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The CICM First Part Exam: A User’s Guide

The CICM First Part Exam: A User’s Guide

I’ve recently passed the College of Intensive Care Medicine of Australia and New Zealand’s First Part Examination.

It mostly sucks. It is a second job’s worth of after hours study and preparation for more than a year. And one must pay $5,375 for the privilege of showing up to an office building to write the exam, and the cost of a trip to Melbourne if one is fortunate enough to be invited to the oral section.

There are no refunds for failure. Only more fees for the resit.

But, if I can do it…

I will share my recommendations for anyone looking to prepare for this particular exam. But the CICM syllabus is similar to ANZCA’s. And some of my recommendations may be relevant to the other Colleges. Who knows.

I was working as an ICU Registrar for the bulk of the study time. Before heading to Anaesthetics in the February changeover (before my March exam). And I had a College Examiner available to me in one of the Consultant Intensivists of the small-ish ICU in which I was the only exam candidate for that sitting.

(Thanks, again, Prashanti!!)

In hindsight, these were probably the optimal conditions for exam preparation and one should probably invest considerable planning and effort to not be on a night admitting medical registrar term while preparing for exams…

I studied alone because I did not happen to see the point of group study. And I used lots (all) of the free online resources available.

Starting Points:

I printed out the First-Part-Examination-Syllabus_Fourth-Edition-2023 and assaulted it with some scissors.

I just wanted to see the scope of the problem first.

The Scope of The Problem (not including the Pharmacopeia…)

Then I did some calendar planning and strategising.

Stage 1: Planning

I read around to see how to do this. Part One is a fantastic resource, both for simplified syllabus content notes and for the ‘How to Pass’ and ’How to Fail’ sections that are very useful for someone just starting to approach the syllabus. And the emphasis on practice questions as a primary means of study - more on those later.

So I started reading ‘Chambers D, Huang C, Matthews G. Basic Physiology for Anaesthetists. Cambridge University Press. 2015’ as an introductory Physiology taster on February 10th, 2024 while I continued to plan out the year and accrue my resources.

Stage 2: Structuring and Resource Accrual

While I happily read through a Basic Physiology textbook, making some cursory notes along the way, I mapped out a tentative calendar of study and started organising my resources.

My aim was to hit Cardiovascular and Respiratory first because they are, I suppose, bread and butter ICU physiology but also because your Consultants will be able to confidently and extensively quiz you on them without needing to be College Examiners (or have actually done the First Part exam) and, most importantly, because those are large, core topics from which most of the past exam questions are drawn.

Structuring:

So I came up with this: (I’ve just copied and pasted what I wrote back in the February, then added in bold what actually happened)

  • Month 1 = March/April - Finished right at the end of April
    • Cardiovascular System
  • Month 2 = April/May - Finished in Mid June
    • Respiratory System
    • (Likely to bleed in to next month)
  • May pause a bit here and tick off some Pharmacopeia stuff - This all took me to the end of June
    • Pharmacokinetics
    • Pharmacodynamics
    • Variability in Drug Response
  • And some Practice Exams
  • Did the Mater First Part Course in early July
  • Then did Cell Physiology and Renal
  • Mock Exams with local Examiner - we are at the start of August by now
  • Month 3 = May…June - more like August/September
    • Nervous System
    • Musculoskeletal System
    • Autonomic System
    • Thermoregulation
  • Month 4 = June - towards start of October
    • Renal System
    • Body Fluids and Electrolytes
    • Acid Base
  • Month 5 = July - this got me to November
    • Endocrine System
    • Liver
    • Gastrointestinal System
    • Nutrition and Metabolism
  • Mock Exams with local Examiner - After some review, I’m at the end of November by this point
  • Month 6 = August
    • Cellular Physiology
    • Immunology and Host Defence
    • Microbiology
    • Haematological System
  • Month 7 = September - Finished by the end of December
    • Obstetrics
    • Principles of Measurement and Equipment
    • Procedural Anatomy

Such that my year looked like:

I used Notion for this, but I still kept my cut-up paper syllabus around so I could rearrange things to keep the big picture in scope.

Obviously, I under estimated how long I would take.

College Resources:

In terms of getting some resources organised, one must pay attention to the ‘Recommended Texts’.

  • General Physiology
    • I chose to read “Principles of Physiology for the Anaesthetist” by Kam and Power
      • This seems to be the most familiar book to the examiners and specific diagrams will be referenced by them when giving you feedback on practice questions
      • Do not buy it
      • There are google drive folders floating around everywhere with free PDFs of all these books
  • Respiratory Physiology
    • Read both.
    • Nunn’s is the reference textbook for all of Respiratory, but long and dense and dry. Best used for key concepts.
    • West’s is probably the exemplar physiology textbook. Full stop. Fairly short. Simple. No fluff. Excellent diagrams (that are examinable).
    • Again, free PDFs only
  • Cardiovascular Physiology
    • If the Examiners are only listing one book about Cardiovascular Physiology, you should probably read it
    • Not too bad to read
    • Annoying green colour scheme is a poor choice by the publishers
    • Free PDFs everywhere
  • Renal Physiology
    • For whatever reason I did not find this textbook very useful and thought that the renal sections of the syllabus were better covered by some of the free online resources
  • Pharmacology
    • I purchased “Pharmacokinetics made easy” by Birkett and Australian Prescriber. It can be read in a single sitting.
    • I also purchased “Drugs in Anaesthesia and Intensive Care” by Smith et al. I think I’m just a sucker for a pocket-sized reference book.
    • I chose to use Katzung for the big reference book. It’s not a particularly easy read but it is well organised with pretty pictures. Free PDF for that one.
  • Measurement
    • I used a PDF of the Davis and Kenny book.
    • Some free online resources are probably more relevant to the CICM questions compared to a fairly dry physics textbook.
  • Anatomy
    • You guessed it, free PDF.
  • Blood
    • Self-explanatory…

Free Online Resources:

  • Part One via Life in the Fast Lane
    • As mentioned above
    • Excellent, simple, lean notes mapped out across the syllabus
  • Deranged Physiology
    • Resource specifically mapped to the CICM syllabus
    • With past questions linked to syllabus items within textbook quality chapters
    • Excellent for practice question review as the author puts some effort into answering the questions with ten minutes worth of handwritten words
    • Realistically, it’s an amazing resource and a CICM candidate would be silly not to use it
  • CICM Wrecks
    • Particularly useful when doing practice exams around weak points and poorly answered questions
    • Most of their model answers cannot be handwritten in ten minutes
    • So it becomes a crossover of model answers and physiology notes organised by question as opposed to by system
  • Jenny’s Jam Jar
    • Anki Flashcard decks
    • The pharmacopeia decks are of drug monograph quality
  • ICU Primary Prepcast
    • Fantastic podcast specific to the CICM Pat One with long form content podcasts and shorter snippet podcasts that resemble Vivas
    • Along with past examiner input for relevance
    • Excellent for when you take a ‘break’ to go for a walk

Stage 3: Actually doing the Study

Step by Step:

To take the G1(i) subsection of the Cardiovascular block as an example -

My process involved:

  • Read the Pappano and Wier chapter on the anatomy of the heart ie Chapter 4
  • Read the Deranged Physiology chapters relevant to G1(i) - which can be searched for in the search bar eg
  • Hand write my notes for the topic
  • Then read the Part One summary
  • And so on…

Or for F3(ii) subsection of the Respiratory block -

  • Read the Respiratory Physiology section (Chapter 3) of Kam and Power
  • Read Chapter 2 of Nunn’s
  • Read Chapter 7 of West’s
  • Read the relevant Deranged Physiology chapters - again, easily searchable
  • Hand write my notes
  • Read the Part One summary

And so on and so on.

For months. And Months.

Handwriting:

I purposely wrote my notes by hand.

I have bad handwriting and I knew that ‘legible marks per unit time’ would be required for the exam. So I thought I should practice.

And because a lot of the syllabus can be summarised with diagrams so the ability to draw quickly and completely and correctly would probably be useful.

Pharmacopeia and Flashcards:

I made my own flashcards for the pharmacopeia, specifically with different subheadings for the different levels of understanding:

If I had to do it again, I would just start by downloading the Anki flashcards from Part One and from Jenny’s Jam Jar, which I did eventually anyway. They are excellent and better than the cards I made.

Working through the syllabus, you cannot help but cover much of the pharmacopeia, for example:

But I think flashcard-ing the drugs has to be done as well.

Courses:

I did the Mater Short Course ($1300). I honestly don’t know if I found it helpful. I had not covered the whole syllabus by the time I attended. So the sessions about Gastrointestinal Physiology or Immunology, for example, felt like learning from a firehose. And I could imagine that a candidate who had covered the whole syllabus and was close to their exam would have favoured the review and practice questions of the course more than the didactic lectures.

The content is presented by current and past examiners which is excellent for relevance.

It’s expensive. And takes a week. So factor that in.

Studying for the MCQ Portion:

Not to sound flippant, but these were easy and should not be the main focus of your study.

Just flick through some flashcards here and there.

Practice Exams:

These are essential.

Practice completing timed past questions then use the examiners comments for scope; CICM Wrecks for a broad review of the content required to answer that specific past question; and Deranged Physiology for an example of something that can actually be written in ten minutes.

I would not recommend trialling practice exams on a topic from the syllabus that you have not yet covered. It will just cost you ten minutes to write a crap answer that you will feel bad about. This seems wasteful.

Distant from the exam, doing one at a time when reading the relevant chunk of syllabus is reasonable.

Increase the number of questions per block, and breadth of syllabus that they can be drawn from as you get closer to the exam. Deranged Physiology has a practice exam generator.

Ideally, get your questions marked by an examiner. A local examiner in your unit is best, otherwise start sending some emails to find someone willing to mark you.

Then increase to timed ten question practice runs closer to exam time.

In the weeks before the exam, I became ‘first-name-basis’ familiar with all of the past questions. Literally all of them. Print out all the past questions (annd examples answers like from Deranged) and examiners comments on a work printer, bind them together and speed run the entire corpus. You can become very familiar with the style of answer expected of you and common pitfalls that show up repeatedly in the examiners comments. And you can start to rapidly map out subheadings in your head as you are reading the questions.

I also did a lot of ’two-minute-timed-subheading‘ answers close to the exam. Read the question, start your timer, and spend 2 minutes mapping out your answer with subheadings. Just the subheadings. Just practicing the skeletons of an answer that you can then flesh out. And you can really start to see the patterns of the past questions emerge.

Sitting the Written:

You will need some pencils for the MCQ section. Do not spend the morning of the written exam wandering around Adelaide street looking for the Officeworks…

I would recommend including a ruler in your exam-approved pencil case. A neatly drawn table is one that is easier to fill out with markable content.

The MCQs and SAQs are answered in the same section. Do the MCQs first. Any time saved by quickly answering the MCQs equates to extra minutes per SAQ. Our ANZCA cousins apparently do not have this luxury. We should continue to take advantage of it while we can.

Although you may have stretched to 12 minutes per SAQ by speedrunning the MCQs, still set yourself ten minutes to do each. Those last marks per question are not worth wasting all that hard earned time. And you can leave yourself some checking time at the end.

So You’ve Done the Written:

Take a week off. Or two.

Then start studying for the Viva.

Go to your local examiner or Consultant and ask to either schedule some Viva practice time, or for the contact details of someone that is happy to hear Vivas. You will be given a bunch of names. Start sending the emails and text messages and schedule some sessions.

There is a reassuringly high pass rate for those who receive a Viva invitation.

However you need to start studying before you find out if you passed the written.

I found that I had to adjust my answer style from Written to Vivas, because verbalising the ‘subheadings’ under which I would give my verbal answer does not start scoring points until……I actually started giving the answer. You can’t really speak in subheadings and dot points. It is something that can be practiced and improved.

So You‘ve Got a Viva:

Book and pay for your flights and accomodation early. Because although the exams were done via Zoom during COVID and the specialty of Intensive Care Medicine did not collapse, we still have to travel to Melbourne because reasons.

I booked to arrive two days early because I don’t trust the domestic airlines in this country and I could just drive if I really had to. And I wanted the full day prior to wander around and make sure I knew where the venue was.

I continued to wander around Melbourne listening to the ‘ICU Primary Prepcast’ and I took all my handwritten notes with me to have open in my hotel room.

Do the Viva:

The Viva itself is fine. It’s stressful. You will recognise some well known names and faces as your examiners. It‘s a strange setting as they give you no verbal or expressive feedback for your rambling answers. Then it’s over in a flash.

If you don’t understand the question, you can just say so.

My preferred verbal tic for when I didn’t know something was “sorry, just blanking on the other example at the moment” or “I’ll try and come back to that”.

You will not come back to it. There’s not enough time.

Do not say “dunno, next question!!”.

There are two rest stations per cycle. Then you are done.

Then you quarantine for a few hours and play Uno with other candidates.

Then you do it again the next day.

Afterwards:

Then you ruminate on that idiotic answer you gave and how could you be so stupid to have forgotten to say that and did you guys all have the same experience with that one examiner yeah I had no idea what they wanted and as if they would ask about Thiopentone!?…

You will write down all the questions you were asked while fresh in your mind. You will discuss them with your peers and local Consultants.

Doesn’t change anything.

Just wait for the email.

Then you are done.

Reflecting:

It was a second job for about 15 months. It’s expensive. Don’t sit it unecessarily. Pick a timeline that works and try and just do it once.

It’s easy to underestimate how long you‘ll need to get through the syllabus.

Go for a walk. See some sun. Maintain some semblance of nutrition. Schedule some days off.

Have fun,

Luke.