Intensive care guides · Examiner reports

Why candidates lose marks in the CICM exams

CICM examiner reports repeat themselves from sitting to sitting. Most marks are not lost on rare facts; they are lost on how answers are written and on the same core gaps. These are the themes that come up most.

  1. Generic "proforma" SAQ answers (ABC, lines, cultures, antibiotics) that are not tailored to the patient in front of you, and missed parts of multi-part questions.
  2. Not allocating time by the marks: pages on a 2-mark section, a line on a 6-mark one.
  3. Management choices listed without a justification, a dose, a target or the evidence behind them.
  4. First Part: answering a neighbouring topic (cardiac output when asked about oxygen delivery or venous return) and not linking mechanism to effect; anatomy and measurement are the weakest SAQs.
  5. Hot cases: missing or inventing signs, a rough or unfocused examination, weak synthesis and differentials, and needing prompts to commit to management.
  6. Hot cases are the biggest hurdle: only about 40% of candidates pass both.
  7. Vivas: knowledge gaps and not explaining the rationale for a decision; the radiology viva is consistently the weakest.

What this looks like when it is marked

A SP SAQ question, an answer of the kind examiners see every sitting, and how a point-by-point marking guide scores it.

Question · 5 marks

A 66-year-old man is on day 2 after an emergency Hartmann procedure for faecal peritonitis. He has received 4 litres of crystalloid; noradrenaline is 0.35 micrograms per kilogram per minute, mean arterial pressure 62 mmHg and lactate has risen from 3.1 to 4.8 mmol/L. Outline your next steps in managing his shock.

Answer

I would assess his airway, breathing and circulation, insert an arterial line and a central line, send blood cultures, give more fluid and broad-spectrum antibiotics, and consider source control. I would titrate noradrenaline to a mean arterial pressure of 65 mmHg and monitor his lactate…

✓States a mean arterial pressure target of 65 mmHg1/1
✗Assesses fluid responsiveness before more fluid after 4 L (passive leg raise or echocardiography), rather than giving it reflexively0/1
✗Adds vasopressin (about 0.03 units per minute) as noradrenaline exceeds 0.25 micrograms per kilogram per minute0/1
✗Starts hydrocortisone 200 mg per day for escalating vasopressor need (ADRENAL)0/1
✗Hunts for a surgical cause on day 2: stump leak, ischaemic stoma or collection; CT and early surgical review0/1

This is a sepsis proforma: the lines, cultures and antibiotics were done two days ago. Marks go to the next step for this patient, with a dose or target and a reason. CICM examiners report generic answers like this at every sitting.

How to practise against these

Reading a list of mistakes changes little. What changes the score is writing or speaking answers under exam conditions and being marked against specific points, so you can see exactly which one you missed. Do that for every area, weakest first, and repeat the ones you got wrong until they stick.

Know the references examiners expect: ANZICS guidelines, including the ANZICS Statement on Death and Organ Donation; DonateLife; ANZICS CORE and the Adult Patient Database; ANZICS Clinical Trials Group landmark trials (NICE-SUGAR, ADRENAL, SAFE, SPLIT, PLUS, BLING III, ARISE); ANZCOR and Australian Resuscitation Council guidelines; Therapeutic Guidelines: Antibiotic; National Blood Authority Patient Blood Management guidelines; Australian Red Cross Lifeblood; State guardianship, advance care directive and medical treatment decision laws; CICM syllabus (Second Part syllabus V2, November 2025) and CICM professional documents.

Where do you stand?

Thirty questions across every area, scored by area with a plain verdict. Free.

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