Resources for Candidates
ICM Curriculum Syllabus
The assessment blueprint for the new 2021 ICM Curriuclum: Supporting Excellence can be found here. However, we appreciate that more detail would be useful for exam revision and an updated exam syllabus for the new ICM Curriculum is in development.
In the meantime, candidates may wish to refer to the 2010 curriculum syllabus that demonstrates the areas of the curriculum examined in the FFICM (e.g. items marked with an 'E'). This syllabus can be used by trainees and trainers to aid reflective learning, formal teaching and to guide some aspects of assessment.
Standard Setting in the FFICM Examination
A group of subject-matter experts judge how difficult each item is in an exam. This produces a defined absolute ‘pass mark’ standard, based on the questions. The Angoff method is widely used in high-stakes exams such as OSCE and MCQs.
The experts consider each item and how likely a borderline (or minimally competent) candidate is to answer each item correctly, and then allocate a probability of this borderline candidate answering correctly. A ‘borderline’ candidate is one who has completed the required training, has an average amount of knowledge and has done a reasonable amount of exam preparation, and who has a 50% chance of passing the exam (and 50% chance of failing).
Borderline regression is an examinee-referenced standard setting method, which uses a global score, based on the examiner’s judgement of each candidate’s performance during the exam. It is also a well-recognised widely used method of standard setting in high stakes exams.
A candidate is awarded marks for their answers to items within the question, then a ‘global score’ for overall performance in the question. Examiners agree the definition of the points of the global score in advance (e.g. score 1-5 with 3 as ‘borderline’).
A graph is then plotted of marks against global scores and a line of regression is drawn. Where the regression line intersects ‘borderline’ indicates the pass mark for the exam.
The MCQ paper pass mark is set by the MCQ sub-group examiners. The Angoff method is applied to each question individually. These scores are then weighted, because ‘long’ single best answer questions are worth two marks compared to ‘short’ single best answer questions. The paper pass mark is the sum of the weighted individual question Angoff marks. Because of the small number of candidates taking this exam, (which is a ‘gateway’ to the oral components), one standard error is then subtracted to arrive at the final MCQ paper pass mark. This subtraction works in favour of a candidate who has scored just below the calculated pass mark; however, it does lead to a few candidates who have not demonstrated the required knowledge progressing to the oral components of the exam.
Each OSCE question has a number of sub-questions, with a total of 20 marks available for each question and 12 questions per exam. The test question does not contribute to the candidate’s score. The Angoff process is carried out by the OSCE sub-group examiners, who apply the process separately to each mark within each question. The Angoff mark for a question is the sum of the Angoff scores for each mark within the question, and the pass mark for the OSCE exam is the sum of Angoff marks for the questions it contains. As each question has an individual Angoff mark, if more difficult questions were to be selected into an exam, then the pass mark for that exam will be lower.
SOE questions are subjected to an Angoff process (undertaken by the SOE sup-group of examiners) in order to establish the question difficulty; this is to aid question selection but is not used to establish the pass mark.
Borderline regression is used to establish the pass mark for the SOE exam. Each examiner awards a separate score for a candidate’s answers to the two questions in that station, then awards an overall global score for their performance in the station. The total score for a candidate in the exam is the sum of individual question scores. The pass mark for the exam is determined by borderline regression of the question scores against global scores for all candidates.
Past Topics and example questions
Please find below in the related downloads section, information releases concerning previous exam round topics and examples questions.
Guidance on answering ECG and Imaging questions in the FFICM OSCE
Candidates are expected to be able to interpret a wide range of ECG abnormalities, as might be present in patients in or referred to a general critical care unit, as well as cardiac critical care and PICU.
When the examiner asks for a ‘report’ or ‘systematic report’, a full report is expected.
This should include
- Patient name/ date of birth/ number (or absence of these)
- Date of investigation (or absence of this)
- Comment on paper speed and calibration
- Rhythm, rate (approximate rate is acceptable), axis
- Any abnormalities of PR interval, ST segment, QT interval
- P wave, QRS, T waves – any abnormal features
- Lead location of any abnormalities (e.g. Q waves or ST segment elevation)
- Presence of ectopic beats or beats that are different to the others
- Presence of other abnormalities e.g. J waves, pacing spikes etc
Having described these features, the candidate should then interpret the important findings, i.e. conclude what these descriptive features mean.
If the examiner asks for ‘abnormal findings’ then a full report is not required, just an identification of the specific abnormal findings.
If the examiner asks for ‘interpretation’ then a conclusion is required. For example, the abnormal findings of ST segment elevation in leads II, III and aVF leads to the conclusion of acute inferior myocardial infarction. Be as specific as is possible e.g. including ‘acute’ and ‘inferior’.
Candidates are expected to be able to interpret a wide range of relevant radiology investigations, as relevant to patients on or referred to critical care units (including PICU, cardiac ICU and Neuro ICU). These can include plain radiographs (e.g. chest, thoracic inlet, abdomen, neck, limb), CT (head, neck, thorax, abdomen, limbs, including reconstructions).
Where MRI, interventional angiography or radioisotope images are used, these will be straightforward images only. Only one or two images from a series will be shown (e.g. CT scans) that have been selected to show the relevant anatomy or feature(s).
Single images or short videos of echocardiography or ultrasound may be included. These will be normal or straightforward abnormalities, such as those obtained by a FICE-accredited practitioner in a bedside study or similar (e.g. echo of ventricular function, filling status, valve abnormality, size of the heart, any kinetic or dyskentic segments, pericardial effusion with or without evidence of tamponade, ultrasound of abdomen chest vascular access).
If the examiner asks for a report or a systematic report of a chest x-ray, then the following should be included. Note a report will only be asked for when a complete examination is present in the exam (e.g. chest radiograph) and not when a single ‘image’ from an investigation that contains multiple images (e.g. CT) is used.
A report for a chest radiograph should include:
- Name, date of birth, number (or absence of these)
- Date of image (or absence of this)
- Comments on other relevant available details e.g. mobile/antero-posterior (AP) projection etc.
- Adequacy of image, penetration, rotation
- Systematic review and comment of all areas including;
- lung fields
- trachea and airways
- mediastinum and heart shadow
- diaphragm, costophrenic angles
- areas below the diaphragm
- ‘hardware’ visible e.g. nasogastric tube and the position of the tip, surgical clips
- Anything else abnormal
If the examiner asks for ‘main abnormalities’, or ‘important findings’, a full report is not required, only an identification of what is abnormal on the image (or that the image has no abnormalities) or what is relevant to the clinical details of the question.
Topics From FFICM Chair Of Examiners Reports That Have Previously Scored Poorly
- ECG analysis
- Basic sciences - sodium
- Never events
- Pulmonary hypertension
- Venous oximetry
- Environment hazards in the ICU
In this exam, ECG analysis was felt to be poor, with a number of candidates not using a systematic approach (so missing areas such as rhythm rate axis) or missing abnormal findings. Radiology, in particular chest radiograph analysis was also felt to be weak for a number of candidates. These topics are noted to be done poorly by a number of candidates in each of the recent exams.
Many candidates had difficulty with the questions relating to the Stage 2 curriculum such as pulmonary hypertension, venous oximetry, brain stem death testing and with also with the applied basic sciences parts of questions such as sodium homeostasis and pharmacology of common ICU drugs.
Many candidates found the questions which did not relate to a specific clinical presentation challenging e.g. never events and environmental hazards in the ICU.
Examiners also noted that some candidates would likely score more marks if their answers had been more precise, e.g. saying ‘hospital acquired pneumonia’ instead of ‘infection’ when a diagnosis is requested.
- Basic sciences
- Radiology interpretation
- Lack of systematic description of radiology images and ECGs
- Non-invasive ventilation
- Dermatology as relevant to ICM
- The coroner/procurator fiscal’s process
- Communication with simulated relatives or patients – candidates would benefit from teaching and feedback in the workplace on these skills.
Examiners noted the lack of systematic description of radiology images and ECGs. It was, however, noted that some candidates did this very well, while others still missed marks by omitting this.
- ECG interpretation, including basic rhythm analysis
- Chest Xray interpretation
- Applied basic sciences, including abdominal anatomy and physiology of cardiac output
- Knowledge of relevant microbiology and antibiotics
- Critically ill obstetric patient
- Practicalities of oxygen and CPAP therapy
- Renal replacement therapy, in particular the circuit components
- Ethical issues in resuscitation
Marks are lost by stating ‘ask another specialty’ in answer to some questions eg ‘ask a microbiologist’ on antibiotic choice, ‘ask a nurse’ on set up of CPAP; while involving the multidisciplinary team is clearly important; candidates are expected to have an understanding of the management of all relevant ICU conditions and therapies.
Marks are lost by using casual, inaccurate terms and not then clarifying, such as ‘use electricity’ when ‘DC cardioversion’ was required.
Many candidates found the following areas challenging;
- ECG interpretation, including basic rhythm analysis and chest x-ray interpretation e.g. applying basic sciences, including abdominal anatomy and physiology of cardiac output.
- Knowledge of relevant microbiology and antibiotics
- Renal replacement therapy, particularly its circuit components and on chronic critical illness.
Examiners also noted that some candidates were not able to answer the questions on a critically ill obstetric patient that included recent national guidance and practicalities of oxygen and CPAP therapy.
- Basic sciences- pharmacokinetic principles, mechanisms of action of inotropic drugs, lactate production
- ECG atrial flutter, atrial fibrillation and ventricular fibrillation
Examiners noted that many candidates were weak in basic sciences where they were not able to answer questions on pharmacokinetic principles, mechanisms of action of inotropic drugs and lactate production. They also observed candidates unable to recognise common abnormalities in the ECG station. Atrial flutter, atrial fibrillation and ventricular fibrillation should be basic knowledge for a trainee intensivist.
Candidates failed to consider and recognise sepsis, where they stated they would offer antibiotics to a simulated patient suffering from sepsis which concerned the Examiners.
In the simulation station some candidates performance was below a level that would be expected in ALS training.
- Osmolality, osmolar gap, hyperosmolar hyperglycaemic states
- Basic structure of proteins, protein requirements in the critically ill
- Oxygen, hypoxaemia and oxygen delivery
- Hypercalcaemia and calcium homeostasis
- Amniotic fluid embolism
Examiners noted that candidates were struggling with discussing the following topics;
- Osmolality, exploring osmolar gap and leading to a discussion on hyperosmolar hyperglycaemic states.
- Basic structure of proteins leading onto protein requirements in the critically ill; oxygen, hypoxaemia and oxygen delivery and hypercalcaemia and calcium homeostasis
- Clinical conditions should be expected to be explored in depth even if rare such as amniotic fluid embolism which was covered in the exam.
- Many candidates seem to have received the message about structuring their description of images and ECGs but there were still those losing marks for not referencing basic information such as name and date.
- Communication – using medical jargon when talking to simulated relatives or patients
- Bowel management systems
- Short bowel syndrome
- Acid base balance
- Basic science relevant to clinical practice
Visitors who observed the ECG, simulator and communication stations highlighted the following;
- Candidates were finding assessing ECG’s difficult. It was suggested that candidates were looking for complicated diagnoses and so missing simple ones such as atrial fibrillation. They noted on occasions there would be a positive finding of minimal significance, such as a small subdural haematoma, that appeared to stop the candidate searching for the real problem.
- Candidates were improving on the Communication Station but some were still inclined to talk in jargon. Although working with members of the public on a daily basis they seem to forget that it is unreasonable to expect the public to have a knowledge of technical terms. Candidates entering the communication station in the OSCE exam may be introduced to a scenario that includes a simulated patient or relative and asked to talk to them. The examiner may say nothing and simply observe. Candidates would do well to remember that the exam uses actors who are members of the public and do not have to act when they profess not to understand what is said to them unless it is in plain English. It is not uncommon to hear the simulated patient ask for a term to be explained such as non-invasive ventilation, tracheostomy, vascath, inotrope or filtration.
Examiners noted that candidates were struggling with discussing the following topics;
- Bowel Management systems such as Flexi-Seal. The candidates, should be aware of the risks and benefits of such systems.
- Dealing with problems experienced by patients with short bowel syndrome. These patients often need critical care support and can be difficult to manage.
- Acid base balance. The content was mainstream and not well answered by candidates. It is important that candidates are familiar with basic science relevant to clinical practice.
FFICM Exam Prep Course
The Faculty has run an FFICM OSCE/SOE Examination Prep Course since 2015, to assist the trainees in preparation for the exam.
The course includes a series of small group workshops, lectures and all-important OSCE and SOE practice sessions with feedback.
Please note that this course is intended for ICM Trainees, Members and Affiliate Fellows who are preparing to sit the FFICM OSCE/SOE, having completed the FFICM MCQ. There will be no FFICM MCQ preparation during this two day event.
Further details of the next scheduled course can be found on the Events page.
There are numerous independent resources available to assist candidates with exam preparation, many of which use in their title or advertising literature the post nominals FFICM. We wish to make it clear that these are independent resources and are not affiliated with the Faculty of Intensive Care Medicine and consequently the Faculty accepts no liability for the accuracy of any examination related content which they contain.
- The Bottom Line - A compendium of appraised landmark papers in critical care from a team predominately based in the UK. Contains previous exam questions and answers, and a library of core topics in CCM.
- Critical Care Northampton.com - From Northampton, a website containing a huge amount of information including drug formularies, medical calculators and guidelines to use in every day practice. Also contains exam resources including infographics and podcasts.
- Crit-IQ - This learning resource makes staying up to date with the latest literature easy and is accredited by the College of Intensive Care Medicine of Australia. Podcasts, vodcasts and modules will appeal to all levels of clinician, and they provide an extensive range of exam resources.
- Deranged Physiology - Australasian resource aimed at the CICM part 2 exam, with a slant towards physiology.
- EMCrit Project - American website created by ED Intensivists. It features evidence-based information from the fields of critical care, resuscitation, and trauma. Every two weeks they post a full 20-minute podcast and in between, the site gets filled with blogposts, links, and EMCrit Wees (minature podcasts). They also have an “internet book of critical care”.
- European Society of Intensive Care Medicine (ESICM) - Information on courses, webinars and an e-learning programme (formally the PACT programme). Requires membership to access.
- Intensive Care Network (ICN) - Australasian website producing podcasts, blogs and exam resources for Anaesthesia, ICM and Emergency Medicine.
- Intensive Care Education & Training (ICET) NEPEAN - From Nepean Hospital in NZ, a website contains areas on critical care education with videocasts on a variety of topics including POCUS.
- Life in the Fast Lane - Australasian website produced by physicians and AHPs. Contains sections on clinical conditions, ECGs, ultrasound and self-assessment questions relevant to intensivists.
- Neuro ICU Guru - Neurocritical care resources, education and protocols from the team at Salford Royal Hospital.
- Portsmouth Hospitals NHS Trust - Standard operating procedures and guidelines that, whilst specific to Portsmouth, also provide some great bite size revision material.
- PulmCCM - American website that regularly updates on relevant trials in ICM and distils them into readable summaries. Also includes quizzes, reviews on core topics, and links to key guidelines.
- RCEM Learning - The Royal College of Emergency Medicine’s (RCEM) eLearning platform. Whilst some of the content requires RCEM membership to log in (Exam and CPD sections), the remainder is open access and comprises an e-textbook, hundreds of interactive sessions, podcasts, and blogs.
List of books that may be useful for exam revision
- Arora N, Laha SK. The Beginner’s Guide to Intensive Care: A Handbook for Junior Doctors and Allied Professionals
- Bersten AD, Handy J. Oh’s Intensive Care Manual 8e
- Gillon S. Revision Notes in Intensive Care Medicine (Oxford Specialty Training: Revision Texts)
- Hinds CJ, Watson JD. Intensive Care: A Concise Textbook, 3e
- Parrillo JE, Dellionger RP. Critical Care Medicine: Principles of Diagnosis and Management in the Adult, 5e
- Singer M, Webb A. Oxford Handbook of Critical Care 3/e (Oxford Medical Handbooks)
- Vincent JL, Abraham E, Kochanek P, Moore FA, Fink MP. Textbook of Critical Care, 7e
- Waldmann C, Rhodes A, Soni N, Handy J. Oxford Desk Reference: Critical Care (Oxford Desk Reference Series)
- Webb A, Angus D, Finfer S, Gattioni L, Singer M. Oxford Textbook of Critical Care
- Bonner S, Dodds C. Clinical Data Interpretation in Anaesthesia and Intensive Care (FRCA Study Guides)
- Hampton J, Adlam D, Hampton J. 150 ECG Cases, 5e
- Joyce CE, Saad N, Kruger P, Foot C, Blackwell N. Diagnostic Imaging in Critical Care: A Problem Based Approach
- Venkatesh B, Morgan TJ, Joyce C, Townsend S. Data Interpretation in Critical Care Medicine
Exam Revision Aids
- Bellchambers E, Davies K, Ford A, Walton B. Multiple True False Questions for the Final FFICM
- Benington S, Abbas S, Herod R, Horner D. Intensive Care Medicine MCQs
- Davies K, Gough C, King E, Plumb B, Walton B. Single Best Answer Questions for the Final FFICM
- Flavin K, Morkane C, Marsh S. Questions for the Final FFICM Structured Oral Examination
- Hersey P, O’Connor L, Sams T, Sturman J. OSCEs for Intensive Care Medicine
- Lobaz S, Hamilton M, Glossop AJ, Raithatha AH. Critical Care MCQs – A Companion for Intensive Care Exams
- Jeyanathan J, Johnson C, Haslam JD. Viva and Structured Oral Examinations in Intensive Care Medicine
- Jeyanathan J, Owens D. Objective Structured Clinical Examination in Intensive Care Medicine
- Nichani R, McGrath B. OSCEs for the Final FFICM
External Revision Courses
PINCER is an established course run by the team in Portsmouth and Wessex. Click here for more information.
FFICM Examination preparation course held at the John Radcliffe Hospital, more information about the Oxford SOE/OSCE course can be found here.
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