Wessex Intensive Care Society (WICS)

Guide to the Final FFICM Examination

Know your enemy and know yourself and you can fight a hundred battles without disaster
Sun Tzu, The Art of War
The views expressed here are my own and not that of any organisation. It’s meant to be a guide on how I successfully tackled the unknown entity that was the inaugural FFICM exam (and not how to practice ICM). A bit of background, I completed my MRCP and FRCA before sitting the FFICM. I haven’t got a clue about the ins and out of the FCEM/MCEM exam and thus the transferable resources.

In each subsection, I have included the description of that part of the exam as taken from the
Critical Eye followed by my approach to it.

Please do feel free to contact me if you have any further questions, comments or discussions.

Adrian Wong
It’s the Wong way or the wrong way
ST6 Anaesthetics/Intensive Care Medicine
BSc (Hons) MBBS MRCP FRCA FFICM
Email –

Twitter -
@avkwong
General Advice

I
did not read Oh’s Intensive Care Manual or the Oxford Desktop Reference at all. We all know that in the constantly changing world of medicine, information goes out of date exceedingly quickly. Whilst these textbooks are excellent references, there are many more simple-to-read articles readily available.

The new world of ICM in the UK will comprise of trainees from a variety of parent specialties as well as run-through trainees. However, there is no denying that training in ICM has been engrained in Anaesthetics for decades. Hence, all I read were the
British Journal of Anaesthesia Continuing Education in Anaesthetics Critical Care and Pain supplement (BJA CEACCP) and the Anaesthesia Tutorial of the Week (ATOTW) articles. Not only did they cover the necessary clinical subjects, they also covered the relevant basic sciences (sorry, there is no escaping this). Another area that is covered are summary of the important guidelines relevant to ICM e.g. CMACE, NICE, BTS. Google is obviously your friend when it comes to filling in the gaps.

When it comes to keeping up to date, again technology and social media are your friends. I subscribed to
Critical Care Reviews. Every Sunday, Rob sends out a summary of all the relevant trials and their results. There is also a list of the Top 100 Trial in ICM on the website. Personally, I don’t think you need to know all the little details regarding methodology, statistical analysis, etc of all the trials. You will however be expected to know about the “essential” ones e.g. HACA.

MCQs
90 True or False questions. No negative marking.

The MCQ component of the examination is completely new and needed to be developed from scratch. We were allowed access to the Final FRCA database to select and rework questions that could be used for ICM but the majority of our questions are completely new, having been written by the FFICM examiners. Examiners formed groups of three or four and were allocated two domains of the CCT curriculum to base their questions on. Prior to submission they were peer reviewed by the MCQ core group members. Once all questions were received the MCQ core group checked them for errors of fact etc. Some of the questions were deemed to be better developed in a different format – Single Best Answer (SBA) – and were therefore excluded but will be eventually re-formatted to this style. With the adapted questions from the FRCA this has left over 300 MCQs to enter into the new database which has just recently been completed and the questions are being formatted to fit into the requirements of the optical mark reader system used by Speedwell.

The MCQ core group is currently exploring other types of questions. We have SBAs to develop and will introduce these to the exam in 2014. We are also considering Extend Matching Questions (EMQs) but at present it is not clear if we will be able to use them.

The pass mark for the MCQ exam is set using the Angoff reference method and adjustments are made for the borderline candidate using methods approved by the GMC.

The format of this part is going to change. The dreaded best-of-five styled questions will be introduced in Summer 2014 although the extended matching styled questions will not be. Like most medical MCQ exams, practice makes perfect. I have always used MCQ books to guide my reading prior to all my MCQ exams (almost to the exclusion of reading textbooks). There is a definite knack to tackling MCQs. You know you are ready when you can predict the options and the reason behind them after reading the question.

There was no MCQ database available for this exam. However, the FICM openly admits that they borrowed from the RCoA database and made modifications. Hence, my advice is to practice using FRCA MCQs. The RCoA e-learning website (access restricted to anaesthetist) has an extensive database as do Anaesthesia-UK (open access). There is obviously the Bennington book but I felt that the questions were more reflective of the FRCA questions. Another source of questions is the
BJA CEACCP.

SOE
4 stations. 2 examiners with a set of questions each. 7 minutes per examiner. 1 minute between stations.

The SOE core group are working up new questions and modifying those previously used in the old DICM. The format of the questions will be broadly the same as the DICM although the mode of the examination will be more like an OSCE as the candidates will move between stations and will be asked questions on the one subject at each station. A notice outside each of the station will highlight the topic to be covered in the station. The reasoning behind this way of conducting what is effectively a usual structured oral examination is to expose the candidates to the maximum number of examiners as possible. Following on from the principle of the ‘home ICU’ the questions are those that may be asked during a ward round or teaching session or journal club at any ICU in the UK. They test knowledge of the principles behind the work we do.

The examiners are all practicing intensive care clinicians. Candidates are all asked precisely the same questions. There is no negative marking and candidates are
expected to give clear and concise answers.

The examiners will use a three point grading system with marks allocated as follows:
Pass = 2,  Borderline = 1,  Fail = 0.

There are eight questions in total, with two examiners marking each question, 8x2x2 = 32 marks available in total.  The pass mark will be set using methods approved by the GMC and will be in the range of 80% - 85% which is in line with all other Medical Colleges and Faculties.

A well-organised viva with suitably chosen examiners can be enjoyable, making it feel like a genuine discussion between clinicians. The FFICM examiners were pleasant and not intimidating.

It is often difficult to get true viva practice in a day-to-day working situation, even with CEX and CBDs. I’ve had the benefit/pleasure of sitting viva styled exams in the MRCP and FRCA along with the various exam courses leading up to them. Perhaps I have found a style of being vivaed which works for me. For those of you who haven’t experience such an exam format, you need to practice!

During the exam, there will usually be questions to which you do not know the answer/know enough to hold a conversation- the process of talking through one's chain of thought is much more productive than failing to say anything at all. You are allowed to ask for clarification if you don’t know what they are getting at. I’ve been told by colleagues that this bit of the exam is no longer as flexible as the old-styled DICM or indeed the EDIC 2.

The questions were all very relevant and reasonable. The level of knowledge was set at that required of a registrar in order for him/her to manage an ICU safely and effectively or until help arrives.

OSCE
13 stations. 12 “live” and 1 test station. Neither examiner or candidates know which is which. No killer station. 7 minutes per station. 1 minute between stations

The aim of the Objective Structured Clinical Examination (OSCE) component of the new FFICM examination is to recreate a ‘normal working day’ on duty for the Intensive Care Unit (ICU). In a normal working day, a trainee will manage a number of medical and surgical patients with an interesting variety of problems. During any typical normal working day, trainees review patient history, perform physical examination in a systematic yet focused manner, interpret data from monitors and investigations (most commonly arterial blood gases, laboratory data, electrocardiograms, chest X-rays and CT scans), plan patient management and perform a range of procedures. The trainee may be called to deal with life-threatening emergencies anywhere in the hospital. Back in the ICU, the trainee will communicate with patients, their relatives, the supervising consultant and the multidisciplinary team. In addition to the diagnostic and therapeutic skills already listed, the trainee is expected to ensure that care is delivered in a compassionate and professional manner, including at the end of life. The breadth of knowledge and skills required is set out in the syllabus.

Candidates will be given the opportunity to demonstrate a selection of the required knowledge and skills in the OSCE component of the examination. The OSCE is a development of the clinical viva component of the old DICM. In this viva, common and important clinical problems were discussed. The viva was based on clinical history, examination findings The OSCE format allows a slightly broader range of clinical questions. To use tension pneumothorax as an example, a candidate may be asked to examine a mannequin representing a ventilated patient. This is probably more valid than being told a list of physical examination findings.

Actors, equipment, data and both part-task and whole patient simulators will be used to recreate a ‘normal working day’. When candidates are expected to examine a patient, perform a task or demonstrate communication skills, clear instructions will be given.

Each station is marked out of 20 with the pass mark for each station being determined by the Examiners before the examination, using the Angoff Referencing method. The pass marks for each of the 12 'live stations' are summed to obtain the pass mark for the whole examination.

I found this section more challenging than the SOEs. As described above, the questions/scenarios/stations are meant to reflect an ordinary day at work. I can honestly say that in my exam, this was indeed the case. The breadth of knowledge required is considerable but as with the SOEs, they were all relevant. Unlike SOEs though, there is no talking/discussing, you either knew the answer or you didn’t.

Mock OSCEs from the courses I attended had a few unmanned stations with just the relevant props and the question/answer sheet. This was fundamentally different in the actual exam where all the stations had an examiner. Hence, the real exam felt like a quick fire SOE with an examiner. Another important difference is that in an unmanned OSCE station, you are free to move back and forth between the list of questions. With the presence of an examiner, this is no longer possible. Once you‘ve moved past a question, there is no going back. If you take too long to answer a question, you will run out of time.

Having sat the FRCA, this style of exam was not foreign to me. If you haven’t sat an OSCE-styled exam, courses such as the Oxford and PINCER course do incorporate excellent mock circuits.

Courses

I have never found much benefit from MCQ preparation courses and therefore did not attend any. In the run up to the SOE/OSCE exam, there were three FFICM courses available in the UK. I don't believe anyone else in the country had the opportunity to attend all three available courses. A brief description of each to help you decide which on is for you.
ICS FFICM Course (www.ics.ac.uk)

Run at the ICS by the same group that organised the Bristol courses. The day was divided into 2 parts. The morning compromised a series of lectures, which covered the main topics in ICM. The afternoon was spent rotating around several viva stations in pairs. I have included a copy of the programme from this year’s course.
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Portsmouth INtensive Care Exam Revision (PINCER) Course wessexics.com

A much more exam orientated course. No lectures. An entire morning spent on 2 OSCE circuits under examination time conditions. The afternoon was dedicated to the SOEs with candidates moving in pairs. By the end, each candidate would have faced 4 full SOEs and had the opportunity to listen in on another 4. The day is rounded off with an extremely useful “Hot Topics” lecture.
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Oxford FFICM Course

Again, an exam orientated course. No lectures at all. Again a morning of OSCEs and an afternoon of SOEs. All under actual exam timing of 7 minutes each.
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Summary
  • Don’t rely on textbooks. I used free online resources
  • Practice lots of MCQs for the MCQ bit.
  • The OSCE is just a quick fire SOE with a simulator and communication station thrown in.
  • Exam courses are available and I would personally recommend PINCER or Oxford.
  • It is a very passable exam!! See you on the other side.
Resources

Anaesthesia Tutorial of the Week
British Journal of Anaesthesia: Continuing Education in Anaesthesia, Critical Care and Pain supplement
Critical Care Reviews
Anaesthesia UK

Courses

PINCER Course
Oxford FFICM Course
NICERC Course
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Read Adrian Wong's update to his popular guide to success in final examination here
Some new additions include:
- tackling the MCQ
- what's changed since the inaugral exam?


- Still not reading Oh's!
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Read Nigel Chee's insightful views and top tips for the final FFICM exam here
Nigel successfully sat the exam in September 2013. Read about the structure of the day and mentally rehearse by reading his blog

…and he didn't read Oh's either!

This page was last updated on Wednesday, July 06, 2016 14:44