CICM First Part Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for ICU registrars sitting the CICM First Part Examination in the next twelve months. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary. It now covers 21 colleges because trainees from each specialty asked us to build for them. The CICM First Part Examination curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The CICM First Part is the basic sciences gate of the College of Intensive Care Medicine of Australia and New Zealand training pathway. It tests applied physiology, pharmacology, anatomy, and measurement at the depth required to manage a critically ill adult in an ICU. You sit this exam in the early years of your core training time. Pass the First Part and you progress through clinical training toward the Second Part Fellowship Examination at the end of training. Most candidates sit the First Part once they have at least twelve months of accredited ICU time and a written exam in the back pocket from anaesthetics or emergency medicine, though the syllabus is built to stand on its own.

Format

• One written paper containing 20 short answer questions, split into two ten-question papers on the same day
• Each SAQ is worth 20 marks, total of 400 marks across the day
• Approximately ten minutes per SAQ, written under timed conditions
• A separate viva day with 8 cross-table vivas of approximately 10 minutes each
• Each viva opens with a 2-minute reading period followed by examiner-led probing on a single basic science topic applied to the ICU
• The written and viva components carry equal weighting in the overall result

Sittings and timing

• Two sittings per year, traditionally one in the first half of the year and one in the second half
• Eligibility requires accredited ICU training time, registration with the college, and a paid examination fee
• Re-sit available the following sitting if unsuccessful, with no formal cap on attempts but practical limits set by training time
• As of 2026, check the CICM website for the current dates, examination fee, and venue list before locking in study plans

Pass marks and standardisation

The college does not publish a fixed percentage that guarantees a pass. Standard setting is performed by the examination committee against the candidate cohort and the marking criteria for each question. The pass rate fluctuates by sitting and tends to land in the range of forty to fifty-five percent for first-attempt candidates, but treat any single quoted figure as approximate. The college publishes an examiner report after each sitting that breaks down performance by question with commentary on what was awarded marks and what was not. The examiner report is the single most useful document for re-sit candidates and is worth re-reading even if you passed.

Day-of logistics

• Photo identification required, current driver licence or passport
• The written paper is sat under invigilated conditions at college-approved venues
• No personal materials at the desk: no phone, no smartwatch, no notes, no calculator unless one is supplied
• Bathroom breaks are escorted and the clock keeps running
• The viva day is run with paired examiners at a college venue, with a structured scoring sheet behind each station
• Voice-projection matters in vivas; the examiners cannot mark what they cannot hear, especially through a mask

What the college actually tests

The PRIMEX CICM First Part curriculum holds 244 mapped learning objectives across 17 syllabus sections, drawn directly from the CICM First Part Examination Syllabus Version 5 (2025). The breadth is the point. The First Part is engineered to test applied basic sciences across the whole of intensive care medicine, not depth in any one organ system. Cardiovascular and respiratory physiology carry the heaviest single-section weighting in most papers, but a candidate who neglects acid-base, pharmacokinetics, or measurement will find a paper that punishes them.

The 17 syllabus sections

The mapped sections in the PRIMEX curriculum file cover Cellular Physiology, Pharmacology Concepts, Respiratory System, Cardiovascular System, Renal System, Body Fluids and Electrolytes, Acid-Base, Nervous System, Musculoskeletal System, Gastrointestinal System, Nutrition and Metabolism, Endocrine System, Thermoregulation, Haematology and Immune, Microbiology, Obstetric and Neonatal Physiology, and Antidotes. Each section holds between roughly five and forty learning objectives. Topic-level reviews are linked to study notes, MCQ pools, flashcards, and SAQ practice prompts.

The highest-yield areas to anchor your study

Cardiovascular physiology

• Cardiac output and its determinants. Preload, afterload, contractility, heart rate, with normal values (cardiac output around 5 L/min, cardiac index around 2.5 to 4 L/min/m2) and the equations to back them up
• Pressure-volume loops including changes with inotropy, lusitropy, valvular disease, ischaemia, and tamponade
• Cardiac action potentials, the ionic basis of each phase, and the mechanism of antiarrhythmic classes
• Coronary blood flow autoregulation, the determinants of myocardial oxygen demand and supply
• Arterial blood pressure measurement and regulation, including the differences between non-invasive and invasive monitoring and the sources of error in each
• Haemodynamic monitoring in ICU: PA catheter waveforms (a, c, v waves), thermodilution, pulse contour analysis, fluid responsiveness assessment

Respiratory physiology

• Oxygen delivery, consumption, and extraction ratio. The Fick equation, normal values for DO2, VO2, and SvO2, and the clinical significance of each in shock
• Oxygen-haemoglobin dissociation curve, the factors that shift it left and right, and what those shifts mean for tissue oxygenation
• Ventilation: lung mechanics, compliance and resistance, time constants, the work of breathing
• Mechanical ventilation: pressure versus volume control, PEEP physiology, recruitment manoeuvres, ARDS and lung-protective ventilation
• Control of breathing: chemoreceptor and central control, the response to hypoxia, hypercapnia, acidosis, and the loss of those reflexes in critical illness
• V/Q mismatch, dead space, shunt, the alveolar gas equation and the A-a gradient

Renal, fluids and acid-base

• Acute kidney injury pathophysiology, KDIGO definitions, pre-renal versus intrinsic patterns and the markers used to discriminate
• Renal tubular physiology, sodium and water handling, the counter-current multiplier, the loop of Henle as a target for diuretics
• Acid-base disorders. The Henderson-Hasselbalch equation, the Stewart approach, the strong ion difference, anion gap, delta-delta and the compensation rules
• Fluid compartments and distribution, osmolality and tonicity, sodium handling in critical illness, hyponatraemia workup and correction caps
• Renal replacement therapy principles. Diffusion, convection, ultrafiltration, anticoagulation choices, drug dosing during CRRT
• Renal pharmacology: the diuretics, the nephrotoxic agents commonly used in ICU, dose adjustments by GFR

Pharmacology concepts

• Pharmacokinetics: absorption, distribution, volume of distribution, protein binding, clearance, half-life, context-sensitive half-time
• Pharmacodynamics: receptor pharmacology, agonist and antagonist behaviour, dose-response relationships, therapeutic index
• Variability of drug response: age, sex, pregnancy, organ failure, drug interactions, genetic polymorphism
• Pharmacokinetic changes in critical illness, including augmented renal clearance in sepsis, altered protein binding, and increased volume of distribution
• Drug dosing in renal failure and hepatic failure, the principles for adjusting maintenance dose versus loading dose
• Specific ICU drug classes: vasopressors, sedation and analgesia, antibiotics, anticoagulants, neuromuscular blocking agents, corticosteroids

Nervous system, neuromuscular and endocrine

• Intracranial pressure and cerebral perfusion pressure. The Monro-Kellie doctrine, autoregulation, ICP-CPP-MAP relationships, ICP monitoring techniques
• The neuromuscular junction, the mechanism of depolarising and non-depolarising blockers, reversal pharmacology, sugammadex
• Sedative pharmacology: propofol, dexmedetomidine, midazolam, ketamine. Mechanism, kinetics, haemodynamic profile, ICU-relevant adverse effects
• Endocrine response to critical illness: cortisol, thyroid, glucose homeostasis, adrenal axis and critical illness-related corticosteroid insufficiency
• Calcium and phosphate homeostasis, the management of hyperkalaemia and other electrolyte derangements with their ECG correlates
• Pain assessment and analgesic pharmacology in the sedated and ventilated patient

Haematology, immunology and microbiology

• The coagulation cascade, fibrinolysis, platelet function, the workup and management of DIC and thrombocytopenia in ICU
• Transfusion medicine: indications for red cells, platelets, fresh frozen plasma, cryoprecipitate, the major and minor incompatibilities and reactions
• Anticoagulants: heparin, low molecular weight heparin, DOACs, their pharmacology and the reversal options
• Innate and adaptive immunity at the level required to talk about sepsis, immunomodulation, and immunosuppression in transplant recipients
• SIRS, sepsis, septic shock pathophysiology, source control principles, the major antibiotic classes and their resistance mechanisms
• Common ICU pathogens, gram positive and gram negative organisms, fungal infections, ventilator-associated pneumonia prevention bundles

Common pitfalls that fail candidates

• Treating the First Part as a recall test. The paper rewards mechanistic explanation of physiology and pharmacology with ICU-applied clinical context, not lists of facts
• Skipping specific values and units. The examiner reports repeatedly note that candidates lose marks for vague answers; normal CO of 5 L/min, normal DO2 of around 1000 mL/min, normal VO2 of around 250 mL/min, normal SvO2 of 65 to 75 percent are the kind of figures that earn marks
• Confusing the direction of physiological change. The classic trap is reasoning the wrong way through cardiac output and CVP, or getting the direction of an arrow wrong on a Starling curve. Practise sketching diagrams with the directions written in
• Memorising drug names without mechanism. A SAQ on noradrenaline rewards the candidate who can write about alpha and beta receptor selectivity, dose-response, and the pharmacokinetic changes in shock; not the candidate who lists five vasopressors with one line each
• Neglecting measurement and equipment. Pressure transducers, ECMO principles, pulse oximetry, capnography, ventilator waveform analysis collectively make up enough of the paper to swing a borderline pass
• Underestimating the smaller sections. Obstetric and neonatal physiology, antidotes, microbiology, and thermoregulation reliably appear, and candidates who plan around the big sections only get caught
• Leaving SAQ writing practice until the last six weeks. The cognitive task of constructing a structured ten-minute answer is its own skill, separate from knowing the content

How to read the curriculum file like a study plan

• The PRIMEX curriculum tab groups every learning objective by syllabus section. Filter by section to get a finite list per session, rather than trying to hold the whole 244 in your head at once
• Each learning objective links to a study note, a flashcard pool, and an MCQ or SAQ pool. Treat the learning objective as the unit of work for a sitting, not a topic name from a textbook
• Mark every objective with a status: not started, working, confident. Re-rate every fortnight. The visible delta tells you whether your study is producing learning or just hours
• Use the section-level progress bar as a triage tool. Two sections stuck below sixty percent confidence in the final two months are where mock-paper performance will collapse

A realistic study timeline

Most CICM trainees work full ICU clinical hours alongside study, with rotating shifts and on-call. The plans below assume that. Cut hours back where you have to and protect sleep ahead of caffeine.

Nine-month plan

• Months one to three. Read through every syllabus section at a head-of-topic level. About ten to twelve hours a week. The aim is breadth and the formation of a mental index, not mastery. Keep brief notes per topic so you have something to revisit later
• Months four to six. Step up to fifteen hours a week. Begin spaced-repetition flashcards across sections. Start SAQ practice at low intensity, around one to two written SAQs a week, untimed, with full reasoning written out
• Months seven to eight. Twenty hours a week. Switch SAQ practice to timed conditions. Begin past-paper-style two-hour blocks of five SAQs once a fortnight. Identify your weakest two sections from a quarter-mark mock and rebuild them
• Final month. Pull back to twelve to fifteen focused hours a week. Mocks under exam conditions. Voice-mode viva practice three times a week. Sleep, exercise, and rehearsal of the day-of routine. No new content in the final ten days

Six-month plan

• Months one to two. Fifteen to eighteen hours a week. Read across all seventeen sections. Start flashcards at the end of week two so that revision compounds
• Months three to four. Twenty hours a week. Steady SAQ practice at three to five questions a week. Write out reasoning. Start the viva simulator at one station per week with debrief read in full
• Month five. Twenty-five hours a week. Timed conditions. First full mock paper at the end of the month. Targeted re-read on weakest sections
• Final month. Twenty hours a week. Two more mocks, one for the written and one for the viva. Refine flashcard decks. Drop into recovery mode in the final week

Four-month plan

• Month one. Twenty-two to twenty-five hours a week. This is brutal alongside ICU shift work; build it into protected weekends and one weekday morning. Sweep through every section with summary notes, no deep dives
• Month two. Twenty-five hours a week. Full flashcard rotation, five SAQs a week with structured marking, write a written reason for every wrong answer in MCQ practice
• Month three. Continue at twenty-five hours, add timed two-hour blocks once a week. Run two short mocks. Start viva simulator at three stations a week. Triage: focus only on sections where your performance is below the cohort average
• Final month. Pull back to twenty hours. Two full mocks across the written. Daily viva simulator stations. The last fortnight is consolidation, not new content. Treat the final week as a taper

How to use past papers

• Past papers from the college are gold. Don't burn them in the first month. Save at least two complete sets for timed conditions in the final eight weeks
• For each past SAQ, write the answer in full first, then mark yourself against the published examiner report comments. The gap between what you wrote and what the report rewards is the learning, not the tick
• Track recurring stems across multiple past sittings. The college reuses themes (oxygen delivery and consumption, cardiac output measurement, vasopressor pharmacology, sedation, acid-base, ECMO, neuromuscular blocking agents). These are reliable marks you cannot afford to lose
• If a question relies on a guideline that has been updated since the paper was written, learn the current version. The college tests current practice, not historical answer keys

Mocks and viva practice

• Run at least three full written mocks before the real day. One at the halfway point of your study window, one four weeks out, and one ten days out
• Replicate the conditions: same start time, same chair and table, same total duration, no phone, no music, no toilet break in the first hour, hand-write the answers if that is how you will sit the paper
• Score yourself honestly and break performance down by section. The section-by-section breakdown is more useful than the headline percentage
• For viva practice, find a partner if you can but do not skip practice if you cannot. Voice-interactive simulators run cross-table style probing and demand the kind of structured verbal answers the examiners want
• Treat the post-mock debrief as a study session in itself. Two hours of structured review of a mock paper is worth more than four hours of fresh content

The single biggest mistake people make

The pattern that breaks competent CICM First Part candidates is reading and re-reading textbooks without ever writing a structured ten-minute answer under timed conditions. You finish Pappano. You finish Brandis. You finish Power and Kam. Your knowledge feels solid in your head and you can talk through cardiac output to a co-registrar over coffee. Then you sit down with a blank sheet of paper and a stopwatch and the first SAQ asks you to describe the determinants of myocardial oxygen demand. Ten minutes is short. The page asks for headings, normal values, units, mechanisms, ICU application, and a structure that gives the examiner something to mark against. You produce a paragraph that is medically correct and earns a borderline. The fix is uncomfortable: you write SAQs from week one of your study window, even when you have not finished the reading. Five SAQs a week, ten minutes each, with the text in front of you for the first month and progressively closed as the weeks go on. The candidates who ace the written are not the ones who read the most. They are the ones who wrote the most under timed conditions and got their structure tight enough that the examiner could find the marks without searching.

How PRIMEX helps

• The PRIMEX curriculum tracker for the CICM First Part covers 244 mapped learning objectives across 17 syllabus sections, with progress tracked per topic and per section. Available inside the PRIMEX app for CICM First Part
• The AI SAQ grader returns tier-marked feedback against marking points calibrated to CICM examiner report language, with structure feedback and the specific values you missed. The public version sits at primexstudy.com.au/grader
• Ask PRIMEX is the in-app tutor that takes any question or topic name and returns a sourced, First-Part-level answer with mechanisms, normal values, equations, and ICU application baked in
• The cross-table viva simulator runs voice-interactive 2-minute reading plus 10-minute station practice with examiner-style probing and a structured debrief at the end. Available alongside the written tools on the CICM First Part page

Building the routine that holds for nine months

The trainees who pass the First Part on the first sitting almost all share a small set of habits. None of them is glamorous. They protect three weekday mornings a week with a non-negotiable two-hour study block before clinical work, they keep flashcards open on a phone for ten-minute gaps between ward rounds, and they rebuild the weekend block on the same days each week so the partner, the housemate, the children all know the rhythm. They batch-cook on Sunday so weekday dinner is fifteen minutes instead of an hour. They tell the consultants and the registrar group what they are doing so colleagues understand the absences from the post-shift drinks. They use the long blocks for new content, written SAQs, and timed practice, and the short blocks for spaced-repetition flashcards and quick MCQ pools. The routine matters more than the volume.

What breaks routines is not laziness, it is unrealistic ambition. A plan that requires twenty-five hours a week of study while you are working full clinical hours plus a stretch of nights is a plan that fails by week four. Build the schedule around the ICU roster you actually have, not the one you wish you had. If a fortnight contains a stretch of seven on-call nights, write zero study hours into that fortnight and accept it. The candidate who studied for twelve hours in week six and zero in week seven and beat themselves up about it ends up doing less than the candidate who planned for ten in week six and zero in week seven and showed up.

Frequently asked questions

Related study guides

• CICM Fellowship 2026 Study Guide
• ACEM Primary 2026 Study Guide