Critical Care Medicine

Certification Examination Blueprint What Does the Examination Cover? The examination is designed to evaluate the extent of the candidate's knowledge and clinical judgment in the areas in which a critical care physician should demonstrate a high level of competence. Expertise in the broad domain of critical care medicine, and the diagnosis and treatment of both common and rare conditions that have important consequences for patients, will be assessed. Examination content is consistent with a pre-established blueprint, or table of specifications. The blueprint is developed by the Subspecialty Board on Critical Care Medicine and is reviewed and revised annually to ensure that it is current. In addition, practicing critical care medicine trainees, and training program directors are surveyed periodically to provide feedback on the blueprinting process. The blueprint is used as a guide in developing the examination. The majority of questions (over 75 percent) are based on patient presentations occurring in settings that reflect current medical practice. Questions requiring simple recall of medical facts are in the minority; the majority of questions require integration of information from several sources, prioritization of alternatives, and/or utilization of clinical judgment in reaching a correct conclusion. Some questions require interpretation of pictorial material, such as ultrasound scans, magnetic resonance imaging scans, electrocardiograms, radiographs, computed tomograms, radionuclide scans, and photomicrographs. Topics covered may include the following: Airway maintenance and management of mechanical ventilation Interpretation of data from hemodynamic monitoring devices Medical problems related to burns and acute illness Postoperative medical management, which frequently involves consultation by the internist Indications for and complications of surgical procedures Drug metabolism, toxicity, and excretion in acute illness Administrative and management principles and techniques General internal medicine as encountered in the practice of critical care medicine (including some general pediatrics with an emphasis on adolescent medicine)

The content areas covered and their relative proportions on the exam are as follows: Medical Content Category Renal/Endocrine/Metabolism Cardiovascular Disorders Pulmonary Disease Infectious Disease Gastrointestinal Disorders Neurologic Disorders Hematologic/Oncologic Disorders Surgical/Trauma/Transplantation Pharmacology/Toxicology Research/Administration/Ethics Total Relative Percentage 15% 17.5% 20% 12% 5.5% 9.5% 5.5% 7.5% 5% 2.5% 100%

Content Outline of the Certification Examination This content outline describes a typical Critical Care Medicine Certification Examination; actual content on a specific examination may vary. Each medical content category from the examination blueprint is listed in boldface below, along with target blueprint percentage and total number of questions in the category. Within each category, the approximate distribution of questions in specified areas is also listed.

Medical Content Category (Relative Percentage) Renal/Endocrine/Metabolism (15%) Sodium/water balance Potassium disorders Acid-base disorders Calcium/phosphate/magnesium/ammonia disorders Diabetes (excluding DKA) and energy metabolism Thyroid disorders Adrenal disorders Pituitary abnormalities Tumor-related syndromes Acute renal failure Nutritional support

Number of Questions 30 as follows: 4 2 9 2 2 1 2 1 1 4 2

Cardiovascular Disorders (17.5%) Acute coronary syndromes Arrhythmias Congestive heart failure Hemodynamic monitoring Advanced cardiac life support Vascular disorders Valvular heart disease Pericardial disease Myocardial disease

35 as follows: 4 4 6 9 2 4 2 2 2

Medical Content Category (Relative Percentage) Pulmonary Disease (20%) Pulmonary physiology/pathophysiology Diagnostic and therapeutic procedures Mechanical ventilation Airway disease Parenchymal lung disease Pulmonary vascular disorders Pleural disorders Hemoptysis Sleep disorder breathing Infectious Disease (12%) Systemic infections Central nervous system infections Head, neck, and upper airway infections Cardiovascular infections Gastrointestinal and intra-abdominal infections Genitourinary tract infections Soft tissue, bone, and joint infections Non-vascular transcutaneous catheters (intracranial, transhepatic, peritoneal, nephrostomy) Antimicrobial therapy and resistance Immunocompromised hosts Other special hosts Virulence factors, toxins, and bioweapons Hospital epidemiology and infection control

Number of Questions 40 as follows: 4 3-4 12 3-4 10-11 4 1-2 1 1 24 as follows: 3 3 2 2 2 2 1 1 2 2 1 2 1

Gastrointestinal Disorders (5.5%) Esophagus Stomach Small bowel Large bowel Liver Pancreas Gallbladder

11 as follows: 2 1 1 2 3 1 1

Medical Content Category (Relative Percentage) Neurologic Disorders (9.5%) Brain death Cerebral vascular disease Seizures, status epilepticus, subclinical status, myoclonus Neurogenic pulmonary edema Neuromuscular diseases Increased intracranial pressure and hydrocephalus Head trauma Spinal cord injury and neurogenic shock Encephalopathy/coma/delirium Pain control, sedation, and neuromuscular blockade

Number of Questions 19 as follows: 1 5 1 1 2 1 1-2 2 1 4

Hematologic/Oncologic Disorders (5.5%) Red blood cell diseases White blood cell diseases Platelet disorders Coagulopathies Hypercoagulable states Transfusion medicine Solid tumors Oncologic syndromes Bone marrow transplant Complications of immunosuppressive drugs and chemotherapy

11 as follows: 0-1 1-3 1-3 1-3 1-3 1-3 0-1 0-1 0-1 0-1

Surgical/Trauma/Transplantation (7.5%) Cardiovascular/vascular Abdominal/gastrointestinal Obstetric/genitourinary Skin and soft tissues/extremities Environmental injury Postoperative management (general) Trauma Transplantation

15 as follows: 2 2 0-1 0-1 6-7 0-1 2-3 0-1

Medical Content Category (Relative Percentage) Pharmacology/Toxicology (5%) Basic pharmacologic principles Drug interactions Common adverse drug interactions and allergic reactions Toxicology, drug overdose, and poisoning

Number of Questions 10 as follows: 0-1 0-2 3-4 3-4

Research/Administration/Ethics (2.5%) Intensive care unit (ICU) administration Continuous quality improvement/patient safety Staffing issues Economic considerations Medicolegal interactions Ethical considerations Medical research Teaching and education Psychosocial issues

5 as follows: 0-1 0-1 0-1 0-1 0-1 2-3 1-2 0-1 0-1