Critical Care Medicine

Purpose of the exam

Maintenance of Certification Examination Blueprint

The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified Critical Care Medicine specialist in the broad domain of the discipline. The ability to make appropriate diagnostic and management decisions that have important consequences for patients will be assessed. The exam may require recognition of common as well as rare clinical problems for which patients may consult a certified Critical Care Medicine specialist. Exam content Exam content is determined by a pre-established blueprint, or table of specifications. The blueprint is developed by the Subspecialty Board on Critical Care Medicine and is reviewed annually and updated as needed for currency. Trainees, training program directors, and certified practitioners in the discipline are surveyed periodically to provide feedback and inform the blueprinting process. The primary medical content categories of the blueprint are shown below, with the percentage assigned to each for a typical exam:

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

% of Exam 15% 17.5% 20% 12% 5.5% 9.5% 5.5% 7.5% 5% 2.5% 100%

The blueprint can be expanded for additional detail as shown below. Each primary medical content category is listed again, with the percentage of the exam devoted to this content area. Below each major category are the content subsections and their percentages within the major category. Please note: The percentages below describe content of a typical exam and are approximate; actual exam content may vary.

Renal/Endocrine/Metabolism

15% of Exam

Approximate % within Renal/Endocrine/Metabolism

12% 6% 30% 6% 6% 5% 6% 5% 5% 13% 6%

Sodium/Water Balance Potassium Disorders Acid-Base Disorders Calcium/Phosphate/Magnesium Disorders Diabetes (excluding DKA) and Energy Metabolism Thyroid Disorders Adrenal Disorders Pituitary Abnormalities Tumor-Related Syndromes Acute Renal Failure Nutritional Support

Cardiovascular Disorders 17.5% of Exam Acute Coronary Syndromes Arrhythmias Congestive Heart Failure Hemodynamic Monitoring Advanced Cardiac Life Support Vascular Disorders Valvular Heart Disease Pericardial Disease Myocardial Disease

Approximate % within Cardiovascular Disorders

10% 10% 20% 30% 5% 10% 5% 5% 5%

Pulmonary Disease 20% of Exam Pulmonary Physiology/Pathophysiology Diagnostic and Therapeutic Procedures Mechanical Ventilation Airway Disease Parenchymal Lung Disease Pulmonary Vascular Disorders Pleural Disorders Hemoptysis Sleep Disorder Breathing

Approximate % within Pulmonary Disease

10% 10% 30% 10% 20% 10% 5% 2.5% 2.5%

Infectious Disease 12% of Exam 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

Approximate % within Infectious Disease

12% 12% 8% 8% 8% 8% 5% 5% 8% 8% 5% 8% 5%

Gastrointestinal Disorders 5.5% of Exam Esophagus Stomach Small Bowel Large Bowel Liver Pancreas Gallbladder

Approximate % within Gastrointestinal Disorders

15% 10% 10% 15% 30% 10% 10%

Neurologic Disorders 9.5% of Exam 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

Approximate % within Neurologic Disorders

5% 25% 5% 5% 10% 5% 10% 10% 5% 20%

Hematologic/Oncologic Disorders 5.5% of Exam 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

Approximate % within Hematologic/Oncologic Disorders

5% 15% 15% 15% 15% 15% 5% 5% 5% 5%

Surgical / Trauma / Transplantation 7.5% of Exam Cardiovascular / Vascular Abdominal / Gastrointestinal Obstetric / Genitourinary Skin and Soft Tissues / Extremities Environmental Injury Postoperative Management (General) Trauma Transplantation

Approximate % within Surgical/ Trauma/Transplantation

10% 10% 5% 5% 45% 5% 15% 5%

Pharmacology / Toxicology 5% of Exam Basic Pharmacologic Principles Drug Interactions Common Adverse Drug Interactions and Allergic Reactions Toxicology, Drug Overdose, and Poisoning

Approximate % within Pharmacology /Toxicology

10% 20% 35% 35%

Research / Administration / Ethics 2.5% of Exam 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

Approximate % within Research/Administration /Ethics

5% 5% 5% 5% 5% 55% 10% 5% 5%

Exam questions in the content areas above may also address clinical topics related to: Exam format The exam is composed of single-best-answer multiple-choice questions, predominantly describing patient scenarios that occur in practice settings. Clinical information presented may include various media illustrating relevant findings, such as diagnostic imaging studies. Some questions require interpretation of pictorial material, such as ultrasound scans, magnetic resonance imaging scans, electrocardiograms, radiographs, computed tomograms, radionuclide scans, and photomicrographs. Questions pose tasks such as the following: making a diagnosis determining a treatment or management plan ordering diagnostic tests recognizing clinical features of a disease determining means of prevention, screening, staging, or follow-up Exam tutorial A tutorial including examples of ABIM exam question format can be found at http://www.abim.org/exam/prepare.aspx. 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)