, organises a series of courses for trainee anaesthetists preparing for the Primary and Final Fellowship Examinations at the Royal College of Anaesthetists.  Both exams are in two parts, a written paper followed by structured oral examinations aka ‘vivas’ , the trainees only proceeding to the latter when successful in the former.

Many years ago, both on the MSA courses and when I visited the College as an Observer at the examinations, I noticed some candidates, predominantly but not always male,  feigned a sort of nonchalance as they strode or, with rolling shoulders, even swaggered to their allocated examination cubicle or table with hands-in-pockets (HIP). Such a pose never works. The brow is moist, the pupils dilated and, if any innocent, well-meaning examiner, real or mock, reaches to shake the hands, those hands are unpleasantly hot and clammy.

To digress. From the start, the MSA was a charitable function of an NHS Foundation Trust, a relationship which was successful and problem-free. However, when the Trust was forced to reorganise its Finance Department as part of an economy drive, the Finance Officer responsible for the MSA account was retired and not replaced. Because of the volume of work demanded by the account, the Trust gently suggested that it was time for it to be moved elsewhere, hence the independent charitable company.

Although the running costs of the MSA as a registered charitable company are markedly more than they were when it was comfortably cosseted within an NHS Trust, the change did have some advantages. Previously, the MSA was only able to donate surplus money to charities with something of an NHS texture. Thus, in 2011, when a donation of £5000 to Lifebox was proposed, the Charitable Trust Committee at the hospital advised that such a donation could not be endorsed as Lifebox was not of the NHS.

To return to the story.  Free of the constraint of a necessary NHS label, in November 2012, partly to dissuade candidates from any sorry HIP pose at the College but mainly to support the then inchoate Lifebox mission, I instituted the HIP rule. Thus, at the start of the every course we run, candidates are warned that they will receive the ‘metaphorical tap’ for every time a hand is seen to be lost to a pocket and that, at the close of the course, they will be invited to donate 50p per Tap to the Lifebox Collection Box, this on the understanding that the MSA will match the total collected.  It works, certainly with regards to raising money for Lifebox (See Table). Whether it dissuades any to refrain from swaggering towards the scaffold, I have no idea but I like to think it does and that all our candidates impress the examiners with their cool, calm and mature appearance and behaviour.  Unfortunately or fortunately, depending on whether one is for the candidate or for the cause, some, having received four or five taps in as many hours are only too pleased to buy out with the purchase of a £5 Badge which entitles them henceforth to parade with hands in pockets wherever and whenever they choose. Some habits die hard but it is surely an ill wind that does no good.

As the MSA Director since its inception in 1997, I soon realised that the majority of those trainees who fail the viva examinations do so because they surrender to the stress of the occasion. In the unfamiliar and awesome surrounds of the College, when formally challenged by unknown seasoned examiners, all consultant anaesthetists, testing them on their basic knowledge and clinical practice, they panic, loses their composure and the game is over.  See you next time.

The MSA offers six viva courses for the Primary and four viva courses for the Final, a total of ten such courses per year.  At these courses, during the mock viva sessions, every effort is made to create an intimidating ambience in tune with that which the trainees understandably expect to encounter in London. The aim of such a ploy is to render the trainees immune to the stress of the occasion but this can only be achieved by first creating stress.

Encouraged by the success of the HIP gambit, in pursuit of stress, more by happy accident than devious design, I have come to employ an irregular catalogue of offences which, if committed during a Mock Viva Session, merit censure and fine. For instance, there is to be no talking while waiting in line to start; no walking in the wrong direction; no arriving at the wrong cubicle; no visit to the toilets outside the announcement of “toilet time”; no talking in the toilets where viva material might be exchanged; no standing when supposed to sitting and no sitting when supposed to be standing.

The viva sessions are complicated and difficult to run but the difficulty is greatly alleviated if candidates stay silent when asked and obey the rules when told. Undoubtedly, the imposition of that same “ irregular  catalogue of offences”, besides creating the desired Stress, now capitalised, has the welcomed side effect of making things that much easier for those orchestrating the show.

Unsurprisingly, on a number of trainee websites, the MSA Viva Courses are referred to as ‘Boot Camps’.  Be that as it may, such a modus operandi achieves its end. Candidates, seeing the forthcoming exam for what it is not, leave relatively fearless and, in some cases, even looking forward to their day at the College while the Lifebox Charity benefits from the friendly abuse those same candidates have received.

The great majority of candidates, recognising the purpose and value of the Game of Stress, play along obediently and with good humour. Now and then, a few will signal resentment viz: “I do not appreciate being treated as a student teenager. A little more professional respect required” but later, when the exam is done and dusted, most of those few graciously admit that it is a winning formula, a formula garlanded by results on two counts – the Course Pass Rates are higher than those recorded by the College while Lifebox has received more than £11,000 worth of penalty tap money in the last two years. Added to the original kick–start of  £5000, this takes the total donation to Lifebox since October 2012 to £16,000. At the MSA, we like to think that even the most churlish of our candidates will be pleased to have contributed to so worthy a cause.

So it goes and long may it continue to do so. With certainly no apologies but immeasurable gratitude to all those who have played the game so well, so willingly and so generously. Thank you.

David Gray.””


£ Fines


£ Total

Jan. 2015   OSCE/Orals Week (HIP +) £106 £106 £212
Jan. 2015   Primary Viva W/End (HIP +) £122 £122 £244
Jan. 2015   Primary OSCE W/end (HIP +) £58 £58 £116
Nov. 2014  Final Viva W/end  (HIP +) £321 £321 £642
Nov. 2014  Final Viva Revision Week (HIP) £52 £52 £104
Oct. 2014   Primary Viva W/end (HIP +) £123 £123 £246
Oct. 2014   OSCE/Orals Week (HIP +) £104 £104 £208
Oct. 2014   Primary MCQ/SBA Week (HIP) £128 £128 £256
Oct. 2014   Primary OSCE W/end (HIP +) £31 £31 £62
Aug. 2014  Primary MCQ/SBA Week (HIP) £197 £197 £394


£1,242 £1,242 £2,484

HIP                Hands-in-Pockets    No Game.

HIP +             Hands-in-Pockets    + Game.

Email 28/01/15 – Verbatim extract from the first Feedback received from the January 2015 OSCE/SOEs.

“At this point, however, I would like to confess that your talk before the magic roundabout* left me thinking what an absolute waste of time that was…. until I had been to the exam myself!!”

* The Opening Mock Viva.”