Most of the advice about FCPS Part II preparation assumes you have long blocks of time available, that your days are structured around studying, and that your main challenge is choosing between resources. That is not the situation most residents are in. You are covering on-calls, doing procedures, writing notes, and somewhere in the middle of all of that, trying to prepare for one of the hardest postgraduate exams in Pakistani medicine.
I prepared for Part II while working. Here is what actually helped, and what I stopped doing because it was not worth the time it cost.
Narrow the resource list and commit to it
The worst thing you can do when time is limited is spread your reading across five different textbooks. You will cover everything shallowly and retain very little. Pick one comprehensive anaesthesia text, one pharmacology reference, and one physiology resource. Know those well rather than skimming everything widely.
For Part II specifically, Miller’s is the standard. You do not need to read every chapter in equal depth. The chapters on pharmacology of anaesthetic agents, regional anaesthesia, obstetrics, and critical care are the ones that come up most consistently in the clinical and viva components. Start there and work outward.
Use your clinical work as a study tool
Every case you do is an opportunity to ask a question. After an epidural, ask yourself: what are the pharmacokinetics of the local anaesthetic I just used? Why did I choose this concentration? What would happen at a higher dose? After a high-risk intubation, trace the physiology from laryngoscopy stimulus through to cardiovascular response and how you modified it.
This kind of active reflection takes five minutes after a case and builds exactly the kind of applied understanding that the Part II viva tests. The examiners are not looking for someone who can recite a definition. They are looking for someone who can explain what the drug does in the patient in front of them. Clinic-based learning builds that better than passive reading does.
Study in short blocks, not long sessions
When you are working full days and running on limited sleep, a three-hour reading session is almost never as productive as it sounds at the start. The first forty minutes are reasonably sharp. After that, retention drops significantly and you are mostly turning pages.
Thirty to forty-five minutes of focused reading, with active note-making and a few self-generated questions at the end, beats two hours of passive reading almost every time. Schedule shorter sessions more frequently rather than trying to find large blocks of time that may never materialise. Even fifteen minutes before morning rounds, used consistently, adds up.
Prepare specifically for the viva
The viva is where candidates who understand clinical application separate themselves from candidates who only know the facts. You cannot prepare for it by reading silently. You have to talk through your answers out loud, tolerate being interrupted mid-sentence, and keep your thinking coherent under pressure.
Find one colleague who is also preparing and practice with each other. Take turns asking and answering. Start with straightforward questions and move toward the edge of your knowledge. The examiner will push toward your limits and what matters is how you handle being at those limits, not whether you have a perfect answer ready for every possible question.
What to do the week before the exam
Stop starting new material. Review what you have already covered, focus on anything that still feels uncertain, and spend time on your weak areas rather than your strong ones. Sleep as much as the rota allows. Your ability to recall and connect ideas under exam conditions depends significantly on how rested you are in the days before. The temptation to stay up reading until 2 AM the night before a viva is real and almost always counterproductive.