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Guide to the FFICM

FOR ICM Trainees

FFICM Introduction

If you are embarking upon the FFICM then you are most likely an ICM trainee. Although there is wider eligibility for consultant who do some ICM , for those who have done the equivalent of intermediate training or MTI trainees. For full eligibility for the latter categories check the FICM website here. From this point on I will assume you are an ICM trainee.

 

As things stand, dual and single specialty ICM trainees will need to complete this exam during stage 2 of training before entry into stage 3. You will need to have completed Stage 1 ICM and have been issued a stage 1 certificate. This may be changing so keep an eye on it and if you have a compelling reason to do it before you stage 1 certificate arrives then speak to your Training Programme Director. I have heard rumours of people allegedly doing it early….

 

If you have completed stage 1 then you must have done a postgraduate exam such as the primary FRCA, MRCP (UK)or MCEM (Full). That means you know how to complete this sort of exam and basically its more of the same. The only difference is that you're a little older, life may have become busier and more complicated and the grey cells may be fading.

 

The Final FFICM includes three distinct parts.

  1. MCQ

  2. OSCE

  3. SOE

The initial multiple choice exam (MCQ) must be passed before moving onto the Objective Structured Cinical Examination (OSCE) and a Structured Oral Examination (SOE). The OSCE and SOE are taken together down in London at the RCOA. Fortunately if you fail one of these components (the OSCE or SOE) you can just repeat the part you failed which saves you repeating both elements.

 

The examination currently takes place twice a year, although this may change, and is normally at the RCOA in London. There is a paper or online application system via the Final FFICM web page. You should wear appropriate clothes as you would for work for the MCQ and for the OSCE/SOE I would wear suit and tie or equivalent with a view that you may lose the jacket/tie if its boiling.

 

There have been ten sittings of the exam up to October 2017. In July 2017 59% of those who took the MCQ passed, the mark required to pass was 70.64%. Of those completing the SOE 73% passed and of those completing the OSCE 78% passed. Overall 67% passed the combined SOE/OSCE components and achieved the FFICM at this sitting.

 

They have published some new example questions of each component of the FFICM. See here

Currently includes 30 single best answers (SBAs) and 60 Multiple True/False questions, it lasts 3 hours and cost £470 (depending when your reading this this may have changed).

 

You have a maximum of six attempts to pass and a pass lasts 3 years. The tricky part about SBAs is that you get four points for a correct answer and no points for an incorrect answer and often you can whittle them down to two reasonable choices. The MCQs are slightly more straightforward at a mark per correct answer.

 

Of Note from January 2019, the MCQ exam will change to include 50 Multiple True/False questions and 50 single best answers over 3 hours which might make it harder.

 

The FICM website states this about the content of the MCQ

 

the examination tests breadth of factual knowledge in the areas of science applied to clinical practice including resuscitation and initial management of the acutely ill patient; diagnosis, assessment, investigation, monitoring and data interpretation; disease management; therapeutic interventions and organ support; perioperative care; comfort and recovery; end of life care; paediatric care; transport; patient safety and health systems management.' 

 

This is a clinical exam in the same way that the final FRCA is much more clinical than the primary FRCA for those of you who have completed that. There is a requirement to have background scientific knowledge but there is also data interpretation and clinical components making it more relevant to daily practice.

 

There are a three example questions on the FICM website that give some idea of the sorts of questions you may be asked. See here here and here

The FFICM OSCE

This contains up to 13 stations including an unspecified test station that doesn't count toward the overall mark. It is based at the RCOA in London and lasts approximately 1 hour and 45 mins.  

 

This is a traditional OSCE with a bell sounding as you rotate through the different stations, each lasting 7 minutes, followed by a 1 minute information point before entering the next station. There may be a simulator manikin used in one of the stations and there may be a rest station.

 

The exam is designed to test knowledge and skills and cover a broad selection of the curriculum. The four areas of practice used to select questions from include Data, Equipment, Professionalism and Resuscitation. Data interpretation may include ECGs, Echo images, USS chest images, CT images, and laboratory data.

 

From my experience the examiners asked structured questions around the data giving the OSCE the feel of a series of small scale vivas.

 

The examiners reports highlight things done poorly and suggest areas that will continue to be asked, in the 2017 report these included ECG interpretation and presentation of findings, radiology, and calcium.  There are some example questions from the FFICM here and here

Each station is marked out of 20 and your pass mark will be derived from the total of the 12 live stations. All stations must be attempted, there is no negative marking and no ‘must pass’ stations.

 

A pass in the OSCE is valid for two years after which all components of the exam must be retaken.  

The FFICM SOE

This is a structured viva with four stations each containing two questions giving a total of 8 viva questions.

 

Each question lasts 7 mins, with 14 mins in each station with a total duration allowing for moving between stations of 1 hour and 15 mins. There will be two examiners in each station asking the questions in turn and possibly an observer.

 

When I did the exam there were four booths each with a notice outside highlighting what two question topics were going to be asked at that SOE station. There was no long Vignette just topics for example 1. Tracheostomies, 2. Fungal infections in ITU. Im not sure why they tell you as there wasn't much thinking time. There was no long case like the final FRCA exam.

All questions must be attempted and each examiner will independently mark the answer to the question with a Pass (2), Borderline (1) or Fail (0). The pass mark will be determined on the day.

 

A pass in the SOE is valid for two years after which all components of the exam must be retaken.  

 

Again, there is a broad area of the curriculum that can be covered and there may be some data interpretation involved in the answers with a focus on a clinical problem. There are some example questions from the FICM here and here

Why embrace the FFICM?

If your one of the chosen few who has the pleasure of training in ICM (tongue firmly in cheek), or just a glutton for punishment who is eligible to apply then the FFICM is on your must do list.

 

With the knowledge that completion is mandatory then I would say the best approach is find a time in your life when its not impossible and then fully embrace it. 

 

Undoubtedly, it's a hassel, its expensive, your probably more tired now than when you did your last exams, you may even have children or enjoyable time consuming hobbies, it's the last thing you want to do when all your colleagues have celebrated doing there last professional exam ever. 

 

However as annoying as it is, the old adage that your first chance at passing is your best chance, is probably true. More vitally, this time in your life is too important to waste by repeating this over and over. Having revised for and completed the FFICM I honestly feel my relevant clinical knowledge was better than before embarking upon the exam and this has only got to be good for patient care and the credibility of our specialty.

 

As much as nobody likes an exam other specialties have exit exams to prove that they have the knowledge to provide expert opinions. So embrace the pain and read and learn about stuff that matters to you and your patients, become the expert you want to be, and hopefully that will be enough to pass the exam.

 

Remember by this stage you know most of it already, its just time to refresh and fill in the gaps.

Past Exam Questions for the FFICM

The faculty have produced a selection of example questions for each part of the FFICM exam. The Scottish Intensive Care Society have also produced a list of previous exam topics from some years back. These would be a good starting point when considering topics to choose. 

Faculty of Intensive Care Medicine official example FFICM exam questions 

FFICM MCQ

FFICM OSCE

FFICM SOE

Combination questions for all parts (MCQ/OSCE/SOE)

Topics from past questions published on the Scottish Intensive Care Society website

Although I can't verify these questions from the SICS there is no reason to think they are not genuine and would be a sensible focus to start your revision.

Topic areas from past exams from the SICS

SOE

  • AKI

  • Adrenal insufficiency

  • Myasthenia

  • Pulmonary Embolism 

  • Pulmonary haemorrhage

  • Scoring systems Burns

  • Nutrition

  • Pleural effusions

  • Drowning

  • Intra abdo sepsis

  • Fluid responsiveness

  • Infective endocarditis

  • Pseudo obstruction 

  • Weaning from ventilation

  • Arrhythmias

  • Child protection

  • Phosphate

  • Cardiogenic shock

  • Inotropes

  • Pre eclampsia

  • Local anaesthetic toxicity

  • Acute stroke

  • Management of the trauma patient

  • Heparin Induced Thrombocytopenia

  • Status epilepticus 

 

 

OSCE

  • Carbon monoxide poisoning (simulation station)

  • Epidural haematoma

  • Tension pneumothorax

  • CRBSI and bundles

  • DKA (uk guidelines)

  • CT abdo - retroperitoneal haemorrhage

  • CT head - MCA thombosis, TBI with subdural

  • Stroke thrombolysis

  • CXR - pulmonary hypertension!!!

  • ECGs - WPW, SVT with aberrant conduction, PTE, inferior STEMI 

  • Blocked tracheostomy

  • Paracetamol OD

  • Pulmonary Artery Catheter

  • Delirium

  • ARDS

  • Head injury and neuro protection

  • DKA

  • Stroke thrombolysis and decompressive craniectomy 

Just think can you talk sensibly on the topics listed for around 5 minutes?

 

Can you define the important elements of each condition, its diagnosis, management and outcome? 

 

Can you talk about any relevant national guidelines or published evidence relating to this topic area? This would be an obvious start to a viva question and could also come up in questioning on an OSCE.

For example if answering a VIVA question on Tracheostomies in ITU it would very reasonable to be asked what national guidance and publications you know on the topic. To which you would reply

 

'the important publications on this topic include NAP4, the NCEPOD report On The Right Trach, and the Tracman trial..not to mention the national algorithms for the management of displaced or blocked tracheostomies.....'   see the links and resources sections for the documents relating to this topic

 

If the answer is No get reading or listening to podcasts on the topic or viva you mates and get them to answer it for you and teach you at the same time....

I will add resources relating to the main themes as time goes on. 

Any old questions you want to share or you find links to please get in contact. Themes would be good. Im trying not to annoy the FICM by publishing full questions. 

Top 10 Tips for preparing for the FFICM

1. Pick a good time to do the exam.

Be that just after completing the final FRCA, MRCP (UK) or MCEM (Full) or when life’s commitments will allow you to commit.

2. Set aside up to 6 months of your life to lay waste to.

The reality was it was 3 months toying with the idea of doing work and 3 months working hard and a further step up once you pass the MCQ.

                           

3. Get yourself a revision buddy.

Not so essential for the Final FFICM MCQ but a must to pass the Viva. This is probably the most important advice you can have. 

 

4. Borrow a textbook.

You could buy one but in this short period of time until there are some essential textbooks why waste the cash. People suggested: Oh’s Intensive Care Manual (I bought it but didn't have time to read it) or The Oxford Desk Reference In Critical Care but that was published nearly 10 years ago so it can’t be up to date. I borrowed Critical Care Secrets 5th edition which was very good, concise and easy to read although the units were American not UK. Let us know if you have any good suggestions here. I am aware of a few new ones coming out but would like to hear some reviews before recommending them.

 

5. Listen to podcasts and watch vodcasts.

Maximise your time when you’re on the go by listening to podcasts from the FOAMed community for free while commuting about the place. Emcrit would be good start in the world of resuscitation podcasts, embrace the american style. There are also some amazing videos for learning about ultrasound and echo and most things ICU. See the expanding podcast section of this website.

 

6. Use a Journal club/Journal summary resource.

These free resources provide summaries and take home points from a lot of the most important papers published in our specialty. It would be nice to read all the original papers but there isn’t time. I used an 'ICU Trials' APP to read info offline on the move, if online I would recommend The Bottom Line. Also the free critical care reviews books covering the big trials from the last 3 years are now a must (See here).

 

7. Learn some Chest Ultrasound and some Echo.

If your already on the FICE and CUSIC pathway then all the better. If not there probably isn’t time to do a course but for the OSCE and possibly the VIVA you absolutely must be able to recognise the four echo views and basic findings e.g. normal/severely impaired function, kissing ventricle and tamponade. You also need to be able to recognise basic chest USS views e.g. normal pleura/parenchyma, pneumothorax, pleural effusion. I hadn’t done either FICE or CUISC pre-exam but thankfully I spent two days learning it. You can do this through 'Intensive Care Echo & Basic Lung Ultrasound' module from E learning for health which you should have/get access to here. For more echo and lung ultrasound check the vodcasts at 5minsono.com or the ultrasound podcast.

 

8. Be slick at interpreting investigations.

Otherwise you will be throwing marks away. For the OSCE but also any part of the exam you need to be able to identify abnormalities on bedside tests, radiology and laboratory data.  Modalities you should be able to interpret include CT head, CT abdo, CXR, AXR, USS chest, Echo. You should be slick at providing a structured presentation of ECG (time to break out ‘ECG Made Easy’ again). You need to be able to interpret lumbar punctures, lab results etc. it may even be worth looking at Sleep studies. If you want a really useful tutorial in CT brain Anatomy that's free go to radiologymasterclass. For more radiology cases with images try radiopedia.org such as this necrotising pancreatitis  case with CT here. For a fibreoptic bronchoscopy simulator to remind yourself of the anatomy head to thoracic-anaesthesia.com 

 

9. Do a VIVA/OSCE Course it’s probably worth it.

I don't think doing a course for the MCQ would be worth the money especially as the MCQ seemed so random, mostly about microbiology that I hadn’t revised and doubt would come up on a course. I think a VIVA/OSCE course is probably worth the money given you didn’t want to repeat it and waste even more of your time and money. I did the Leeds course and it was well run by a nice faculty and not too expensive. Any reviews or recommendations for other courses contact us here and write a review. I have been told that the Sunderland course (see here) provides a realistic experience of the exam day. 

 

10. Get some VIVA practice from consultants/colleagues.

As embarrassing as it is to put yourself out there in front of your consultants or colleagues better that than getting down to London and realising you don’t have a hope of passing the exam. Find a friend who has done the exam recently and get some old questions from them. Most of it is technique so refine that, most success is gained in the first 90 seconds so practice your opening for common topics. Remember to work on your non-offensive open body language that makes you look like your enjoying yourself, looking broken and miserable ensures failure. 

The FFICM Curriculum: Know the curriculum to give yourself your best shot

​To Guide your revision its well worth having a brief look at the FFICM curriculum. 

 

If the topic you are revising is not on the curriculum then you are wasting your time as you cannot be asked about it in the exam.  The opposite is also true- if its on the curriculum then its fair game so you need to have a think about if you need to focus on particular topics and target your revision. 

The curriculum is divided into 12 domains (+ basic sciences that could also be tested)

  1. Resuscitation and initial management of the acutely ill patient

  2. Diagnosis, Assessment, Investigations, Monitoring and Data Interpretation

  3. Disease Management

  4. Therapeutic Interventions/Organ Support in single or multiple organ failure

  5. Practical Procedures

  6. Perioperative Care

  7. Comfort and Recovery

  8. End of Life Care

  9. Paediatric Care

  10. Transport

  11. Patient Safety and Health System Management

  12. Professionalism

+ Basic Sciences 

Unfortunately as you might expect its a long list of 80 pages of competences. Some of which are more easily assessed by examination and some less so.

 

However, don't be put off by its length as most of it is standard bread-and-butter intensive care that you know anyway. There is also lots of overlap between the sections with the same topics coming up repeatedly. 

 

So use it to highlight some specific areas you haven't thought about and some areas of weakness and reassure yourself that you have heard of most of it before.

 

Using the curriculum you can tease out potential questions such as

 

An exam question on 'Measures of adequacy of tissue oxygenation, e.g. base deficit, lactate, central venous saturation' from 1.1

An OSCE station involving 'Indications and methods of cardiac pacing in the peri-arrest setting' from 1.2

A viva about 'causes recognition and management of Hypertensive emergencies' from 1.3

 

Or 'Issues of consent in children or National child protection guidelines' from 9.2

Or 'Pathogenesis, risk factors, prevention, diagnosis and treatment of complications of ICU management including: ​pulmonary oxygen toxicity' from 11.4

So basically its all there in the syllabus letting you know what you could be asked about.

 

How much do you have to know about each topic? Probably not too much. There is a huge breadth of knowledge so your best bet is knowing about 4-5 mins chat about most of it rather than being an expert on one topic.

Here is a link to the Curriculum and to the FICM curriculum page, there are updates on the way but currently this is the most uptodate.

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