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. 

MRCEM Part B

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 post: This 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