ICU and You · Exam focus · CICM First Part · Number 1
What the examination is, how it is marked, and how people pass it — before any of the content
A new section. Exam focus will build up over time, starting with the CICM First Part and adding other examinations as they are written. This first piece is the map rather than the territory: everything you should know before you open a textbook.
Almost everyone who fails the First Part knew enough physiology to pass it. That sentence is the reason this piece exists.
The examination is not principally a test of whether you understand the basic sciences. It is a test of whether you can retrieve the right part of them, under time, in the shape the college asks for, and apply it to a patient. Those are four separate skills, and only the first is trained by reading.
Almost every candidate underestimates it, and that is not carelessness. It is the predictable result of who sits this examination. You are, by selection, a high achiever. There is a fair chance you have never failed anything, and a good chance you have rarely had to fight for a pass. Nothing in your education so far has prepared you for an assessment that a substantial number of intelligent, hard-working, well-prepared people do not get through at the first attempt.
Because that is what this is. Candidates who fail the First Part almost never fail for want of intelligence, or effort, or even knowledge. They fail on approach, strategy and technique. So before you open a textbook, stop and think properly hard about how you are going to prepare and how you intend to perform on the day. Work smarter rather than merely harder — you will be working hard regardless.
The First Part is a basic science examination sat during core training, and it is a gate: you cannot progress without it. It covers physiology, pharmacology, measurement and equipment, and a smaller component covering microbiology, statistics and research methods. Physiology is the largest part by a distance, pharmacology next, and the remainder is where a lot of candidates quietly decide not to bother.
It runs in two stages. A written component of two papers, each combining multiple choice questions with short answer questions written out by hand, and then, for those who pass it, an oral component of eight cross-table vivas of about ten minutes each, opening with a couple of minutes of reading time on a single topic. The college publishes the exact paper structure, and it has changed more than once, so check the current format on the CICM website rather than trusting anybody's summary — including this one.
These are exacting papers. They are long, they are dense, and they are unforgiving of a candidate who has not rehearsed the specific act of producing organised prose at speed with a pen.
You almost certainly do not write by hand for hours any more. Nobody does. Yet the short answers are handwritten, under time, and a marker can only award what they can read.
Practise this long and hard, and practise it under exam conditions — full questions, full time, a pen, no notes, no stopping. Candidates discover late that their hand cramps at forty minutes, that their writing degrades as they tire, and that they cannot plan an answer and write it inside the time allowed. All three are trainable, and none of them is trained by typing.
There is no fixed pass mark. The written pass marks are set for each sitting by a standard-setting method, and the viva component by another. They move. In recent sittings the multiple choice pass mark has sat somewhere in the high fifties to mid sixties per cent, and short answer markedly lower — but those are descriptions of past sittings, not a target.
Two consequences follow, and both matter. The multiple choice section behaves as a hard gate: fail it and the rest does not save you. And “what mark do I need?” is not a question with an answer, so the only sane strategy is to be comfortably above the line rather than aiming at it.
By a considerable distance, candidates do not come unstuck on the multiple choice or in the vivas. They come unstuck on the short answer questions.
That should change how you divide your time. Most candidates allocate their preparation in proportion to how comfortable each format feels, which means they do most of their work in the format least likely to fail them. The short answers deserve the largest share of your practice, from early on, and they are the part almost everybody under-rehearses.
Applied basic science. Not physiology, but physiology as it turns up in an intensive care unit. The difference is the whole examination.
Work through every past paper and every examiner report the college has published. The reports tell you what candidates actually wrote, what the examiners wanted, and which errors recur. The same criticisms appear sitting after sitting: no structure, no ICU application, no values, graphs described rather than drawn, whole sections of the syllabus left blank.
That is the examination telling you, in writing and for free, exactly how it will mark you. It is remarkable how many candidates read the questions and skip the report underneath.
It is worth being told plainly at the start: this is going to be hard, and for a long time. Not hard in the way a difficult week is hard, but hard in the way that a second job is hard, on top of shift work, for the better part of a year. Every candidate who has done it will tell you the same thing.
Which means the rest of your life needs a deliberate look, not an apology. Some things will have to be put down for a while, and it is far better to choose which ones in advance than to have them fall over one at a time. Talk to the people you live with before you start, not in month four when everybody is already unhappy. Tell them roughly how long it will last and what it will look like, and agree what stays protected — because something has to.
Working in isolation is, in my experience, one of the more reliable markers of a candidate in trouble. Not because solitary study is inefficient, though it often is, but because the isolated candidate has nobody to tell them that their answers have no structure, that they have avoided a whole topic for three months, or that everybody finds this part hard.
So build something around yourself. A study group. Somebody to examine you out loud, weekly, whether or not you feel ready. A course, if one is available and it suits you. Your supervisor of training, early. Colleagues who have recently sat it, who will remember exactly what you are going through and are usually pleased to be asked. Take any help that works, and do not wait until things are going badly to ask for it.
And build the preparation around how you actually learn, which may not be how the person next to you learns. Some people need to see it — diagrams, flow charts, a wall of paper. Some need to say it, and only understand a topic once they have explained it to somebody else. Some need to write it out longhand, which for this examination has an obvious secondary benefit. Some work best in ninety-minute blocks and some in twenty. None of these is the correct method. The correct method is the one that produces recall in you, and part of preparing is finding out what that is rather than copying whatever the last person said worked for them.
This examination has a substantial failure rate, and a great many excellent intensivists have sat it more than once. It measures preparation for a particular assessment on a particular day. It does not measure whether you will be a good doctor, and it is not a verdict on you.
If you are struggling, tell your supervisor of training early rather than late. That is what the role exists for, and the conversation is much easier before a sitting than after one.
Later pieces in this series will go into the content — the topics that recur, the answers that keep going wrong, and the specific things worth having at your fingertips. This one is deliberately the map. Get the shape right first, and the studying gets a great deal more efficient.
If you have sat it: what do you wish somebody had told you at the start?
And if you are sitting it now — what would you most like the next piece in this series to cover? I would rather write what candidates actually need than what I assume they need. Both kinds of answer are welcome, and I will use them.
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