How to Pass

The first part exam is:

• Painful
  The knowledge demanded is huge, and cannot be avoided.
• Eminently achievable
  Remember, it is not impossible - everybody before you has completed it.

Plan for Success

This is not an exam you want to have to sit more than once - try to give yourself the best chance of success the first time round:

• Commit yourself early
  Decide when you are going to sit:
  • Pick a date ~9 months in advance
    • 6 months is probably pushing it
    • 9 months is achievable
    • 12 months is almost too long - you will lose motivation and knowledge will fade.
  • Accept that the time between now and the exam is not going to be the best time of your life
  • Consider paying the money as soon as possible - lock yourself in
  • Your family and friends will forgive you, eventually
• Don't lose faith
  • There will be times that you question why you have to learn this
  • Those are very legitimate feelings
  • Accept that part of this exam is an academic hazing you must pass through on your path to fellowship
• There is no substitute for knowledge

Be Strategic

The curriculum provided is overwhelming, and probably not achievable for most of us. Have a plan about how you will approach it:

• Have a timetable
  • Content to cover each week
    • I found setting a weekly goal would allow me to plan around day-to-day variations (finishing late, good days, bad days, etc)
    • A daily timetable was often mangled by life, creating unnecessary stress
  • Time to start viva practice
    Aim to start before the written.
    • Topics that you can't explain, you probably don't understand fully
      This may not be apparent until you try and explain it.

• Know the enemy
  • Syllabus
    Read through it so you appreciate the breadth of knowledge required.
  • Know the style
    This allows you to give answers efficiently - the key metric for both the vivas and the SAQs is marks per unit time.
    • Style of exam questions
      Including the style of answers - see the SAQ.
    • Style of vivas
      • Do practice vivas
        • Record yourself, so you know your tics
        • Do a dress rehearsal
          Make sure your suit still fits before the day.
    • Graphs
      Be able to draw them while talking about them.

• Do past questions
  I cannot stress this enough. This is the key to preparing for this exam.
  • Past questions:
    • Teach you appropriate structure
    • Teach you to write to time
    • Ensure you learn the content in the way it will be recalled
    • Ensure you don't waste time learning things that are unlikely to be examined
      When I sat the CICM exam, I had done almost all the past questions, which covered ~60% of the curriculum. There was 1 (out of 24) of the SAQs on a topic I had not answered an SAQ on before.
  • Do questions to time
    Keeping to time is vital.
    • It is almost impossible to write a perfect answer in 10 minutes
    • In many cases you will need to move on to the next question despite still having things to say
    • Remember that the marking follows a sigmoid distribution
      • The first 30% of marks for a question are easy to get
      • The last 30% of marks are very difficult to get
      • Therefore, the most efficient use of your time is to aim to get ~60-70% of marks for each question.

• Remember the pass mark is 50%
  • You are not expected to know everything
  • Breadth tends to be rewarded over depth
  • It is normal to sit the exam and have a question you have not thought about before

Suggested Approach

There are many equally valid ways to approach these exams. This is how I would do it, if I had to do it again:

1. Read a general physiology and pharmacology textbook
   This will help you understand the scope of the undertaking. I would recommend spending 2-3 weeks reading:
   • Chambers D, Huang C, Matthews G. Basic Physiology for Anaesthetists. Cambridge University Press. 2015.
     In my opinion, this is the general physiology text. I believe that if you knew everything in this book, you would pass the physiology component of both exams.
   • Peck TE, Hill SA. Pharmacology for Anaesthesia and Intensive Care. 4th Ed. Cambridge University Press. 2014.
     The first few chapters are a good introduction to pharmaceutics and pharmacokinetics, which will help you put later information from more complete texts into context.
     
     
2. Start doing practice questions:
   This is the key to the exam. I suggest:
   • Start doing one question at a time
     In the beginning, you will not know enough to write for 10 minutes.
     • After doing the question, check your answer against available past answers
       This forces active learning, and is far more efficient than reading. Look at:
       • Structure
         How did you structure your answer? What was the example structure?
       • Content
         What did you miss? Are the numbers/graphs you used correct?
     • Then study the curriculum areas that question covered, and make notes
       This would take me ~1-2 hours for a new curriculum area.
   • Once you start doing questions which you know something about (having answered one similar previously), move up to three questions in 24 minutes.
     This teaches you to keep time, which is vital for success in the SAQ.
     • Still check each answer afterwards, look over that area of the curriculum, and revise and refine your notes
   • When you find yourself running out of time before you run out of things to write, give yourself 9 minutes per question
     I would suggest not going beyond this - you need to allocate your time strategically on the day, and writing to time is critical.
   • As this gets easier, start doing 6 or more questions at a time to train your writing hand
   • Do one or two full exams to time before game day
     
     
3. Do a lot of flashcards
   Flashcards are less demanding than doing questions, and a simple form of revision.
   • They are the absolute best way of rote learning facts (in my opinion)
   • I used anki, but use whatever works for you
   • My anki deck is available here
     
     
4. Do practice vivas
   Start before the written. There is a lot of crossover of skills between the viva and the written. Both require a structured approach, and good content knowledge.
   • Remember to take a break after the written exams, it is exhausting

The Bottom Line

• Pick a date, and commit to it
• Work out which times work best for you with respect to study
  Different times will be better for different things. I found:
  • Days off (including weekends) were best for learning new content
  • Work days were for revising
  • Post night shift was a write-off
• Maintain a positive attitude
  Study groups are good for this - share the suffering!
• Split large topics into manageable chunks
• Don't lose your head
  Set aside time for relaxation, and don't feel guilty about it.
• You don't have to know everything
  The pass mark is 50%

Prizewinners Perspective

Key thoughts from those who won the prize; for those of you feeling anxious, wanting to excel, or are Renton-inclined

• Spend 12 months learning content, and 6 months revising
• Manage expectations of friends, family, and partner early
• Learn from good quality texts and credible online resources
• Preference and use multiple references for core topics, and minimise time spent on peripheral topics
• Engage in rote-learning on a regular basis
• Reinforce knowledge in other ways besides re-reading
• Heed the examiners reports
• Focus on the SAQ
  Practice:
  • Under exam conditions
  • Recently asked questions
  • Poorly answered questions
  • Repeatedly

References

1. A talk I gave at the 2016 VPECC Course, still raw from the CICM primary.
2. Periodic updates from talking to colleagues, and guiding junior trainees through the academic crucible.