Wessex Intensive Care Society (WICS)

Examination

Nigel Chee's Guide to the FFICM exam - what to expect

Author: Dr Nigel Chee
Follow @nigelchee


What can I add to Dr Wong’s guide?

Having navigated the second sitting of the exam (Sept 2013) I can offer some insight into the consistency of the exam and anything I learnt from the Adrian from the first.

Make sure you budget enough time for the exam. Despite being told it’s aimed at ‘intermediate level’ training, that’s not to say it’s a simple exam. Final FRCA was intermediate level too. Don’t take the exam lightly.

Did I follow Adrian’s approach? In parts - I too did not read Oh’s Intensive Care Manual nor the Oxford Desktop Reference. If you have either of them or the time and want to use if for some core knowledge then I think it would be useful- but not necessary. I read the last two years of relevant
BJA CEACCP journals and the JICS articles as well. The ICS website has some guidelines which are ripe for questions.

In addition to the resources already mentioned,
Crit-IQ was quite helpful as they had a bank of MCQ questions marketed at the FFICM audience and reasonably up to date journal club and podcasts, although you have to pay now for access.


MCQs

Practise, practise, practise…
The Final FRCA RCOA book was helpful, Bennington (the green one) and also the online resources mentioned. Doing them a couple times over seemed to help me. I didn’t notice it being overly anaesthetically orientated, but then they’re both intertwined.

OSCE

The OSCE consists of 13, seven minute stations with a one minute reading time between stations. All stations must be attempted, there are no ‘killer stations’ and the negative marking is not used. There are 12 ‘live’ stations (marks counting towards the final mark) and one station used for validating new questions (the test station). Neither the examiners nor the candidate will be made aware of the test station, therefore all 13 stations must be approached equally. The examination draws questions from four different areas, Data, Equipment, Professionalism and Resuscitation.

After the first sitting of the OSCE Crit Eye wrote in the Aug 2013 edition,

‘Examiners found that the weakest examination stations were those involving ECG and X-ray interpretation. It would be our intention to continue including such stations in future examinations in an attempt to improve standards in these areas.’

Pay heed to this - in my OSCE about half the stations were ECG or radiology related (including trying to identify the compartments of the calf). The imaging quality has improved and there weren’t any grumbles about poor quality radiology.

My only other advice is to remember the basics - e.g. for a procedure related station -
‘Introduce yourself, get consent from patient/ full monitoring/ staff/ resuscitation equipment available etc..’ they are all ticks on the mark scheme. Also try to keep talking (bullet point answers sometimes required) - once the examiner has moved on, you can’t go back to get marks. Don’t waffle prose in the OSCE, there simply isn’t time for you to mention the latest article or esoteric origins of the disorder/ case.

Structured Oral Exam (i.e. the Viva)
You should all have experience in these exams by this sitting. My advice (which I wish I’d taken) would be to get into small groups and practice viva-ing each other or get a consultant to do this. Skype/ FaceTime vivas work too. The essence of which is to get practised at talking and structuring your answers again. Depending on your department, organising practise session may not be so easy so definitely start early.

Courses

I did not attend any MCQ courses for this exam, for the 2nd part I did attend the PINCER course held in Portsmouth - which I found invaluable. Highly recommended.

On the day

So what’s my recollection of the OSCE/Viva?
Well, it began in a hotel room just off Bloomsbury Square. Suited and booted it was a quick walk to the college where I signed in, picked up my candidate number and then fumbled for a £1 coin to use in the locker rooms downstairs. Back in the foyer, now wearing a classy ‘wristwatch locker key’ I nervously acknowledged the presence of the other warriors. There were 8 of us in total; some looking relaxed and chatting whilst others were a little more pallid. Fifteen minutes before the Viva, we were greeted and had the rules of the day read out to us. We were then ushered up to the second floor where we sat with plastic cups of water awaiting further instruction - this is your last time to go to the bathroom before the start.

The exam room has two parallel sets of stations lettered A-D. Starting at your designated station, you have two vivas (7 minutes each) per station before the bell rings and you move on. The stations are partitioned off from one another and pinned to the outside of each station is a sheet of paper with the heading of each viva topic. This may give you some valuable organising time in your head or stress you out even more. Either way forewarned is forearmed. At the bell, you enter the cubicle with a desk and two examiners +/- an observer. After a brief meet and greet you sit down and wait for the fun to begin. Remember to smile.

The examiners are usually quite friendly and will not set out to trip you up. If you have a disaster station you should block it out; I’m not sure how exactly - but like being dumped for the first time, it hurts but move on. You can score a zero for a question scrape a 1 in another and still pass, so don’t give up whatever they throw at you.

Before the OSCE we were again taken to a room where we were briefed and given our starting station number. Each station is numbered and you rotate around. There maybe reading material before you enter, so have a look around. The afternoon was a little tiring and it’s difficult to gauge how you’re doing. In some stations you’ll be pushed to finish whilst others they’ll be time for small talk afterwards. After a gruelling afternoon, you may customarily find yourself at the Square Pig across the road.

For any further information please email me:


Good Luck!

Nigel


Declaration of interest from webmaster: Steve Mathieu who edits the WICS website is also a co-director for the non-profit PINCER course and is an ICM consultant in Portsmouth (Wessex). He has not contributed to or influenced this guide. There is also (amongst other) courses, the ICS national revision course and details for this can be found on the ICS website
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Adrian Wong's Guide to the final FFICM exam - an update

new update copy



Well, Christmas means that 2013 is coming to an end, my relief at passing the FFICM has since been eclipsed by passing EDIC and finally 2014 beckons. Since publication of the initial exam guide, there has been another sitting of the FFICM exam and this forms an update to the original guide.

The detailed analysis of the first sitting has also been published in the
FICM’s Critical Eye magazine . I strongly suggest anyone planning to sit the exam to read it. I’m somewhat bemused that some colleagues have never heard of Critical Eye. Also read the FICM’s guide to the exam

So what does the FICM say? I've quoted the above reference and provide my intepretation on what this means if you are preparing to sit the exam.

As before, please 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

ST7 Anaesthetics/Intensive Care Medicine
BSc (Hons) MBBS MRCP FRCA FFICM EDIC
Email –


Follow @avkwong


MCQs

The MCQ was held on 9th January. 79 candidates sat the exam, of whom 62 passed (78.5%). 55 (88.7%) of these went through to take the OSCE/ SOE part of the examination. The MCQ pass mark was 75.78% which was reached by Angoff referencing, carried out by a dedicated MCQ Angoff group. The Angoff score was adjusted by the use of a Standard Error of Measurement to allow for the borderline candidates.

The exam achieved a Kuder-Richardson (KR-20) score of 0.718, which is considered reasonable and comparable to FRCA Final MCQ exams. The box plot in Figure 1 indicates that candidates scored consistently as a cohort with a standard deviation of 14 marks (3.12%); only two candidates scored low outlying scores (there were no high outliers). The mean score was 77.74% (349.8 out of 450). The average age of candidates at this sitting was 34.2 years; this was slightly lower for those who passed (34) and slightly higher for those who failed (34.9). Figure 2 shows the distribution of candidates’ ages. Figure 3 indicates that the majority of candidates at the exam were of a white ethnic origin (81%); 12% of candidates did not specify their ethnicity.

I am not going to comment on the age and ethnicity issue.

For a medical exam, the pass rate for the first sitting was high (78.5%). If you passed the MCQs, you had a good chance at passing the SOE/VIVA section- hardly surprising. My reading of the narrow box plot of the scores is that is a fair exam. There were few outliers suggesting that the majority of candidates performed to the same standard.

Perhaps most importantly, the report has made reference to the FRCA Final MCQs! As I have previously said, the FRCA exams are a ready pool of tried and tested questions for UK ICM. It would be wise to practise these.

SOE/VIVA

In order to assist with the standard setting of the SOE exam, Angoff and Ebel standard setting methods were carried out by the SOE Core Group two weeks before the exam using the questions set for the exam. The Linear regression and Hofstee calculations were plotted against exam data post-exam. All statistical analysis was made available and was discussed by the Court of Examiners; the final pass mark of 26 was reached through a combination of statistical analysis and expert judgement after consideration of borderline candidates. This pass mark matched the score obtained from the Hofstee calculation.

Eight candidates failed the SOE, four candidates on each day and therefore failed the examination overall. All fail scores were closely grouped in a range of 22–24; no candidate scored 25. It is also noticeable that all candidates who failed received a low overall global score with the majority receiving scores below the minimally competent.

Figure 4 indicates that there was not a great deal of correlation between scores achieved in the three exam components. This is reassuring insofar as it suggests that the three components are testing different abilities in the candidates.

Therefore 47/55 (85.45%) passed the SOE component. Of the 47 who passed 20 (42.5%) achieved maximum marks of 32, which is an indication of the high calibre of candidate attending this exam.

All OSCE questions were Angoff referenced by the OSCE working party in advance and a cumulative pass mark of 146/240 and 147/240 was reached for the questions sets used on each day of the exam. The Court of Examiners looked at various methods of supportive statistical analysis of the exam data post examination but none of the findings were conclusive. It was therefore agreed that the pass marks reached by the working party were set in good faith using the approved Angoff procedures and therefore should stand.

All 55 candidates (100%) passed the OSCE component, once again a reflection of the high calibre of the candidate cohort. Therefore 47/55 (85.45%) achieved a full pass in
the Fellowship of the Faculty of Intensive Care Medicine examination.

The range of topics covered on both days was considerable. The list below is not fully comprehensive but does give a flavour of the topics covered: Rhabdomyolysis; Diabetic emergencies; Fluid responsiveness; ALI / ARDS; Rehabilitation after ICU; Status epilepticus; Eclampsia; Necrotising fasciitis; Nutrition; Hyponatraemia; Ethylene glycol poisoning; CVC insertion; Anaemia on the ICU; Pancreatitis; Non-invasive ventilation; Endocrine abnormalities on ICU; Ventilator associated pneumonia; Resuscitation; Heparin induced thrombocytopenia; Communication with ICU patient relatives; Plasma exchange; Assessment of delirium; Scoring systems; ECG interpretation; Guillian Barre syndrome; Abnormalities of acid base balance; Tracheostomy; Interpretation of X-rays.As is evidenced by the high pass rate, the questions were handled well overall. However, the Examiners found that the weakest examination stations were those involving ECG and X-ray interpretation. It would be our intention to continue including such stations in future examinations in an attempt to improve standards in these areas.


Firstly, the candidates who failed the exam failed in the SOE component. The passmark was set at 26 out of 32 (81.25%). It is possible to score full marks – over 40% of candidates did. Unfortunately we had 2 colleagues who failed (they have since passed) on the first day. Speaking to them, they maintained that the questions were fair although one of them was particularly agrieved by the discussion on the physiology of the sympathetic nervous system.

The passmark for the OSCE was approximately 60% and all candidates were successful. I thought this was on the low side for medical exams but on the day, I was convinced that if I had failed, it would have been in this section. On several occasions, it was difficult to tell what the examiners were trying to get at but the topic itself was fair.

Note the comment on X-rays and ECGs! This was indeed the case in the second sitting. Due to the nature of an OSCE setting, there is little room for discussion, you either know what the radiograph showed or you didn’t. Remember, you can’t go back to a question you skipped in the OSCE.

Whilst the range of topics examined was considerable, they were hardly surprising – the exam is meant to reflect the day to day work on a General Intensive Care unit.

Conclusion

Again, I must emphasise that this guide is a strategy for passing the exam, and NOT a guide to clinical practice.

IF I were sitting the exam, I would:

  • MCQs – practice from the FRCA database e.g. AnaesthesiaUK, Crit-Iq
  • SOEs/OSCEs – practice, practice, practice. Speak to colleagues who run anaesthesia courses. There are overlaps.
  • I still wouldn’t read Oh’s Textbook or Oxford Desk Reference.
  • FFICM courses are starting to spring up. I can highly recommend PINCER and the Oxford courses.
  • Read FICM’s Critical Eye and the Journal of the Intensive Care Society. They are UK-based resources from the relevant bodies.



YOU WANT MORE? READ NIGEL CHEE'S INSIGHTFUL VIEWS ON HIS EXPERIENCE AND WHAT TO EXPECT ON THE DAY
HERE!

Declaration of interest from webmaster: Steve Mathieu who edits the WICS website is also a co-director for the non-profit PINCER course and is an ICM consultant in Portsmouth (Wessex). He has not contributed to or influenced this guide. There is also (amongst other) courses, the ICS national revision course and details for this can be found on the ICS website

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