Frequently asked questions about College Exams
This document should be read in conjunction with (but does
not replace) the regulations for the exams. Any further questions can be
addressed to the exams department at the College of Emergency Medicine and will
be added if thought to be useful.
Website:
www.emergencymed.org.uk
Where
can I find out more information?
The regulations are published on the website and are
updated yearly for the following year. The College aims to give 12 months
notice of any significant change in the format of the exams.
When are the
exams?
The exam timetable is published on the website. The FCEM
is usually held in March/April and October/November, and the MCEM in May to
June and November to January. The College are hoping to bring the MCEM forward
to be in line with the recruitment of ST4 posts in 2008.
What is the part A
MCEM about?
This exam explores the ability of the candidates to
use basic sciences in clinical situations, and includes testing the knowledge
of anatomy, physiology, pathology, pharmacology, and evidence based medicine
among other things. The syllabus for Part A is available on the website and is
currently the subject of a Delphi panel which are identifying the essential
knowledge within the basic sciences. As of 2007, anatomy and pharmacology have
been completed
The Part A is a multiple choice examination of 200
true/false questions which is not negatively marked
What about Part B
and C?
These two exams are usually taken together and test
the clinical competence of the candidate. The standard is of the doctor about
to enter ST4, so able to competently run a clinical shift, run resuscitation
and manage difficult situations as the middle grade doctor present. In addition
it includes some teaching assessment
The part B is a short answer paper, (16 questions).
Candidates are advised to read the SAQs explanation on the website which
discusses two SAQs that have been used previously as an illustration of how to
answer the questions.
Part C is an 18 station OSCE, each of 7 minutes,
encompassing a range of clinical scenarios.
What are the
elements of the Fellowship exam?
The Fellowship examination is now “modular”. This means that candidates initially enter the whole exam but if they are unsuccessful they only have to take the section(s) they failed. The only exception is that the two clinical exams (SAQ and OSCE) have to be passed on the same diet of the exam.
Vivas
How should I
approach the management section?
The management section consists of two parts
i) The “in-tray” which will contain up to 9 pieces of paper representing letters, emails, notes from the secretary as well as a diary for the day and some background about your department
ii) The long case scenario which will held back until halfway through the viva by the examines.
You will get 5 minutes at the start of the management viva to read the papers. You will be given post-it notes to read, and we would recommend you use these to make clear concise bullet points of the issues raised by the individual item in the in-tray. This can then be referred to during the viva and allows you to quickly refresh your memory on what you thought whilst you are under pressure.
DO not write on the papers themselves. Finish by putting the items in an order of priority.
The 5 minutes are timed and the examiners all return
at the same time for the first half of the viva lasting around 15 minutes. You
will be asked the order you wish to tackle the topics and will then be taken
through each in turn.
You are advised to read the “behaviours” document on
the website which suggests how you can influence the viva outcome by favourable
behaviours and actions
What will come up
in management?
There will be a range of topics; it is likely to
include at least one complaint, something that requires you to think about
confidentiality, something relating to manpower, dealing with doctors in
difficulty and the multiprofessional team. Spotting what cross references there
are or links in the papers is important as there are often little clues within
letters or appointments in the diary. Remember delegation and decision making
What can I take into the critical appraisal paper?
You
are not allowed to take in electronic devices that might store crib sheets or
any other information and you will be provided with paper, pencils and
post-its. If a calculator is judged to be needed, we will provide them. If you
are keen to take your own calculator it might be disqualified if you cannot
prove it is only a calculator.
During
the viva you will retain the copy of the paper you have read and the notes you
have made.
Should I prepare an abstract or a summary to give the examiners?
The examiners will ask you at the beginning
for a short abstract – this means short and really only one sentence for each
section of an abstract – hence the word summary or outline may from time to
time also be used. Essentially they are looking for you to provide in your own
words a pithy, structured description of the paper to ensure you have
recognised the salient points within the paper.
How much statistical knowledge is expected?
You
are expected to be able to describe common statistical principles, such as 2x2
tables, standard parametric and non-parametric analysis, confidence
limits, sensitivity, specificity, PPV, NPV
and but not to know multiple statistical tests in detail. The standard is that
of the working emergency consultant.
Trisha Greenhalgh’s book is an appropriate book to read and if you are
familiar with the terms and tests in that, it should be sufficient.
Can I take in my
CTR to the viva?
You
are allowed to take in your CTR and any other supporting papers, with writing
on if necessary. It would be sensible to restrict this though as you do not
want to be leafing through a pile of papers while the examiner waits. Mark the
relevant passages using post-its or labels so you can easily find the key
information if necessary. If you do bring in a guidelines or something that
relates to the CTR be prepared to defend it’s relevance to the subject and your
part in the design.
OSCE and SAQ
papers
What can I wear to an OSCE?
Smart attire is expected for the exam but the
College is happy for you to wear Scrubs in the OSCE if you feel more
comfortable. You will not be admitted to the exam however if you arrive wearing
scrubs, and will not be able to go outside for a cigarette while wearing
scrubs.
What if I am not
clear about the task in a station?
Each station will have clear instructions outside,
not only setting the clinical scenario but a separate line for “task”. In
addition there will be a pie chart of the breakdown of skills that is being
examined ie clinical examination, communication skills, diagnostic reasoning.
Example of instructions for candidate
Instructions for the
candidate for suturing station
A
20 year old builder (Mr Jones) has sustained a laceration to his right upper
arm on a piece of sheet metal while at work. The wound is not dirty and
suitable for primary closure. There is no neurovascular deficit or foreign body
Task
Briefly confirm the history with
the patient and close the wound using the equipment supplied. You should advise
the patient on the care of his wound and removal of sutures.
Examiner
role – observation and time keeping
There is also a copy of the candidate instructions
inside the station and the examiner will reiterate as you go in the station
what the task is. If you are in any doubt, clarify before you start
Should I talk aloud in an
OSCE?
If you are in an examination station, and the
station does not include a section at the end for you to give the examiner your
findings, then you should say out loud what you are doing as you do it. This
helps the examiner to be clear that you are performing each task. The examiner
can only give you a mark for doing something if s/he sees and understands
clearly that you are doing it.
What if I finish a station early?
There are some stations where it is common to finish
before the bell. Do not be alarmed. In a scenario station, the examiner will
say, “you have completed the scenario”. Alternatively in the history taking or
communication stations the examiner may ask you if you have finished. We would
recommend that you stay in the station until the bell, since you may remember
something you would have wanted to say and can mention it and still get
marks. Remember it is your time.
What is the global score?
The global score is a mark out of 5 given by the
examiner (and the role player where relevant) that gives a mark for your
“professionalism”. This is described in a matrix found on the website. Reading
the matrix is useful as you will see that you get marks for the unspoken
communications, the way you ask questions, aspects of team leadership etc. This
global score is added to the marks for the task itself and so you can score a
proportion of your marks easily if you know what professional behaviours we are
looking for.
What do I do in a
team resus scenario?
The resus stations will be set up either as a small
junior team where you will be clearly required to do some of the procedures
yourself (ie all nurse team) or as a team whereby there are skills in the team
members and your leadership skills are being tested. Remember to check the pie
chart to see which it is, and if leadership is being tested, keep your hands
off the patient! An important tip when you feel desperately short of hands is
to consider if you are using the given helpers properly. Have you released the
neck immobiliser for example?
If
it is a teaching station, do I have to do the whole four-step approach as in
ATLS?
The stations are not really long enough for this.
The College is not wishing to see any particular method of teaching, other than
the ability to explain simply and carefully the skill involved and to check the
student has taken in the instruction. Therefore talking as you demonstrate a
skill and then allowing the student to practice is acceptable.
Should I introduce
myself as I go in to a station?
This
can be confusing, as the scenario may suggest that you have already examined
the paeints, or taken a history and so it does not seem natural to introduce or
recap. However, for the sake of the integrity of the station, and bearing in
mind the need to demonstrate professional skills, we would recommend that you
do introduce yourself, and indeed recap on what you have been told in the
scenario before commencing the next bit of the patient management. Hence in a
station providing advice on a given diagnosis, you would always revisit the
diagnosis to check what the patient has been told. The station may be
constructed that you have taken over from an SHO so it is natural to introduce
and recap, but occasionally you have to suspend your disbelief and just act as
if you have just met the patient!
How many answers
can I put down in the SAQ?
The examiners ask for a number of answers in almost
every question. They will only take the first ones given, so that you should
try to think what the most discriminatory test, or treatment is, and only list
them, so as not to waste the answer. Occasionally the answer will ask for a
class of drug (diuretic) or investigation (blood tests) rather than individual
ones. On the website is a glossary of terms which helps to explain some of the
terms used.
Do I have to pass
each question or station?
The OSCE is marked so that you can fail a number of
stations (the equivalent of 4 provided they are not both of the double
stations) and each station is pass/fail individually.
The SAQ is marked as a cumulative score, so you
could potentially score 0 on one or two questions and still pass if your
performance on the other questions was excellent. This is however a high risk
strategy and we recommend writing something for every question.
Are
there any critical questions, stations or individual parts of questions or
stations that mean I will fail the exam?
Within the MCEM and FCEM there is no “sudden death”
or critical response questions or actions. This means that there is no one
thing that you can do in the written, vivas or OSCE that will result in an
automatic fail.
How much weight
does each bit of the SAQ carry?
Each question gives 10 marks and has 3-4 sections
within it. The marks for each section within a single question are given on the
paper. For example there might be three sections, with 2, 4, 4 marks respectively
for each section, making a total potential mark out of 10. With 16 questions in
MCEM and 20 questions in FCEM the total possible marks are 160 and 200 marks
respectively.
What are the pass
marks?
The pass marks for each diet vary with the
difficulty index of the exam. The panel of examiners meet to determine the pass
mark and to ensure the questions are clear, unambiguous and fair. The pass mark
is roughly in the range 60-68% for all sections of all exams
Where can I find
what has been in the exams?
A table of topics in the last 2 years of the exams
will be available in mid February 2007.
When /how will I
get the result?
You will get the result within two weeks of the
exam. In practice the results are usually posted on the website within 5
workings days but sometimes it takes longer for full validation of the results
to occur. Please note that the office will not be able to give you any further
information on when to expect the results, and that the correspondence will be
in the main by email, so you should ensure we have an up to date working email
address.
What standard is
expected for each section of FCEM?
Academic –
First day consultant –
CTR: should be of the
standard that is publishable in EMJ
Critical review: the
standard of critique of a reviewer for EMJ
Management –
First
day consultant –
Good at shop floor
management; needs advice on more complex issues
Clinical –
First
day consultant –
You
should be very close to your clinical peak, i.e. the best you will ever be
clinically
(Source: College of Emergency Medicine, UK)
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