Exams and Qualifications

FRCEM: An Overview for Emergency Medicine Doctors

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Understanding the FRCEM postgraduate qualification for EM doctors


Emergency Medicine Doctors applying for GMC registration via the postgraduate route will need to hold either the MRCEM or FRCEM qualifications. We’ve written an FRCEM overview to help Emergency Medicine Doctors better understand this postgraduate qualification. You can view our MRCEM overview separately by clicking here.

What is FRCEM qualification?

FRCEM Primary Exam: Overview

FRCEM Intermediate Certificate

  • SAQ paper overview
  • SJP paper overview 

FRCEM Final Exam: Overview

  • Critical Appraisal (Short Answer Question Paper)
  • Quality Improvement Project (QIP)
  • Clinical Short Answer Question (SAQ) Paper
  • Objective Structured Clinical Exam (OSCE)

Applicants who passed the MRCEM exams Pre-August 2016


What is FRCEM qualification?

Our FRCEM overview for Emergency Medicine doctors begins by detailing what the FRCEM qualification is.

FRCEM stands for: Fellowship of the Royal College of Emergency Medicine

The Royal College of Emergency Medicine is responsible for setting the standards of training and administering exams in Emergency Medicine. In August 2016, the College’s exam structure was redefined, merging both the MRCEM and FRCEM exams together.

FRCEM is now awarded to doctors who have passed the entire suite of exams. This includes:

FRCEM Primary exam

FRCEM Intermediate Certificate

  • Short Answer Question (SAQ) Paper
  • Situations Judgement Paper (SJP)

FRCEM Final exam

  • Critical Appraisal (Short Answer Question Paper)
  • Quality Improvement Project (QIP)
  • Clinical Short Answer Question (SAQ) Paper 
  • Objective Structured Clinical Exam(OSCE)

FRCEM Primary Exam: Overview

Entry Requirements

To enter the FRCEM Primary exam, candidates must hold a GMC recognised primary medical qualification (PMQ).

In addition to this, the Royal College of Emergency Medicine recommend that overseas candidates should have a level 7 IELTS standard to complete the FRCEM/MRCEM exams.

Exam Structure

The FRCEM Primary exam is based on the Emergency Medicine Curriculum. For more detailed information, please refer to the RCEM Basic Sciences Curriculum

Sat over a 3-hour period, the exam contains 180 multiple choice single best answer questions. The questions are broken down into the following areas:

  • Anatomy (60 questions)
  • Physiology (60 questions)
  • Pharmacology (27 questions)
  • Microbiology (18 questions)
  • Pathology (9 questions)
  • Evidence Based Medicine (6 questions)

Single best answer (SBA) questions will test a candidate on their order of thinking. They usually have 3 parts: a clinical scenario, a question and then the answer options.

Marking

To determine the cut off score, the Royal College use the Angoff Method. Which means that a group of experts judge how difficult each item is in an exam. For this reason, the pass mark varies between exams.

Dates, Locations and Costs

Applicants are able to take the FRCEM Primary exam in numerous locations including the UK, Iceland, Malaysia and Oman.

The cost to take the FRCEM Primary exam is:

  • £310.00 for UK Centres
  • £390 for Iceland, Malaysia and Oman

For a fully up to date list of the locations and dates, please click here

Royal College Resources

FRCEM Primary Information Pack

2015 curriculum page

2021 Curriculum changes

FRCEM Primary Exam Sample questions

FRCEM Intermediate Certificate 

Entry Requirements

To take the FRCEM Intermediate Certificate, candidates must have completed the equivalent of the UK Foundation Programme. They must have also passed the FRCEM Primary exam.

For the entry requirements for candidates who have passed any of the exams from the previous format, please click here

Exam Structure

The FRCEM Intermediate is made up of the following 2 papers:

  • Short Answer Question Paper
  • Situations Judgement Paper

SAQ exam 

Sat over a 3-hour period, this exam is a short answer question (SAQ) paper compromising of 60 questions in the following areas:

  • Common Competences
  • Clinical Presentations – Core Major and Acute Presentations
  • Anaesthetic Competences CT1&2
  • ICM within ACCS
  • Acute Presentations – Additional Adult ST3
  • Paediatric Presentations – Major & Acute Presentations
  • Practical Procedures (ACCS)

To find a full list of the sub-categories within these areas, please click here

A maximum of 6 attempts are allowed to complete this exam.

SJP exam 

SJP stands for: Situations Judgement paper

Made up of 120 short best answer questions, the SJP paper is sat over a 2 hour period. In brief, candidates will need to select the most relevant and effective answer based on a hypothetical clinical situation that they are presented with. This will test their common competencies from the Emergency Medicine Training Curriculum.

The 120 questions are broken down into the following areas:

  • Patient Focus (25 questions)
  • Problem Solving (15 questions)
  • Decision Making (15 questions)
  • Working in a Team (25 questions)
  • Time Management (10 questions)
  • Self Awareness (10 questions)
  • Professional Integrity (10 questions)
  • Professional Development (10 questions)

A maximum of 6 attempts are allowed to complete this exam.

Marking

To determine the cut off score, the Royal College use the Angoff Method. Similarly to that in the FRCEM Primary exam.

Dates, Locations and Costs

Applicants are able to take the FRCEM Intermediate papers in numerous locations across the world. These include the UK, Iceland, Malaysia and Oman for the SAQ. However the SJP can be taken in either the UK or Malaysia.

The cost to take the FRCEM Intermediate SAQ Paper is:

  • £305.00  for UK Centres
  • £385 for Iceland, Malaysia and Oman

The Cost to take the FRCEM Intermediate Situational Judgement Paper is:

  • £200.00 for UK Centres
  • £280 for Malaysia

For a fully up to date list of the locations, dates and fees for the FRCEM Intermediate Papers please click here

Royal College Resources

Glossary of terms used in the College exams

Exam FAQ’s

Sample SJP questions

Royal College practice questions

FRCEM Success

FRCR Final Exam: Overview

Entry Requirements

In order to take the FRCEM Final Exam, emergency medicine doctors must have:

  • Passed the FRCEM Primary exam 
  • Passed the FRCEM Intermediate SAQ & SJP

For a full list of the eligibility requirements for each part of the final exam, please click here

For entry requirements for candidates who have passed any of old format of exams, please click here

Exam Structure

The FRCEM Final exam is broken down into the following 4 components:

  • Critical Appraisal (Short Answer Question Paper)
  • Quality Improvement Project (QIP) 
  • Final Clinical Short Answer Question Paper 
  • FRCEM OSCE 

Critical Appraisal Short Answer Question Paper

The Critical Short Answer Question paper is taken over the course of a 90 minute period.

Quality Improvement Project (QIP) 

The Quality Improvement Project is a written submission which is completed during ST4-6. It focusses on improving the quality within Emergency Medicine.

For further information about the QIP from the Royal College of Emergency Medicine, please click here

FRCEM Clinical Short Answer Question (SAQ) 

The SAQ paper is made up of 60 questions, each being worth 3 marks. It is broken down into the following topics:

  • Major and Acute Presentations
  • Additional Paediatric Practical Procedures
  • Practical Procedures
  • Ultrasound
  • Clinical Presentations – Core Major and Acute Presentations
  • Common Competences
  • Anaesthetic Competences CT1&2
  • ICM within ACCS
  • Acute Presentations – Additional Adult ST3
  • Paediatric Presentations – Major and Acute Presentations
  • Practical Procedures (ACCS)

FRCEM OSCE

OSCE stands for: Objective Structure Clinical Exam. The FRCEM OSCE exam is made up of 16 stations which last 8 minutes each. They cover the below areas:

Station 1Core Acute
Station 2 aResuscitation
Station 2 b Resuscitation
Station 3 Core Major
Station 4 Common Competences 
Station 5 Common Competences 
Station 6  Anaesthetic Competences
Station 7 aPaediatric Resuscitation
Station 7 b Paediatric Resuscitation
Station 8 Paediatric Acute
Station 9 Paediatric Major 
Station 10 HST Major
Station 11 HST and Adult Acute
Station 12Practical Skills
Station 13 Paediatric Practical Skills
Station 14 Non-technical Skills

Candidates are provided with one additional minute of reading time in-between each station.

Marking

The FRCEM Final Critical Appraisal is marked using a domain based marking matrix. 

The FRCEM Final QIP is also marked using a domain based marking scheme. Please refer to the RCEM Quality Improvement Guide for further details on the assessment of QIP. 

The FRCEM Final SAQ is standard set using a modified Angoff method (similarly to the FRCEM primary and intermediate exams).

The FRCEM Final OSCE is standard set using the Borderline Regression method. Therefore one standard error of measurement (SEM) is added to the cut score identified to calculate the final pass mark. 

Dates, Locations and Costs

The Final FRCEM SAQ and OSCE can only be taken in the UK.

The cost for each part of the Final exam is:

  • Clinical SAQ – £300.00
  • Critical appraisal SAQ – £240.00
  • QIP – £150.00
  • OSCE – £420.00

For a fully up to date list of the dates available for the FRCEM Final, please click here

Royal College Resources

FRCEM Final Information pack

Critical Appraisal Most frequently offered answers glossary of terms used in RCEM exams (August 2019)

Sample QIPs – reducing the referral rates of paediatric patients to plastic surgery

Sample QIP on management of fractured neck of femurs in the ED

Glossary of terms used in the College exams

Applicants who have passed any MRCEM exams Pre-August 2016

Doctors who have passed the MRCEM exams prior to August 2016, are able to use the following exams which are accepted to contribute towards your FRCEM:

  • MRCEM Part A or FRCEM Primary
  • MRCEM Part B or FRCEM Intermediate SAQ
  • CTR or QIP

A pass in the MRCEM Part A exam, achieved prior to August 2012, is now deemed expired. Candidates who sat the MRCEM Part A prior to this date are now therefore required to pass the FRCEM Primary exam.

Additionally, MRCEM Part B passes attained prior to August 2012 are also deemed expired. Candidates are now therefore required to pass the FRCEM Intermediate SAQ exam.


If you are interested in working in the UK, want to discuss available job opportunities or may have already begun your journey and need further advice, please contact our team today.