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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, February 13, 2017

FRCEM intermediate SAQ: It’s about momentum. How you build it. How you plan it.

I recently cleared my FRCEM intermediate SAQ exam. Many of my colleagues and juniors have been asking to share my experiences about it as the exam format is new. Also the pass percentage was very low this time (~15%)

I’d like to begin with what can go wrong. I will confess. This was not my first attempt. I had a torrid time giving my part B exams in June last year. I read a lot. I Read OHEM (Oxford Handbook of Emergency Medicine), Practiced online questions. Was I stressed about the exam? Perhaps a little too much. I was doing a lot of combined studies with friends and when I was alone the tension/ stress got the better of me. Sitting for even 10minutes with the book seemed like a great deal. And to set it off I used to browse FB/ chat/ watch YouTube just to cool things off. This caused a lot of wastage of time. The targets set for the day were not being achieved and getting procrastinated. Although I was already scoring around 100/160 in all practice tests but that was borderline. I was like ‘Read OHEM complete, revise it again’ also I had some cloudy concepts regarding dermatology/ choice of antibiotics/various fractures and injury management and many more. To eliminate that uncertainty I had to probably read and make my own notes. But how? 

The syllabus is enormous and time always seemed limited. So the exam date came closer and closer and I continued with my haphazard way of studying. I was hoping that somehow I will pass the exam. But on the night before the exam I had a sinking feeling that things were not alright. The doubts still existed. The uncertainties were still there. I could barely sleep that night. I was just hoping that somehow I will pass. But such prayers are rarely answered. Next day the exam was a disaster. The questions seemed familiar but the answers were not on my fingertips. I had to try hard to remember each and every answer. Since the accurate answers were not striking fast and smooth I was writing longer sentences to rephrase my answers. This took me longer time and the momentum never built up. You need that flow to answer some questions which are not straight forward and need some logical reasoning.

After the exam I was a little broken. Not knowing exactly where to start again. But I knew the problem was not only the knowledge per se but also how I need to plan and prepare for it. As the saying goes Proper Planning Prevents Poor Performance I realized I have to learn to study alone. I had to learn to sit still and. Have some self control so as to achieve my daily targets. Learn to stay calm and not panic. And for that I did try meditation. No rocket science, but a simple way of learning how to stay in the moment.

So now let’s come to the point. How to prepare for the new format of FRCEM SAQ intermediate exam. We will go through it retrospectively. Describing the exam process and proceeding backwards to the time now.


This exam is not just a theory paper. The paper is designed to test your clinical acumen. Most of the questions are clinical case based scenarios supplemented with images. The exam has 60 questions of 3 marks each divided into 3 (1 mark each) or 2 SAQs (2+1marks). Time duration is 3hours. So that makes 180mins for 180 marks. You should be at the exam centre atleast 30mins before the starting time or at the reporting time as suggested. You will be required to verify your identity and then wait till you are called in and seated according to your candidate numbers. You will be provided with pencils/erasers/sharpeners and refreshments like chocolates/fruit juice/ water. You will be required to enter your details in the sheet provided. The timer/clock will be displayed where you can easily see it.

TIMING the exam

60 questions in 3hours. 180 marks and 180mins. You should aim to complete 10 questions in every 25mins. Hence try to finish all 60 in 150mins. Do not pause or wait too long at a question of which you are not very sure of or are doubtful. Keep moving. Keep time to come back for a second round. Mark with pencil the question you have left and have to review. There were candidates who failed marginally this time because they could not read all the questions! Do not make that mistake. You fail the exam even if you fall short by 1 mark or 10 marks. If you feel stressed out during the exam take a deep breath and exhale through mouth, take a sip of water and start again. Answers may strike you a little later when you have developed a flow. Keep moving. Time is of essence. I had only 15mins left for the second round but I think I managed to answer atleast 8-10 stems (8-10 marks then)
1 day before the exam and the morning: This day is very important. Every hour should be planned for. You have to reach the peak level of your preparation and stay calm no matter what. Things to take care of:

TRAVEL and STAY: If you’re travelling to a different city reach atleast by evening. Try to find a place of stay within 5kms of the exam venue as it may save you good time in the morning and helps in getting a peaceful sleep.

READING: You have to reach your peak level of preparations on this day. You cannot be carrying all of the study material or planning to revise everything on last day. So filter out. Prepare your notes of all the important material that may be volatile like drug doses/ scores/ treatment protocol/fracture names/investigation findings or whatever you think is vital. You should plan it properly. And DO NOT read anything past midnight. Just shut it off. Anything you read after that will do more harm than good. Do something to take your mind off the exam. Chill. Unwind.

SLEEP and the MORNING: People say to take a good night’s sleep before the Exam. Of course it is important but I find that advice very futile. I myself have never been able to get a sound sleep before a major exam and this was also no exception. But I think more important thing is to not fret over if you’re not able to sleep. We as emergency physicians can save lives even if we have been awake for 24hours straight. Stressing over lack of sleep does you more harm than lack of sleep itself. And when it’s the morning take a power shower that washes off all tiredness and anxiety and sets you all ready for the exam. Take a good breakfast. Get into the cab or whatever transport you’ve arranged and GET SET GO.

The WEEK before the exam: 6 days excluding the penultimate day

PLAN. EXECUTE. REPLAN. DO. KEEP DOING. This is how I will describe the last week.

PLAN your leaves/ duties well in advance. Arrange duty replacements or take leaves. I suggest breakup the last week or last 6 days as first 4 days and last 2 days of the week. You should have gone through your books atleast twice before entering this week. Try to finish subject wise in the first 4 days of the week. Break the syllabus into 4days and cover all that can be. (Syllabus available from
page2image32136 https://www.rcem.ac.uk/docs/Exams/2.2%20FRCEM%20Intermediate%20Certificate%20Information%2 0Pack.pdf)

Last two days try to read the high yielding and must know topics. Build the momentum and prepare the material you will revise the last day. For example I had notes written for antibiotics/ antidotes with doses/ treatment regimens and guidelines/ scoring systems/ ECG abnormalities/eponymous fractures etc.

Take practice tests: Simulate yourself atleast once according to the exam scenario – 3hrs & 60 questions. May be sit in a group or do it alone. You can use online question banks for this purpose. This exercise is most important to time yourself. Use pencil while writing answers as you will do in the exam.

Lastly all you need to do from the time now till you enter the last week:
Go through the curriculum and identify the areas that you find difficult to understand or remember. Read them through standard text books of your preference or some reliable internet sources. Clear your concepts and preferably make small notes about them. Organize and Simplify.

Oxford handbook of Emergency Medicine: Each and everything. Read atleast 3-4 times cover to cover. Mark sentences which could be possible questions.

Oxford handbook of Acute medicine (especially Dermat/ Rheumat/ Onco/ Practical Procedures/ Infectious diseases/ventilator modes)

I also suggest to google search images of the clinical conditions which involve a rash and take screenshots of them. Try to correlate the image with the definition of rash/ diseases. Similarly go through images of ECGs and radiographs. Go through as many images as possible.

Updated NICE/ SIGN guidelines for topics enlisted in curriculum. Also read Medicolegal and social aspects example Rape/ Violence/Abuse/ Consent/discharge advices. Go through Critical care basics like: Ventilator management/ modes/ permissive hypercapnea/ weaning strategy etc.

Online resources: There are few websites like ‘mcemprep.ac.uk’ and others which provide sample questions for you to practice. It is reasonable to subscribe them atleast 3 months prior to exam. Make a target of doing 10-20 questions/ day. Simultaneously try to finish off those topics from the books you refer.

Also I came across a facebook page named ‘MRCEM examination resources’ which gives out valuable information time to time. You may choose to follow it.

FINALLY the question... when to start preparing - Although there is no alternative to daily reading but you should ideally start preparing 6 months prior to exam date. Late starters may choose to begin with 3 months in hand but that’s a little risky. I also think people should have atleast 2.5yrs of experience in Emergency Medicine when they plan to attempt the exam. But remember it is never too late to begin. Plan properly whatever time you have. If you have months then plan your days. If you have days left then plan your hours. If you have hours then just take a chill pillBelieving in self and staying positive never hurt anyone.
That’s all about my opinion. I hope that helps! Cheers and All the best Guys.
page3image26976 page3image27136 page3image27296 page3image27456 
Scores Final by Akshay Bhargav on Scribd

                                              Dr. Akshay Bhargav MBBS, DEM, MRCEM
Akshay is an emergency medicine enthusiast. Originally from Kanpur, he did his graduation from Kasturba Medical College, Manipal and his post graduation residency in Emergency Medicine from Apollo Hospitals, Hyderabad. He Loves teaching via simulation methods. His dream is to spread emergency medicine awareness among masses and improving standards of ED care in the country. As a student has always hated examinations but thankfully chose never to give up.


  1. Brilliant study guide. Will be giving my Intermediate exam in September. Hoping for the best. Cheers.

    1. Hello Doctor, I wanted to know that is it necessary to get into training in UK to appear for FRCEM intermediate? I am currently enrolled in an MD program in Emergency medicine in Pakistan, your early response will be much appreciated

    2. Hello Doctor, I wanted to know that is it necessary to get into training in UK to appear for FRCEM intermediate? I am currently enrolled in an MD program in Emergency medicine in Pakistan, your early response will be much appreciated

    3. Working in in UK gives you a better insight for all these exams. You can certainly appear for MRCEM whist working in Pakistan or India. And I presume that you should be allowed to sit FRCEM exams as well. Since many changes are still in the pipeline, I recommend you to confirm this directly with RCEM.


  2. Thanks for the help. Really helpful

  3. Can you pls give a brief list of high yield topics according to you. Thanks