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.
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
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 pillBelieving in self and
staying positive never hurt anyone.
That’s all about my opinion. I hope that helps! Cheers and All the best Guys.
Scores Final by Akshay Bhargav on Scribd
Author:
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.
Brilliant study guide. Will be giving my Intermediate exam in September. Hoping for the best. Cheers.
ReplyDeleteHello 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
DeleteHello 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
DeleteWorking 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.
DeleteLakshay
Thanks for the help. Really helpful
ReplyDeleteCan you pls give a brief list of high yield topics according to you. Thanks
ReplyDelete