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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, April 23, 2018

FRCEM Final SAQ - The Holy Grail

I took the FRCEM Final SAQ exam lately and in this post, I am going to share the way I prepared for this exam. EM Trainees take this exam anytime between ST4-6 years of training (EM training lasts for 6 years in the UK). This way of preparation worked well for me and this is just one of the ways to prep for the exam. If you have any further thoughts, please feel free to comment below. 

Exam pattern: 60 questions with 1-3 stems in each question. Each question carries 3 marks and you score out of a total of 180. To pass the exam, you need to get about 120-130 questions correct. This exam basically tests your EM knowledge and management skills. It is a good idea to familiarize yourself with the basic structure of NHS. However, it is not must to have UK work experience prior to taking this exam. 

Study time: I spent around 2 weeks to actively prepare for the exam. Since I work in a busy A&E, I was in constant touch with Emergency Medicine. I believe 1 month is a decent amount of time to prep for this exam. 

Study Material: 
  • Oxford Handbook of EM
  • Oxford Handbook of Acute Medicine
  • Oxford Handbook of Clinical Specialities
  • Victoria Stacey 
  • RCEM guidance from RCEM website 
Tintinalli's Textbook or Rosen's is not typically followed in the UK as core EM Textbooks and are not must for this exam. But you will certainly have an extra edge over other candidates if you have read an EM textbook cover to cover. 

RCEM Curriculum, Images (Clinical Images, ECGs, X Rays)
Scroll through the college curriculum as you read OHEM and as you do the practice questions. Ensure you cover each bit of the curriculum, for instance, stuff that we don't see routinely (STDs, vaginal discharge, rheumatological diseases, sarcoid, spinal cord syndromes etc) should also be covered. Questions related to Lupus Psychosis, Ovarian Hyperstimulation Syndrome are some of the favourite topics. 

Questions with image interpretation are easy to score. Glance through X Rays of various differentials of limping child, C-Spine injuries, images of skin rashes in children and fundus findings for ophthalmological pathologies. Search "Google images" and look what pops up whenever you come across a question with a likely image interpretation scenario. 

Important ECG topics include 
  • Posterior wall STEMI
  • Types of Ventricular Tachycardia 
  • ARVD
  • Brugada
  • Subtle ischemia (Wellens, de winters T waves, Early reciprocal changes in aVL)
  • Torsades
  • Trifascicular block
  • AV Blocks
  • Sgarbossa Criteria 
  • ECG findings of PE
  • Long/Short QTc syndromes 

How is FRCEM Final SAQ different from MRCEM SAQ?
While preparing for the exam, I always thought that this exam appears very similar to MRCEM SAQ. FRCEM Final SAQ focusses more on management aspects (RCEM Guidelines) in addition to core EM textbook knowledge. Please make sure that you go through the RCEM website and have a glance through the guidelines (absconding patient, frequent attenders, dealing with police, domestic violence, sexual assault, valid consent, confidentiality, handling complaints, adverse events, MH issues covering all the sections, common law and assessing capacity, dealing with intoxicated colleagues, major incident management, quality indicators, RCEM standards of care etc.)

Study Buddy: Choose to have 1 or 2 study buddies to prepare. I suggest to read the text on your own but do questions followed by discussions together. As you read OHEM, you will realize that it possible to frame a question from each sentence of this handbook. It is a good idea to think how a question can be framed on a particular topic as you read OHEM and then test your partner with that. 

Exam preparation courses: Surprisingly, there are only a few resources and question banks to prepare for the exam. Take your pick between a formal prep course or an online question bank. Going to a course (which is more expensive than the exam) without brushing up OHEM is a sheer waste of time. 

Exam taking strategy: With electronic health records in place, most of us are not used to swiftly scribble on a sheet of paper. In fact, one of my mentors once told me, if you attempt all the questions then you are highly likely to pass. Therefore, practice a few timed mock tests prior to the exam. Tips for the day of exam:
  • You are given 3 hours to answers 60 questions. If you are not sure about an answer, keep moving forward and get back in the end. 
  • Do NOT spend more than 2:00 - 2:30 minutes on one question 
  • Image questions: Don't jump to conclusions and Don't jump to the stem after seeing the image. Even if you are 100% sure about the image interpretation, you MUST read the question completely before you write down the answer. 

Decision-making tools
You don't need to remember all of them but have an idea about few components of each decision tool. For instance, remember 4 things that makeup PERC criteria or 4 things that make up TIMI score or HEART score. Use mdcalc to check up to date scores. 

We have also covered 2 posts in the past about MRCEM SAQ. A lot of what has been mentioned in these posts holds relevant for Final FRCEM SAQ as well. I highly recommend you to go through them:

MRCEM part B by Lakshay Chanana
MRCEM Part B by Apoorva Chandra

Posted by:

     Lakshay Chanana
     Speciality Doctor
     Northwick Park Hospital
     Department of Emergency Medicine


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