ICU and You · Exam focus · CICM First Part · Number 2
Thirty-eight pages nobody finishes — what is in it, and where the marks are
The syllabus is the single most important document in your preparation and the one most candidates never read to the end. This is a map of it. It is not a substitute for it.
The fifth edition was published in 2025 and is current. Every question in the examination is derived from it. The College says so in the opening pages, and says the objectives set the minimum level of understanding for each topic.
They do not read it once. They keep it open beside the study plan and use it as a checklist, because it is the only document that tells you, in the College's own words, what you are expected to be able to do with each topic — not just what to know about it.
The verbs are the whole game, and almost nobody notices them. A topic marked “outline” and a topic marked “explain” are different amounts of work, and the difference is written down.
I counted, because as far as I know nobody publishes this.
Objectives are not evenly distributed, and the College tells you as much in the foreword: respiratory and cardiovascular were given subheadings in this edition precisely because more depth is expected in those two.
| Section | Objectives | Subsections | Note |
|---|---|---|---|
| C Respiratory system | 47 | 8 | Flagged by the College: given subheadings because more depth is expected |
| D Cardiovascular system | 38 | 6 | Flagged by the College: same |
| B Concepts in pharmacology | 28 | 3 | Kinetics, dynamics, variability — underpins every drug question |
| H Nervous system, autonomic and pain | 27 | 4 | |
| J Gastrointestinal system | 18 | 4 | Now includes liver physiology |
| N Haematological and immunological | 15 | 4 | Now includes immunology |
| E Renal system | 11 | 3 | |
| L Endocrine system | 11 | 2 | |
| P Obstetrics and neonatal | 11 | 3 | |
| K Nutrition and metabolism | 9 | 3 | |
| F Body fluids and electrolytes | 8 | 2 | |
| I Musculoskeletal system | 8 | 3 | |
| O Microbiology | 8 | 2 | |
| A Cellular physiology | 6 | – | |
| G Acid–base | 5 | 2 | Small section, disproportionate exam presence |
| M Thermoregulation | 5 | 2 | |
| Q Antidotes and decontamination | 1 | – | One objective, a whole pharmacopeia |
| Total | 256 | 51 |
Read that table as a time allocation, not a ranking of importance. Respiratory and cardiovascular together are a third of the objectives. Concepts in pharmacology is third largest and is the section that makes every drug question answerable, which is a better return than memorising one more pharmacopeia entry. Acid–base has five objectives and turns up far more often than five objectives would suggest, because it integrates with respiratory and renal.
The syllabus states that for all sections a thorough understanding of normal physiology and pharmacology is expected, together with how it varies in:
1. Extremes of age — neonates, paediatrics and the elderly.
2. Extremes of body size — obesity.
3. Pregnancy — including parturition, and the foetus.
4. Critical illness — sepsis, and cardiac, respiratory, liver and renal
failure.
The same four are repeated in the pharmacology notes, so they apply to every drug as well. This is a syllabus-wide multiplier stated once, on page five, and then never repeated in the individual objectives. If you learn a topic only in the healthy seventy-kilogram adult, you have learned a fifth of it.
These define both the depth required and the structure your answer should take. Learn them the way you would learn a drug.
Two are worth dwelling on. Outline explicitly excludes the minor detail — a candidate who writes everything they know in response to “outline” has misread the question and spent time they needed elsewhere. And understand requires you to apply the knowledge to a new situation, which no amount of recall will produce.
Every drug and drug class in the pharmacopeias is tagged Level 1, 2 or 3. This is the most actionable thing in the document and it is on page seven.
| Level | What is required | Entries |
|---|---|---|
| Level 1 the deep ones |
Class, indications and dose; pharmaceutics — packaging, formulation, isomerism and its significance, compatibility, excipients; mechanism of action; pharmacodynamics and adverse effects; and full pharmacokinetics. | ~53 |
| Level 2 | Class, indications and dose; mechanism; pharmacodynamics and adverse effects; and only the important kinetic considerations or differences in the ICU. | ~47 |
| Level 3 | Class and indications; mechanism; pharmacodynamics and adverse effects. No dose, no kinetics. | ~106 |
Half the drug entries are Level 3, and Level 3 is a short answer: what class, what for, how it works, what it does and what goes wrong. You do not need the kinetics.
The Level 1 list is about fifty entries and it is where isomerism, excipients and formulation actually get asked. If you have ever wondered why a viva went to the ampoule and the preservative, this is why. Level 1 is the only tier that demands pharmaceutics.
The Level 1 classes, for orientation: oxygen; the adrenergic and non-adrenergic inotropes and vasopressors; the antiarrhythmics; frusemide; crystalloids, colloids and buffers; the sedatives, amide local anaesthetics, opioids, paracetamol, ketamine and atropine; the neuromuscular blockers; heparins and warfarin and blood products; and the main antibacterial classes.
The syllabus lists them on page eight, and the relationships between them matter: some are offered as alternatives, some are required together. Most are available through the ANZCA library, reachable from the CICM website.
| Area | What the syllabus lists |
|---|---|
| General physiology pick one |
Kam and Power, Principles of Physiology for the Anaesthetist or Guyton and Hall or Boron and Boulpaep or Ganong's Review of Medical Physiology |
| Respiratory both |
Lumb, Nunn's Applied Respiratory Physiology and West, Respiratory Physiology — the Essentials |
| Cardiovascular | Pappano and Wier, Cardiovascular Physiology |
| Renal | Eaton and Pooler, Vander's Renal Physiology |
| Pharmacology two required, then pick one |
Birkett, Pharmacokinetics Made Easy and Smith et al, Drugs in Anaesthesia and Intensive Care and then Katzung or Milner and Welch or Peck and Hill |
| Measurement pick one |
McLintic et al or Davis and Kenny or Middleton et al |
| Anatomy both |
Georgiou, Thompson and Nickells, Applied Anatomy for Anaesthesia and Intensive Care and Drake et al, Gray's Anatomy for Students |
| Blood | Australian Red Cross Lifeblood and the New Zealand Blood Service websites |
| Also named | The antibiotic chapter of Therapeutic Guidelines; MIMS Online for individual drug detail; and Oh's Intensive Care Manual, singled out for monitoring devices and waveform interpretation |
Two things the College says about them are worth reading closely. It notes that online non-peer-reviewed sources may not be reliable and have deliberately been left off the list, and that care should be taken to confirm the accuracy of any online material. And it states that the examination is prepared and marked using the recommended texts together with online peer-reviewed sources — so the reading list is the floor, not the ceiling.
This is not an examination you read a textbook and pass. Candidates fail every sitting having read the recommended texts carefully, and some of them have read more than the people who passed. Reading is necessary and it is nowhere near sufficient.
What works is a balanced approach in which no single component carries the load. Past questions, certainly — a great many of them, and the examiners' reports alongside. But also the texts, reputable websites, good video explanations, podcasts on the drive in, a study group that meets whether or not everyone has prepared, and a study partner who will tell you your answer was vague. Each of those does something the others cannot.
Part of the task is working out which mix works for you, and that is itself a piece of preparation rather than a preliminary to it. Some people learn by writing, some by drawing, some by being asked questions out loud until they stop waffling. Nobody can tell you which you are; you find out by trying, and the candidates who find out early get months of benefit from it.
And there are three things you need, not one. Depth, because the Level 1 drugs and the flagged systems are examined to a level that surprises people. Breadth, because the paper samples across seventeen sections and a hole is a hole. And exam technique, rehearsed until it is automatic — reading the verb, structuring the answer to it, allocating the time, writing legibly, and stopping when the time is up rather than when the knowledge is.
The candidates who fail are rarely the ones who did not know enough. They are usually the ones who knew it and could not get it onto the page in the time available.
This is a map, not the territory. I have counted, grouped and summarised, but I have not reproduced the objectives, and the wording of each one is the thing that matters. Two objectives about the same topic can demand very different work depending on their verb, and you cannot see that from a summary.
Read the actual document. Read it in pieces if you must — one section at a time, alongside the topic you are studying. But read it, and go back to it, because the examiners did.
The counts here are mine, derived from the fifth edition, and are for orientation rather than quotation. Verify anything that matters against the College's own document, which is the only authority.
Open the syllabus at a section you think you know, and read the verbs.
Pick something you are confident about. Read the objectives properly, one at a time, and ask whether you could do what each verb actually asks — not whether you know the topic, but whether you could explain, classify, or compare and contrast it under time.
Tell me what you found, and what the gap was. I will collect them, because the pattern across candidates is more useful than any one answer, and supervisors reading this would like to know where people are consistently over-confident.
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