FRCEM -Intermediate (SAQ)

So I took the Intermediate exam back in September 2017 (the SAQ bit only, I did not book the SJP or the OSCE) and I am happy to say I passed it. That’s two down and…err…about 6 more to go? or is it 5? Sheesh! give me a break!
Anyway – this post is a long time coming, I thought I had written this already but turns out I had done so only in my head.

Having passed the FRCEM Primary in June that same year (thank you thank you *takes a bow*) I was in no way in the right mind to take another exam so soon. The next available attempt for the SAQ was end of September, which meant that I had little over 2.5 months to prepare for yet another exam – along with a new rotation change (I was about to enter the wonderful world of anaesthetics and ITU in August) new responsibilities and the very many issues related to portfolio hassles. Not to mention my wife would not be too happy at literally having had to raise our 2 year old on her own these past few months as I juggled preparing for the primary, and then right after finding out I had to prepare for a second exam. Flowers. And chocolates. lots of them. problem solved. I spoke to my colleagues and my friends and specially my mentor back home in Pakistan. He really really I mean REALLY pushed me to seriously attempt this. This being a clinical oriented syllabus of this exam, he was of the opinion that I just had to build on my standing knowledge and based on my experience having worked in ED these past few years I would not find preparing or taking the exam too hard. I had my doubt but he impressed upon me the need to give it my best shot – if I pass then that’s good, if I don’t then it will be a learning experience. He felt that if i gave it my all there was no reason 2+ months of prep time (sincerely) couldn’t help me pass.

I discussed it with my wife who to my surprise pushed me to go for it! I applied for the exam about 2 days before the deadline to apply. And here is where I found out how every little thing you do, even the smallest tiniest thing, can help out in the long term. It is a long and boring story, but the long and short of it is that someone from an exam prep website saw my blog posts and were interested in sharing said posts on their own website – as a gesture of good faith and in lieu of my contribution to their site, they offered to ‘allow’ me to use their vast question bank free of charge to help me prepare for the intermediate examination! It felt like a sign from above (yes I am that superstitious!) and I decided to do the questions from WWW.FRCEMEXAMPREP.CO.UK

The SAQ is an interesting exam in that I have never taken an exam like this before. As it’s name suggests, you have to write short answers to each of the questions. There are 60 questions in all, each carrying 3 marks. Each question can be one solid question requiring a lengthy answer, for 3 marks, or it can be divided into 2 or even 3 parts, with varying marks for each part but the total for that whole question would be 3. You have 3 hours (180 minutes!) in total but essentially 3 minutes to read each question’s stem (or the stem in each part or each question), think of and formulate your answer or the order of your answer and THEN WRITE IT ALL DOWN. It sort of leaves not much room for any errors or erasing and re-writing or thinking a lot. This I found the toughest thing to do: TIME MANAGEMENT. Since you are not used to writing answers out to questions, you do not realise how time consuming it is to think about your answer and then to write it down so that the examiner can read it and find all the required information that was asked in the question.

The practise questions were good, but like any practise question bank for this sort of exam, it only gives you a key of answers that are deemed correct. There may be other answers/varieties of the same answer worded differently that may be correct, or indeed a completely different answer might be correct. For example, in a scenario of a young male patient with appendicitis apparent as the clinical picture, if the question asks for 4 steps of management in ED, the answers could be: 1) analgesia 2)surgical consult/referral 3)fluids 4)antiemetics 5)antibiotics 6)urine dip and other investigations to rule out other causes for similar clinical picture 7)NBM till further orders – now if the key shows only options 1/2/3/4 as the only steps in management, someone writing the other steps could be deemed correct as well, or any combination of the above options. They essential bit to understand is that the more you practise these questions, the better you become at thinking about the answers and formulating the correct answer and writing them down in a concise and legible manner, with the addition of time constraints.

There were recommendations to read some textbooks as well – but I found I had no time to read anything, I only focussed on practising as many questions as I could. The questions I got wrong, I did read up on a few of those concepts, but mainly I found the explanation in the website to be quite sufficient, it gave you a broad overview of the topic at hand, and it gave all relevant information related to the query at hand. With each question I got more and more confident, and the explanations were very very helpful in preparing for these. I first utilised the option of doing the questions subject wise – there were a wide variety of them, including paediatrics and gynae and medicine and pharmacology etc – I found I didn’t do too well when I knew what the subject matter was. After I had gone through all the questions in the subject wise manner, I then opted for the shuffled questions – The site rang up a mixture of all subjects and gave me 20 or 50 or whatever number of questions I needed to do or had the time for.

On my days off I did approximately 10-14 hours of these question banks, approximately 50-100 questions with their explanations – my days off were very few and far between. On my days at work, while I was still in A&E I found myself unable to do more than 20 or a maximum of 30 questions a day – but I made it a point to do atleast some if not too many, every day. I think the trick to this exam is to be consistent in your prep. In the last 5-6 weeks before the exam I started in my new rotation in anaesthetics – and I found a great rota, one with weekends off and no nights or on call commitments. Granted, I was paid a lot less than I expected but I got a good time to do those questions! Once I had finished the questions subject wise, and then again as a mixture, I just randomly kept doing questions – I still got a few wrong, I only read explanations for those, the ones I got right I didn’t waste time reading up on them unless I felt it was a weak subject for me.

I took 5 days of study leave (not including the day of the exam) and the day before the exam I did not study anything. I do not believe in cramming till the last second. I spent the day with my family, went out with them to the town centre, had an educational supervisor meeting, made a few phone calls to family back home in Pakistan, watched the Minions movie with my son for the thousandth time, cooked a meal and just generally relaxed and enjoyed and rested – before the trauma of the next day.

Even though it was an early start for me, I was almost 7 minutes late to the exam (effing traffic jams on the way to London where my station was!) and I rushed in and totally convinced myself that there is no way I am passing this exam now – but I did, and so can you! Just…make sure you do not convince yourself that time is too short and there is no way I can prepare for this in such a short time…just make sure you atleast attempt it, you may end up surprising yourself. I did, and so can you. Just…make sure you do as many questions as you can, as frequently as you can, in as timely a manner as possible. Again. And again. And again.

Good luck!

Exams – what to do, what not to do – and when to do?!

Having recently passed the FRCEM (Primary) – I have yet to decide what my next step is going to be. I start my second year of training in 4 weeks. I had initially planned on a practical approach to training requirements, such as trying to get atleast 1 exam (check!) and 1 course (ALS/ATLS/APLS) per year of training, and though I have not yet done another course (I did my ALS in 2015!) this year and ideally would like to do another course this year – I am getting more and more inclined towards taking the next part of the FRCEM, known as the intermediate part. I am wondering whether that would be a good idea. Everyone I encounter seems to think that is a good way to go. One of my consultants even feels the intermediate might be an easier exam to take than the primary, since it is clinical oriented and has to do with what you deal with on a day to day basis rather than the facts and figures of physiologyanatomymicrobiology and the other basic sciences. So it tends to be easier for someone who is working in an environment that gives them good amount of clinical exposure to day to day EM cases. Thoughts, anyone?

The whole examination schedule is a bit of a confusion at the moment – well, let’s face it, examinations are very confusing anyways, atleast for someone like me. So let me break it down for you, if you were as confused as i was – if you weren’t, good on you and you can move on!

It used to be a membership exam, which entailed 3 parts and got you a ‘Membership by examination’ of the Royal College of Emergency Medicine, UK (which used to be just the College of Emergency Medicine until about 2014 when it was given the status of a Royal college, in essence converting the MCEM into the MRCEM) – the first part was the written, true or false patterned exam. It dealt with all the basic sciences (physiologyanatomymicrobiology), and the format was 50 questions with 4 parts each (so in essence 200 questions) each with a true/false answer. This was followed by a 2nd part, the MCEM B which was a clinical knowledge exam, also written. And then came the MCEM C, the practical or “multiple stations of interaction, examination, history taking, counselling etc” exam. Pass all three and you gained the membership of the RCEM. This was the prerequisite for someone training, or interested in training, in emergency medicine needed to pass before being considered for a higher training post (the ST4 onwards stint in a ST1-6 training program). After entering ST4, and before the end of ST6 you were required to sit for the FRCEM (used to by the FCEM) exams which were the Fellowship of the RCEM exams – pass the 5 parts of that (yes FIVE! hideous, I know!) and you can move on to a consultant post – a specialist in the field of emergency medicine.

They are now in somewhat of a transition period. They are starting to phase out the MCEM/MRCEM exams as a requirement for trainees in the UK at least – after 2018 I believe it won’t be a requirement at all. They have now coalesced the MRCEM and the FRCEM exams into one single entity, called the FRCEM exams, which entails three parts. The first part is the basic sciences bit, the equivalent of the MRCEM A, and is called the FRCEM (primary) – *please click here to get to the post about my experience with this exam*   followed by the FRCEM (intermediate), which as I understand consists currently of 1 part, the written clinical oriented short answer questions exam but as of a few months later (autumn 2017) there will be a ‘part 2 of the part 2’ a second component of the Intermediate exam. This bit, called the Situational Judgement Paper or the SJP for short (and for convenience!) is more of a management type exam that is once again a written exam like the SAQ. But I have no idea what else it entails; more on that in a later post! But as it stands right now, the FRCEM intermediate is just the clinical written exam.

I am yet to figure out what is the counterpart of the MRCEM C, the practical bit of the previous set of exams, in this new-fangled exam scenario. I have been told however that you can take the part C exam of the MRCEM and if you are able to do that before August 2018, then you have 2 pluses: you are exempt the SJP (which means its the counterpart of the MRCEM C?) and you get an official membership degree, the MRCEM, in addition to the FRCEM degree when you complete it.

The third and final part of the FRCEM exams is the FRCEM (final) which is basically what the original FCEM exam used to be – with a slightly different format/ and 1 or 2 parts either exchanged to something else or dropped completely from the list.

As I understand, you need the FRCEM  primary and intermediate before you can be considered eligible to progress from ST3 to ST4 as an EM trainee. The rest you can complete thereafter. You have 6 attempts at each part, previous attempts at their counterparts do not count – so if you have attempted and failed the MCEM A, those failed attempts won’t count when you attempt the FRCEM primary, it will be a clean slate that you start off with. If you fail a 6th time, and can explain away the reason for failing as a genuine distraction/trigger for failing – the college does consider and may allow you to take the exam a 7th time but that is to their discretion and is dealt with on a case by case basis. You are also allowed an extension of 6 months of your rotation, from ST3 – to allow you to pass the exam and move to the 4th year of training.

Non-trainees or doctors not working in the UK can still choose to obtain the MRCEM by examination, and take parts A, B and C of the MRCEM; it carries weightage in India, Pakistan, Sri lanka (not sure) and UAE/Dubai/Middle East. If you are in a UK based training program in emergency medicine you automatically become a member of the RCEM by association – so the MRCEM is now technically obsolete. It is still a good exam to have on board, a great feather in the cap.

I am just beginning my journey in the EM training field so my experience with the rest of these exams is minimal. I will update this post as and when I prepare/take the other exams, and/or find out more knowledge/updates about the various parts/schedules/content. Or it may be in a later post, the link of which I would put up here. Till then, I sincerely hope I have not confused you further!