By Adam Doggett 
On the 4th November 2021, the professional and statutory body for intensive care medicine specialists in the UK, The Faculty of Intensive Care Medicine (FICM), published FFICM Final OSCE (Objective Structured Clinical Examination)/ SOE (structured oral exam) results. A successful pass of both parts of the exam is required for healthcare professionals (HCPs) to move through the Intensive Care Medicine (ICM) training pathway.
The examination, designed to test practical clinical competence, including effective application of clinical science knowledge and skills in safe practice, returned less than inspiring results. Among the trainee cohort, 28% and 67% pass rate in OSCE and SOE components respectively warranted an FICM investigation into “initial concern with the exam results” which resulted in a delay to the publication of results and in turn, an official statement addressing the delay.
As intensive care medicine specialists and trainees from across the pathway took to Twitter to bemoan the outcome, any suggestion that COVID-19 could be blamed for the poor results was swiftly swept aside, with HCPs considering the pandemic to be an inconvenience to learning rather than an education deal-breaker.
When I sat fficm (2017) it seemed like a fair exam with the content analogous to what you might find on a particularly diverse ward round. It'd be interesting to know how that has changed- from what I'm hearing about fire ext this year it would appear rather a lot.
— John Rae (@Raeforce1) November 6, 2021
If that were the case Viva result would have been worse. I think it's more the result of an ICM exam that didn't ask any questions about ICM.
— Ben Eagle (@beneagle82) November 6, 2021
With COVID-19 avoiding blame, HCPs turned to FCIM to take the brunt of the dissatisfaction. The predominant view of those working in the field was that the examination system, rather than the candidates, lacked the required quality to produce intensive care medicine specialists.
As a generalist specialty I think broad is good as long as clinically relevant & not esoterica. However at 28% pass rate clearly something has gone very wrong with the exam
— John Rae (@Raeforce1) November 7, 2021
With so many candidates failing to make the grade, FCIM runs the risk of leaving future ICM specialists disenfranchised and let-down by the system. Trainee Rachel Ward epitomised feelings of falling victim to the exam, describing how their efforts have been “thrown back in our face”.
To see many prominent ICM figures coming out with ‘feel sorry for the examiners’ and ‘they’ve had limited clinical experience with Covid’ is just horrendous. We have given everything to the specialty in the last 18 months and you’ve just thrown it back in our face. #MedTwitter https://t.co/SsCAMCIsTt
— Rachel Ward (@rachie_ward30) November 6, 2021
There is a feeling from previous exam candidates that content being covered may have changed over the years as the FCIM looks for the best way to make sure intensive care specialists are adequately trained and of high quality before continuing through the pathway.
However, the higher the standards, the greater the barrier to entry and the reflections of Thom Hall offer notable insight into the struggles of an already understaffed specialty.
When I sat fficm (2017) it seemed like a fair exam with the content analogous to what you might find on a particularly diverse ward round. It'd be interesting to know how that has changed- from what I'm hearing about fire ext this year it would appear rather a lot.
— John Rae (@Raeforce1) November 6, 2021
It’s another factor in me not applying for ICM this year. Got an offer last year but couldn’t take it as also had anaesthetics ST3 offer. Now I’m kinda glad.
— Thom H🦀 (@ThomHall) November 6, 2021
While some may be put off going through the training and joining the specialism, the pressures of the profession causes others, who already have ICM credentials, to change course. Emily’s experience is all too common and extends across healthcare roles, as reported by a recent CREATION.co study to investigate views towards, and reception of UK health policies. The research identified work/life balance as one of the primary areas where HCPs looked for greater support and protection from the system in which they work.
Resigned my ICM no in March and am now single speciality Anaeathesia. Added to (but not solely caused by) exams and portfolio pressures.
— Emily (@dr_doddle) November 6, 2021
Rigorous examination which only allows suitable candidates entry to the next phase of training whilst simultaneously not discounting competent trainee physicians seems a tough balance to strike. While many have been quick to blame FCIM for staffing an institutional failure, there is a sense of sympathy for an organisation ultimately working to achieve the best outcomes for patients in the most critical of situations. There is a solution to be found and that solution will come through collaboration and humility.
Hard agree Neil. The exam situation absolutely needs sorting, solidarity to colleagues affected by this .But the recurrent gleeful anti-ICM stuff from some people is an absolute unhelpful snore-fest 🥱
— Chris Wright (@curlychris82) November 6, 2021
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