Guest Blog Post by Dr. Hassan Alraee – “My MRCEM OSCE Experience”

This is our second guest blog post from esteemed colleague Dr. Hassan Alraee – Emergency Medicine Registrar (Ireland). I take no credit for the following text.

Dear Colleagues,
I am sharing my MRCEM OSCE experience with you guys as I realized while preparing for the exam there was not much guidance available online. The aim of this post is to familiarize everyone with what the exam entails and a few tips which may be helpful in your preparation for the OSCE.
This may not be a structured or typical guidance post, it may come out as a random collection of thoughts but I will try my best to note down everything that was helpful to me during the preparation for the OSCE.
First of all to be eligible to appear in the exam you need to have passed the FRCEM Primary exam, passing the FRCEM Intermediate SAQ exam is NOT one of the eligibility criteria. However, in my experience passing the FRCEM Intermediate SAQ exam gives you a baseline in theoretical knowledge that is required for the OSCE. So it would be ideal to attempt the exams in the sequence that has been set, i.e. Primary, Intermediate and OSCE.
Before beginning your preparation for the exam have a look at the MRCEM Information Pack available on the RCEM website. A list of study material that may be helpful includes;
1. MCEM Part C: 125 OSCE Stations by Kiran Somani
2. Mastering Emergency Medicine: A Practical Guide by Mathew Hall
3. Bromley Webinars
4. At least 1 (if not more) of the following courses; The London Clinical Course, The Bromley Course or the Manchester Course.
The exam itself feels like a daunting task during the preparation phase as it is completely different to the previous parts and reading books alone is not the best way to get through it. My advice would be to stick to one of the above mentioned books and go through it once. The next step would be to create a practice group which should comprise of at least 3 members. This would mean all 3 of you would be able to rotate through different roles during the practice sessions, i.e. The candidate, The actor and The examiner. In my humble opinion this practice group is the key to being successful in the exam. The final step would be to book one of the above mentioned courses. In order to maximize the courses you need to be fully prepared for the exam by the time you attend the course and treat it as a Mock Examination.
Each of the courses has their own pros and cons but all of them are helpful in preparing you for the OSCE.
Each OSCE comprises of 18 stations, 2 of which are rest stations. The exam does not test your theoretical knowledge to a great extent, the stations in the OSCE are designed to test various skills. Like all OSCE exams there is a fair degree of play acting and exaggeration of your daily practices is required. By this I mean that the examiner will only mark you on the actions you perform during the exam, so make sure you show every step and tick most boxes in the examiner’s checklist.
The basic outline of the stations encountered within the OSCE are;
1) There are 2 to 3 history taking stations, remember to complete the station by giving the patient a management plan based on the history.
2) A Systemic examination station (CVS, Respiratory, Abdominal, Cranial Nerve or Peripheral Vascular examination)
3) A Joint examination station (Hip, Shoulder, Knee, Back, C-spine or a limb examination)
4) A Breaking Bad News scenario
5) There are 2 or 3 teaching stations which may include teaching a procedure or examination to a student or a junior doctor.
6) There is always a Conflict Resolution in the OSCE as well, which may be a missed fracture or pneumothorax or a difficult referral. This station also includes talking to a patient with Alcohol Dependence or Binge Drinking.
7) 2 scenarios within the OSCE are always Resuscitation Scenarios and test your skills in ACLS, APLS or ATLS. These stations seem like they are the most difficult ones while preparing for the exam, but in my opinion you can easily pass these if you make a good approach towards resus stations during your practice sessions. The Key to the resus scenarios is sticking to the ABCDE approach.
8) ENT and Eye station; in the exam they can check your knowledge on these in various ways it can be a simple otoscopic or ophthalmoscopic examination, teaching may be incorporated into it or history taking could be tested but there will always be a station that will involve ENT or Eye.
9) A quick assessment station; this one is a tricky one, it usually has the task of taking a short history, performing a focused examination and formulating a management plan based on your findings and summarizing it to the patient.
10) An Information Providing station; this station usually involves a relative of the patient to whom you have to explain a new diagnosis or management of a medical condition. Juvenile Diabetes Mellitus and Addision’s Disease are 2 examples that I can recall.
11) A Psychiatric Station is always present in the OSCE, you may be asked to performed a Mental state examination on a patient or assess suicide risk, they may add a conflict resolution component to this station as well.

In my opinion if you divide your preparation according to these 11 types of stations you will be able to cover most of the things required to be successful. Some additional topics that are tested in different ways and I haven’t categorized under the stations include; DVT, major incidents, seizures and driving advice. It would be wise to look up the NICE guidelines on these.
I would also suggest that you reach the city where the exam is being held one day earlier and have a look at your examination center that day. Just so you know how long it takes to get there and don’t have the extra stress of finding the center on the morning of the exam. Please spend your last 2 days traveling and relaxing, there is no point in trying to cram in stuff over the last 2-3 days as this is not a theoretical exam where they expect you to know everything.
On the exam day itself it is understandable to be anxious and stressed and believe me the examiners know that the candidates are under pressure and are not there to fail you. You should know that staying cool and calm is the most important feature that will enable you to be successful. It usually takes 1 or 2 stations to get into the groove of the exam as the 1st station comes up it is normal to feel a little nervous or blank out temporarily. Do not act bold and wing it if you are unsure about something, be safe at this stage and say you are unable to recall at this point in time and that you will consult the department policy or your consultant before implementing it.
Do not worry if any of your stations don’t go as well as you expected them to, leave the previous station behind you and move on to the next one. Do not let your performance on the previous station affect your performance on the next one. I know this is easier said than done but it has to be said as it is human nature to dwell on the past. You should also know that there is not a minimum number of stations that need to be passed to pass the exam, that was how it used to be in the past. The marking scheme has changed to a cumulative score now and a different passing mark is set for every OSCE day so even if you fail a station you carry forward marks from it towards your overall score. Therefore it is imperative that you score marks for the basic things on each station. Some of these include greeting the actor, washing hands before and after examination, wearing personal protective equipment (or at least mentioning it to the examiner), being warm and courteous and thanking the actor at the end. These simple things may be the difference between a pass and fail score in your OSCE.
I hope it was helpful for all those that are reading this post, good luck with your exam, with a bit of structure and practice I’m sure you will pass the OSCE.

Guest Blog Post by Dr. Bilal A. Jadoon: “Guidance about FRCEM Intermediate – SAQ”

This is a guest post by Dr. Bilal A. Jadoon – Emergency Medicine Trainee, Ireland (email: bilalicp@gmail.com)
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Hi fellow,
This would be my first ever writing in the form of a blog and I hope it would be informative for all the ED fellows appearing in the FRCEM Intermediate SAQ exam. Before I move forward, you need to know the eligibility for this part of the exam, which you can see in detail on the RCEM website in detail but the least requirement is successful FRCEM primary exam and work experience in the Emergency department as you will need a supervisor to give approval for this exam.
​Before every exam, you need to know the content that is going to come up in the exam, which is available on the RCEM website with the name of blueprints (link given below). As you go through the curriculum you will notice that the exam not only test your knowledge about the diseases diagnosis and management but also tests your theory for the practical procedures and the various rotations (especially paediatrics and anaesthetics) stuff. It also incorporates the very less commonly read topics like infection control, medical ethics and medico-legal aspects etc too, which is the most difficult and extensive part of the exam. The paper is 60 SAQs with all questions atleast 2 parts and most will have 3 parts with marks written in front of each part/question. The available time is 3 hours and this exam is time critical.
​Most of the questions which come up are your routine ED patients presentation, however to cover up the course and get successful in exam, you would have to read/ listen to the following material.
1. MRCEM B revision notes by Victoria stacy
2. FRCEM intermediate SAQ paper book (recently available)
3. FRCEM Intermediate SAQ by Moussa Issa
4. Bromely webinars videos
5. Frcem exam prep online course/SAQs
6. NICE guidelines (relevant and latest ones)
I have no idea about the FRCEM intermediate SAQ books as, they were not available by the time I was appearing in the exam, but I would say they would be worth reading as one of them is the newer version of victoria stacy book.
As the course is extensive and difficult to cover ED calls, you will have to cover the major portions of the blueprints and give less time to parts like common competencies and anesthetics etc, because if you cover up the major portion of the course you will certainly pass the exam.
Preparing for exam is always different for everyone and my suggestion would be to start preparing atleast 3-6 months before the exam and do study on daily basis or otherwise whatever suits you.
Last 2-3 days before exam, just get relax and if you can revise well and good, if you can’t, don’t worry and don’t panic. You will always think that you have forgotten everything but in reality you remember most of the stuff. Reach the examination city 1 day before and have plenty of sleep 8-10hrs on the night before the exam.
During examination, timing is the most important and essential component, which is you didn’t manage properly, you will end up in a disaster for sure. Try not to spend more than 3 mins on each question. Write a single word to a single line answer at max. Those questions which are time demanding due to any reason, just skip them and mark them for later, if you get a chance to do them. You should aim for reach all 60 questions, even if you have to skip a few because they are time consuming as you will end up doing max questions and attain max question.
I hope this benefits all you and best of luck for those appearing in the exam.
Please do let me know about the short comings or any suggestions/corrections in this writing and that would help me write better stuff in the future.

https://www.rcem.ac.uk/docs/Exams/2.2FRCEMIntermediateCertificateInformationPack.pdf