The FRCEM exam has recently been re-structured and the format altered. The first sittings of the new FRCEM Intermediate and FRCEM Primary examinations took place in the autumn and winter of 2016 respectively. Prior to this the examination was two separate exams, the MRCEM and FRCEM examinations. These have now been merged into a single examination that will take the candidate all the way through their training from the foundation years until they become a consultant.
The FRCEM Primary Exam Breakdown
The first step in the new FRCEM examination is the new FRCEM primary examination. The paper is three hours long and comprises 180 single best answer questions. The examination is conducted in English and candidates are advised that IELTS Level 7 is the expected standard for completion of the FRCEM examinations.
The exam concentrates on basic sciences and is based on the Royal College of Emergency Medicine Basic Sciences Curriculum, which can be found here.
The RCEM Basic Sciences Curriculum is highly representative of the content that is found in the exam and should form the centerpiece of your revision. There have been some content changes from the old MRCEM Part A examination that are worth noting. There are no longer any clinical scenarios or biochemistry questions as there were in the MRCEM Part A examination. Haematology is still present but has been merged with the Pathology section and it is possible there will now be less questions on this topic.
The following areas are tested in the following proportions:
- Anatomy (60 questions)
- Physiology (60 questions)
- Pharmacology (27 questions)
- Microbiology (18 questions)
- Pathology (9 questions)
- Evidence-Based Medicine (6 questions)
Preparing for the FRCEM Primary
To get a good grip of the basic sciences takes a great deal of time and candidates should start preparing at least 6 months before the examination. A robust textbook covering each of the areas should be used and this should form the basis of your initial revision. Some suggested texts can be found on the Royal College of Emergency Medicine website.
It would be wise to focus the majority of your revision on Anatomy and Physiology, which together account for two-thirds of the marks available in the examination. The Anatomy syllabus is vast and most candidates find this the most difficult aspect of the exam to get to grips with. This is where a good understanding of the curriculum will really help you. An example of this is that there are very few muscle attachments that are required knowledge in the examination, but a large number of candidates spend valuable time memorizing these. The curriculum is very clear in giving advice on what is not required knowledge and it is very important to pay attention to this advice. Most former candidates agree that within the Anatomy section of the examination the upper and lower limb sections tend to be more heavily weighted and this is also worth consideration when planning your revision.
Be regimented on the amount of time that is spent revising the four subjects that are tested on in smaller quantities. These can be easier to get to grips with and, on occasion, a little more interesting than Anatomy and Physiology curriculum, but it is a mistake to spend too much time on them.
Once you have started to get to grips with the basics of each topic it is sensible to start to supplement your learning with regular question practice using resources such as our website.
Try to isolate areas of weakness and concentrate on these areas; spend less time on your areas of strength. It is a good idea to use your performance in questions as a benchmark of your knowledge base in each area of the curriculum and use this as a means to support your revision planning. By the time each of you has qualified as a doctor you will already have sat numerous exams and developed your own methods for preparing. It is a good idea to keep using the revision methods that you are used to when preparing for this exam. It is very important not to under-estimate the amount of work that is required and to spend plenty of time preparing!
The New FRCEM Primary Question Style
With a shift to the new examination the Royal College of Emergency Medicine has moved away from the old true-false style multiple choice questions used in the MRCEM Part A. The questions in the FRCEM Primary exam are now single best answer questions (SBAQs).
Single best answer questions are probably the most commonly encountered question style currently encountered in medical exams. They require convergent thinking and the ability to come up with a single answer to a set problem. It is easier for the examiner to test higher order thinking, such as application and evaluation of knowledge, in a SBAQ than in the true/false style questions that were previously used.
Standard format SBA questions usually have three parts:
- A statement or a scenario that the question will be asked about
- The question itself
- The answer options, which will include one single correct answer
An example of a standard SBA question is shown below:
A 38-year-old man suffers a laceration to his arm that damages the posterior cutaneous nerve of the forearm. Which of the following best describes the sensory area supplied by this nerve?
A. The medial half of the palm
B. A tapered strip of the middle portion of the posterior forearm
C. Part of the posterior aspect of the upper arm
D. The posterior surface of the lateral three and a half digits and the associated areas of the palm
E. The lateral aspect of the palm
Answer: B. A tapered strip of the middle portion of the posterior forearm
In this question an intimate understanding of the anatomy of the radial nerve is required. The sensory function of the radial nerve is provided by its four main sensory branches:
- Inferior lateral cutaneous nerve of the arm – supplies the lateral aspect of the anterior upper arm between the deltoid and the elbow
- Posterior cutaneous nerve of the arm – supplies part of the posterior aspect of the upper arm
- The posterior cutaneous nerve of the forearm – supplies a tapered strip of the middle portion of the posterior forearm
- The superficial branch of the radial nerve – supplies the posterior surface of the lateral 3 ½ digits and the associated areas of the palm
General Approach to Answering SBAQs
The answer options will contain one single correct answer and several other distracting options. The question commonly asks for the ‘single most likely’ answer or ‘which single statement is true’. In many SBAQs several of the answer options are correct, but only one will be the ‘best’ answer.
It is generally good to read the question first, which will allow you to see what the main emphasis of the question is. Then scan the answers, so that you know what particular kind of answer is required. Finally read the statement or scenario at the start of the question.
Within the statement or scenario there will be many useful clues to point you towards the correct answer. It is worthwhile highlighting or underlining these clues whilst reading the scenario. Some scenarios will include clues such as examination findings and/or results of investigations. Try to highlight anything that is abnormal.
In addition to the correct answer, each SBAQ will usually contain at least one or two answers that are highly unlikely or obviously wrong. There are then often one or two answers that are plausible and these serve as the main distracters within the question. Cross out and eliminate the answers that are obviously incorrect so that you have narrowed your choices.
A good way of practicing SBAQs in the run up to an exam is to cover up the list of answers and attempt to formulate an answer without the answers to guide you. By attempting to remember key facts from your memory in this way you can augment your ability to recall the information later. This strategy is not recommended in the exam though, as on the day itself you will need every advantage that you can get!
Some SBAQs require multiple cognitive steps in order to reach the correct answer. These sorts of questions are used to discriminate the best candidates. Typically you will be required to make a diagnosis and choose an answer based upon this diagnosis.
If time allows, review the questions and answers again after finishing the exam, as it is possible that you may have misread some questions on the first attempt. When you are unsure of the answer it is usually best to stick to your first instinct and not be tempted to change the answer on re-reading.
Good luck with your exam preparation!
Thank you to the joint editorial team of FRCEM Exam Prep for this ‘Exam Tips’ blog post.