DICM - Studying for the exam

Studying for the exam

By now you will have studied for at least two postgraduate exams, plus numerous exams at school and medical school. You should therefore have worked out what works for you in terms of study techniques. This section will focus mainly on suggestions specific to the Diploma in ICM, with a few general study suggestions at the end.

1. Remember what you're aiming for: a mandatory pass in the Dissertation viva, and passes in at least two out the remaining three vivas (two 'general' vivas and one on ETR cases plus data interpretation'). This means that you must know your Dissertation (and its ramifications) well.

2. Don't take the Examination Syllabus too seriously. I found the syllabus somewhat misleading, with its heavy emphasis on basic sciences (of 11 pages in the syllabus, 7 cover anatomy, physiology, pharmacology, physics and measurement, equipment, radiology and IT). This was not at all representative of the exam, which dealt with hard-core clinical ICU (e.g. organ support, nosocomial infection, scoring systems, SIRS and sepsis, ICU outreach teams, end-of-life decisions). I wouldn't neglect the syllabus completely - you'd look pretty silly failing for not knowing coronary anatomy or acid-base physiology - but don't spend too much time on basic sciences. The "Domains for the Viva Examinations" (published as an appendix to the DICM Regulations) are a more reliable guide to the sort of thing you are likely to be asked.

3. Know the literature well. This doesn't mean you need read every article in Critical Care Medicine for the last two years; but you should have a reasonable knowledge of the methods and findings of the top papers in intensive care medicine in the last few years. In my general vivas, it was rare that a topic went by without me being asked if I knew of any evidence from the literature on the issue; and while most of the time I could name the paper they were looking for, I was often a bit hazy on details like the size of the finding, or strengths and weaknesses. I wish I had spent more time revising key papers and less time on basic sciences.

4. Get yourself a decent ICU textbook (if you haven't got one already), to establish a broad basic knowledge. Teik Oh's 'Intensive Care Manual' is probably the current 'bible', though the latest (5th) edition is now five years old. Hinds and Watson might be an alternative, despite being less detailed overall (third edition due out soon!). An American text called 'Critical Care Secrets' presented a nice question-and-answer format, directed the reader to key journal articles, and occasionally highlighted clinical controversies; a new edition came out in 2007. At present I'd say the current edition of Oh's Intensive Care Manual is your best bet - but if anyone has a better suggestion, let me know at austin@dicm.co.uk !

5. Two journals to enhance your knowledge of the literature: Current Opinion in Critical Care presents review articles. Each two-monthly issue covers two or three fields within intensive care (e.g. 'Cardiovascular System', 'Trauma', 'Ethics and Organisation'), so that all fields are addressed in a one-year cycle. Within each field there will be up-to-date reviews on about half-a-dozen (often 'trendy', sometimes obscure) topics. A few references in each reference list are highlighted as being of special or outstanding interest, serving as a further guide to important papers. Intensive Care Monitor is also published every two months and surveys the medical literature for papers in intensive care. A summary and critical analysis of the most important papers is presented. As a source of up-to-date, expertly-reviewed info, and a guide to 'what's hot and what's not', these two journals complement each other nicely.

6. Use the internet. Medline should already be at your fingertips. Most journals (including Critical Care Medicine and Intensive Care Medicine) will email you their table of contents for free, so you don't have to go to the library to see if there's anything worth reading each month. Some (including BMJ, Lancet and NEJM) publish free full text of many of their original articles, usually a certain time after the print publication; BMJ and NEJM both have specific archives of articles relevant to intensive care. Useful general resources include sites such as eMedicine and the Merck Manual; and there are several sites containing review articles and forums specific to intensivists (e.g. sepsis.com, the Critical Care Forum, and Remedica's 'Advances in Sepsis').

General studying tips

1. Start studying sooner rather than later. I started 'serious studying' about five months before the exam, and although I passed, I felt this was not enough time - I felt more panicked in my final week than for any other exam. One of my fellow examinees told me he'd been working for the exam for eighteen months, and he looked pretty relaxed!

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 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 ACCP/SCCM definition of SIRS; criteria for ARDS; the Ranson score for acute pancreatitis - I got asked all three of these in my vivas): 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.

5. The 'business card' technique can be adapted for remembering important journal references. On one side write the name of the author, journal and year; on the other write the key findings in one or two sentences. Test yourself as above.

6. 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.