Final FFICM Resources

This article was originally published in the Summer 2020 edition of Trainee Eye

Preparation for the Final FFICM was tough and consumed much of my free time for several months. However, I felt that it was, on the whole, a fair exam,
and the revision (and first-time learning in some areas!) has definitely prepared me well for my Stage 3 training and beyond.

The curriculum is available on the FICM website and while at first it looks very superficial, scrolling down reveals much more, and this is an invaluable guide
to revision topics. It is useful to be familiar with the format and marking scheme of each exam component, which is clearly explained on the FICM website.

Multiple Choice Questions (MCQ)

The MCQ component is the first part of the exam and has to be passed before progressing to the SOE/OSCE. The pass mark is approximately 68% (although
this varies slightly from year to year). I would say that the SBAs are much more difficult than the MTF questions and it is worth bearing this in mind when
preparing and during the exam itself. In terms of preparation, the core revision method is to do lots of practice MCQs. I used the following resources:

1. Bennington et al – Intensive Care MCQs. This a great all-round resource with both MTF and SBA questions, with helpful answers/explanations
2. Davies et al – Single Best Answers for the Final FFICM. This is really useful book to focus on the SBA format, which most people find more challenging.
3. BMJ OnExaminaton – there is now a dedicated FFICM question bank available, but this was released after I sat the exam. I used the Final FRCA question bank, with a filter set to only include ICM questions. It is a good way to do
   on-the-go revision, using the mobile app.
4. Crit-IQ – the question bank was variable in terms of its relevance for the FFICM exam, and the website is clunky and difficult to use.

   While it is tempting to focus entirely on practice MCQs, with minimal additional reading, I would advise against this, as the breadth of the curriculum is such that it would be very difficult to cover all topics adequately using practice MCQs alone. It is definitely useful to do some reading around the topics. The BJA Education supplement (the online archive) is an excellent resource
   for this, and a search of the archive usually yields an article relating to almost any ICM topic. Many articles also include some MCQs at the end to test your
   understanding. I only occasionally used textbooks such as ‘Oh’s Intensive Care Manual’ and the ‘Oxford Desk Reference in Critical Care’, but these can be useful to read up on certain topics.

I also think it is a good idea to approach the MCQ revision with half an eye on the upcoming SOE/OSCE component. This may not work for everyone, but it
pushed me to learn topics in more detail and helped highlight weak areas. The SOE books (see below) are an excellent resource to read up on difficult areas on
the curriculum, and this helps with answering tricky MCQs in the short term as well viva questions in the medium term.

Structured Oral Examination (SOE) & Objective Structured Clinical Examination (OSCE)

The SOE is a viva-style exam. Anaesthetic trainees may be more familiar with this type of assessment but, as a medic, the format was new to me. I think
it is a fair exam overall, but it really does test the full breadth of the curriculum and there are inevitably going to be some questions you can answer better
than others. Most topics are clinical, but there will occasionally be a question on basic sciences, ethical/legal or management issues so it is important to
prepare accordingly. I would suggest a two-pronged approach to preparing.

Firstly, nothing beats practice! Spend as much time as you can constructing and
rehearsing viva-style answers by yourself, with peers and with senior colleagues. And secondly, have bullet-proof answers for core material such as ARDS, pancreatitis, delirium and subarachnoid haemorrhage.

You should also meticulously tighten up any gaps in your understanding of the less well-known parts of the curriculum by reading more whenever you come
across something you think you are less familiar with. You need to ask yourself for each curriculum item, ‘can I talk about this for a few minutes and sound
sensible?’ I used the following resources:

• FICM Curriculum
• Specific FFICM websites (“PINCER” and “PENNINE”)
• BJA education supplement
• Books: Flavin et al – Questions for the Final FFICM Structured Oral Examination; Jeyanathan et al – Viva and Structured Oral Examinations in Intensive Care Medicine.
• FRCA SAQ resources are also useful – particularly Northern Ireland School of Anaesthaesia Final FRCA website
• EBM/FOAMEd online resources such as Bottomline and Critical Care Reviews
• FICM and ICS guidelines
• Podcasts – EmCrit/Pulmcrit, Internet Book of Critical Care
• Courses – various ones available. I went to the official FICM one in Leeds and also the one in Stoke, both were excellent.

The OSCE is, in my opinion, the most difficult component of the exam, and has the lowest pass rate. Again, the format was unfamiliar (very different to medical school OSCEs or PACES; possibly some similarities with the primary FRCA). There is a heavy emphasis on data interpretation (e.g. ABGs, CSF results) although there are also communication, simulation and equipment stations. ECGs are a common stumbling block, and it is also important to be familiar with basic X-ray, CT, ultrasound and echocardiography images. I found it very tight for time, so make sure your answers go straight to the point so you can progress quickly through the mark-scheme.

Many of the SOE resources served me well with OSCE preparation too. However, some of the more OSCE-specific resources I used were:

• Books: Nichani & McGrath – OSCEs for the Final FFICM; Jeyanathan et al – Objective Structured Clinical Examination in Intensive Care Medicine
• Life in the Fast Lane website (particularly ECG library)
• Intensive Care Network, Crit-IQ and Radiopaedia websites (radiology libraries)
• Intensive Blog (data interpretation)

Final Tips

• Start preparation early and don’t leave things to chance.
• Know the curriculum, exam format and marking system.
• Use print and online resources.
• Do lots of practice questions, supported by plenty of background reading.
• Go to a course.
• Test yourself (and others) and set yourself high standards.

If you do all of this then you have every chance of sailing through the exam!