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

     England

     @EMDidactic

Gillick competency and Fraser guidelines

The terms ‘Gillick competence’ and ‘Fraser guidelines’ are frequently when consenting children to medical treatment. These are often used interchangeably despite there being a clear distinction between them.

Gillick competence (assessment of a child's maturity and intelligence) is concerned with determining a child’s capacity to consent while Fraser guidelines are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment. Confusion and misunderstanding these terms may have profound medicolegal implications. 

Gillick competence

In UK law, a person's 18th birthday draws the line between childhood and adulthood. Therefore, an 18-year-old enjoys as much autonomy as any other adult. To some extent, 16 and 17 year-olds can also take medical decisions independently of their parents. The right of younger children to provide independent consent is proportionate to their competence i.e depends on their Gillick Competency.  For instance, we have all seen very sensible 16-year-olds who are at par with 20 years old. More commonly, we encounter 22 years old who still behave like a teenager. Therefore, child's age alone is an unreliable predictor of his or her competence to make decisions.

Children under 16 can consent if they are Gillick Competent i.e. if they have sufficient maturity and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options. Decision making competence does not simply arrive with puberty; it depends on the maturity and intelligence of the child and the seriousness of the treatment decision to be made.

The rule in Gillick must be applied when determining whether a child under 16 has the competence to consent. The aim of Gillick competence is to reflect the transition of a child to adulthood. Legal competence to make decisions is conditional on the child gradually acquiring both:

• Maturity - That takes account of the child's experiences and the child's ability to manage influences on their decision making such as information, peer pressure, family pressure, fear, and misgivings.
• Intelligence - That takes account of the child's understanding, ability to weigh risk and benefit, consideration of longer-term factors such as the effect on family life and on such things as schooling.

It is not just an ability to choose but it is an ability to understand, where the child must recognize that there is a choice to be made and that choices have consequences and they must be willing, able and mature enough to make that choice.

If a child passes the Gillick test, he or she is considered ‘Gillick competent’ to consent to that medical treatment or intervention provided if the consent was given voluntarily and not under influence or pressure. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. However, where the same child refuses consent then they may obtain it from another person with parental responsibility who can consent to treatment on the child's behalf.

If a child does not pass the Gillick test, then the consent of a person with parental responsibility (or sometimes the courts) is needed in order to proceed with treatment.

Gillick test is not a blood test! It forms a part of the assessment requiring an examination of how the child deals with the process of making a decision based on an analysis of the child's ability to understand and assess risks. It is a high test of competence that is more difficult to satisfy the more complex the treatment and its outcomes become. Where a child is considered Gillick competent then the consent is as effective as that of an adult and cannot be overruled by a parent.  

If a Gillick competent child refuses medical examination or treatment then the law does allow a person with parental responsibility to consent in their place. Where a health professional accepts the consent of a Gillick competent child it cannot be overruled by the child's parent. However, where the same child refuses consent then they may obtain it from another person with parental responsibility who can consent to treatment on the child's behalf.

What if a 10 years old appears to meet Gillick Competency? Can we treat him without consent?

There is no lower age limit for Gillick competence or Fraser guidelines to be applied. That said, it would rarely be appropriate or safe for a child less than 13 years of age to consent to treatment without a parent’s involvement. When it comes to sexual health, those under 13 are not legally able to consent to any sexual activity, and therefore any information that such a person was sexually active would need to be acted on, regardless of the results of the Gillick test. 

If a person under the age of 16 is not Gillick competent then he/she deemed to lack the capacity to consent, it can be given on their behalf by someone with parental responsibility or by the court. However, there is still a duty to keep the child’s best interests at the heart of any decision, and the child or young person should be involved in the decision-making process as far as possible.

Fraser guidelines

The ‘Fraser guidelines’ specifically relate only to contraception and sexual health. They are named after one of the Lords responsible for the Gillick judgment but who went on to address the specific issue of giving contraceptive advice and treatment to those under 16 without parental consent. The House of Lords concluded that advice can be given in this situation as long as:

1. He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment (Is he/she Gillick competent?)
2. He/she cannot be persuaded to tell her parents or to allow the doctor to tell them
3. He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
4. His/her physical or mental health is likely to suffer unless he/she received the advice or treatment
5. The advice or treatment is in the young person’s best interests.

Health professionals should still encourage the young person to inform his or her parent(s) or get permission to do so on their behalf, but if this permission is not given they can still give the child advice and treatment. If the conditions are not all met, however, or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality.

Fraser guidelines apply to contraceptive advice and treatment, decisions about treatment for sexually transmitted infections and termination of pregnancy.

What about taking consent in 16-17 year olds? 

Young people aged 16 or 17 are presumed in UK law, like adults, to have the capacity to consent. However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court. This is because we have an overriding duty to act in the best interests of a child. This would include circumstances where refusal would likely lead to death, severe permanent injury or irreversible mental or physical harm.

Summary

Gillick competence is the principle we use to judge capacity (maturity and intelligence) in children (<16 years old) to consent to medical treatment. If a child passes the Gillick test, he or she is considered ‘Gillick competent’ to consent to that medical treatment or intervention but If a Gillick competent child refuses consent then they may obtain it from another person with parental responsibility who can consent to treatment on the child's behalf. 

Fraser guidelines apply to contraceptive advice and treatment, decisions about treatment for sexually transmitted infections and termination of pregnancy.

There is no lower age limit for Gillick competence or Fraser guidelines to be applied. That said, it would rarely be appropriate or safe for a child less than 13 years of age to consent to treatment without a parent’s involvement. 

Further Reading

• Wheeler R (2006) Gillick or Fraser? A plea for consistency over competence in children. BMJ 332(7545): 807
• Gillick v West Norfolk & Wisbech AHA & DHSS [1983] 3 WLR (QBD)
• Axon, R (on the application of) v Secretary of State for Health [2006] EWHC 37 (Admin)
• Mental Capacity Act 2005 
• https://www.gmc-uk.org/static/documents/content/0_18_years.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1432156/pdf/bmj33200807.pdf

Posted by:

              

     Lakshay Chanana

     

     Speciality Doctor

     Northwick Park Hospital

     Department of Emergency Medicine

     England

     @EMDidactic

Don't be critical about "FRCEM Critical Appraisal"

The September 2017 diet FRCEM critical appraisal results were released last week and passing rates remained close to 60%. I took this exam in September diet along with some of my other colleagues. 

While preparing for this exam, we often used to ponder - Why are we doing this? But as our preparation went on, we realized that “Critical Appraisal” is one of the most essential aspects of modern day medicine. As exam-going candidates, like everyone else we had a lot of doubts and concerns about the pattern, how to start preparation and we found that there is a ton of stuff on MRCEM Part A, B and C prep but there was not much about FRCEM Final set of exams. 

I am going to address few BIG questions regarding FRCEM Critical Appraisal here:

Can we take this exam from India?

To my knowledge, I am not aware of anyone who appeared for this exam while working as an ED doctor in India. However, I think this should NOT be a problem and it is quite possible to crack this. The issue is lack of good mentorship, someone who can guide you through the process. At this point, I know only two practicing physicians in India who have been through the FRCEM series of exams. The exam itself is pretty much a revision of your third year medical school statistics and epidemiology (no rocket science!). You don’t need to be an expert in statistics but should be able to understand the very basics and know what the numbers mean to a clinician.

Cost will be another issue; the exam fee is approximately 25,000 INR, which is a hefty amount for an EM resident in India. If I include the cost of travel and stay, the exam will cost you at least 100,000 INR (including tickets and accommodation). Add another 100,000 INR if you want to attend a exam prep course.

Bottom-line – If you are lucky enough to have a mentor, then taking FRCEM Critical Appraisal is quite possible from any country (not only India) provided you are financially strong.

Do we need to attend a pre-exam preparatory course?

Well, my standard answer is - most of us do end up going to a prep course due to peer pressure. But if you are going to a course, make sure you read about the basics first. Trust me, it makes an immense amount of difference and the course itself works like a revision for you. Also, it is much easier to grasp the "statistics terminologies" if you have already read it once or twice. Otherwise, going to a prep course is a waste of time and money. My recommendation is "Read the basics and then go to the course to clarify things that you did not understand". 

If you end up attending a course without any sort of pre-course reading, then you will be bombarded with information overload. 

Bottom-line: If you are motivated enough, I assure you that you can easily pass this exam with the below mentioned resources and without attending any prep course. 

Exam Pattern

The exam lasts for 90 minutes and you get one paper (Diagnostic or Therapeutic, rarely Meta analysis) to critically appraise. You are expected to write your answers in the space provided (gauge the length of your answer as per the size of the box). The exam comprises of a total of 6-8 questions. There are some standard questions like "writing a summary of the paper" and "strengths and limitations" of the study. These are pretty standard and it is easy to fetch marks on them. 

Bottom-line - Enough practise and time management is the key. 

How we prepared?

We started preparation about a month prior to the exam. Despite understanding the concepts, most of us found it challenging to jot down things on paper. For instance, we knew what "p value" signifies but we could not define it. I recommend reading the "glossary section" everyday for 1-2 weeks. This will make the exact definitions stick to your mind. Glossary also includes all the equations to calculate Sensitivity, Specificity, PPV, NPV, PLR, NLR etc. Glossary is high yield. 

We read about 1-2 papers everyday starting 10 days prior to the exam, each one within a span of 90 minutes. 

On the day of exam?

As always, don’t try to do a lot on the day of exam. If you are very keen, then once again – go through the glossary, which should take <1 hour at this point. Just sit back and relax. You have done your bit in the last month and outcome depends entirely on that, not on the last minute preparation. Stay calm and remember, this is just another exam and not the end of your life! Sooner (hopefully) or later, you will get through this. 

Resources for exam preparation

Critical Appraisal for FCEM - This book is designed for FRCEM critical appraisal (as the name suggests) and focuses on key aspects that you need to understand to critically appraise a paper from an examination standpoint. It is designed for A&E doctors by A&E doctors. You also get a couple of practice papers at the end and glossary of all the important definitions, which are very likely to be asked in the exam. Highly Highly recommended. 

Rahul Patwari's Youtube videos – Even if you are not taking the exam, I insist spending some time with these videos. You will mature as a clinician during this process. In these videos, Rahul takes us through the very basics of evidence-based medicine and explains how to bring that evidence to the bedside. Every practicing physician, not only A&E doctors, must see these videos. The concepts are presented in a very simple and easy to understand way enough for a 10 year old to comprehend. Reading statistics comes with a mental barrier for most of us, as this stuff can be hard to grasp. I often felt like a dyslexic as I could not decipher what the text means, but these videos came with a solution.

Recommended Playlists on the youtube channel:

• Basics of Clinical Reasoning
• Probability and Odds
• Hypothesis Testing
• Sampling
• Distribution of Sample Means
• Sensitivity and Specificity
• Confidence Intervals
• Incidence and Prevalence 
• EBM - Introduction
• EBM - Evaluating articles on Diagnosis
• EBM - Evaluating articles on Treatment 

Sketchy EBM - Once again, a picture is worth a thousand words. Concepts that are difficult to understand are explained very well here. 

SGEM: One of the best blogs/podcast on Evidence Based Medicine. This will ensure that you get into that mindset and be comfortable with the terminologies that are used while interpreting evidence. REBELEM and COREEM are other options.

USMLE Step 1 Statistics – The concepts remain same across the world, whether it is UK, USA or India. If you have the time and patience, then check out these videos by Steven Daugherty. These videos give you a slightly more in depth review of Epidemiology and Statistics and are worth watching but not mandatory.

In hindsight, I feel that Rahul Patwari's and Sketchy EBM videos are a good place to begin rather than reading a textbook. Following this, go through the Critical Appraisal for FCEM.  If needed, review the videos again. One needs to read the textbook at least a couple of time because the content is quite volatile. I think 1-2 months are more than enough to prepare for the exam. Once you have gone through the videos and text, do several papers and simulate exam like conditions (write with a pencil, write legibly and within the box, finish under 90 minutes).

I hope this helps. Let me know if you have any further questions regarding the exam.

Further Reading:

http://stemlynsblog.org/the-critical-appraisal-fcem-exam/

http://stemlynsblog.org/taking-fcem-you-feeling-lucky/

http://emergencymedicineireland.com/critical-appraisal/

http://fcemprep.co.uk/tag/critical-appraisal/

Posted by:

              

     Lakshay Chanana

     

     Speciality Doctor

     Northwick Park Hospital

     Department of Emergency Medicine

     England

     @EMDidactic

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.

THE EXAM

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 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.

 

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.