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!