Orientation for the ICU Fellowship Exam

Authors: Ruvini Vithanage, Jeff Kam, Novia Tan, George Zhou

Summaries for Success:

CICM Exam Resource Links and Videos (Requires CICM Login)
Question Types and Structures
Optimizing Your Mindset
Study Techniques and Resources

Orientation, Preparation and Planning

What is the exam?

The level required for the CICM exam is that of a junior consultant. Answers are expected to be to the standard of an independent, safe intensive care medicine practitioner. When you are writing an answer, or answering a viva or hot case stem, you are demonstrating competence and experience in managing common intensive care medicine scenarios safely.

The written exam can be challenging to convey knowledge and competency through writing. Common pitfalls include:

Illegible handwriting
Not answering the question or misreading the question
Not giving context in a question to ensure that the information written is relevant or can be followed
Being too general and not using specific, knowledge words

Exam Scoring

Answers are marked by 2 independent examiners, then moderated by a third if borderline – thus it is rare to change if appealled

Angoff scoring

Video explaining Angoff scoring In detail

Glossary

The written exam glossary is very important when answering questions.

Marking keys will be tied to the glossary definitions.

As of 2026, the glossary is:

Critically evaluate: Provide and explain the evidence available relating to a topic
Outline: Provide a summary of the important points.
List: Provide a list.
Compare and contrast: Provide a description of similarities and differences. You may tabulate your answer.
Assessment: Generic term that implies determining an underlying diagnosis, encompassing; history, clinical examination, and relevant investigations.
Management: Generic term that implies determining an overall management plan encompassing; resuscitation, definitive treatment, initial and ongoing monitoring with supportive treatment.
Discuss: Explain the underlying key principles. Where appropriate, this may include controversies and/or advantages and disadvantages.
Explain: Make plain or known in detail.

Should I attend a course?

There are multiple courses across Australia and New Zealand, but the course content and target audience differ. A course can supplement study at various stages of your exam journey and it is recommended that at least one course be undertaken, cost permitting.

Course	Location	Stage of study	Written	Clinical
MCEC	Melbourne	Early	X	X
Sydney short course	Sydney	Mid	X	X
SAFE course	Western Sydney	Mid	X	X
WICM course	Wellington	Mid	X	X
ABC2 course	Melbourne	Late		X
‘Tub’s’ course	Adelaide	Late	X	X
Bala’s Course	Brisbane	Late		X
Canberra Course	Canberra	Mid	X	X

What should I study?

CICM has now published a syllabus that serves as a guide to the content expected in the exam. Traditionally, the ratio of 1:1:1 of textbooks and articles, past questions, literature has been suggested for study content. This is a good guide with the following caveats:

Textbooks are regularly out of date and journal papers or review articles can be more relevant. The recommended textbook to study is Oh’s Intensive Care Manual.
Online resources, such as Deranged Physiology, are becoming more accessible.
Review resources, such as UptoDate, are extremely useful.
The exam is changing and as questions evolve and become more targeted and specific, older past questions may not be a good guide to future exam questions.
Literature based questions, such as ‘Critically evaluate’ questions are diminishing in number and are now sometimes integrated into other questions.

Online resources

LITFL
EMCrit Blog
Deranged Physiology
Crit-IQ
Up to Date
Identifying as an intensivist: The transition from failure to success in a high-stakes medical specialist exam https://journals.sagepub.com/doi/abs/10.1177/0310057X251382957

Preparation

The Second Part is demanding by design
Exam performance is a skill, not a measure of your worth as a clinician
The skills required to pass can be deliberately developed

There is no denying that preparing for the Second Part is demanding. For many trainees, it feels more sustained and complex than the Primary, and more challenging than most examinations they have faced before. It is designed to assess whether you can access, apply, and communicate the knowledge base required of an intensivist. That said, performance in the exam is not a direct measure of your worth or potential as a clinician. An unsuccessful attempt does not mean you are a poor intensivist; more often, it reflects that the exam process itself has not yet been fully mastered. The skills required to pass: structuring answers, thinking under pressure, and applying knowledge clearly, can be developed with reflection, deliberate practice and focused preparation.

Situational Readiness for the Exam

Passing requires more than knowledge
Deliberately arranging your professional and personal life to support preparation is essential
Clarity about priorities early reduces friction later

Success in the CICM Fellowship examination requires more than knowledge acquisition; it requires situational readiness. This means deliberately aligning your professional and personal circumstances to support sustained preparation. Preparation of this magnitude rarely happens accidentally. It requires planning, prioritisation, and, at times, trade-offs.

Sacrifices may be necessary. Certain professional opportunities, additional projects, or leadership roles may need to be deferred. Personal commitments may need to be simplified or scheduled with intention. This is not about withdrawing from life entirely, but about recognising that preparation demands focused capacity for a defined period. Clarity about priorities early on reduces friction later.

Situational readiness is not about perfection. It is about creating conditions in which consistent, deliberate effort can occur.

Work

Clinical work is not an obstacle — it is one of your best learning resources
The key is being intentional about how you use the clinical environment

Work is not the enemy during exam preparation; in many ways, it is one of your greatest learning resources. The key lies in being intentional about how you use the clinical environment to strengthen exam skills rather than simply accumulating hours. With thoughtful planning, daily cases, ward rounds, and conversations can reinforce knowledge and exam technique. This will be explored further in the next section on how to study effectively while at work.

There is evidence to suggest that sustained focus on a single demanding goal necessarily reduces capacity for other tasks, a concept described as “opportunity cost” (Kurtzban et al., 2013). In parallel, cognitive load theory emphasises the importance of minimising unnecessary demands on working memory in order to optimise learning (Sweller, 1988). Together, these ideas highlight a practical reality: preparing for the fellowship examination requires prioritisation. For a defined period, the exam will need to take precedence, and other professional or personal commitments may need to be scaled back. Where possible, non-clinical responsibilities such as leading teaching programs or additional projects may be better delegated during this time, particularly if they are not directly aligned with exam preparation.

Some trainees choose to reduce clinical hours while studying. This can provide additional study time and may be particularly helpful depending on family circumstances, learning style, or personal wellbeing. However, financial implications should be considered carefully. Financial strain can introduce additional stress, which may undermine preparation rather than support it. As with most aspects of fellowship preparation, the decision should be intentional and aligned with both personal circumstances and exam goals.

Life

Fellowship preparation is a team effort
Early, honest conversations about expectations and capacity make the process more sustainable
Preparation is intense, but it is not permanent

The exam is a team sport. Fellowship preparation is rarely a solo pursuit. Just as professional commitments may need to be adjusted, personal life often requires recalibration. For a defined season, the exam will demand a disproportionate share of your attention, and that focus is usually made possible by the understanding and support of those around you.

If you have a partner, early and honest conversations are essential. Expectations around household tasks, meal preparation, social commitments, holidays, and emotional availability may need to be revisited. There may be periods where your contribution to domestic or relational labour is reduced, not from lack of care, but from limited capacity. From the perspective of cognitive load theory, reducing competing demands helps preserve mental bandwidth for learning (Sweller, 1988). This does not mean relationships are placed on hold; rather, it acknowledges that preparation is a time-limited investment requiring shared planning and mutual understanding. Preparation is intense, but it is not permanent.

Nutrition, exercise and sleep

Consistent nutrition, regular movement, and protected sleep are strategic — not optional
Sleep is foundational — memory consolidation depends on it
Reducing sleep to create study time is usually counterproductive

Whilst we will not provide a detailed review of the literature on nutrition and cognitive performance, it is worth acknowledging that diet plays a meaningful role in sustained energy and concentration. Exam preparation is cognitively demanding, often over many months, and inconsistent nutrition can contribute to fatigue, impaired attention, and reduced resilience under stress. Prioritising regular meals, adequate protein intake, and micronutrient-rich foods supports stable energy availability for the brain. This is less about optimisation and more about consistency, avoiding large fluctuations in energy that compromise long study sessions.

There is also strong evidence that physical activity supports cognitive health, memory consolidation, and executive functioning (Boere et al., 2023). Exercise is associated with improved neuroplasticity and stress regulation, both of which are particularly relevant during prolonged preparation. Incorporating movement into your weekly schedule, whether through structured training, resistance work, or simply regular walking, should be viewed as part of preparation rather than a distraction from it. A sustainable routine that includes exercise is more likely to support long-term cognitive performance than one built solely around sedentary study.

Sleep, however, is foundational. Memory consolidation occurs during sleep, particularly during slow-wave and REM phases, when newly learned information is stabilised and integrated into existing knowledge networks. Reducing sleep to create additional study time is therefore often counterproductive. Chronic sleep restriction impairs attention, working memory, and decision-making, which are precisely the functions most relied upon during written papers, vivas, and hot cases. Protecting sleep is not indulgent; it is a strategic component of exam preparation.

Support

A small circle of trusted peers reduces isolation and provides perspective
An experienced mentor makes preparation more efficient and targeted
You don’t have to navigate this alone

Strong social support is invaluable during fellowship preparation. While your availability may fluctuate during busy periods, maintaining connection with a small group of trusted friends can provide perspective and emotional steadiness. Sometimes this support is simple — a coffee, a walk, or a brief conversation where you can acknowledge that the process is challenging with someone who understands. These moments do not detract from preparation; they often make it more sustainable.

An exam mentor can also be extremely helpful. Ideally, this is someone who has recently completed the fellowship examination and has the insight and capacity to guide you through the practical aspects of preparation, structuring answers, navigating expectations, and avoiding common pitfalls. Many institutions have informal or formal mentorship pathways. If not, consider approaching a recently successful fellow, a TY fellow, or a senior registrar who remembers the process clearly and is willing to share their experience. Targeted guidance can reduce uncertainty and make preparation more efficient.