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CICM Fellowship Exam


A few brief words about the exam.

Little is available out there to prepare the candidate for the horror of these end days. The exam is separated into three distinct cognitive niches. The written paper and the vivas integrate together very well; the hot cases are a totally different kettle of fish. This content represents my notes for the CICM Fellowship Part Two Examination. If one distrusts secondary sources, one can peruse the original past papers here, at the college website. The College have some material on their site, particularly their Notes to Candidates; this is useful insofar as it is an explanation of the exam process, the marking of the papers, and the expected behaviour of examiners and candidates during the clinical section.

Life In The Fast Lane have a good page with useful links to exam preparation resources.

Crit-IQ offer a paid service, with excellent podcasts and a regularly updated journal club. There one may also discover various exam preparation courses which may be helpful.

The Intensive Care Network has some of the same notes as LITFL, but in word document format. There is also a wealth of educational material in the format of lectures and podcasts, presented in a luxuriously media-rich format.

In their preparation, the candidates may wish to consider the following issues.

They don't want any more fellows.

That is probably the most important concept to internalise when preparing for this thing. Unfortunately, the ICU environment has a strongly pyramidal structure, and in order to function there must always be more junior trainees than consultants. Ergo, not all trainees can expect to become consultants. Ergo, there is no incentive to produce new consultants, given that at present there are few unstaffed positions.

They aren't threatened by you.

The exam is fair, and the examiners are not trying to fail you. Certainly the likes of you are no competition for them. In any case, under the present conditions, their jobs are untouchable - particularly in the public health system. As a "staff specialist",  one is like a barnacle: practically impossible to dislodge from the hull of the ICU. You would have to sexually assault the nurse unit manager or do something equivalently criminal to stand a chance of being kicked out of such a position. Ergo, the exam is fair. It would actually take more effort to make it unfair, and that would be wasted effort. The worst thing that could come from a fair exam, as far as the existing cadre are concerned, is an excess of unemployable fellows, whining about their job prospects.

Merely spouting key phrases is not enough.

Some discussion is expected. The exam is marked in what can be described as "the Delaney Grid", named after Anthony Delaney who has been instrumental in developing it. Essentially, the marking criteria of each question (or viva) has a list of concepts. Each concept has a marking breakdown, ranging from zero (not mentioned at all) though the 2-3s (mentioned briefly, or with errors) to 6-7 (discussed in detail, and accurately) and 9-10 (weepingly beautiful answer). This is how you are marked. A person who attempts to answer a viva in the verbal equivalent of point-form will only score the 2-3s (mentioned briefly) for each mentioned concept.

Don't do anything weird.

Do you normally wear a full three-piece suit to do your rounds? Do you engage in bed sheet origami, folding it weirdly around the patients' groin? Do you normally carry a briefcase full of physicianly equipment? Hell no. So, don't do it at the exam. Wear a tie, if you must; it gives the impression of neatness without affectation. Generally, try to dress like you're going into a family conference where some piece of horribly tragic news is going to be unveiled. Don't be absurd. Of course you don't perform direct ophthalmoscopy on every patient; so don't tell the examiners that you would do this. Don't try to test the olfactory nerves in the comatose cardiac arrest survivor. Don't ask too many questions- it irritates them. Especially avoid taking the first five minutes of your hot case asking them questions about the ventilation and dialysis settings. Avoid gibberish: as you do your examination, it is ok to point out salient findings as you go (particularly as you demonstrate neurological signs) but do not rant continuously. Rapid pressured speech commenting on everything during the process of examination gives the impression of poor confidence; it is the mark of an amateur. If you are more comfortable with silence, perform the examination in a quietly businesslike manner, saving your comments for the end.