FFICM Examiners Report - October 2017

ver the two days of examining 11 visitors attended the exam. There is a limit to the number of places available to visitors and it is unfortunate that on both days visitors fail to attend without warning denying others the opportunity to see how the exam runs and increasing the time applicants have to wait to visit the exam. All visitors attending the exam on this occasion were involved in organising training and assessment. The feedback during this exam was similar to previous sittings. Visitors appreciated seeing the standard of candidates and the expectations of the examiners. The standard expected was seen as fair and it was recognized that questions seen as difficult for practicing clinicians were within the syllabus and often dealt with surprisingly well by candidates who would have done the expected bookwork prior to attending. When discussing the standard with visitors it was noted that the FFICM Final examination can be taken at any point during Stage 2 of the new training programme prior to entering ST7. The earlier candidates chose to take the exam the greater chance that they may not have seen all aspects of intensive care. Candidates should understand the need to put in the required amount of study to compensate for this before taking the exam.

Discussion amongst the visitors about the way in which a communication station ran revealed that what some visitors witnessed in the station was different to others. This is due to the station being designed to simulate a real life encounter where the simulated individual (actor) would only reveal information to the candidate if appropriately prompted.

Visitors commented upon how worthwhile and well organized the simulation station was. Interestingly some candidates lost marks because despite mentioning diagnoses in discussion they failed to follow them up. This was generally because they opted for an alternative, incorrect, diagnosis rather than keeping an open mind as they should clinically.

Examiners understand that candidates often find the exam situation stressful. On occasion examiners feed back to the board of examiners at call-over that some candidates appear debilitated by stress. There is only so much examiners can do to ally anxiety during the exam. Occasionally they request that concern is fed back to tutors. One strategy that may help these candidates is extra exam practice to try to normalize the exam environment.

Topics that were raised as not being well done by candidates include a question on calcium. Yet again the issue of ECG and radiology needs mentioning. It seems the concept of examiners asking for a structured description of the findings in some artifacts but just the obvious findings in others is now understood by candidates. There still remains a need to improve both interpretation and presentation of findings. A systematic review of an ECG for example includes rate, rhythm and axis. Visitors and examiners were surprised that candidates failed to recognize obvious abnormalities like atrial flutter. On occasion it is surprising that the candidate does not expect certain diagnoses from the clinical scenario. One would expect widespread T wave inversion across the chest leads in a patient without signs or history of acute myocardial injury to prompt a candidate to consider left ventricular hypertrophy both in real life and the exam.