Authors: Mark Brown / Editor: Charlotte Davies / Codes: SLO7, SLO9 / Published: 19/09/2023

It’s July 2022 and I am sat in the control room of the Lancashire simulation centre facilitating a course. A colleague looks over at me and causally says, “you sat the OSCE, didn’t you? How did you do?” The FRCEM OSCE results are out – I hadn’t realised. I’ve already passed the SBA. Opening the email and seeing ‘pass’, my overriding emotion was relief, no more exams. I didn’t really believe the result and checked it multiple times over the next few weeks just to be sure. It didn’t feel real until I was on stage at the diploma ceremony to receive my diploma along with hundreds of my colleagues. I definitely didn’t expect to be receiving the Luka Randic medal* especially given how stressed I felt in the lead up to the exam…

October 2021 – I have booked my FRCEM, both SBA and OSCE. They are the last two examinations I must sit. I feel confident calm and relaxed, I have been sitting exams for 25 years and finally the end is in sight; I know how to prepare for this by now. I have been organised and I am LTFT to give me a defined day per week to prepare.

November 2021 – Well, this is more difficult than before. When do I revise? Pressure in the ED is extreme, there are rota gaps everywhere and a 9-10 hour wait every morning, so I finish each shift exhausted. My extra day off being LTFT is now childcare as both my parents and in-laws, who do 2 days per week childcare, have covid. I’m listening to podcasts on the commute and I like ‘EM Cases’ (although it’s Canadian so not always applicable to UK practice), ‘The Resus Room’ and ‘St Emlyn’s’. I am also trying to read before bed; ‘EM3’, ‘First 10 EM’ and ‘LITFL’ are my current favourites. It’s ok – still 4 months left, that’s loads of time.

December 2021 – I manage to sit down and start some structured work, on top of ad hoc podcasts and blogs. My son hates my laptop as it means I am not playing with him, so revision now happens after bedtime. Wow, the curriculum is huge! How am I going to cover all this? Where do I start? I look through the FRCEM regulations and information pack, which give a question breakdown per SLO, as well as the syllabus descriptors. The RCEM learning website lists syllabus topics,which I use to structure my revision plan. It details each specialty, with more specific breakdowns of topic, with direct links to the learning. I started my revision by prioritising what I thought were my weakest areas. I was particularly using the RCEM learning sessions as a knowledge bank. The questions and knowledge checks through the sessions work very well for me.  I supplemented this with BMJ learning, NICE, NICE CKS, College Guidelines and LITFL, especially if there wasn’t a RCEM session available.

January 2023 – The fear is now starting to kick in. I have only managed to cover 4 topic areas. Revision feels all consuming, I find myself gradually losing my family life to devote time to work. My wife is understanding and starts to pick up the slack at home despite a full-time job and morning sickness. It’s hard for both of us to keep the plates spinning. I definitely need to pass first sitting, I can’t do this again with a new baby also in the mix. However, with the consistency of being able to devote a few hours a day after work, I start to make good progress. I sit the regional SBA mock but find it incredibly difficult. I don’t score well enough to pass in 2 of them, not even close.

February 2023 – Revision is going well now, I have a good system of revision in place, working through all the RCEM learning sessions. Grandparents are fully recovered and doing a lot of childcare, so I am getting good blocks of revision in. I am using the 20-30 minutes RCEM learning sessions with breaks in between as bitesize revision chunks. I am now working through the RCEMLearning SAQ and SBA questions, and able to answer most of them, so feeling a bit more confident. I am watching the trauma care webinars, which I think are an easy way to cover the trauma topics.

March 2023 – I take some private study days. I have finished all the RCEM learning sessions, SBAs and SAQs. I then read through the RCEM guidance thinking these will have a high probability of coming up – which they do. My final push is the statistical definitions on RCEM learning (critical appraisal dictionary), the practical procedures in the curriculum, rashes and other spot diagnosis and LITFL 100ECGs. I haven’t covered everything I would have liked, but I don’t think it is possible to. I didn’t revise the core things that we see in ED every day in the hope that my previous knowledge will carry me through, which it did.

In the exam, to my surprise, lots of the questions are familiar, covered in detail in the RCEM learning and other revision materials. I am surprised by how many of the things I have never actually treated in practice, rarer conditions seam to predominate. Leaving the exam, I feel it went badly, and dwell on the questions I guessed on. Now I have my results, I think that is just the nature of how SBAs make you feel, however well you performed.

April 2023 – Just the OSCE to go. I was empty after the SBA and I didn’t have the energy to revise again until about 2 weeks before the exam. I did the regional revision day, and I felt I performed well. I then read the St Emlyn’s OSCE guide which was invaluable in providing a structure for answering the different types of questions. It was the single best OSCE resource I found. I didn’t do much more knowledge revision and trusted SBA preparation would suffice. The only knowledge review I did was reviewing the college guidelines.

May 2023 – The OSCE is now done. It felt like the worst EPIC shift I have ever done, the pace is frenetic and unrelenting but oddly it was actually quite fun. I felt my clinical experience, supported by revision, had prepared me well for it and even for topics I didn’t know the specific answer using a structured, safe approach carried me through with good marks.

The Alison Gourdie Medal

Alison Gourdie was a highly respected Emergency Physician and by all accounts would have been a major figure in the development of the specialty. She had just been appointed to her first Consultant position at Stirling Royal Infirmary when she died tragically in a Himalayan plane crash at the age of only 34. The Alison Gourdie Medal has been awarded in her honour since 2004 for the top performance in both MCEM and FCEM. I was fortunate enough to win the medal for FCEM in 2013/14 (it wasn’t FRCEM then).

Anyone who has passed the fellowship exam knows that it takes over about a year of your life. That's if you’re lucky and make it through first time. The (now defunct) CTR involved months of painful revision and corrections. The exams then take six weeks to complete so its a long and intense period.

I had rather carelessly left all five parts of the exam until a few months before my CCT date, and returned from a registrar position in Melbourne shortly before the SAQ. Whilst I hit the books regularly whilst working on my tan, I made the extra investment on several revision courses and signed up to all manner of websites.

The critical appraisal was first up at the end of April, followed by the SAQ. The questions ranged from the frankly bizarre (spider bites?) to the commonplace (sepsis and glaucoma). After that, there were five to six weeks until the OSCE and vivas. The OSCE took place in the Royal College of Anaesthetists; it was fairly similar to MCEM but tougher overall, with many more communication stations. It went pretty well but I’ve still got no idea how to insert a wrist block, and the informed consent station still has me baffled.

I took the Kings management course a couple of weeks before the (now not used) exam and got as much practice as I could. I learned to use phrases that I never knew existed before (doctor in difficulty, information gather). My CTR was criticised so badly at the Birmingham FCEM course that I wondered if there was any point in turning up for the exam! It seemed to go OK on the day though, and then it was all over. I headed off into Leeds for some champagne and sushi and an anxious month-long wait until the results would be released.

I was on holiday in Italy in July when I found out that I’d passed all five components of the FCEM. It was a huge relief after months of self-doubt and stress. Two months later the College emailed me to tell me that I’d won the Alison Gourdie Medal. It was totally unexpected and I thought that they must have made some sort of mistake. I had never won anything of an academic nature before. In fact, I hadn’t won anything of any nature before so I was absolutely delighted. I attended the awards ceremony in December and it was the biggest honour of my career to be presented with the medal at the Royal Festival Hall.

Top five tips for approaching the FCEM:

  1. Use a wide range of media to source knowledge. Podcasts like EM:RAP and websites such as Hippo:EM are great resources and it doesn't feel like real studying.
  2. Splash the cash and attend as many courses as you can. The knowledge gained on these goes well beyond the exam, and the cost is offset by not having to pay to re-sit.
  3. Start your QIP early, and get it ripped apart by someone who knows what they’re doing. Email the lead authors of your main papers to get opinions on future developments. Print everything out and have it colour-coded in a folder. This looks slick and professional and means that you wont get caught out on the day.
  4. RCEMLearning is a high-yield resource that involves contributions from College examiners. Do as many modules as you can and copy and paste notes onto Evernote to read later.
  5. Beg, borrow and steal past exam papers and topics. Do as many as you can. Book learning is good for reference, but the breadth of knowledge required is too broad for this to be valuable on its own.

We’re not examiners, so these tips all come from our personal experience of sitting the SAQ — we found that the hardest thing was actually just knuckling down to revision. Please add your tips, hints, and resources in the comments section, or on Twitter.

https://twitter.com/AlexNevard/status/1299091573800660994

Before the Exam:

  • Revise properly and don’t convince yourself watching Holby City counts as revision! There’s a blog on Time Management – you could read it…or that might count as procrastination.
  • Consider forming a revision group, and writing a question bank together. The final SAQ examination is designed to test your knowledge, as well as your clinical reasoning and logic. When writing questions try to write questions that have clear answers, test thinking rather than purely knowledge, and are of an expected knowledge level (not esoteric).
  • We’ve suggested that you write questions because:
    • Writing helps you think about “the mind of the examiner”
    • Writing the question helps you revise that curriculum area
    • It means everyone has more questions to revise from
    • Questions need an educational answer, and relevant links – a good way of “filing” your revision notes.
  • Know the syllabus - the exam information pack has lists of how many questions will be from each curriculum area. There WILL be paediatrics and there WILL be ultrasound.
  • Revise carefully.
  • Practice writing with a pencil. Not typing on a computer. Writing. In pencil.
  • Do as many mock questions as possible – RCEMLearning has so many SAQs, and some of these themes might be replicated in the exam. When you’ve done all of the RCEM SAQs…consider doing the RCEM cases. They’re not SAQs but they’re still testing and informative.
  • Twitter is great for keeping up to date and hearing what is topical, so it’s worth a quick look at. However…don’t let it distract you.
  • Mental rehearsal – Imagine yourself sitting, and passing the exam. Imagine, and practice, sitting the exam under timed conditions – see how well you speed read, and speed write. As well as mentally rehearsing these things, actually rehearse them- do a timed paper.
  • Use the glossary to help your interpretation of any questions.

On the Day

  • Stay calm – know your triggers. If other medics stress you out, stay away. If cramming stresses you out don’t do it. If you like to keep busy and cram – go for it.
  • Power pose – it’ll help your confidence.

In the exam

  • Time is against you.
  • Read the question, then the information.
    Sometimes questions say “blah blah blah fox sat on mat. Patient sudden onset headache. Blah blah blah. You think you know what it is and you’ve wasted a lot of mental effort getting to this point. Then the question ends “you think it’s pituitary apoplexy“.
    Reading the question helps you to know what information you need from the stem.
  • If you can’t answer a question, skip it out – mark it somehow, and come back to it at the end. You might know the answer – but if you think about it for 5 minutes, you might not get to the end of the paper to reach the question you certainly will know the answer too.
  • 3 hour exam. 60 questions, each with 3 parts. That’s a minute per “part” – three minutes per question.
  • Work out the times before hand – at 11am, I will be on question 22 etc.
  • If there’s an image, look at the stem, as the clinical stem may tell you what you will see in the image.
  • If you don’t know, power guess. If it’s a foot x-ray…liz franc. If it’s an emergency drug…ketamine or adrenaline. There’s no negative marking – so anything is better than nothing!!
    You need to be on at least question 20 by the hour mark.

After the Exam

  • Know what de-stresses you. If you need to talk about the exam…go to the pub with medics. If that makes you panic…go to the pub with non-medic friends.
  • What’s done is done – wait for results to come out.

Good Luck!!