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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

Sunday, January 22, 2017

FRCEM Primary: Cracking the new beast!

FRCEM Primary has now replaced MRCEM Part A exam. The first ever FRCEM Primary exam took place on 7th December 2016. Most of us were anxious with the new Single Best Answer (SBA) exam pattern, nobody had complete clue what to expect. Only 8 sample questions were provided to us on ‘rcem’ website one month prior to exam 1.  I have been asked plenty of questions by my colleagues and friends regarding this new beast- FRCEM primary. In the following article, I try to answer the most common questions pertaining to this new exam and my strategies to successfully pass it.

Question 1: How is FRCEM Primary different from MRCEM Part A?
The good thing about RCEM exams is that they have a well-defined syllabus2. The syllabus remains the same. The difference is change from true/false to single best answer question. It has its advantages and disadvantages. True/False would give you a 50% chance of getting the answer correct, while single best answer out of 5 options, reduced the chance to 20%. The questions are application based with a clinical vignette, so one can apply knowledge to get the right answer as opposed to true/false, where a candidate either knows or doesn’t know the answer and still has a 50% probability of getting it right.

Based on the above statistics, it is expected that the cut-off scoring also reduces.

Question 2: How difficult was FRCEM Primary exam?
I personally enjoyed solving it. All the questions are clinical cases 2-3 sentences each, they are pretty straight forward and working in Emergency Department helps answer most of the questions. But unless one studies thoroughly it is difficult to pass. Let me give you a perspective, out of 1138 candidates, only 432 passed this exam.

Question 3: How should I start?
I shall tell how I started. Firstly I went through the rcem website. I printed out the syllabus, went through it. Then I immediately started with question banks: frcemexamprep.co.uk & frcemsuccess.com3. I kept a target of at least 50 questions per day for first month, which went to 120-150 by 4th month. My aim was to learn from questions. It kept me motivated to read. For anatomy (my weakest subject), I used teachmeanatomy as my primary source4. For rest of the subjects I heavily relied on the explanation given after questions.

I used Revision Notes for MCEM by Mark Harrison, only in last month as a revision book5. It is very dry. This approach helped me remember the questions I solved while reading Mark Harrison. I also referred to Snell’s Anatomy and google search for few topics while solving bank.

Question 4: Should I use question bank? Which ones are the best?
Since no one knew how the exam was going to be, me and my friends subscribed to 2 question banks and took turns solving them. For me question banks were very helpful as they kept me focused and motivated. I tried to give 3-4 hours out of my daily schedule to solve them. The biggest problem that I faced was; if I wasn’t able to solve on a particular day/ days, I would forget everything. It was an eye-opener for me to be consistent throughout my preparation. I can’t say which one is best, I liked frcemexamprep for anatomy as it had pictures and loved frcemsuccess for rest of topics for their thorough explanation.

Question 5: Are the Bromley courses useful?
In retrospect, I definitely find it useful. I took advice from Lakshay and did this course. It is expensive, but worth it. Not mandatory. I went with 2 goals- 1) 2 days revision of entire syllabus and hope of knowing how the questions will be asked and 2) to come back and teach/ share knowledge of what I learnt.

Question 6: Tips for exam day?
a)     Time management: the more questions you do before the exam, easier will be the time management. 3 hours for 180 questions are sufficient.
b)     Stay calm
c)     You have to cross the box on the answer-sheet with pencil, so mark all the questions and if in doubt, at the end you may return to the doubtful answers.
d)     There will be questions pertaining to emergency procedures and its relevance to anatomy/physiology and that of trauma and injury to underlying structures. There will be case scenarios and they may ask mechanism of action of particular drug, drug-drug interaction, etc. See that you read them well.
e)     Read only the volatile section of syllabus on the day of exam- for me it was the nerve supply- sensory/motor and dermatomal distribution (heavily tested).

Be consistent. Do plenty of questions. It is a doable exam. Although this was a basic science exam, all questions are about emergency medicine. If you love EM, this will be a fun exam.

If you have any doubts please feel free to contact me at tambe_nikhil@yahoo.co.in



Nikhil N. Tambe - @nikhil16mar

Emergency Medicine Resident (PGY-2)
Masters in Emergency Medicine (GWU)
Kokilaben Dhirubhai Ambani Hospital, Mumbai
Instructor (American Heart Association)
Lifesupporters Institute of Health Sciences, Mumbai


  1. This comment has been removed by a blog administrator.

  2. Can we have an updated view on FRCEM Intermediate as well?
    Thanks :)

  3. Do you have any idea about FRCEM All in one notes by Moussa Issac? It has written things which are not mentioned in the RCEM Basic science curriculum. Is Mark Harrison plus MCQS websites are enough? Regards

  4. I sat the FRCEM Primary yesterday. Studied from the Moussa Issa book. It did cover all the questions apart from a few. The book is to the point and has Practice MCQs also. It helps to Google about topics also as an added visual aid. The book does require reading in detail. A double read IS REQUIRED. I tried 2 Online MCQ banks. Sadly not helpful at all for me.