FFICM Examiners Report - April 2018

Over the two days of examining 12 visitors attended the exam. It was much appreciated that unusually all visitors who had arranged to visit managed to attend.  There were a range of interests and geographical areas represented. One visitor was a consultant Paediatrician and another was Chair elect of a postgraduate exam. Visitors provide a useful source of external auditors and their presence is much appreciated at the exam. Those whose last visit to the college was to take the DICM were interested to see the way the FFICM has developed. All found the standard to be set at a fair level although some had been unaware of the range of material used, such as the wide range of imaging. Visitors felt many candidates performed well but also saw some who were less well prepared. 

The visitors were advised to make a point of observing the ECG station, simulator station and communication station. As noticed by previous observers of the exam they were surprised that candidates were finding assessing ECG’s difficult. One suggested the candidates were looking for complicated diagnoses and so missing simple ones such as atrial fibrillation. They noted on occasion there would be a positive finding of minimal significance, such as a small subdural haematoma, that appeared to stop the candidate searching for the real problem.

When it comes to communication candidates are improving but still inclined to talk in jargon. Although working with members of the public on a daily basis they seem to forget that it is unreasonable to expect the public to have a knowledge of technical terms.  Candidates entering the communication station in the OSCE exam may be introduced to a scenario that includes a simulated patient or relative and asked to talk to them. The examiner may say nothing and simply observe. Candidates would do well to remember that the exam uses actors who are members of the public and do not have to act when they profess not to understand what is said to them unless it is in plain English. It is not uncommon to hear the simulated patient ask for a term to be explained such as non-invasive ventilation, tracheostomy, vascath, inotrope or filtration.

Visitors remarked on the importance of timing in the OSCE exam. They noted that they would feed back to local trainees that often a lot of material is covered quite quickly. This means that candidates should be prepared for the examiner to move on from topic to topic quite quickly and not become concerned when interrupted. The examiner will aim to complete all the material in the allotted time. 

In most sittings of the exam the odd question stand out as being badly handled. These then feature in my report and often are better done in future exams. Examiners do not attempt to seek out areas of the syllabus where candidates are weak. Our aim over the course of a number of exams is to cover as much of the syllabus as possible in the exam format. 

Examiners are often surprised at the questions that are not answered well. In this exam many candidates had problems with a question on bowel management systems (such as Flexi-Seal). This was raised at call over and the wide use of the devices confirmed not only with examiners but also visitors. It is possible that they are considered within the realm of the nursing staff but intensivists, and thus candidates, should be aware of the risks and benefits of such systems. Another question that caused problems was one dealing with problems experienced by patients with short bowel syndrome. These patients often need critical care support and can be difficult to manage. Examiners and visitors commented on how poorly questions on the topic were handled. A less complex area that also caused candidates problems in this exam was a question on acid base balance. Visitors felt the content was mainstream but not well handled by candidates. It is important that candidates are familiar with basic science relevant to clinical practice. 

Some visitors commented that they had seen candidates appearing to test a number of suggestions for answers in the OSCE in an attempt to randomly find what the examiner is looking for, ‘the blunderbuss approach’. The OSCE format is well liked by educationalists because it is very flexible. This is not good practice as it is possible for those setting the question to define the number of attempts a candidate can make answering a question such as indicating on the mark sheet ‘accept first answer only’. If candidates do not know the answer to a question they would be better spending the time on the next question.