The FRCEM Final

The FRCEM Final examinations test the entirety of the Emergency Medicine 2015 Curriculum. Candidates for the FRCEM Final examinations are therefore strongly advised to familiarise themselves with the 2015 Curriculum in preparation for sitting the exams.

Structure

Until 1 August 2018, the FRCEM Final consists of the following components:

• The FRCEM Critical Appraisal Short Answer Question (SAQ) Paper,
• The FRCEM Clinical Topic Review (CTR)/Quality Improvement Project (QIP), completed during ST4-6, and its accompanying Viva,
• The Management Viva,
• The FRCEM Final Short Answer Question (SAQ) Paper – comprising 60, three-mark questions over a three-hour paper, and
• The FRCEM OSCE consisting of 16, eight-minute stations, with an additional one minute of reading time between each.

From 1 August 2018, the FRCEM Final will consist of the following components:

• The Critical Appraisal (Short Answer Question Paper),
• The Quality Improvement Project (QIP),
• The Clinical Short Answer Question Paper, and
• The Objective Structured Clinical Examination (OSCE).

The FRCEM Critical Appraisal Short Answer Question (SAQ) Paper

The FRCEM Critical Appraisal is a 90-minute appraisal exam on a published academic paper, requiring skill in critical examining published material, and academic arguments and logic.

The FRCEM Clinical Topic Review (CTR)/QIP and accompanying Viva

The CTR is comprised of a written CTR review of no less than 3,500 words, for 60% of available marks, and a 15-minute Viva of the CTR for the remaining 40%. The CTR itself should be of direct relevance to clinical practice in EM, rather than focussing on management of a department, or the wider aspects of NHS provision. Primary research into topics relating directly to Emergency Medicine will be accepted, however.

The FRCEM Management Viva

The Viva is split into

• the in-tray exercise, and
• the long case.

Part One – In-Tray Exercise

For the first section of the task, the candidate will have five minutes’ reading time, followed by 15 minutes to complete the viva itself. The task simulates a consultant’s in-tray of different management situations.

Part Two – Long Case

During this section, the candidate will have to read a single document describing a clinical topic. They will then have to answer questions relating to what they have just read. The questions will begin as soon as the candidate has stopped reading the text.

The FRCEM Final SAQ

The FRCEM Final SAQ is conducted in IELTS Level 7 English, and consists of 42 questions on the ST4-6 curriculum, and 18 questions on the material previously covered in the Intermediate SAQ.

The ST4-6 Competences examined follow below.

Higher Specialist Training Major and Acute Presentations

Comprising 25 questions, with questions on

• abdominal pain,
• acute back pain,
• alcohol and substance abuse,
• anal pain and rectal bleeding,
• blackouts,
• breathlessness,
• bruising and spontaneous bleeding,
• chest pain,
• dental emergencies,
• dialysis,
• environmental emergencies,
• epistaxis,
• falls,
• fever,
• fits /seizure,
• haematemesis and melaena,
• headache,
• joint swelling – atraumatic,
• limb pain and swelling – traumatic and atraumatic,
• major incident management,
• oncology emergencies,
• Observational Medicine,
• palpitations,
• penile conditions,
• poisoning,
• pre-hospital care,
• pregnancy,
• rash – life-threatening rashes,
• research,
• sexual assault,
• sexually transmitted disease,
• visual loss,
• weakness not due to stroke,
• wound management,
• complex older patients,
• the patient with chronic disease,
• anaphylaxis,
• cardio-respiratory arrest,
• major trauma,
• shocked patient, and
• unconscious patient.

Additional Paediatric Practical Procedures

Comprising three questions, with questions on

• replacement of tracheostomy tube,
• cricothyrotomy and percutaneous trans-tracheal ventilation,
• external cardiac pacing,
• safe sedation in children;

Practical Procedures

Comprising 11 questions, with questions on

• preoperative assessment,
• management of spontaneously breathing patient,
• administer anaesthesia for laparotomy,
• demonstrate RSI,
• recover patient from anaesthesia,
• demonstrates function of anaesthetic machine,
• transfer of patient to operating table,
• demonstrate CPR resuscitation on a manikin,
• technique of scrubbing up and donning gown and gloves,
• basic competences for pain management,
• patient identification,
• post-op nausea and vomiting,
• airway assessment,
• choice of muscle relaxants and induction agents,
• post op analgesia,
• post op oxygen therapy,
• emergency surgery, and
• safe use of vasoactive drugs and electrolytes; and

Ultrasound

Comprising three questions, with questions on

• ultrasound physics,
• sectional and ultrasonic anatomy,
• focused assessment using sonography in trauma (FAST),
• assessment of the abdominal aorta competency, and
• echo in life support (ELS).

Previously-Assessed Competences

Clinical Presentations – Core Major & Acute Presentations

Comprising six questions, with questions on

• abdominal pain including loin pain,
• abdominal swelling, mass & constipation,
• acute back pain,
• aggressive/disturbed behaviour,
• blackout/collapse,
• breathlessness,
• chest pain,
• confusion, acute/delirium,
• cough
• cyanosis,
• diarrhoea,
• dizziness and vertigo,
• falls,
• fever,
• fits / seizure,
• haematemesis & melaena,
• headache,
• head injury,
• jaundice,
• limb pain & swelling – atraumatic,
• neck pain,
• oliguric patient,
• pain management,
• painful ear,
• palpitations,
• pelvic pain,
• poisoning,
• rash,
• red eye,
• mental health,
• sore throat,
• syncope and pre-syncope,
• traumatic limb and joint injuries,
• vaginal bleeding,
• ventilatory support,
• vomiting and nausea,
• weakness and paralysis,
• wound assessment and management,
• anaphylaxis,
• cardio-respiratory arrest,
• major trauma,
• septic patient,
• shocked patient, and
• unconscious patient.

Common Competences

Comprising two questions, with questions on

• history taking,
• clinical examination,
• therapeutics and safe prescribing,
• decision-making and clinical reasoning,
• principles of quality and safety improvement,
• infection control,
• managing long-term conditions and promoting patient self-care,
• health promotion and public health,
• principles of medical ethics and confidentiality,
• valid consent,
• legal framework for practice,
• ethical research, and
• evidence and guidelines.

Anaesthetic Competences CT1 and CT2

Comprising one question on any of

• preoperative assessment – history taking, clinical examination, and specific anaesthetic evaluation;
• premedication;
• induction of general anaesthesia;
• postoperative and recovery room care;
• management of respiratory and cardiac arrest;
• control of infection;
• introduction to anaesthesia for emergency surgery;
• airway management;
• procedural sedation;
• transfer medicine; or
• critical incidence.

ICM within ACCS

Comprising one question on any of

• obtaining an arterial blood gas sample safely, and interpreting results correctly,
• demonstrating aseptic placement of central venous catheter,
• connecting mechanical ventilator and selecting initial settings, and
• prescribing safe use of vasoactive drugs and electrolytes.

Acute Presentations – Additional Adult ST3

Comprising two questions on any of

• major trauma – chest injuries, abdominal trauma, spine, maxillofacial, and burns;
• traumatic limb and joint injuries – lower limb, and upper limb;
• ABGS – interpretation of abnormal blood gas results in the emergency department;
• abnormal blood glucose;
• dysuria;
• emergency airway care (CT3 and covers HST);
• needlestick injury;
• testicular pain; and
• urinary retention.

Paediatric Presentations – Major & Acute Presentations

Comprising three questions, with questions on

• abdominal pain,
• accidental poisoning, poisoning, and self-harm,
• acute life-threatening event (ALTE),
• blood disorders,
• breathing difficulties – recognise the critically ill and those who will need intubation and ventilation,
• concerning presentations,
• dehydration secondary to diarrhoea and vomiting,
• ent,
• fever in all age groups,
• floppy child,
• gastro-intestinal bleeding,
• headache,
• neonatal presentations,
• ophthalmology,
• pain in children,
• painful limbs – atraumatic,
• painful limbs- traumatic,
• rashes in children,
• sore throat,
• anaphylaxis,
• apnoea, stridor and airway obstruction,
• cardio-respiratory arrest,
• major trauma in children,
• the shocked child, and
• the unconscious child.

Practical Procedures (ACCS)

Comprising three questions, with questions on

• arterial cannulation,
• peripheral venous cannulation,
• central venous cannulation,
• arterial blood gas sampling,
• lumbar puncture,
• pleural tap and aspiration,
• intercostal drain – Seldinger,
• intercostal drain – open,
• ascitic tap,
• abdominal paracentesis,
• airway protection,
• basic and advanced life support,
• DC cardioversion,
• knee aspiration,
• temporary pacing (external/wire),
• reduction of dislocation/ fracture,
• large joint examination,
• wound management,
• trauma primary survey,
• initial assessment of the acutely unwell,
• secondary assessment of the acutely unwell (i.e. after initial resuscitation and in the intensive care unit),
• connection to a mechanical ventilator,
• safe use of drugs to facilitate mechanical ventilation,
• managing the patient fighting the ventilator,
• monitoring respiratory function,
• deliver a fluid challenge safely to an acutely unwell patient, and
• describe actions required for accidental displacement of tracheal tube or tracheostomy.

The FRCEM Final OSCE

The Objective Structured Clinical Examination for Final FRCEM candidates consists of 14 stations, each around 8 minutes in length, which examine the follow competences

• 1 – Core Acute Presentations,
• 2a & 2b – Resuscitations,
• 3 – Core Major Presentations,
• 4 – Common Competences,
• 5 – Common Competences,
• 6 – Anaesthetic Competences,
• 7a & 7b – Paediatric Resuscitation,
• 8 – Paediatric Acute,
• 9 – Paediatric Major,
• 10 – HST Major Presentations,
• 11 – HST and Adult Acute Presentations,
• 12 – Practical Skills,
• 13 – Paediatric Practical Skills, and
• 14 – Non-technical Skills.

FRCEM Final Examination Dates

The FRCEM Critical Appraisal Paper and SAQ Paper can be taken in London, Nottingham, Manchester, Cardiff, Edinburgh, and Dublin. The Viva and OSCE can only be taken in London.