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I have completed bits of my EM training from India. Currently I am boarded with credentials from Christian Medical College, Vellore and also from the prestigious Royal College of Emergency Medicine, UK.  I am currently working in London as an A&E doctor, trying to appreciate the differences in the practise and culture of Emergency Medicine across different healthcare systems. I have always been an avid FOAMed supporter because FOAMed played an indispensable role during the days of my initial training. Through this blog, I aspire to disseminate knowledge and stay up to date with the EM literature. 

Monday, September 14, 2015

MRCEM Part B: Do you know the exam well enough?

We are going to hop on to Part B this week. Once again, this is just how I think about it, there are many ways of preparing for MRCEM part B examination and this is just one of them. I prepared in a group three. We used to read individually and do the questions together. 

Exam Pattern
This exam comprises of short answer questions (SAQs) and tests your ability to make the diagnosis, request investigations, give differential diagnosis and management. ECGs, CT scans and X-Rays are often provided with a short history. Usually, each question carries about 10 marks distributed over 4-5 stems (a/b/c/d/e). Each of the stems are marked individually (for instance: 2+1+3+2+2 for a five stemmed question). You have about 7:30 minutes for each question. Exam gives you a total of 16 questions (7:30minutes x 16 = 120 minutes).  

Preparation Material
  • Oxford Handbook of Emergency Medicine (OHEM) - Read cover to cover
  • MCEM Part B Revision Notes by Victoria Stacey (More of Part B examination pattern, bullet points, easily digestible esp the chapter on "Resuscitation" in this textbook is amazing)
  • Get through MCEM Part B: Data interpretation questions (SAQs)
  • Oxford Handbook of Clinical Medicine (OHCM) - not mandatory
  • Oxford Handbook of Clinical Specialties (OHCS) - not mandatory
Read OHEM and revision notes by Victoria Stacey at least three times. If you want to choose one out of these two, that's a tough call. I personally like Stacey more than OHEM but OHEM is kind of difficult to read and a MUST for the exam. Choose OHEM over Stacey if you are really short on time and read just the paediatrics section from Stacey + also read the intro to the examination from Stacey to understand the "language" that the exam speaks. 
I still recommend doing both thoroughly and that is the key to success. 

Decision Rules: These are often tested on the exam. Here is list of decision rules that we went through and this by no means is a complete list. I know this is painful, just remember them for a day then continue using your smart phones. (Please excuse me for the terrible handwriting, but I am sure you can read most of it once you have read OHEM/Stacey)

Time required for preparation: 2-3 months (guesstimate!) in addition to the 2-3 years of experience in an ED/ Critical Care setting. You would be familiar with most of the stuff mentioned in these texts if you have been working in an acute care setup. 

Do we need to read Tintinalli/ Rosen's for Part B?
These are the core EM textbooks, you cannot just mug them up and regurgitate in the exam. The matter provided in these texts is assimilated over years of residency and then used in clinical practice. If you are in touch with these texts from day one of the residency program, you definitely have an advantage over others. Undoubtedly you need to read one of them for your clinical practise, but not for this exam (not in my opinion!). 

We used Oxford Handbook of Emergency Medicine (OHEM), Revision Notes for MCEM (Victoria Stacey) and Get through MCEM Part B - SAQs (Q bank). In addition to this, we had   already covered a good bit of Tinitinalli (over two years) before we took the exam.

Online Q banks
They cost a lot of money but they are definitely helpful. With Q banks, you get an idea of how you are expected to answer. To start with you will make mistakes even if you know the answer to a question (Yes!). But with time, learn the technique to write. When doing these questions set a stop watch. Give yourself 6-6:30 minutes/ question when practicing these Q banks. Do sets of 16 questions at least three times (over a 2 hour period) before the final exam.
Bottom-line: With Q banks, get a sense of how quick you need to be and learn the trick to write the exam.  

I don't recommend any specific online Q banks, go through the trial questions on each one of them and then take your pick. They all look more or less similar to me!

What the major issue with Part B? Why do candidates get stuck here?
The sole reason why people don't make it here is due to poor time management. Please remember that you are just given 7:30 minutes for each question. Time just flies during the examination and if don't move at a good pace you will probably end up attempting 12-13 questions out of 16 questions and that's not a happy ending.

My solution to this problem
Remember that nobody is perfect and even in the exam you are allowed to make a few mistakes. There is no negative marking here so your only goal should be to attempt all 16 questions.

Biggest Point from this postThis is something that I have observed over time.
In the question paper, say there are 16 questions with five stems under each question i.e 1a/b/c/d/e to 16a/b/c/d/e.
Now, the difficulty level increases with every stem as we move further in a particular question (Order of difficulty for stems in general is e>d>c>b>a) i.e. stem "e" is the most difficult one to crack and stem "a" is usually a cakewalk. This applies to all the 16 questions.
Suppose you get stuck on Q5e and Q8d (d/e are the tough ones) and took about 15 minutes to answer them. Essentially now it is less likely that you would be even attempting Q14a/b/c, Q15a/b/c and Q16a/b/c (a/b/c are the easy ones to crack) due to time constraints. So, NEVER waste too much time on a single stem. Keep going, Keep moving. 

If you are not sure about something, give it 30 seconds to a minute maximum and then move on. Get back to these tough ones "d/e stems" once you have attempted all the 16 questions. If you have attempted all the questions, it is likely that you are make it through. So your goal is to attempt all the questions.
Bottom-line : Don't waste time on the relatively difficult d/e stems, attempt all the questions first and then review the tough ones.

Write legibly, to the point, in order of priority. If you ask me, these are the skills that you should acquire during the preparatory workshops. One thing that you need to walk away with from these workshops is "the trick to write the exam". Having knowledge is not sufficient to pass here, you must know how to convey your thoughts to get through.

On the day of exam:
  • Reach well before time
  • Relax
  • Expect one or two vague/ unexpected questions. Don't freak out, go back to the very basics and I am sure you will come up with an answer
  • Attempt all the 16 questions. 
Key Points:
  • OHEM, Victoria Stacey + a Q bank is must (OHEM>Stacey)
  • With the help of your Mentors/ Preparatory Workshops : Learn how to write the exam
  • Time management - Your goal is to attempt all the questions
  • OHCM/ OHCS/ Tintinalli/ Rosens - not mandatory
Hope this was useful. If you have anymore questions, please e-email me at drlakshay_em@yahoo.com. I would be more than happy to help.

Best Wishes
Lakshay Chanana


  1. You are doing an awesome job dude. Keep up the good work..!!

  2. Thanks a lot for taking out the time to appreciate.

  3. great effort Dr Lakshay... very helpful...

  4. nice post Dr. Lakshay, to add to this, there is an amazing course you one can attend to get the feel of an exam scenario - a well organised and determined course to help us out in preparing towards the MRCEM exams - which is the " EAST OF ENGLAND EMERGENCY MEDICINE REVISION COURSE" (http://www.emcourses-india.org/McmeCourses.aspx?qry=23). Highly recommended.

    1. Thanks Krushna..
      These prep courses get really important esp when you dont have a group to practise
      Thanks for providing the link.

  5. Hey Lakshay.... And heads up to all those preparing for Part B&C.... I was speaking to Lakshay about this and he asked me to put it up as a comment for All to benefit.

    "One more question and there lies the clue"
    if you are unable to answer the first question and have absolutely no idea on what the clinical vignette is all about, SCAN through all the question stem- There'll be a clue in one of the questions atleast. Let me give you guys an example..
    Say, your vignette says the patient is 60/M, mechanic by profession & has a picture of a RED EYE, but the vignette does't say painful or painless.

    Q1 What's the diagnosis?
    You aren't sure, it could be an arc welder's eye (occupation history), angle closure glaucoma, conjunctivitis....

    Keep reading..

    Q2 What Other differential can you give for a painful red eye?

    Q3 What three groups of drugs will the patient benefit from?

    You are unsure about the diagnosis, but Q2 says 'painful' and Q3 says '3 groups of drugs' which really narrows down your final diagnosis to be an Acute Angle Closure Galucoma.

    Hope this helps

    P.S. this was from a discussion which we had at the 'East of London Rev course'
    All The Best Everyone

    Thanks Lakshay Again!

  6. Very very useful.especially for me it gave me good idea.Thank u Lakshay sir.

  7. thanks dr Lakshay and guys,nicely summerised,good luck to all

  8. nice post Dr. Lakshay...can i get the formal curriculum for mcem part

    1. Thanks Hany Abbas. I am not sure if they have a curriculum for part B and C. Please check out the RCEM website.

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  10. Hi Lakshay
    Great Going
    Good luck
    When you find time do update on the new exam pattern.

    1. Sure. I am actually looking for someone who can do that.

  11. excellent post !
    could you please put up Part A or send the link?

  12. Hi..how to prepare for part C OSCE? Any good resources?