Preparing for the FJFICM exam
© James Austin 2007
OK, you've done plenty of exams before: school, a medical degree, a Primary fellowship exam, and possibly a Final Fellowship in another speciality. So by now you should know what study techniques work for you. Nevertheless, here are a few general suggestions, as well as some thoughts on preparing for specific parts of the FJFICM exam.
General studying tips
1. Start studying sooner rather than later - ideally when you first decide to do intensive care. It's a wide-ranging exam, and six months before the exam is too late to start serious studying; a year is probably a reasonable minimum.
2. Set aside dedicated time for studying. If you can get two or three weeks of private study leave to 'break the back' of your swotting, that's great - if not, it might be worth considering using annual leave for this (I did, and found it well worth the sacrifice).
3. It's better to read a given topic once from three or four sources than three or four times from one source. This reinforces key points, widens your exposure to non-key points, and reduces the chances of your falling asleep from boredom.
4. For those irritating things that simply have to be learnt by heart (e.g. the actions of activated Protein C; criteria for ARDS; the Ranson score for acute pancreatitis): buy a box of blank business cards. On one side write the 'question', and on the other, the 'answer'. Carry these around with you, and test yourself in the odd moments that you're waiting for the bus/the ward round to start/the patient to arrive etc. In particular, due to the heavy clinical emphasis of the exam, I made up cards with differential diagnoses to memorise – for example “Causes of coma”; “Causes of hypercalcaemia”; “Causes of cyanotic congenital heart disease”; “Causes of acute abdominal pain”; “Causes of hepatomegaly”; “Causes of hypertension”; “Causes of cavitating lung lesions” – every single one of these came up somewhere or other in my exam, and I was able to rattle them off reasonably fluently (except for the hepatomegaly one, where I kept getting interrupted!). I thoroughly recommend this technique – it’s well worth the time investment.
5. Do you need to know 'the literature'? In contrast to the DICM, I found I was rarely asked to quote evidence or journal articles in the FJFICM exam. Scanning the written papers, it seems that no more than one or two questions in thirty might benefit from journal knowledge. Despite what some courses or exam texts might imply, my impression is that knowing the literature is not at all essential to passing the FJFICM, and may take valuable time from other forms of studying. At most I would look through the 'headline studies' from the four major journals (NEJM, JAMA, Lancet and BMJ) from the last five years - with particular attention to Australasian studies. In contrast, however, knowing key guidelines was definitely worthwhile in the FJFICM - I had occasion to discuss the Surviving Sepsis guidelines, the Brain Trauma Foundation guidelines, and the EAST guidelines for clearing C-spines at various stages in my exam. Overall, when I sat the DICM I wished I had spent more time in the journals; when I sat the FJFICM I wished I had spent less.
6. Past exam reports can be downloaded from the JFICM website, though you need a log-on to access them. Most Australasian ICU trainees will have a log-on – otherwise you can apply for one from the JFICM. The reports contain the written papers, with an examiner’s outline for potential answers; a rough outline of the content of the OSCEs; the initial scenarios for all the vivas; and (most importantly) a critique of why candidates as a whole did well or badly. Can't say they didn't warn you!
7. Spend some time at Crit-IQ - an excellent, relatively new site from Todd Fraser and Neil Orford of Geelong ICU, pitched specifically at FJFICM candidates. Some of the features already up-and running include:
8. Be good to yourself! Reward yourself for a good day's studying (e.g. with a night out at the movies). Sleep well, eat well and get some exercise - it makes your studying more efficient.
Preparing for specific sections
1. The Written Papers: when you first start studying, download all the Examiner's Reports from the JFICM website - these include the written papers. Look through about half-a-dozen of them, to get an idea of the kind of questions asked, the level of answer expected, and the criticisms of past candidates' technique. Put the rest aside. About two or three months before the exam, get out all the written papers and start doing them under exam conditions. This is invaluable in so many ways: it teaches you to think and structure your answers under pressure; it forces you to be disciplined about time management (maximum ten minutes per question); and perhaps most importantly, it builds up your hand muscles for the forthcoming marathon! You can download all the written papers from 1997 to 2006, without answers, as a zip file here. The Examiner's Reports, including answers, can be downloaded from the JFICM website - if you don't already have a log-on, as a prospective candidate you can apply for one by email.
Occasional questions do get repeated in the Written exam - perhaps only one or two per paper, but that's still a bonus if you've done them before. Future papers may contain proportionately more data interpretation, as the OSCE has been dismantled. Some questions from the Written paper could also serve as Viva practice.
In answering the written papers, try wherever possible to format your answer as a list, table, or point form - this is much quicker to write. Stick to the question asked - you don't get bonus marks for 'extra' irrelevant information (though it's occasionally hard to decide where the limits of 'relevance' are!). Above all, don't spend more than ten minutes per question - you can score far more marks spending the next three minutes on the the next question than by adding still further to the current one. If you're quick, you can save time to go back and add to questions where you feel you can still score more marks.
2. Hot Cases: I was working in a small ICU in a rural town (Wagga Wagga, NSW) when I sat the FJFICM. This was probably not ideal practice for the exam, so two of my colleagues put me in touch with a variety of consultants in teaching hospitals in Sydney. On two occasions I took a few days off, flew into Sydney, and toured around the teaching hospitals, where several very generous consultants grilled me on some of their patients under exam-like conditions. I can’t emphasise enough how valuable this was as preparation for the Hot Cases. Not only did I get to see a range of cardiac, neurosurgical, transplant and burns cases that was largely absent in Wagga Wagga; but I also got used to examining patients in a foreign environment, and to a variety of styles of different ‘examiners’. By the time I came to do it for real, it all seemed like old hat. I was astonished by the generosity of colleagues I’d never met before, who gave up hours of their time and without exception invited me back for more if I so wished. So wherever you are, bite the bullet, write to some ICUs you don’t know, and invite yourself round. Don’t worry about embarrassing yourself (I’m sure one particular Sydney neuro-intensivist must be slightly horrified that I passed) – much better to be humiliated before the exam than on the day! If you have the opportunity to observe other candidates practising Hot Cases, grab it: you can pick up tips from both their strengths and their weaknesses.
3. Vivas: as with the other sections, the best way to prepare for vivas is to do vivas. While 'off-the-cuff' vivas from consultants are useful, it's even better if you can find someone who will take the trouble to prepare structured vivas (with a mark sheet) as in the exam. If you have a colleague sitting the exam with you, you could design vivas for each other - and then keep them on file for future candidates. That said, I would argue that time spent practising vivas is much less important than time spent practising Hot Cases or written papers; but if vivas are your weak point (e.g. if English is not your first language), then prioritise accordingly! Once again, answer the question asked - a common and fatal mistake is to answer what you think the examiner's getting at, not what he actually asked.