FCICM Exam Preparation

Reviewed and revised 25 May 2014

Authored by Jeremy Fernando and Chris Nickson

OVERVIEW

• This page supports the session at the Wellington Intensive Care Medicine (WICM) course 2014 on ‘Preparing for the Exam’ by Jeremy Fernando and Chris Nickson
• Specific components of the exam were covered in other aspects of the WICM course
• The LITFL CCC resource page for the WICM course is:/li>
• The College (CICM) has a webpage on the second part exam here, with links to the exam calendar, previous exam reports, etc.

FAQ

What are the best sources of information?

• Many examiners and others advise that it is essential to read Oh’s Intensive Care Manual  cover-to-cover as preparation for the exam. Neither of us think this is necessary and neither of us did this!
• Use whatever information source is useful for filling the gaps in your knowledge
• Past exam questions and the model answers provided as a guide, are the core (search past exams here on LITFL)
• We prefer niche books like: Examination Intensive Care Medicine (the CD is gold!), The Toxicology Handbook for toxicology, Diagnostic Imaging for Critical Care for radiology, Data Interpretation for Critical Care, and Practical Intensive Care Medicine for the basics. Oh’s Intensive Care Manual is worth dipping into for areas of weakness and checking out the tables and figures (these are easy for examiners to make questions from)  — plus many of the authors are examiners!
• The LITFL CCC grew out of Jeremy Fernando’s ICU exam study notes. Most topics are exam focussed and provide streamlined summaries. They are hyperlinked to relevant blogs, websites, videos, podcasts, landmark articles and recent reviews (ideally those that are free full text online). Also, if something doesn’t make sense or seems out-of-date we try to be very responsive to comments and questions – in fact, we rely on this to make the CCC even better so the more comments and queries the better!
• Social media can be useful for engaging high yield summaries, perspectives and keeping up-to-date (e.g. scan The LITFL Review each week, follow a few key thought leaders on Twitter, the weekly newsletter from CriticalCareReviews.com). Beware of the dangers: is the information source reliable? Are you wasting time getting distracted?
• Podcasts are useful for filling otherwise wasted time (e.g. commutes), and help with motivation and different perspectives, but are not active learning and may contain information that is not ‘ready for primetime’.

What is the best way to study?

• Find a quiet private place to study with a good desk, lighting, etc
• Study at a time when you are most alert and rested
• Make sure you have regular breaks (e.g. 5 min every 30mins do  star jumps or something!)
• mix up sessions and learn actively – this maintains interest, helps build associations, and mimics exam conditions where a variety of topics will be thrown at you in quick succession. For instance you might do something like: do some past questions to time, identify your weaknesses, read a section of a relevant textbook or review article targeting these, listen to a relevant podcast on the topic, then go back and do some more questions in a day; with frequent brief breaks throughout.
• Time sessions and keep a ‘to done’ logbook so you can track your progress and efficacy
• Uses cases you see in everyday practice as ‘hooks’ to hang your study on – read/ learn around real cases
• Tailor your study towards identifying and working on your personal weaknesses – don’t waste time on stuff you know well unless you are trying to boost your confidence! (worth doing from time to time)
• Consider using a spaced repetition approach (see Learning by Spaced Repetition) and flashcards to memorise key facts and principles. Some people swear by pinning up posters of key information on the toilet door or around your room.
• For evidence-based approaches to studying have a look at Effective Learning Techniques Revealed.

How to stay motivated?

• Break the exam into doable chunks, set yourself SMART goals (specific, measurable, achievable, relevant and time-specified) and track your progress
• Announcing goals to others is controversial (see here) but may work if you give friends, family or mentors permission to check your progress and crack the whip…
• Reward yourself periodically (e.g. breaks, time with family, holidays)
• Remember how lucky you are – the exam is a tough time, but you have a great job, you help people and work with great people… The exam is your ticket to doing this even better!
• do not expect to ‘master’ ICU – that is a life long journey – just aim to pass the quiz!
• Commit to a specific exam time, then attack it! Plan what jobs you will do, how you will study, who will help you and make the commitment.
• Find a ‘coach’ who can help monitor your progress and just talk things over with. A Study group may help serve a similar purpose.
• Expect motivation to ebb and flow, and allow for modulating the intensity of your study over time

How long do you need to prepare?

• It depends!
• You need to gauge how many more building blocks of basic knowledge you need to put in place, or whether you can focus on exam technique
• If you have done another Fellowship exam, have been in clinical practice for long enough and have been reading around cases then you will need less time and can focus more on the exam technique
• You can’t start too early, but don’t peak too early!
• Most people spend 6-12 months of exam-focussed preparation
• Pick an exam date and commit! (wishy washy plans to ‘maybe do it this year’ just don’t cut it…)

How much primary literature do you need to read?

• Basically none for the exam per se, but you need to know the key findings of major studies
• Useful resources include: LITFL CCC Literature Summaries (search the database for ‘literature’), Critical Care Reviews include the SMACC podcasts on 2013 in review, The Bottom Line, The NNT, Gordon Doig’s EBMedicine.net site and  the CritIQ journal summaries (the latter is not free)

What exactly is the curriculum?

• The real curriculum is the past exam questions – I have heard examiners say this. this is partly why poorly answered questions tend to repeat – the College wants to make sure trainees know this information
• Topic guides can be developed from the Examination Intensive Care Medicine book, LITFL CCC, Jeremy Fernando or David Tripp’s Notes, Oh’s Textbook or other short topic-orientated texts like the Oxford Handbook
• Dividing up the topics into what you need to cover is a personal decision based on your prior experience and knowledge — spend more time on your weak areas and don’t waste time reading about things you already know.
• Map out a plan on a calendar showing how much time you will spend on each topic in the months leading up to the exam
• To anticipate what may come up in the next exams look at which questions were done poorly in recent SAQs and vivas — typically badly done SAQs in the last exam come up as vivas in the next, and vice versa — and anticipate hot topics/ controversies (keep abreast of the literature (see below), listen to what intensivists are talking about and see what is being talked about at recent ANZICS CTG meetings – see current ANZICS research.)
• The boundaries of intensive care medicine are nebulous and constantly changing – you are not expected to know everything but you must know enough to demonstrate that you are safe, and think like a consultant and can deal with uncertainty by resuscitating and stabilising first, initiate the diagnostic process and then seek further information (from collateral history, investigations, colleagues and other information sources).

 How important is exam technique?

• To paraphrase former Liverpool manager Bill Shankly: “it’s not a matter of life and death… it is far more important than that!”
• Practicing exam Qs is the key to success – do every question over at least the past 5 years, ideally more than once
• Start Hot Cases early! They inform all other aspects of the exam and give you one-on-one time with an intensivists/ examiner. Doing hot cases keeps you bounded in reality and shifts the focus from esoterica. The FCICM exam is a practical exam where you have to say “I will do this… because…”. Don’t over-complicate things — imagine you are on a ward round and the Director of the ICU says to you, ‘ can you have a look at bed 5, are they ready to extubate?’ – what will you do and say?… “No… because ….(insert relevant points) … they need these things to be done …. (insert relevant points)”

How can you develop exam technique?

• Train as you plan to fight!
• Embrace the feeling of inadequacy you get when practicing in from of your peers and consultants – it is making you stronger!
• Guided practice – perform, analyse (ideally with a coach), correct, perform again…
• Work on the microskills of exam performance: e.g. key lists, key phrases, how to lay out questions on the page, how much hot case information can you get from a 90 second endofthebedogram?
• Emulate real conditions: use a timer (the one you will use in the exam), use actual exam paper, use the type of pen you are going to use
• Get others to check your questions for readability; get examiners to mark questions if possible
• One SAQ is easy to do to time, 5 or 10 in a row is much more difficult, 30 in a day is harder still!
• Prepare for things going wrong – practice 5 min SAQ questions saw you can prioritise the big issues and know what to do if you only have 5 min left. Choose a point of no return — if you are behind time on the SAQs at this time, switch to 5 minute question mode
• imagine the examiner is deaf, dumb, and blind – you have to be explicit in demonstrating your knowledge and abilities, never assume or think things are obvious! Never say the word ‘obvious’
• Consider filming your performance in practice vivas to see what you need to improve
• Reflect on SAQs, vivas and hot cases — keep a journal/ logbook of what could be done better and how to do it
• For vivas and hot cases practice thinking before you speak, cultivate a’ thoughtful look’, then preview and chunk information you are going to present. Use rehearsed, individualised ‘motherhood’ / overview statements to give you time to think and organise what you will say next
• Assess how big the question is — depending on the time available and the emphasis the same question my involve listing 5 points or writing an intricate essay
• don’t be rigidly formulaic a la the intensive care examination — modify your approach according to the presentation, and tailor your catchphrases so that they suit you and sound original

What should I do close to the exam?

• Rest, eat, sleep, stay healthy, exercise (even if only a 4 minute workout) but it is OK to study too!
• Do some questions you know well to build confidence
• Revise lists and ‘need to know’ facts
• Revise questions you think will come up
• Don’t try to learn new things
• plan transport and accommodation meticulously – arrive at least day before, travel to the venue and make sure you know exactly where you are going, how you are getting there and how long will it take; stay somewhere nice… and close!
• should family be around? Great for them to be part of the celebration at the end, but may add to stresss levels, guilt, etc
• Use positive thinking and self-talk, visualisation – “I am good at my job”, think about times when you did well, overcame challenges, got out of tricky situations
• Don’t peak too early, avoid burnout
• Know all the relevant deadlines for applications for the exam process – do not stuff this up!

How to stay sane/ married/etc?

• Sanity… what’s that?
• Marry the right person!
• Make the exam a family goal — involve the family in setting and meeting your targets and share the rewards. Families and relationships provide challenges – but are also a source of strength and definitely a positive.
• Give yourself a break(s)
• There is NO point getting through the exam if you don’’t have a life at the end of it!

How to get help?

• Plan early — identify a ‘coach/ mentor’ to help guide you through the exam early, contact the people you want to help you with hot cases early (the good people will have lots of people asking them for help) and ensure your life is sorted (as much as possible) and your supports are in place
• if you are struggling contact your mentor, your GP and/or workplace-based counselling/ psychologists or performance psychologists

What job should I do while studying?

• ICU is the place to be!
• On exam day you need to BE a consultant. Other than working as a consultant the best way to emulate this is working as a Senior Registrar.
• Whatever job you are doing you need to access to ICU cases and to intensivists
• Use other specialists to help you with relevant areas: physicians (and emergency physicians!) are useful for improving clinical exam technique, anaesthetists are excellent for pharmacology and equipment for instance
• Turn work into exam practice — ask to do one patient on every ward round as a practice ‘hot case’, treat phone calls to the consultant as mini hot case presentations

How to study in a group?

• Plan meetings in advance and stick to the schedule
• I prefer to work with one other person (ideally better than me!)
• Choose your group wisely – personalities, different areas of strength
• Be reliable

How to study in isolation?

• Do ICU exam courses (probably only need to do one) to track your progress compared to other trainees, get exposed to examiners, get different perspectives and meet potential study buddies
• Be a tourist and visit other centres, ideally those where examiners are available
• Used web-based resources e.g. FOAM site and the FOAM community (but don’t get distracted!)
• Use other specialties (see above)
• Use skype or Google Hangouts for study groups

What if I fail?

• Remember that failure does not mean you are a bad person or a bad doctor – be sure to associate with people who will remind you of this!
• Preparing for the exam again may make you an even better doctor and even a better person
• Failure usually just means you need more time and better preparation
• Common reasons for failure include exam technique (e.g. adhering to time constraints, illegible hand-writing, lack of structure), not ‘playing by the rules of the game’, clinical inexperience and knowledge deficits
• Get feedback – from the College, supervisors of training, trusted advisers and people you prepared with
• Figure out a plan incorporating SMART goals with your advisers – target weaknesses; doing the same thing over and over is insanity
• Depending on the reason and the remedial action needed, you may want to skip an exam sitting
• Maintain positive psychology – consider seeing a performance psychologist
• Sort out other issues in your life