How I passed the FFICM

Post graduate exams are hard. They have a huge impact on the candidate’s life.  It can be difficult to put the rest of your life on hold for 3 months to focus on revision, but this is unfortunately necessary.  The revision should become intolerable after a few months or you are not revising hard enough. 

To give yourself the best chance of passing the exam, the effect the revision has on your life needs to be unsustainable.  This is only acceptable because it is short lived.  Some people are tempted to try to revise for longer but keep a sustainable work-life balance. In the weeks before an exam I usually spend my time re-looking at topics I had read 2 months ago and forgotten.  Extending your revision to longer than 2 to 3 months will offer diminishing returns and is likely to result in multiple attempts at the exam and a bigger effect on your life in the long run.  There is no good time to do an exam.  It is tempting to find reasons not to sign up and tell yourself that the next sitting will be better.  It almost certainly won’t, so get stuck in and fully commit!

FFICM MCQ/SBA exam

Preparation for the Final FFICM MCQ involves a mixture of reading and question practise.  No single revision strategy will suit everyone.  Some may prefer to read and make notes initially, trying to ensure they cover the breadth of the curriculum.  I personally find this approach too time consuming, particularly with a topic as broad as intensive care medicine. Having a task of that magnitude in front of you is incredibly daunting and impossible for most people. One strategy is to dive straight into questions, using difficult questions as a trigger to read around that topic. Only making notes on those things that need to be learnt verbatim for example the AKIN criteria. The current practise MCQs available cover a very broad range of topics, which match those that appear in the exam well. This means that if the candidate does enough practice MCQs they can cover easily enough of the knowledge base to stand a great chance of passing. Usually completing upwards of 1000 practice questions (each containing 5 true/false questions) puts you in about the right ballpark.  The books I used for practice questions were:

• Bellchambers E, Davies K, Ford A, Walton B. Multiple True False Questions for the Final FFICM
• Davies K, Gough C, King E, Plumb B, Walton B. Single Best Answer Questions for the Final FFICM
• Lobaz S, Hamilton M, Glossop AJ, Raithatha AH. Critical Care MCQs – A Companion for Intensive Care Exams

These resources offer good explanations of the questions and answers, but often further reading may be required and there are a number of good online resources for this.

• E-ICM on the e-Learning for Healthcare platform offer short modules on lots of topics and has a self-test section with lots of MCQs too. 
• The “Life in the fast lane” medical blog is an Australian website that covers a large range of ICM topics in an extremely concise way. 
• BJAeducation articles often cover ICM topics. 
• And of course there are a number of large (and expensive) textbooks out there.  It’s difficult to recommend one over the other – I bought the Oxford Desk Reference of Critical Care but in the end online resources formed the bulk of my reading.

(A list of useful exam related resources can be found here)

FFICM OSCE/SOE

The most important thing with any viva is to ensure that the vast majority of your preparation is in the spoken form.  In the same way as MCQs can structure your entire learning for that exam, answering SOE questions should form the basis of your revision for the SOE. Don’t fall into the trap of thinking you only learning if you are reading or note taking.  Many people have failed oral exam because they have spent their time reading and note making, and not getting enough practice actually expressing their knowledge verbally, and under pressure.  There are three groups of people who will be able to examine you which gives you a large bank to draw on; consultants, post-exam trainees, and your peers who are also taking the exam.  It can be of huge benefit to find a group of like-minded and similarly motivated trainees who are also taking the exam.  Consultants and past-exam trainees will give you an hour’s practice here and there which is invaluable, but only someone also taking the exam with sit for an entire weekend and take turns to be examined! This strategy works well, as asking the questions and checking the answers that your buddy gives is also a valuable way of you learning the information.  If you struggle with a question you are asked then add it to a reading list.  When you have read up on it make sure you are asked it again while the information is fresh in your mind.  This will help reinforce the knowledge. 

The recently published “Questions for the Final FFICM Structure Oral Examination” by Flavin, Morkane and Marsh is excellent and covers a huge breath of topics in the required amount of detail.  Speaking to many others who have taken the exam the topics in this book match those that come up in the actual exam very well.

For up to date evidence based reviews “The Bottom Line” website and the “Critical Care Reviews” website (with free yearly book to download as PDF) are excellent.  The ICU trials smartphone app was also useful to quickly check the main points of the big trials.

The OSCE is more difficult to revise for. “OSCEs for the Final FFICM” by Nichani and McGrath covers relevant topics but revising for practical OSCE stations from a book for me proved difficult. The OSCE requires a good awareness of all advanced life support algorithms including in “special circumstances”, for example a child with hypothermia or a pregnant patient.  These are often difficult to practice before the exam – ask your hospital to see if you can access simulation facilities if available. Attending ALS and APLS courses prior to the exam may also be useful although it may add unwanted stress and expense for what will probably be one station on the OSCE! Either way make sure to have read the manuals and know the algorithms.

Paediatric topics can be a source of worry for adult intensivists but are examined so make sure they are covered in your preparation.  I found the PDFs on the Meningitis.org website very useful for this subject.

The radiology and ECG content can be learned effectively online too.  Websites such as Radiopedia and Life in the fast lane have great content and lots of quizzes. In addition “Radiology for Anaesthesia and Intensive Care” by Hopkins, Penden and Gandhi covers the topic of radiology well.

An obvious but often overlooked point to note is that some OSCE stations are not simulation or interpretation, and simply consist of an examiner asking questions.  It is vital to realise that this is not a SOE, and should therefore be approached differently as the technique is different.  The examiner does not want a long discussion or a demonstration of your knowledge.  They will have a very specific list of correct answers that need to be ticked off. The candidate should list answers quickly in order to cover the ground and don’t forget that there is no negative marking.   Whilst there is crossover in the knowledge base required for both parts of the exam, the answer technique is different.

As with any exam, it is always worth asking colleges that have taken the FFICM exam previously as to what topics came up as there have been some unexpected questions in the past and these do get repeated.

Above all have a plan, look after yourself, create a revision buddy group and give it your best shot.

Good luck!