Mary Pinder1^,2,3
Sandra Carr³ and Charlotte Denniston⁴
1 Sir Charles Gairdner Hospital, WA
2 College of Intensive Care Medicine
3 UWA
4 University of Melbourne 

The FCICM Second Part Examination is a high-stakes assessment in the progression to specialist with the College of Intensive Care Medicine of Australia and New Zealand (CICM) with the pass rate 35-65%. Exam failure has devastating effects on trainees, personally and professionally. Pre-existing research exploring behaviours enabling exam repeaters to succeed is limited and relates to other learner contexts. 

This qualitative study aimed to understand how CICM trainees make the transition from failure to success and their lived experience of the journey, using grounded theory methodology. Individual in-depth interviews were conducted via Zoom with eleven participants who were multiple exam repeaters before succeeding. The interviews were recorded, de-identified, transcribed into text and coded. Data collection and analysis happened contemporaneously to identify emerging themes and theories. 

To achieve exam success participants needed to accept self and acknowledge their competence as an intensivist. This occurred by reconstructing their sense of self, exploring and acknowledging failure; and exam preparedness, becoming ‘match-fit’. Participants needed time to process the emotions of grief and loss, negotiate personal challenges, and rebuild their sense of self. A mindset shift to a learning orientation for professional development rather than exam success was key. The emergent theory was Identifying as an Intensivist. 

Identifying as an Intensivist encompasses the psychosocial, sociocultural and cognitive processes underlying the transition to exam success. Developing this professional self enabled the participants to overcome failure, and was, in turn, enabled by achieving success. 

Conclusion
The findings resonate with those from other learner contexts suggesting broad applicability. 

Recovery for high-stakes exam repeaters should include psychological support, wellbeing advice, and effective learning strategies. 

Medical colleges should be aware of their influence in shaping professional identity and ensure that their activities reflect the diversity of the broader community. 

References (maximum three) 

Dadpe AM, Shah DY, Vinay V, Shetkar P. Factors Facilitating Academic Success in Dental Students After Initial Failure: A Qualitative Study. J Dent Educ. 2018 Nov;82(11):1155-1161. 

Minson S, Adodra A, Brightwell A. Failure of high stakes postgraduate medical exams - what is the impact on trainees and how can they achieve success after multiple failures? AMEE 2013 “Colouring outside the lines”; 24-28 August 2013; Prague. 2013 p. 619-620Available from: https://amee.org/conferences/amee-past-conferences/amee-conference-2013 

Harry V, Bethelmy A. Failing postgraduate exams. BMJ. 2007;335(7630):s200-s201.