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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, September 21, 2015

Cracking the tough nut: MRCEM Part A

Many of you would agree with me on this that Part A is the toughest one to get through.  Now accept this, that these subjects won't let you go further unless you master them. The sooner you understand this, the better it is. 
Basic Sciences make the foundation of what we do everyday. For instance, there is no fun in treating DKA with fluids/K/Insulin, if we fail to understand the different metabolic pathways.

Now lets look at what MRCEM Part A demands:

Exam Pattern
Basic Sciences 
2 hours/ 50 questions with 4 stems under each question (50x4=200 stems)
Each stem is marked as True/False
Passing Marks: Around 70% 

Important Subjects:
  1. Anatomy (Upper Limb/ Lower Limb)
  2. Physiology (Cardiac/ Renal/ Respiration/CNS)
  3. Pharmacology (Cardiac/ Renal/ Respiration/ NSAIDs/CNS/Hematology )
  4. Microbiology (Bacteriology/HBV/HIV/Basic Immunology)
  5. Pathology (General Pathology)
  6. Statistics/ EBM 
(High yield topics are mentioned in parenthesis)
Note: Exam tests a lot of physiology and anatomy. About 60% of the exam consists of questions from these two subjects. So master these two subjects. 

This is a tough one to crack and I would even say that if you take this one seriously, then part B and C can be piece of cake. 

This is how I look at it.
T/F pattern: Lets presume, If you land up unprepared for this exam, then with every question there is a 50% chance of being right and 50% chance of being wrong because it is either true or false. So you are expected to get a score of around 50% . Scoring the next 20% (50-->70) is a big challenge.
No negative marking: Attempt all the questions. Even if you have no clue, you can still be right (its either True or False)

Time for preparation: Depends on whether you are doing full-time preparation or working and preparing, It should take about about 4-5 months.

Material for preparation
  1. USMLE Step 1 Kaplan Notes + USMLE tapes : This is outstanding stuff. Recommended for those who are "okay" with their basic sciences knowledge to start with. After watching these tapes you will have a good grasp over these subjects. The videos come to about 100 hours roughly for the above mentioned subjects. Do go through the notes provided along with these videos. USMLE Step 1 is a much much harder exam as compared to MRCEM Part A. So you have an advantage if you are using this stuff for your preparation.
  2. Dr. Najeeb's Videos: Dr. Najeeb is blessed. If you come from a medical college where you did not learn anything i.e if your basics suck, then pick these videos. He is a fantabulous teacher, makes things really simple and easy to understand. (You don't get any ready made notes when you subscribe for these videos). These videos go a bit slow and start about 5-6 months before if you are going to use them.
  3. Other basic sciences textbooks (Snells, Netters Atlas, Guyton, BNF, Robbins etc)
  4. Mark Harrison (Revision Notes): This text is for revision. Stay in touch with this as you are going through different subjects. Read it at least three times before the exam. One thing that I highly recommend to do is to keep adding the important points in this book as you are preparing right from the very beginning. This can become a great resource for revision during the last few days before the exam.
  5. OHEM: Cover to cover OHEM is not required for part A. Exam often tests on ECGs, Toxicology, Anaesthetic agents and Resuscitation.
  6. Statistics/ EBM: You get a couple of questions on this. These are the questions that can make a difference by pushing your score from say 66-->70%. This stuff looks hard but if you spend a day or two with statistics, its worth it. Once you get this, it is going to stay with your forever. Kaplan notes cover this under Behavioural Sciences. It should take about a day to finish this OR you can checkout Statistics by Philippa J. Easterbrook from the basic medical sciences MRCP Part 1. 
  7. Practice papers for MCEM part A 
Clinical Emergency Medicine
Exam is getting more and more clinical. You have an advantage if you have been exposed to an ED for at least 6 months. OHEM should cover most of this stuff. Expect questions on:
  1. ECGs (Arrythmias, Blocks)
  3. PALS
  4. Electrolyte disturbances (HyperK, HypoNa etc)
  5. ABG Interpretation 
This is what I used:
Kaplan USMLE Step 1 (Anatomy, Physio, Pharm, Micro, Path)
Mark Harrison for revision
Practice papers for part A
Online Q bank

Online Q bank
Don't expect to get the same questions that you see on the Q bank. This is just to understand the exam pattern. Once again, set up a timer while doing the questions. There are plenty of options now, check out the trial questions and take your pick. 

Stick to the curriculum
Have a copy of the curriculum as you prepare for the this exam. Don't spend too much time on Biochemistry, Systemic Pathology. You rarely get questions from these topics. Having a basic knowledge of these subjects should be fine.

1-2 weeks before the exam
Set up your study schedule in such a way that you finish two revisions 10-15 days before the final exam. In the last two weeks, just stick to Mark Harrison (that also includes the important points that you have been adding over 3-4 months). If this gets too monotonous, so add a bit of OHEM (Resus/Toxicology/Anesthesia/ECG). 

Go through the curriculum once again and make sure that you have not missed out anything. 

What about workshops for Part A?

It is really hard to cover the exam curriculum over a couple of days. These workshops for part A can be a good source of revision, particularly the high yield material. So if you are choosing one of them, make sure you are done with the syllabus at least once before attending.
  • Focus on the High Yield Subjects (Anatomy and Physiology) 
  • Attempt all the questions
  • Do not skip Statistics/ EBM
So, this was about what you should probably do to pass part A. If you want to read more on things that you should NOT be doing, then check out this link on "how to fail the MRCEM part A"  


Also go through the RCEM website for more info: http://www.rcem.ac.uk/Training-Exams/Exams/MRCEM


Best Wishes
Lakshay Chanana


  1. Some more tips at: http://www.ponderingem.com/mrcem-exams/revision-tips-for-the-mrcem-afrcem-primary/

  2. Dear Dr. Chanana,
    The post was really helpful as there was not a single place on internet where I could find all these precise details together.
    Thank you.
    Good Luck!