ANZCA Primary Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for anaesthetic trainees sitting the ANZCA Primary Examination in the next twelve months. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for this exam. The Primary curriculum on PRIMEX is maintained against the college's published syllabus — 313 learning objectives across 25 sections — with topic mapping reviewed for accuracy.

The exam at a glance

The ANZCA Primary Examination is the basic-sciences hurdle of the FANZCA training pathway. It tests whether you can integrate physiology, pharmacology, anatomy, and equipment and measurement at the depth a junior consultant anaesthetist would expect of a new senior registrar. The exam has two components.

Written paper (MCQ)

• Single-best-answer multiple-choice questions covering all four examinable domains
• Computer-based, delivered at approved test centres
• Tests breadth across the published learning objectives, with integration questions that cross domains
• Multiple sittings per year — check the ANZCA website for current dates

Viva voce examination

• Structured oral examination, conducted in person by college examiners
• Multiple short stations covering physiology, pharmacology, anatomy, and equipment
• Time-limited, with each examiner working from a marking grid
• Available only to candidates who pass the written paper

Pass marks and standardisation

ANZCA publishes examiner reports after each sitting that describe candidate performance, common failure patterns, and the standard expected. There is no fixed percentage that guarantees a pass; the bar is set against the marking grid for each station. Treat any single pass-rate figure you see online as a rough guide and read the most recent examiner report in full — the report is where the trends live, not in the headline number.

Independent components, sequential structure

The viva is not a parallel paper; it is the second hurdle. Candidates who pass the written paper progress to the viva, and the result for the full Primary depends on both. Most candidates plan the year around the written paper and treat the gap between written and viva as dedicated viva practice time, not as recovery time. The bench you build during written prep is the bench you draw on at the viva, so consolidation matters more than starting fresh.

What the college actually tests

The ANZCA Primary syllabus is built around four examinable domains. Every MCQ and every viva station traces back to one or more learning objectives across these four domains, and the syllabus is explicit about which objectives are core and which are sub-themes. The four domains, and the high-yield clusters within them, are below.

1. Physiology

Cardiovascular physiology (cardiac cycle, pressure-volume loops, determinants of cardiac output, coronary circulation), respiratory physiology (ventilation-perfusion relationships, oxygen and carbon dioxide carriage, control of breathing, lung volumes and mechanics), renal physiology (glomerular filtration, tubular handling, acid-base balance, electrolyte regulation), neurophysiology (autonomic nervous system, cerebral blood flow, intracranial pressure, pain pathways), and applied physiology of the obstetric, paediatric and elderly patient. Examiner reports keep returning to integration questions — questions that ask you to apply physiology in an anaesthetic context, not just recite it.

2. Pharmacology

General pharmacology (pharmacokinetics, pharmacodynamics, drug interactions), volatile and inhalational agents, intravenous induction agents, opioids, neuromuscular blocking drugs and their reversal, local anaesthetics, vasoactive drugs, anti-emetics, anti-coagulants, and drugs of relevance in the perioperative period. The depth expected is mechanism and clinical pharmacology together, with specific attention to the kinetic and dynamic features that drive choice between agents.

3. Anatomy

Applied anatomy of the airway, the spine and neuraxial spaces, the thorax, the abdomen and pelvis, the upper and lower limbs (particularly for regional anaesthesia), and the cranial nerves. The bar is anatomy as it applies to anaesthetic practice — lines and blocks, surface landmarks, ultrasound-relevant cross-sectional anatomy, complications of anatomical variance. Candidates who study anatomy from a general textbook rather than an anaesthesia-relevant resource often answer the wrong question.

4. Equipment and measurement

Anaesthetic delivery equipment (the anaesthetic machine, breathing circuits, vapourisers, ventilators), monitoring equipment (gas analysers, pulse oximetry, capnography, neuromuscular monitoring, depth-of-anaesthesia monitoring), physical principles underlying measurement (pressure, flow, temperature, electricity, ultrasound), and the safety standards that govern equipment in Australian and New Zealand practice. This is the domain candidates most often defer, and it is the domain examiner reports most often flag as poorly answered. The college tests it for a reason: equipment failures and equipment misuse are recurring contributors to anaesthetic incidents.

Common pitfalls that fail candidates

• Studying for recognition, not recall. Reading a textbook and recognising the answer when you see it is not the same as producing it in an MCQ stem or a viva station. The exam tests recall under time pressure. Active recall practice from week one matters.
• Deferring equipment. Most textbooks put equipment last. Most candidates do the same. The viva does not.
• Failing to integrate across domains. The hardest viva stations are not single-domain questions; they are questions that cross physiology and pharmacology, or anatomy and equipment. If you have only studied each domain in isolation, you will hesitate at the integration point and that hesitation costs marks.
• Under-practising the viva structure. The viva rewards a verbal structure (definition, mechanism, clinical relevance, common pitfalls). Candidates who do not rehearse that structure out loud spend the first ninety seconds of every station finding their words.
• Treating the written and viva as separate exams. They test the same syllabus. Time spent on written prep is time spent on viva prep if you are actively recalling rather than passively reading.
• Burning out at month four. The Primary timeline is long. Candidates who study at full intensity from week one without rest blocks lose the back half of their run-in.

A realistic study timeline

The right run-up depends on your full-time-equivalent clinical workload, how comfortable you already are with the four domains, and how early you started revising. Three sample plans, in rising order of intensity:

Nine-month plan (8 to 10 hours per week)

This suits someone working full-time clinically, with on-call and other commitments, who wants slow steady coverage rather than a sprint.

• Months 1 to 3. Walk through the four domains. Cover one or two syllabus sections per week. Build a flashcard deck against the learning objectives as you go. Begin MCQ practice from week one (30 to 50 per week) to surface weak areas faster than reading would.
• Months 4 to 6. Add SAQ-style structured-answer practice under timed conditions. Mark each response against a model answer or marking grid. Continue MCQ volume. Begin viva practice with one short station per week, out loud, ideally with a partner.
• Months 7 to 8. Past paper MCQ mocks under timed conditions. Viva volume scales up to three or four stations per week across all four domains. Identify weak sections and target them.
• Final month. Two full timed MCQ mocks. Daily viva practice. Stop new content two weeks before the sitting and consolidate the highest-yield physiology and pharmacology you already know cold.

Six-month plan (12 to 15 hours per week)

The standard plan for most candidates. Tight enough to keep momentum, long enough to cover the syllabus properly.

• Months 1 to 2. Walk through every syllabus section. Cover two or three sections per week. Build the flashcard deck. 60 to 90 MCQs per week.
• Months 3 to 4. SAQ-style practice becomes the main work. Three to five structured answers per week, marked carefully. Maintain MCQ volume. Begin viva practice with one to two stations per week.
• Month 5. First full MCQ timed mock. Viva volume doubles. Two to three stations per week, ideally with verbal feedback from a study partner or a voice viva simulator.
• Final month. Two more MCQ mocks under exam conditions. Daily viva practice across all four domains. Final consolidation on weak sections.

Four-month plan (18 to 22 hours per week)

The compressed plan. Doable if you are part-time clinical or have a study leave block, painful otherwise.

• Month 1. Speed-read the syllabus. Three or four sections per week, focused on weak areas. Heavy MCQ volume from week one (120+ per week).
• Month 2. SAQ-style answers daily. MCQs continue. Begin viva practice twice a week.
• Month 3. Full timed mocks start. MCQ mock weekly. Viva practice three times per week across all four domains.
• Final month. Polish weak sections. Two MCQ mocks, daily viva practice. Sleep and wind down for the last 48 hours before the written.

When to start each component

• MCQs: from week one. They build recall and surface weak sections faster than reading.
• SAQ-style answers: from month two at the latest. The structured-answer skill is its own muscle and does not transfer from MCQ work alone.
• Viva practice: from month two on a six-month plan, month three at the latest on a longer plan. Verbal performance needs reps. Reading viva model answers does not transfer.
• Past papers and full mocks: last six to eight weeks for the written. Earlier than that and you have not yet covered enough ground for the result to be meaningful.

Weekly study split that actually works

Most candidates run into trouble because their week is shapeless and the work that feels easy crowds out the work that matters. A simple template that holds up: two MCQ sessions per week of 60 to 90 minutes each, two structured-answer sessions per week of 60 to 90 minutes each, one viva station per week from month two onward (more after month four), and one reading session per week tied to whatever weak section emerged from the practice. Flashcards run in the background as ten-minute blocks between cases or on commutes, not as scheduled sit-downs. Protect your viva slot the way you protect a clinical commitment; if you let it move, it stops happening.

Track what you got wrong, not what you got right. Keep a running list of missed learning objectives by syllabus section. After a month you will see two or three sections that come up repeatedly and you can target them directly.

The single biggest mistake people make

You study for recognition, not recall. The written exam feels concrete because the question is in front of you and the four options are on the screen, so you read textbooks and feel the comfort of "I remember this when I see it." Then you sit a timed MCQ paper and find that knowing the answer was there is not the same as producing it under pressure. You sit the viva and find that recognising a topic is not the same as structuring a verbal answer about it in ninety seconds.

The fix is uncomfortable and it is the first thing every trainee resists: from week one, force yourself into active recall. Close the book. Write the answer down before you check. Speak the answer out loud before you read the model. Get a flashcard deck running where the prompt is the learning objective and the answer is whatever you can produce from memory. The early weeks will feel slower and you will get things wrong; that is the point. Recognition is fast and fragile. Recall is slow and durable. The exam tests recall.

Start viva practice in month one or two of your run-up. Even one station a week is enough to keep the skill alive. You can practise with a colleague at your hospital, with a remote partner over Zoom, or with a voice viva simulator that plays the examiner. The point is reps. By the time you sit, the verbal structure should feel automatic and your conscious bandwidth should be available for the clinical reasoning.

How PRIMEX helps

• 196 sourced study notes mapped to all 313 ANZCA Primary learning objectives, written for the depth the syllabus actually expects. See the free preview notes.
• An MCQ bank covering all four examinable domains with full option explanations and per-option distractor analysis after each question.
• An AI SAQ grader that marks structured answers on a Fail / Borderline / Pass / Distinction tier with examiner-style feedback.
• A voice viva simulator that runs viva-style stations with medical-grade speech recognition, plays the examiner live, and marks against the structure used in the real viva. Open it from the viva feature on the ANZCA Primary page.
• 5,466 spaced-repetition flashcards mapped to the published learning objectives, so coverage is checkable rather than estimated.
• A curriculum tracker covering all 25 syllabus sections, with a readiness score per section so you know what to study next.

Frequently asked questions

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