Dr Edward Reje’s New Exam Verdict

The New Fellowship Exam

So here it is.  The unofficial review of the New 2015 FACEM Exam.

Guest blogger Dr Edward Rêjé gives his view of the examination in the form of an open letter.  We accept no liability for any offence caused…

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Re: The Fellowship Exam Re-booted

Dear Dr Cross,

So the first of the “new’ exams is done and dusted. What was it like? Well, let me put it like this; in between the MCQ’s and SAQ’s a seagull crapped on my shoulders and that was the best thing that happened to me all day.

Before I give my opinion of the exam I should say that I am about 95% sure I failed thus my opinions may well be just sour grapes. However, I have spoken to several other people who sat the exam and their opinions are very similar to mine.

A couple of weeks before the exam we got an email saying that there would no longer be critical errors.

A few days later another email went out saying we should ignore that – critical errors were back!

After being repeatedly warned that we needed to be very careful with the timing of our answers, we were told in the last week that we could not take timers into the exam. (but we didn’t need to worry because there would be an “analog clock” on the wall).  However, on the day people used timers and no one said anything. Minor points perhaps, but annoying none-the-less.


Prior to the exam the college made available very few practice SAQ’s. Whilst there were many “home grown” questions in circulation, I thought most of them were a bit Mickey Mouse.  I sat 3 trial exams, including the AFEM exam in Queensland and passed them all with time to spare. Furthermore, whilst I may not have always known the answer, I always understood what they were asking which was not always the case with the old style SAQ’s and VAQ’s. Thus, whilst I was not really sure what to expect, I was quietly optimistic about the new exam format…


The MCQ’s seemed straight forward, clinically relevant and fair. My only criticism would be that you had to stay in the room for all 3 hours so many of us spent 2 hours staring at the clock on the wall (it was analog – at least the college got that right). One complaint I heard was that you couldn’t have a water bottle at the table in case you spilt it on the computer. Thus people were continually walking to the front of the room to get a drink. I didn’t notice but clearly others found it distracting.

It has also been claimed that you could read the answers off the computer belonging to the person sitting in front of you. Perhaps that is what the college means by “full, open disclosure.”


And that brings me to the SAQ’s.  My DEMT spent a lot of time running teaching sessions and trial exams (sorry to waste your time, dude).  Given that he is also an examiner, I figured he would have lots of useful insights. In hindsight, I think he was as much in the dark as we were.  He did say that before marking the questions, the examiners would answer them to see what you could realistically expect in 6 minutes.  Frankly, that’s bollocks. If you want to mark those questions fairly, you need to answer the whole paper in 3 hours.  To just do 3 questions and think that reflects the real exam is just nonsense. Secondly, it didn’t seem like each question was designed to be answered in 6 minutes.  One question went for 4 if not 5 pages whilst others were only 1 and a half pages.  It may be 30 questions in 3 hours but it wasn’t 6 minutes per question.


Before talking further about the exam paper, it is worth describing the AFEM course in Brisbane. These guys, with far less money, time and resources than the college, came up with several hundred excellent practice questions and a 30 question exam with publication quality images. They also gave us 5 separate exams books. The college came up with one gigantic book. You only had to write your name on the front cover. When asked if this was a mistake the rather snarky reply was “Why? Are you afraid the staple will fall out?” The appropriate come back to that is “No, but you’re going to take the book apart so that it can be marked and my exam number won’t be on any of the pages. How much thought did you give this?”

 Paper Clip

An even bigger problem was the quality of the ECG’s and x-rays. Frankly I’d be embarrassed to use such poor quality images in an exam for medical students let alone in a Fellowship exam. There was one x-ray that was only about 4 inches by 4 inches (and I’m really old with possible cataracts). They asked for 3 abnormalities. I could barely tell that it was a wrist let alone spot the abnormalities. I kept looking around to see if they were providing magnifying glasses but no such luck. I don’t know how we can expect the other specialties to treat Emergency Medicine with respect when the AFEM guys take more pride in their trial exam than the college does with the real thing.

Based on the ‘hot’ debrief in the pub afterwards, the most common complaints about the SAQ’s seemed to be:

1) not enough time

2) the questions were poorly written

3) the questions did not reflect the curriculum

It was a very hard exam to finish in 3 hours – many didn’t and God help you if English is not your first language.  I felt like I had fallen behind time quite early on and got quite flustered.  As a result, what may have been a simple question in isolation became far more challenging in a 3 hour slog. I am curious to know if any of the examiners has actually tried to do that exam in 3 hours. I suspect not (but I would be impressed if they have).

I don’t understand why the college is so hung up about doing the exam quickly. If you worked at that pace on the floor you would kill some-one. It is also ironic that they expect so much in so little time and then have the nerve to complain about poor hand writing. For me, 28 questions in 3 hours would be far fairer.

As I have said above, the majority of the practice questions were well written – you knew what they were asking. This was not the case with the real exam. For far too many questions I found myself (hysterically) thinking “WTH? WTH?” This is made worse by the fact that you simply don’t have time to re-read a question or spend time trying to work out what they are asking. On several occasions I gave essentially the same answer to successive questions. Maybe that was just me. I’d be curious to hear what others felt.

Finally, what sort of thing did they ask? Well, let’s start with what they didn’t ask. There were no chest x-rays (or if there was, I was so panic stricken that I missed them).  Maybe CXR’s are on the OSCE. On the other hand since even the college doesn’t know what is on the OSCEs, I kind of doubt it (but that’s alright boys, you’ve got 66 days to sort it out).  There was also bugger all trauma and airway questions. On the other hand there were 2 child abuse and about 4 admin questions. (The college apparently loves “full, open disclosure. I wonder if that will apply to a review of the exam?) That ratio of questions certainly does not reflect life on the floor where I work.

I had a hunch that the first “new exam” would be have some teething problems. Sadly, it was more like “meth-mouth”

 Resigned to may fate.

Yours Sincerely,

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Dr Edward Reje


I am still a believer in the “new exam”.


However, I also believe that the college wasn’t ready but went ahead with the exam anyway.


The candidates deserve better.

115 thoughts on “Dr Edward Reje’s New Exam Verdict

  1. Could anyone who sat the exam please make a comment about this post. We need to know if people agree or whether this is just the rantings of a fat, middle aged recalcitrant. If enough people agree and express their displeasure, just maybe the college will improve things for the next exam.

  2. Hi ED
    Excellent,Lovely, Beautiful Not the Exam but your blog.
    Couldn’t have said it better myself.
    As if u stole words from my mind except you used very few if any swear words unlike me.
    The Quality of Wrist X-ray in SAQ was shit. I agree AFEM guys in brisbane did much better job and only charged $500 for 5 days of course.
    CT scan pictures for cholecystitis and IC hemorrhage were also below par.
    It will be impossible to finish this exam even in 4 hrs.
    I wonder people who set this exam had any idea of what they were doing.
    There is a scope for including more EMQs in first half of exam i think.
    I am all for the new format but in a more realistic way.

    1. We had to censor the first version. After taking out every word starting with “f” it was only half as long.

  3. I sat the exam and also have some very strong opinions,

    I’d sat two mock exams (and passed them) but left this one having no clue. You’ve raised a number of points that I’d like to reflect on.

    1) The physical quality of the paper – whilst the poor quality images were annoying shanti find more annoying was the way the paper was printed. Being bound by staples meant that you couldn’t lay a page out flat to write on it and often I found myself wrestling the paper down to be able to complete a sentence.

    2) Time (or lack thereof) – as I reached the final questions my handwriting certainly deteriorated. I cannot I shine that when standard setting took place a group of examiners tried the whole thing in three hours. I didn’t have time to go back and edit. I also didn’t have to w to read forwatrd so that when a question asked you to work out a couple of derivations from an ABG little did I know they wanted me to use the. Once I had turned over the paper.

    3) the questions themselves – a lot of the time I found myself struggling to,work out what the point of the question was. What does “management decisions” actually mean? Do they mean they want next action steps, such as refer to Ortho, or what? Likewise “diagnostic categories”. I’ve tried not to look up,answers for the questions as I am trying to decompress and. I know it will only make me angry but when a question asks for 4 current controversies in brown snakebite management and the core Tox textbook only lists 3 I lose a little faith in the system.

    Moving forward there is talk of the SAQs also being computerized this penalized us two fingered typists even more. At least I have a better idea of what to expect next time. I think the lack of pre-exam material is shocking for such an important exam. I guess if the final results show that 80% of us pass the MCQs and 2% pass the SAQs then the failing lies not in the candidates but with the exam itself.

    I’m also curious as to how the opening date of the clinical is the day after the writen but, for this iteration at least, you cannot apply without passing the written exam. Just silly.

  4. I also sat the exam, and, along with many of my local colleagues, have many of the same thoughts and sentiments. These have been forwarded to the college using the detailed “feedback” forms, and we are also submitting a group feedback in consultation with our local examiners (who, it would appear, are just as shocked as we, even without having seen the exam in its entirety).

    Feeling “robbed” by this exam was a common theme in our post-exam pub debrief. Everyone who sat the exam needs to submit their feedback so the college can get a balanced view.

  5. I sat the exam and essentially agree with almost everything written. The exam was grossly unfair due a myriad of confusing and poorly written questions leaving candidates scratching their heads as to what was being asked of them. This was compounded with an extreme shortage of time allotted.
    I’ve spoken to many candidates who all shared the same view – uncannily consistent views.

  6. Very well written Edward!

    Your sentiments are mirrored by ALL candidates I have spoken to since sitting the exam.

  7. This exam was incredibly disappointing, and I’m upset that the college set an exam of such poor quality for us.
    Physically the paper was poor. You couldn’t write on it properly because of the stapling in the middle, and I’m quietly terrified that the front page with my number on it will be lost. I certainly didn’t have time to write my candidate number on each question. The ECGs and radiology images were incredibly poor.
    Many of the questions left me wondering what on earth they wanted me to answer – give me a non-specific stem, ask for a broad list of differentials then ask for my specific management priorities – for what?! The people that write the questions shouldn’t also write the answers because I can’t read their minds. I don’t think they’re going to be able to mark these and that will be an even bigger issue. Will everyone who wrote sensible answers that differ from those provided fail? Despite being very reasonable?
    The time pressure is ridiculous. You’re not testing my knowledge, you’re testing my ability to write very, very quickly and stupid mistakes will be made. It was well said in the article that if we were to practice like this on the floor we’d kill patients; I agree whole-heartedly with this.
    Disappointed in ACEM. If AFEM could pull it off surely our college could.

  8. Yep, me sat it as well and couldn’t agree more..
    have done feedback to college and would suggest as many as possible do.
    So please let your colleagues who sat it know also.
    It was the first run, and it -to my oppinion- shouldn’t have gone ahead. There apparently were many red flags and alarm bells going (one being that the members of the comitee couldn’t finish the exam in time themselves, presumably knowing at least some of the questions before starting), but the college pushed on to proceed and hence “traumatised” the entire 2015.1 cohort of candidates….. deliberately!!!…

    That is, what is hurting me most…they did know better but they proceeded…try doing that at work, proceeding, when you know that its not gonna go well, or even proceed, when you are not sure… you are hung to dry and quite rightly so…
    We were tought for all these years what alarm bells and red flags look like/sound like and here the leaders themself ignore them…abysmal, really…

    keep me posted of developments, happy to sign or start any petition that goes forward to bring this kind of SAQ assessment down…in my eyes its a stillbirth anyways, DEAD before being born…unfortunately I had to witness/live the torture…

    1. Thanks for that comment. I have been trying to find out if anyone on the exam committee tried to complete the exam within 3 hours. If what you say is true it is piss poor. I can feel my blood pressure rising again.

    2. Hey guys, I just wanted to point out there is actually nothing intrinsically wrong with the new SAQ format – the problem was how ACEM applied it in terms of the quality of their questions and the time provided. The GP exam has the exact same SAQ format and they do a sterling job at making the questions fair and understandable due to a presumably more robust external review process. Additionally they have a safety mechanism in marking: if a certain answer is coming up repeatedly from candidates that wasn’t in their marking key, they take it to the examining board to decide if it is a fair answer and if so award a mark for it as well.
      It is extremely disappointing ACEM didn’t live up to this standard but hopefully with the feedback they will going forward.
      And yes I agree 25 questions would have been more appropriate in 3 hours.

  9. I also sat the exam and have been left feeling incredibly dejected, mostly due to the timing (though the pictures were terrible!). It felt more like an exercise in how fast I could write superficial answers without having any time to consider the question or have any depth of consideration in my responses. I completely agree with Edwards review other than the suggestion of 28 instead of 30 questions – I think 25 would be a more realistic goal.

    1. I originally suggested 25 questions in 3 hours – not really sure why I changed it to 28.

  10. Thanks for the comments so far. Please keep them coming – I would especially like to here from anyone who feel it was a fair exam.

  11. Feedback forms were provided at the end of exam by invigilators.
    Unfortunately i have filled mine and its full of swear words.
    Just an afterthought, may be college should scrap this exam and conduct a fresh one in a months time( i know its a crazy thought)

  12. I have appeared for the exam and I completely agree with the above comments.One think in particular I need to mention ,is the “ridiculous number of tables” in the exam ….I ran out of time as everybody(I spoke to) did..I have done few trial exams and there is no comparison to what the real exam was…..But I think the next exam format is better compared to old SAQ/VAQ…although it needs lot of changes made for the next(mainly framing specific questions and giving reasonable time- 25 question in 3hr more realistic I feel…)Not sure how the college goes about it!!.

  13. I agree with the bulk of the posts here. The MCQ I thought was fair and clinically based making it easier to work out the right answer. The SAQ paper was asking fair content but I was confused as to what answers were required and felt very rushed. I managed to answer everything but don’t know how much will be legible. I can’t believe the standard setters managed to finish it in 3 hours also.

  14. there could be lots of approvement suggested to this (sorry for repeating myself) stillbirth.
    interestingly in the committee itself is was suggested to break the 30 questions up, i.e. 15 prior and further 15 after the mcq…or any other variation that would prevent this “3 hour slog” getting the candidate tired, hypoglycaemic and flustered…

    well, as so often in life, good suggestions need to find ears that are interested in listening and ready to allow change….reading though the self indulgence prior to the exam, on how confident the college was, that the “new system” would be so much better, I think there was not a lot of readiness or openness or listening ears…

    I still think that further feed back and possibly petitions to the college are the way to go.
    I even think that giving that feedback before(!) the results are out (i.e. before the papers are marked) is more valueble than feedback given as an answer to unfavourable exam results…

    let your colleagues who sat the exam know about the survey/feedback forms..


    1. feed back forms are not anonymous!!! the first question is what is your ACEM ID??!!! which part of the world are they living? How do ACEM expect anyone give a proper feedback without fear of being identified??

  15. 100% on the money , if it had been just a little bit better it would have been sh1t.

  16. Thank-you for putting so well what i have been ranting about since the exam – i too wrote similar feedback on the college forms.

    i sat numerous practice exams (and whilst i didn’t pass them all, i always was able to FINISH them and understand what they were asking). I felt hugely deflated that i had knowledge on EVERY topic they asked with no way of showing it due to not understanding WTF they were asking.

    i think the exam should be just declared void and we get to sit a REAL exam rather then whatever cruel joke this was.

    there is something wrong with an exam when despite having severe crampy abdominal i was too scared to get up to the loo because we were so time pressured and then when i finally got up being so flustered at running behind the rest of the time.

  17. Agree 100% with the post .
    Although i would add a lot more F words in it.
    ACEM probably knew the paper was shit and thats why did not want to release tge question paper soon after the exam.apparentll they might release it after the results.

    I do not agree with re writing the exam..its not that easy .
    We have prepared for the exam for more than 6 -12 months and becoz the college or the exam committe did not bother to get their shit together we will be penalised.
    Now they have another 6 months of our life to play with.

    Another thought :
    The college might be assessing us to see if we can sort out patients earlier than the 4 hours we are given now.😄😄😄😄😱😱.that way they can suck up to the government a little bit more….


    Sorry about the rant.
    Thanks for reading.

    1. Curiously, one of Fellowship Exam Committee members directed me to this website this evening. I sat the exam the other Friday and shared the problems and frustrations that seem to be so universal.

      ACEM and the FEC they have clearly demonstrated their lack of skill and expertise in being able to competently perform that with which they have been entrusted – that is, assess professionals at a professional level.

      The FEC are amateurs and they do not know what they are doing.

      The Australian Medical Council, the body that credentials specialty colleges, have given all Colleges until 2016 to change their assessment processes so that they are fairer and more transparent.

      All the Colleges have done this; in fact, processes have been put into place that have taken years of thoughtful consideration and stakeholder consultation before implementation.

      ACEM, with an embarrassing pass rate of 20 per cent for the past two sittings, has seemingly not considered and not consulted. They are nowhere near achieving this goal.

      Two of the members of the FEC, that I know of at least, each sat half of the actual exam late last year as a “road test”. Despite only doing half of the exam, neither of them could actually finish it. But despite this, the FEC still endorsed the exam in it’s original format.

      I was debriefing to another member of the FEC the other day, and rather than acknowledge my concerns or at least validate my emotions, the only comment that this person had to offer was that “Why don’t you just get over it.”

      I’ll tell tell you why I won’t just get over it:

      I have an email from a senior figure of the FEC saying that it was the responsibility of registrars to achieve the level that was required to make Fellowship.

      No, buddy, it’s the responsibility of ACEM to ensure their candidates are being taught what they need to know.

      No, buddy, it’s the responsibility of ACEM to ensure their processes are robust and transparent.

      I shudder to think what a complete disaster the OSCEs will be.

      What ACEM are doing to the group of doctors that are it’s “trainees” is appalling, unprofessional and disrespectful.

      You know, as I sit here at 2am writing this, I was just about to sign off, but was spurred on by the reading the last word of my text. “Disrespectful”.

      It’s the College mentality and the pursuit of wanting to be better than our colleagues that cause people to


      I’m better than that.

      Oh, the incompetence of the stupid emergency “trainee” who couldn’t compare and contrast the seven sentinel differences between delirium and psychosis.


      \\ EDITED //

      We don’t have to put up with this.

      You know, (EDITED…). I’m not “going to get over this” until our college loses its capacity to be specialty medical college.

      Then we’ll see who is mocking and jeering then.

  18. I suspect unless we all tell the college of this big fuck up nothing is going to change.
    I think we all should find a way to send a feedback to college together.

  19. Agree with all the comments. Any exam that puts you into renal failure due to not being able to pee is badly designed.

    I felt that there were some questions I knew well but had no time to show the depth of consultant knowledge I’d learnt over a year, but more a race to get any answers down without time to think at all about ‘the best answer’ first.
    Many questions that we have good in depth knowledge on but are not able to figure out what is being asked and oh shit I’ve spent 2 mins figuring it out maybe and have now got 4 mins for a question that takes 8 minutes to finish.
    Lots of gaps in tables and lost points because 6 minutes is up and I have to move on.

    The booklet wouldn’t open fully and ended up curling my micrographia to fit onto the poorly constructed lines. No time or space to qualify answers.

    Very frustrated.

  20. Okay. First, a few comments on Edwards rant, some of the ensuing responses, and some on the exam itself.

    1. Critical Errors – This is a non-issue. Seriously, suck it up, sunshine. You’re meant to be an emergency physician. You shouldn’t be unnecessarily harming/killing patients and the exam has always included marking penalties for making a critical/lethal error, and probably always should. It doesn’t change how you approach your preparation for the exam, or your approach to a question.

    2. Timers – The rules promulgated by the college (the exam handbook) say no communicating electronic devices. Timers were not forbidden. Wear a watch, or reach back to Play School rocket-ship days and remember how to tell time with an analogue clock.

    3. Image quality – Yep, the xrays of the wrist and the ECG were pretty crappy quality, and this aspect needs to be improved for the next iteration of the exam. That having been said, the answers to the questions they asked were easily discernible from the poor images.

    4. “I couldn’t write properly because the book was too fat and the staples are sucky and…” – Seriously, people… really? _That_ was your problem with this exam? Clearly we need to ask the college to arrange a separate exam venue for you, where the feng shui is just right, there are ergonomic chairs, whale song playing in the background, and a wide variety of herbal teas available during the SAQ paper for you.

    My personal opinion of the exam:

    1. Too much time for the SCQ section. I could have used that time appended to the SAQ session, personally.

    2. The SCQ section was pretty reasonable. There were only a very few questions where essentially none of the four options was actually correct, and you were left to choose the “least wrong” or the “it’s wrong but if you were basing this question and its answer on a non-evidence-supported textbook chapter from 25 years ago you’d probably choose this option and that’s probably what they want, even though it’s blatantly wrong” option.

    3. Come on… you’ve got to admit the “Adipose windows give you a great FAST scan in fat patients” MCQ option was pretty good… at least one examiner has something approaching a sense of humour. 🙂

    4. EMQs are farrrrr preferable to MCQs, from my point of view. There were not enough EMQs in this exam. It seems the college is aiming to increase the number of EMQs in future exams, and this will be a good thing. To be fair, it is hard to write EMQs that discriminate well between candidates who know their stuff and those who know a little less, and I would guess this is one of the major factors limiting the number of EMQs at this stage.

    5. The SAQ paper was too long for the timeframe. There was definitely not enough time to adequately complete the paper with due attention to detail. I find it essentially impossible to believe that any FACEM, examiner or otherwise, actually sat down and attempted to complete the SAQ paper in 3 hours under exam conditions. I personally would have liked roughly an extra 30 mins for the whole paper, or could have comfortably completed 25 or 26 of the questions in the assigned 3 hours.

    We are emergency clinicians and a crucial part of our skillset is efficient prioritisation and time and resource management under pressure. However, the written exam is emphatically NOT the time to test that. The written exam is there to test our _knowledge_. I am wondering if the college will offer the abovementioned rationale (we need to be good at time management, etc.) as an “explanation” of why the SAQ paper was effectively “Mission Impossible”, and I wouldn’t put it past them to be cheeky enough to suggest that it was done intentionally… but I think it far more likely that they simply screwed up, with inadequate pre-deployment testing, and any suggestion from them of a purposeful “Kobayashi Maru” situation would be disingenuous at best.

    6. The SAQ paper offered effectively _zero_ scope to demonstrate any wider, deeper, contextually-appropriate consultant level knowledge or approach to a given situation. I’m guessing and hoping that the college intends the OSCEs to provide that forum and opportunity. The technical aspects of the SAQ paper could just as easily be answered by a well-read SRMO or very junior registrar, as by a junior consultant. This may be intentional and a result of two things: Firstly that the written exam can now be attempted by those who are just one year into their AT time, and secondly one of the major advantages (for the college) of the new SAQ format is ease and speed of marking, and allowing too much scope or breadth in superlative responses somewhat negates those advantages for them.

    7. Some of the SAQs, despite the new format and short, sharp required answers, _still_ managed to be superbly ambiguous or vague. There were at least 2 large chunks of questions where I was legitimately unsure as to what they wanted. It was clear what generic chunk of knowledge they wished to assess, but the ability to provide the very brief answers that would garner the actual marks on offer was hindered dramatically by the fact that you just couldn’t tell what specific thing they wanted you to say right there at that point. There were many instances of realising what set of (usually pretty damn basic) skills or information they wished to confirm you knew, but the question(s) given were quite definitely NOT the way one would or should sensibly ask about that knowledge.

    1. 1) Critical Errors
      You’re missing the point. I have no problem with critical errors. What I have a problem with is the way both the candidates and DMT’s have either been misinformed or left in the dark about various aspects of the exam and how it will be marked.

      2) Timers.
      You’re wrong. The college was specifically asked about electronic timers and in response sent out an email a week before the exam saying that timers could not be used (I suspect it was the beeping they were worried about rather than the ability to beam your spotty, white arse back up to the Enterprise.)

      The issue here is that many DMT’s emphasized the need to practice with a timer and a week before the exam we’re told “sorry, no timers”

      3) Image Quality
      You’re missing the point again. In real life I don’t look at shitty little photocopies so why am I given them in fellowship exam? I expect them to produce professional standard images (AFEM did and for much less money).

      4) The book
      The book was shit and just another example of ACEMS’s amateurish / last minute approach to the new exam. How hard would it have been to produce 5 books stapled in the middle – easier for us to write and easier for them to mark. The college expects professionalism from their candidates and so, as a candidate, I expect professionalism from the college. What I got was an exam book that looked like it had been put together at Office Works on the morning of the exam.

      We seem to agree on the MCQ’s, EMQ’s and SAQ papers.

      1. 1. I take your point on the _principles_ of the critical errors issue, but the practical impact of it is zero, so I don’t see any point quibbling about it. I’m not missing your point. I just think, in this context, it’s irrelevant.

        2. I never received an email or any other communication about timers in the exam, so I was unaware it had been raised as a specific issue. The official college communications I received forbade communications devices, but made no mention of timers. I wore a watch.

        3. I agree with you. The image quality needs to be better. However, to be fair, you could give them the answers they wanted, pretty unequivocally, based on the images provided. So yes, they need to be better, but the image quality did not affect the outcome… which in general is one of my primary criteria for giving a shit, or not.

        4. I had no trouble physically writing on the exam book/paper. Whining about the “big thick exam book” is like going to a meeting about clinically relevant key performance indicators and bitching about your department’s lack of a user-friendly recycling program.

  21. 1) You think it is irrelevant that 2 weeks before the exam the college was giving the candidates incorrect information? We’ll just have to agree to disagree on that.

    2) Well, now you know

    3) I would not presume that the image quality “did not affect the outcome” until I actually know the outcome.

    4) You had no trouble? I’m happy for you but it’s not all about you, Virat. Many people have complained that they had trouble writing in that exam book and, as you are probably aware, people have failed previous VAQ / SAQ questions because the examiners could not read their hand-writing. If the college is going to bitch about hand-writing, and they are, the least they could do is come up with an exam book that all people can write in. (I didn’t have any trouble either but my handwriting is shit at the best of times)

    For the record, I wouldn’t be seen dead at a meeting about “clinically relevant key performance indicators”

    1. 1. Yes. 🙂 As mentioned previously, the fact they changed their advice close to the exam is generally, on principle, a Very Bad Thing(tm). However, in this case, the practical relevance of it was zero.

      2. Indeed I do. Thanks. This (the timers issue) does seem like a simple thing they could have found an agreed and definite policy on and communicated clearly with a minimum of fuss.

      3. Perhaps more clearly… the image quality was sufficient for me to ascertain what I hope are the correct answers to those particular questions, and I would think any of my colleagues would be able to do the same. But again, yes, the images were craptacular and they need to lift their game next time.

      4. My handwriting sucks, too, especially in a hurry, but I honestly don’t know how the physical layout of the SAQ book caused anyone any mechanical writing difficulties. Were people trying to write stuff in the 0.5cm margins of the page closest to the staples or something?

      And yeah, admin stuff sucks rancid donkey bollocks, but the point was that one should channel their efforts into the more important / efficient / most-bang-for-your-buck aspects of the dilemma (or collection thereof) at hand. The time pressure of the exam was and is far more of an issue than the feng shui of the staples.

      1. Anyone who wrote in the margins is in for a rude shock – any answer “out side of the lines” will not be marked. Some people were warned about this (those lucky enough to have a DMT who is also an examiner), others weren’t. Just another example of the great job the college did in preparing the candidates for the exam.

    2. Just regarding the timer issue. As usual for this exam prep the advice was piss poor. I was one who brought a timer. After reading the college advice I contacted them to confirm whether or not a timer was allowed. Unsurprisingly I got no reply. I then contacted my DEMT who asked the college and was told no – no timers. Then 1 week before the exam I got another email saying yes they were allowed (not sure of the chain of command there), as well as being forwarded an email from a colleague written by Bernard Foley saying that they were allowed. Since my entire exam prep was based on rumours and whispers I took this as standard! It was, as usual, poor communication that confused the candidates. While it is a small mattter, this day is important and these things can be so frustrating

  22. I am wondering what college was testing with this exam. speed writing – speed thinking – the strength of the candidates’ hands, tolerance of candidates against unfair anxiety or candidates’ reasonable knowledge? this exam was not definitely testing the knowledge. It is really a big question what was the aim of the examination committee? and why? It is unfair treating ED senior registrars like this. we deserve better.

  23. bit scared now, taking the exam in August; hopefully the college gets its act together soon

  24. It is interesting that an overriding theme I keep hearing from fellow candidates and reading in this blog is how shocked the candidates were to be treated in this manner. Examples are comments such as “it’s unfair to treat ED Senior Regs like this” and “this is not how you treat people, let alone your professional colleagues”. It is clear that candidates felt that the gross disservice provided by serving up this utterly unreasonable assessment was a sign of enormous disrespect and unprofessional behaviour on the part of the college. It showed a lack of consideration of the extreme amount of time, commitment and emotional turmoil required on the part of candidates to sit the fellowship exam and that this should be acknowledged and reciprocated through a mutual obligation to use its absolute best endeavours to produce a fair and reasonable assessment tool. This clearly did not occur and the salt in the wounds is the recognition of how predictable and avoidable the exam problems were with a more robust pre-deployment external validation process.
    I truly hope the college takes note of not only the specific extremely valid objections that have been raised, but also this overarching theme of concern … that we felt monumentally failed by the college … a real kick in the teeth.
    Hopefully we have been the sacrificial lambs that have made the college take note – your trainee colleagues deserve better than this … far better.
    I was at least heartened by the recent acknowledgement/quasi-apology email from the college – a positive step in the right direction. This has at least restored some lacking faith that appropriate consideration of the exam failures will be taken into account in its marking and that they will do a better job for the candidates in August. Lifting the lid on this unnecessarily secretive and opaque exam construction process to openly disclose all the steps that the college are taking to create a fair assessment next time would be a wise change.

    1. I was also encouraged by the tone of the email from the college. However, it was in contrast to what I was told by an examiner who said that whilst the DMT’s and examiner’s (ie those who mark the exam) are sympathetic to the candidates, those who set the exam don’t see a problem. I think all we can conclude is that the chaos continues. In the mean time keep your fingers crossed and prepare for the OSCE (and read Dr Coggins post.)

      1. that’s disappointing to hear but hopefully when the dust settles, rather than being defensive, those who set the exam will recognise their failure and make the necessary changes based on the enormous and consistent critical feedback. If they don’t, the college must find new people or processes to set the next exam as the college is ultimately responsible for what is produced. The college must be patently aware of how close they are to be on the receiving end of legal class action from the candidates regarding this exam (and future exams if changes are not made). I’ve heard numerous rumblings of the same amongst the candidates and only an appropriate marking process that takes the exam’s failings into account will fend such an outcome off; stubborn indifference to feedback will not.

        Again for the most part, I suspect all that is needed is a robust and openly disclosed pre-deployment external validation process where a bunch of FACEMs who are completely independent to the exam setting process, sit the exam in the 3hr time limit and feedback on the whole exam so appropriate changes can be made to the questions (or questions removed) and the timing and technical exam paper issues (e.g. picture quality) can be dealt with.
        The new SAQ formats lends itself to the risk of ambiguity which can only be dealt with by independent people going through it with a fresh pair of eyes. The many good DEMTs who made the effort to set mock questions for their candidates knew this very early on and used candidate feedback to improve these questions for the future. The college examiners must do the same.

        1. I felt very good about the college’s email too, until I realised that it just followed the exact protocol we had just studied for the appropriate response to a complaint.
          Not sure there was anything heartfelt there unfortunately.

        2. well at least they practice what they preach 🙂 have to give them credit for that!

        3. I suppose the way I look at it is that they didn’t have to send anything so the fact that they did showing they were acknowledging the strength of the negative feedback at least was definitely a good thing. Time will tell how they actually respond to it.

  25. Simple Math

    300 candidates in 2015.1 written attempt X exam fee 1100 AUD = AUD 330000 / per attempt
    AUD 330000 X No Attempts in single years (2) = AUD 660000 annual written exam fee
    Lets give ACEM benefit of doubt & round off the figure to AUD 500000 from Written exam fee only (I am not counting the annual registration fee & Clinical fee)

    What we got
    Poor quality of Paper (I have better printed notes at home then the actual exam paper i sat)
    Poor quality of images
    Lack of educational material by college
    Frustration & depression
    Self doubts at the end of examining process

    ED future in Australia — Bleak because lack respects the ED Docs by there peers + NEAT+ PRESSURE TO DO MORE DESPITE YOUR MAXIMUM EFFORTS & WITHOUT CORRECTING THE PROBLEMS BEYOND ED, But the worst one is the ACEM is loosing the respect of there own trainees (The people who decided to do ED against all negatives)


  26. I have a grouse against the setting of the SAQ by the college. The questions were not so hard. all questions were Ok and answerable. but I am not sure an average human ( ED doctor) would finish the 30X3 questions in 3 hours, that too as per Jo Dalgleish words, wring a consultant level answer. I wonder whether the college examiners sat the exam. Did they finish in 3 hours? suppose there are questions which needs thinking, then the time is taken up by that question. I was racing for time since the first half hour, but i could not finish 2 questions. some of the others had not finished 4. It is very disheartening and depressing. wonder whether all these efforts of studying big books is really worth at all.

    If the college wanted to break the will of the emergency registrars, and get depressed and dejected and look for another job, another profession or leave this once for all, i think they did it excellently well, with this exam. if the college wants us to play the game and not test the knowledge, then I am sorry there are many people who does not know how to play the game, and I am one of them.

    1. It is not a game where the college tests the skill of who can write the fastest or Is it? If that was the main aim, then please cut short 3 hours to 1 1/2 hours. We are doctors aren’t we? Does not the medical profession know the fatigue after writing fast of the thenar and hypothenar ,lumbricals and interosseous muscles and the concentration of brain that long… and if some one decided that in spite of all the adversaries, knowing the scientific reasons ,if they decided to go on with the exam format like this, I am not sure what else to say…

    2. The Monash practice exam- everyone, examiners and exam committee members came and said they are expecting consultant level answer. If that was the case then how on earth did anyone think that this paper could be finished in 3 hours?

    3. If it is fill in the blanks with a word or two, then certainly 3 hours is enough. But that was not we were told. why is that the examiners and committee members tell one thing and do just the opposite in real exam? Every one of the members during the answer discussion said that. Proof is the “expected answers” that they had sent to us.

    4. Please, please ask the examination committee to sympathize with the candidates., If Emergency medicine doctors, are good at patient sympathy and empathy and teach the same to juniors, then why this inflicting pain and enjoying at the miseries of the candidates.? (who are our same species..ED doctors). It reminds me of a story some years ago, that in corporate offices, at tearooms, they had a punching bag, if any staff has anger against anyone they can go and use it to relieve their anger. I am not sure how far the story is true, but I feel examination committee is using candidates as punching bags, but not sure what the anger is?

    5. Many CMOs now, are the failed candidates who could not play this game. Are they bad doctors? Everyone will agree that they are not. Every one of us had x+2+4 (some of them had more than 10 years in training) years of TRAINING, and at the end of it if college says some one is not good enough to be a consultant because the guys cant play the game, then college is flawed. If some one raises voice, they are penalized. That is the reason many candidates do not express their REAL views, fear of bad remark on appraisal and being targeted if they are against, is one of the main reason for many of us keeping quiet. Certainly this does not look democratic. Isn’t it?

    6. Practice of one committee of deciding the exam pattern, another committee of setting the questions and third, a set of examiners marking the answers, are these three not in proper communication with each other? This is not something to belittle the massive effort some of the college members have put in, all their time and energy, it only needs a tweaking. but please… not at the cost of candidate mental and physical and social health. Some of us are having PTSD

    Below is an example of how to set an exam, I am sure examination committee has considered this, but to my small brain, I think they have missed a point.


    It says,

    “Indicate how much time should be allocated to each section of the exam, e.g.

    • ‘You should allow 1 minute for each MCQ and up to 2 minutes for the more challenging ones (which are indicated on the exam by a *)’

    ‘For the short answer section (Section B), allow 3 minutes per mark, e.g. a question worth 10 marks should take you no more than 13 minutes’ (if some of these short answers are really challenging then the mark allocation will reflect this)”

    The web site also says what the candidate should be told,

    “State what you will and won’t accept as an answer, e.g.

    • ‘Mark the scan sheet for the MCQs as indicated in the diagram’ (you might add some more advice here about rubbing out answers carefully, not marking two answers to a question etc)

    • ‘For the short answer questions, you may use note form, bullets, lists, diagrams instead of complete sentences, except where you are told otherwise’ (this might be for giving a definition for example)

    ‘For the extended answers (section C), you are to write in sentences and paragraphs’”

    So going by this example , each of the FACEM SAQ question should have 18 minutes , which is too much to ask for and not practical. But at least there should be a compromise.

    College says that answers should be a consultant level answer; most of the candidates feel that this is a vague definition. Most of them feel that the answers should have fluffy bunnies to bring the consultant perspective.

    Dr Andy Buck one of our well known FACEM, in EDEXAMS, has said this


    “My main concern with the new format as it stands, is the proposed duration of the exams and the number of questions. A 3-hour MCQ/EMQ, plus a 3-hour SAQ! That’s insane. 6 hours of written exams in one day? That’s a guaranteed recipe for brain-meltdown. I defy anyone to be able to think clearly after 2 hours of intense concentration, and the thought of the old 2-hour written SAQ makes my writing hand quiver with memories of cramps and spasms in the hand and forearm… Adding an hour… Not sure this is the best idea.”

    So we the registrars are not the only ones who has been seeing this exam format as bad. IT is better than the previous format, where one can pass the exam with techniques and some knowledge. but the time is all wrong. if one reads the full article which is just a 3 minute read, by EDEXAM, then one can understand that this exam format is probably being pushed by the selective few in the college, who may be powerful, and did not listen to others views. OR they have been asking people about views who will never say any thing against the wishes of these few.

    Some more reason to think there might be some devious?? thinking going on behind the examinations

    ACEM Fellowship pass rates
    2007 – 69.4%
    2008 – 70.2%
    2009 – 65.8%
    2010 – 66.1%
    2011 – 62.9%
    2012 — 56.3%
    2013 – 48.6%
    2014 – 37.4%….

    i can go on and on…. but ………is there any use????

  27. speaking to my DEMT today who was shocked at the 4 questions they have been asked to re-mark. Mentioned there have been multiple class action suits in the past – it’s been something i’ve been thinking about. if somone was to get the ball rolling anyone here interested?

      1. more then anything just a wake up call to the college that they cannot go on treating trainees like this, that they have to be fair and transparent and not just do the college job cause it’s a political thing – to actually give a damn about the people they are training/assessing.

        not looking for money (although a refund for the joke that just passed would be nice)
        not even looking for pass/fail change – given that i dont even know results yet.
        I just feel that SOMEONE objective should look at the joke that was the last exam and MAKE the college lift their game. it doesnt seem likely that they will do it themselves given the exam went from bad to worse
        and that latest video/module that came out was just a slap in the face – “in the new exam canditates will definately know what is expected of them in the question” what a load of hog wash!

        the quote formt he open letter went:

        “The College must, somehow, be held accountable for this debacle. But it won’t be; it will be the candidates who will shoulder the consequence for the Colleges poor planning and preparation; it will be the candidates who will have to shell out another few thousand for another exam attempt; it will be the candidates who miss the opportunity of a specialist appointment; it will be the candidates and their families who are compromised. I am sure the College will absolve itself of all accountability by smugly declaring that the candidates did not prepare themselves properly, but how can we be expected to prepare ourselves properly when the College itself was not sure what was happening even in the final few weeks before the exam. The College was not prepared for this exam and should have been honest and transparent with its trainees from the outset.”

        i just want them and not the candiates held accountable

  28. Just a minor point of clarification on all this – the examiners have had nothing to do with preparing this exam. They have not set the questions, prepared the paper as a whole, determined the correct answers, determined whether it could be done in time, checked the item quality, determined what information was provided, had any influence over the pass criteria for each question, and are not involved in any post marking process to determine the candidate’s result. Previously they had been involved in some of these processes – so please do not blame the examiners for the problems that have occurred on this occasion and also please do not expect the examiners to be able to help rectify any of the issues that have arisen. Examiners now just mark the questions they are given using the answers provided to them by the SAQ committee that made them. The Chair of the SAQ committee, the Chair of the Fellowship Exam committee, The Censor in Chief, the Director of Education are the people within the College who have direct responsibility for the (SAQ) exam.

    1. so examiners have absolved their accountability?!!. if examiners does correct papers with the answers provided by the college, can any one be an examiner.?

      1. No, examiners have absolutely not absolved their accountability – it is just they now have very little input into what happens with marking, and no input into the preparation of the exam. All they are now required to do for the SAQ is check whether the candidate writes one of the answers on the list of required items given to them by the people in the College who wrote the question – they do not do the question themselves or have any other input. This is the system the College has designed and examiners have been instructed to just follow the instructions given to them and not take any other issues into consideration.

        Many Examiners, DEMTs and other senior Fellows share the exact concerns that trainees have expressed on this forum and the impact the recent exam has had on candidates and other trainees. They have already made the highest levels of the College aware of their concerns and are prepared to take further action if the College does not act in a way that is fair to candidates and prevents a recurrence of similar problems in future. The question now is whether College has the capacity to address these shared concerns in a suitable way.

      2. One examiner I know asked the same question. He also seemed unaware until quite recently that he would be given an answer sheet to follow.

  29. My original aim in writing this post was to
    a) vent my anger
    b) find out how many people agreed with me
    c) to try and put some pressure on the college to improve things for the next exam (which will not include me – I’m done)

    I’ve achieved the first 2. However, despite the fact that we have the support of many if not most DMT’s and examiners, I think we are failing with aim number 3.

    In a recent letter to the SAQ Question working group it was stated that they hope that the “next paper will be a better quality than the one just past.” However, they also state that whilst volunteers will do a dry run of the paper at home, they don’t expect anyone to attempt the full exam in 3 hours. (If this were an actual SAQ, that would be a critical error) It then gets worse as they suggest that their volunteers sit 10 questions in one go and “to compensate for your familiarity of some of the questions, I suggest that the total time to do a 10 question paper will be 50 mins, not the 60 mins the candidates get.” So in other words, the people who will test whether the exam can be done to time already know the answers. What on earth is this supposed to prove other than the upper echelon of the exam process live on top of Bullshit Mountain?

    1. from the examiners concerns that comes out after this hardship caused by FACEM 2015.1 Exam,,and the views from DEMT’s, Registrars who have taken this exam, and as per new videos that appear in ACEM website few days back, it becomes clear, that ACEM wants to follow the footsteps of FCEM/MCEM of UK. Similar pattern of exam, more UK faces in the committees( FACEMS) and all I ask is why did the college did not say this before?WE could have prepared ourselves for this unholy mess. At least we have a pattern to follow. I believe, it is the EGO. EGO of ACEM ,that they cannot accept that they copy the UK system and still want Australian way, but only that they could do is the few diagrams and colourful stuffs that they can put in the website. UK exam requires few words and phrases only. it is almost like fill in the blanks type. Hence they got away with the exam format for the past decade after experimenting with FRCS till 2 (ED) till 2004 -5 and AFRCS2004-6 and then came MCEM , after 2006 . So our college had to shed its ego and accept that they wanted to copy UK style. The standardisation means present exam can effectively get away with the need for examiners and any one can become an examiner. ( if you know how to read english and match the words from the answer sheet provided by the college and that with the answer paper by the candidate.) so SAQ / MCQ taken care of – no real examiners needed. now it is OSCE. if they standardise this too, will the old examiners be redundant?!!!

  30. In regards to the discussion re the point of a class action I have some thoughts:

    – the college has several clear legal responsibilities to its trainees and they grossly failed in carrying out their duties (in regards to the SAQ assessment).
    – the candidates experienced losses directly as a result of these college failures and would have a strong legal case to make a damages claim for these losses. The main loss would be the exam fee but there would be reasonable basis to argue for losses based on time spent preparing for the exam. This would be a substantial amount of money – it would be a very interesting test case and an excellent precedent to set if one has not been set already. Would be interesting to see what case law already exists in this area.
    – the whole exam preparation process would be publicly examined and criticised, creating fertile ground for change
    – the substantial financial impact on the college from such a class action would force change. From what I’m reading above, it does not sound like the appropriate changes to the exam creation process are going to be made otherwise e.g. testing the exam on people who actually wrote the questions … have they learned nothing at all from the feedback?

    Now to suffer a significant loss worth pursuing legally one would probably need to fail the exam. Sure many who pass would still have suffered significant emotional distress as well but I doubt it would be worth your time and money to pursue costs based on this alone. So a class action would probably only be able to be pursued properly by those who do not pass this exam. Given this I suspect we may be surprised by a higher pass rate than the past as the exam is “moderated” to throw out many of the awful questions and reduce the pool of potential class action candidates. On the other hand if they have the gall to fail 70% of candidates a class action will be a certainty not a possibility and I’m sure they are patently aware of this.

    So wait for the marks to come out and then decide. Clearly this forum would be a good starting point to find other like-minded interested folk.

    Obviously a legal case won’t exempt those who failed due to lack of preparation from accountability. You’d need to be able to demonstrate that your failure was due to the woeful exam creation process, not your lack of preparation. I suspect the higher the overall pass rate (including the removal of the poor quality questions during marking), the harder it will be for those who failed to be able to demonstrate this.

    The repercussions of such a successful class action could have positive effects for all future trainees, not just in ACEM but in other medical specialty colleges and even other training institutions.

  31. Personally, I didn’t have an issue with the timing. I knew the SAQ’s were going to be a pressure cooker because my DEMT told me so and we were prepared for it. The AFEM course was excellent and if you took the course and expected the exam to be the next level of nasty I think you probably should have gotten in the right ball park. Rather than using a timer I trained with an analog clock and aimed for 5 min per question for SAQ’s. During the exam, I thought some of the images could have been better quality. I feared that I was falling behind but I pushed on and tried to keep to 5 min per question. At the end I had 10 min or so to go back and try scrape in a few extra points here and there. Marks are not out yet so I don’t know if I passed, but I felt I was prepared as well as could be managed and that the exam, if perhaps a little testing, is meant to pick the ED registrars ready to go to the next level. We don’t work in a utopian environment. I think most of you folk should grow up a little and train harder for the next challenge.

    1. I agree that most of the complaints have been a little petulant and trivial (timers, physical construction of the paper, yadda yadda yadda), but the time pressures of the SAQ section is a valid complaint.

      The written paper is just _not_ the place to “test” our prioritisation and time management skills. The OSCEs and WBAs are / should perform that role.

      Yes, the exam is there to act as a barrier to those not ready to lift their game to consultant level. No exam is perfect, and there is always going to be a mismatch between what it tests and what the powers that be actually wish to assess. In this case, however, that mismatch is unnecessarily large. I am reasonably sure that I achieved quite suboptimal marks on some questions simply due to time constraints and, sometimes, ambiguity in the question despite fairly comprehensive subject matter knowledge of the topic they were asking about. It was always clear what chunk of clinical knowledge the whole question was intended to assess or extract from us, however the design of the sub-questions, coupled with the time pressures involved, often made it difficult to know what specific answer(s) to provide to obtain the marks on offer… again, despite knowing more than enough about the topic being examined.

    (Swim the ripples and become a sardine!)

    The lead up to 2015 was hallmarked by the very ominous trend in college (no mention of name) fellowship examination graduation statistics of 2012, 2013 and 2014. i.e., just less than HALF made to fail (2012), more than HALF made to fail (2013), followed by TWO THIRDS made to fail (2014). Take note, this score is inclusive of exponentially rising numbers of more experienced consultant-level re-sitters. Are we blind to what’s going on? Take in depth consideration, if in your evaluation of the seniors that you work with and supervise you, would clearly struggle to pass (or would not pass) these exams of the second decade of the twenty-first century, then, where is our well funded college taking us?

    What will it be for the 2015.1 fellowship examination final outcome – the abyss?

    Do aggrieved candidates see how over the past few years, the whole fellowship level examinations process somehow did not seem to fit in quite right compared to the historical performance of the college? Now, the discrepancies are going out of control!

    All other specialties in Australia have a much better fellowship graduation rate, year in, year out; more than a 50% pass rate. Junior doctors contemplating a journey into Emergency Medicine training should prudently assimilate the output percentages of this college. A convincing sign of wasting peoples postgraduate careers and half their lives. The actions of the trainee funded college have not taken into their account the extreme burden on people’s lives, families, mortgages, costly post-graduate examination fees, etc, etc, etc. We are being controlled! There has been no democracy about our paid representation.

    The new examination system can ultimately be anything, but not without the SMOKESCREEN.

    If at the conclusion of the 2015.1 fellowship examination, more than a third of the total or written or clinical fellowship examination candidates are failed, then, we will see that neither system, new nor old, was there to serve our purposes, but instead the now-in-control-and-powerful college’s prerogative of ‘population control’ and financial power.

    In UK/Ireland, we have two Emergency Medicine programmes and TWO INDEPENDENT examination boards. The fellowship from either is automatically and freely recognized by the other country (www.gmc-uk.org , http://www.medicalcouncil.ie). In U.S, ‘closed shop’ type of behaviour is prevented by having in place THREE INDEPENDENT certification boards for Emergency Medicine, namely, American Board of Emergency Medicine (www.abem.org), American Osteopathic Board of Emergency Medicine (www.aobem.org), and American Board of Physician Specialties (www.abpsus.org/emergency-medicine).

    The message here is, should one examination authority become deceitful, transgress to restrict the graduation numbers or opportunistically hike the examination fees in the midst of turmoil, the disreputation would steer the candidates towards the more fair and transparent examinations authority. That option does not exist ‘downunderground’. Australia/New Zealand, obviously, only has ONE rigid option.

    Is Australia merely and advancing nation, as opposed to an advanced nation? What happened to the well known Australian ‘fair go’? Where’s the ‘fair dinkum’ treatment that vulnerable contemporary trainee candidates should have received?

    Has the angst and anguish the trainees (and their families) have been encountering, not truly been seen by our $900 per year membership provider over the past few years?

    Why should the second highest ranked, Least Corrupt Country in the world, New Zealand (www.transparency.org/cpi2014/results), need to endure any of this scheme? They have no optionless reason to follow a command that is headquartered outside their borders. They can become independent with their own college for their own benefit. [Ka taea e Aotearoa te whakatutuki i tēnei.] Kiwis……….your say?


    This will stand to fulfill the democratic freedom we all are constitutionally entitled to.

    In the one college world, we are deceit-prone, we have lost our say, and we have lost our bargaining power and right to democracy (that we pay annually for). Can diligent trainees see, we are undergoing a paid degradation with a high attrition rate? This upheaval affects all us trainees.

    We say, OUR MONEY, OUR DECISION, OUR SAY! WE are the strongest force in this journey of torment! We are the ones that can cease the pain. Can people see that? Where has your democratic voices and actions been all this time? Why take the risk of succumbing to the verdict of an autocratic adjudicator? Your careers, family, and future are worth IMMENSELY MORE!

    Are WE blind to what WE are funding??

    Are consultant-level Emergency Medicine trainees not able to anticipate and prioritize?

    Are Emergency Medicine trainees not able to see the construction of the ‘incinerator’ with a warranty for the next 5 years?

    Make the next move for your families, not yourselves, because so far, YOU have NOT made a difference.

    Let’s resurrect the once-upon-a-time fair times of 2010 and before, i.e., the decade before.

    The college’s incessant thrill in exploiting paupers is not shared by the vast majority in the medical world, and will NOT be tolerated!

    For the total annual collection ($) coming out of the the trainees, any independent regulator out there would eagerly take the reins in forming the high ranks of a NEW college, with a mere return of transparency and fairness .

    Let’s follow the world of better justice – UK/Ireland and US!

    People writing via the college’s feedback avenue are hiding their points of view, as no forum (blog) will be visible to the large, inquisitive audience in despair.

    Edward and the bloggers, you have taken the great steps forward. Had anyone said you were venting out your anger, much more so you all were unveiling the common ground we all are standing on, but concealing deep in our lonely minds. Now, we are not alone! Spread your good news, and spread this message!

    Pinch your Emergency Medicine colleague candidates as a reminder, had they not expressed their awareness on this blog of what is insidiously brewing underneath their feet (and careers). At least TWO HUNDRED of all the registered trainee members should respond here.

    Give your heartfelt advice to interns (and medical students) naively embarking on an Emergency Medicine career path in this country. Open up their inexperienced minds to the tantalizing reality of a fellowship that could take twice as long as what it takes to graduate into a physician. Interns and house officers embarking on a career in Emergency Medicine can write on this blog as well, to show if they are disheartened.

    All Emergency Medicine college graduates, on our side, will help liberate us from this paid degradation.

    Following the college trend, the current fellowship examination sectional results will affirm that we have lost our democratic rights and entitlement to fairness. Thus, our deadline for tolerance will become when the TRAINEE FUNDED college FAILS MORE THAN ONE THIRD OF THE TOTAL OR WRITTEN OR CLINICAL FELLOWSHIP EXAMINATION CANDIDATES at the conclusion of the 2015.1 fellowship examination. Then, we will follow the TWO college path for fairness and transparency as seen in our advanced international counterparts!

    (Everybody, includes all those consultant-level trainees that have not blogged.)

    We can whine about the exam processes forever. However, we imperil ourselves if we do not DRAW THE REDLINE, but continue to fund the legislator to act with impunity. Emergency Medicine trainees can set the national precedent. Let this be the grassroots campaign for a better postgraduate medical education system in Australia/New Zealand, in consideration of our FAMILIES (no longer for ourselves, because all this time, we had not done anything to achieve any change).

    Together, we can win!

  33. Hi,

    can anyone here give an example of a question in this exam that would be difficult to answer in 6 minutes?? Just wondering what can be done to be better at this SAQ section. In trial papers/questions i’ve looked at, if there was a question I struggled with time, it was almost universally due to a deficiency / knowledge gap. If you don’t know something, i’m guessing even 30mins at a question will not be enough. But in 6 mins, i’m assuming most people can regurgitate short phrases and words for a question??? isn’t it.

    Please don’t hate on me, i’m just looking to understand the frustrations better so I can prepare for it when it’s my turn. cheers.

    1. Question 1. Childhood asthma.
      4 pages of tables. Knew it very well but still takes time to prioritise your answers like they had told us.

      Also in any practice exam I’d never seen a question over 4 pages. Always 2 at most. This meant I allocated 5 minutes to first 2 pages of tables – working fast.
      Then realised 2 more pages of tables.

      This meant for next 29 questions I was having to spend time flicking through handbook each question to determine how many pages there were and to be honest was chasing my tail from question 1 onwards.
      Never really had time to check how many marks were going for questions.

      I answered them all but felt so time pressured and time constrained that I wasn’t giving time to construct answers better or think, which is something that we should be able to do in a breadth of knowledge exam.

    2. The trial papers/ exams definitely had better questions and they were well constructed than the paper we got in the exam. There was definitely lot more thinking and effort put in to prepare those papers.
      Yes it is definitely possible to answer all those questions in less than 6 minutes if you knew the question before hand and you have already have a well constructed answer.but in the exam you need sometime to read the question, think about what the examiners are wanting in the answer and then construct your answer to the question.
      Try doing it for 30 questions straight, when the questions are vague and you are trying to decide what exactly the examiners want.

      1. I believe contrary to some of the postings the SAQ examination was in-fact intensively work-shopped ‘in full’ by several lucky Guinea Pigs (and finished by these FACEMs) – that’s not to say that they gave good answers (I am not sure about this) but it was the full 3 hour paper.

        Suggestions from senior college members have also been fed back to pace one’s self through the questions not by 6 minutes per question but instead keeping to a pace (question 5 by 30 mins, question 10 by 1 hour an so on)…

        I hope this advice helps the guys sitting the next exam. I am afraid it’s not much consolation to the old heads who have suffered the first instalment of this exam…

  34. The question still remains who are these “lucky Guinea Pigs”, and how familiar were they with the exam (both in structure and content). The examiners claim that all the exam questions are very clear and that it would be “nearly impossible for a candidate to go off track”. Yet quite a few candidates have remarked that they found some of the questions very vague and poorly worded (contrasting with the practice exams which most found very clear) . I find this a remarkable contradiction. For a time pressured exam like this having any pre-knowledge of the structure and the actual questions (even if just briefly having seen them at a meeting) will make an large difference.

    To me “exam-conditions” mean that the “lucky Guinea Pigs” were not associated with the development of the exam in any way and were given the same pre-exam information as the candidates (the example questions, FAQ and Handbook).
    I have found all the information ACEM has released about this matter very vague, so I am not sure, but it seems to me that the “lucky Guinea Pigs” were actually examiners involved in the development of the SAQ exam. If this is the case I am not one bit surprised they found the exam which they themselves made very clear (and familiar).

    Maybe we – as a group of concerned trainees- should request the AMC to investigate this matter. The AMC is responsible for the accreditation of all medical educational institutions (including specialist Colleges), and I think ACEM is due for re-accreditation next year. The AMC has significant experience with medical assessments, both their own and as an accreditation body. Other concerns we could present at the same time are the quality and timing of the pre-exam information/material and the absence of a complaints & appeals process (since the changes to the appeals policy in October 2014), which I think is an actual accreditation requirement. While this probably would not change much for the current candidates, it might make a difference for future exams.

  35. 1)
    a2 + b2 = c2 where lengths ‘a’ and ‘b’ are the two shorter sides of a right-angled triangle and ‘c’ is the hypotenuse (the side opposite the right-angle). ‘2’ refers to squared or to the power of two.

    2012.1 + 2012.2 = 130 = the fairly constant market demand (56% pass)
    2013.1 + 2013.2 = 145 = the fairly constant market demand (49% pass)
    2014.1 + 2014.2 = 135 = the fairly constant market demand (35% pass)
    2015.1 + 2015.2 = say, 145 = the fairly constant market demand

    Any guess what the 2015.1 + 2015.2 percentage is going to be??
    (I predict between 17-37%).

    You don’t need a modified Angoff, a modified Merino or a modified Herring to understand this simple message. Got the (downward) drift? Do you like to get (Angus) T-boned?

    {If you’re not the best with mathematics, get yourself a calculator or ask someone who’s good with numbers}.

    Is there a formula for lost income? (Let me hear it if you have one). Do people work for $56.85 per hour for nothing, with no goals in their lives?

    Are you getting your share of the py? The above 3 points are a sample of questions from the BSc(Math) 4th year final exam. What else could I be talking about??

  36. So the results are now out! Judging by our local spread of results we have survived the storm and possibly bucked the trend with 8/8 passing the written. Perhaps the OSCE will be the new bottle neck? We’d be interested to know what the overall pass rate was?

    In regards to Pythagoras of Samos’ comment above I don’t think there is a ‘conspiracy’ in the pass rates at all – in fact based on the way the exam has been marked historically it would be very hard for this theory to stand up. The reason for the recent lower pass rates is probably a combination of several factors.

    Rest assured as the dust settles the new exam will be fairer in the medium term. Many of the comments above reflect the concern that the changes have been bumpy to say the least. Let’s hope things are smoother and less mysterious in future exams.

    1. I think they just let us all pass out of pity, perhaps? 🙂 There were allegedly about 260 candidates, and I counted 233 numbers on the posted list of passers. The OSCEs will be a bloodbath…

    2. I counted 243 numbers listed as passed – I heard about 270ish sat? That’s a pass rate of well over 80%. Something must have been royally wrong with the exam for them to cover their asses THAT much.

      Sounds like in our case at least, the bottle neck will have to be the OSCE – if not it should be interesting watching 240 or so people trying to find a FACEM post.

    3. wow, that’s a high pass rate, and if even half of those go on to pass the osce, then i reckon the future will morph into fellows working nights and weekends while waiting for some consultant to retire!! From 35% to 80% – that is just amazing.

  37. Do we have any historical data on the numbers of people who passed their Part 2 writtens in previous years? 88% seems high, but that’s only the same as passing the writtens of the previous exam – there’s still an OSCE to go!

    Annoyingly, they have gone from 2 days to 3 days and now to 4 days!

  38. OK, so we sat an exam based on what we really do in the daily real-life ED settings, although, somewhat artificially time-machined into a fake, acted out (without tears) 7 minutes with sub-optimal to minimal real setting cues. As experienced registrars, we should, on fair evaluation, pass this exam (unless we killed someone or caused iatrogenic complications), otherwise we would not qualify to be the senior in ED shifts when the consultants are not present, e.g. night shifts.

    Well, this is what I say:

    SBS QE

    Subjective Badly Structured Quasi Examinations, and we should NOT receive the short straw of systemic inadequacies (a chronic problem) and imitation scenarios with lousy academic institutional guidance about what to expect in the lead-up to the OSCE (an acute problem).

    The score:

    – Reasonable MCQ’s (recent exam).
    – 88% passes in written component and a seemingly acquiesced candidate base in reaction to the mediator’s half smile.
    – OSCE done. Commonly seen scenarios, and more ED appropriate/work related vs old system (so we should pass as we have spent the time in ED’s) .
    – Now, breathe a sigh of relief. A lull ensues (duration = few weeks).
    – Our trust in our academic institution, in good faith, that they WILL deliver examinations that evaluate to reflect and pass the real life emergency medicine consultant to be.
    – The board of controllers now starting to assimilate the established and proven examination techniques of an overseas system.
    – Less whining blogs on Coggs’ wall.
    – Formative chatter about establishing a new academy.
    – We/us/candidates/registrars – more studied, diligently prepared, well-tested and well-read than past candidates. This should serve us well into our future careers.
    – Plain ol’ us. Our collective opinion counts!
    – Time to ponder.

    THE BAD:
    – Recycled paper/toilet paper mix quality documents provided as an introductory whiff to the new style Writtens candidates.
    – The Writtens culminating as a test of speed writing, not a test of knowledge and practical experience.
    – Trial run of the computer-based MCQ’s and EMQ’s on the actual real exam candidates, who had not performed MCQ’s in this way before.
    – Outrageous MCQ’s and arbitrary mark-downs (2014).
    – Bottlenecking graduation (2013 & 2014).
    – An unheralded and temporarily appeasing 88% pass in the written component. Candidates assuming glory and rejoicing.

    – The 7 minute consultation (especially had it been 3 part (a, b, c) OSCE), a non-moving, non-sounding, non-mottled skin mannequin that only demonstrated signs had you specifically asked for those features (no longer were we allowed to use our eyes to receive the 1000 cues the visual picture painted). Squashing real-life into an artificial 7 minutes and ACTING back to look real and serious. Reserved cues from within actors (real and Dr/FACEM), as if we were supposed to second guess and mind read, and do our best to act back and picture had this been real life…………………………

    – The very lactic acidotic 7 minute freak sprint with a mere 3 minutes of partial aerobic recovery, concomitantly reading the stem for the next scramble, back to back x 9 (perhaps a 10 minute toilet break in between). Take my breath away!
    – Should English be your second language of practised verbal command – ‘ introducing to u the highly pressurised at 7 atmospheres, the 7 minute consultation’!

    -Shhhhhhhhhhhhhhhh! ”Sign this document and solemnly swear you won’t disclose any exam information you have that’s at your complete discretion, beyond our control. Of course, we are relying on the good faith of all of you …….”. Concurrently, we will closely video tape you, and monitor every step you take within the multi-runs per day of recycled OSCE station premises DEVOID of any quarantining, and use special analytical techniques, that nobody really seems to understand, in order to derive at a pass rate for the overall fellowship examination. (Yes, counterintuitive.)

    – Paucity of committed and consistent academic board advice on OSCE preparation in the vital lead-up to the exam. Nil OSCE samples with confidence.
    – We’re in the calm before the storm.
    – Once again, we are in the calm before the storm!
    – A short reprieve manifested by the unknown factor.
    – Evolution to revolution – strangely coincidental, the thoughts crossed our minds.
    – Lifestyle – we would have flourished had we gone off into GP-land from the outset. Too late now, but this is merely a nostalgic view.

    – Catastrophicadministrativefailure – too many registrars excluded from education classes (can’t accommodate all), too many to examine, too many to pass. Is this our fault?
    – Two hundred plus candidates being assessed in the largest fellowship examination in the history of the continent.
    – Changing rules until the last moment in the lead-up to the Clinicals.
    – Total loss of quarantining capability. (And you thought sighting the front neighbours MCQ’s responses, for those not shortsighted, were a breech!)

    – Secrecy assured and subvertion deterred via marshals, 100 security cameras, and once candidates had departed from the maximum security, prison-like premises, a written oath in force to make one a regulations abiding good bloke and to not share exam case details with others about to sit one of the multi-runs per day of recycled OSCE station .

    – Repeatedly flawed examinations over the past few years, and not passing or being able to pass the fee paying consultant-level senior registrars.

    – Former examinations had not reflected the real work with real life thinking as we had performed daily duties – had it done so, the majority should have passed (with all those years of experience candidates had). Somehow, we (all trainees) landed ourselves in this calamity, when we had laid our trust and deep hopes in the command of the board. There was an obligation on the part of the academic institution to train and examine us, to the extent we progressed. Were the candidates that bad, or did the institution not honestly carry out its obligations like other academic entities. There remains a debt that is owed to us for the mishandling and the misleading of us.

    – Either because of a abysmal training program OR a completely flawed examination process conducted by old-era grads that were never subject to or challenged at modern day exam stringence or fine detail. The jury is out on this.

    – Examiner validation/re-validation by INDEPENDENT external authority – ABSENT.
    – External validity of examination marking justification (pre-2015) – MINIMAL.
    – Transparency – MINIMAL.

    – Medical world loses the best through illegitimate sieve! Delay by the board to investigate internally themselves and rectify or assimilate a better examination process. Consequence – innumerable lifestyle cost to the unfairly treated, not forgetting the outstanding clinicians that made decision to disassociate with an academy that they completely lost faith in. “We’ve lost the good ones” 😦

    – Now, a nebulous algorithm will henceforth decide our future (as we have been told).
    – Conflicting constituants: examiners that would struggle to, themselves, run the full stretch (Writtens or Clinicals) back to back, but examing anyway (for years).

    – Junk justifications: so there’s talk of too many grads if we all pass? So? The entrusted controllers that opened doors to excessive numbers of basic trainees can retire early. They caused it!

    – This incapability or reluctance in recent years to progress registrars to fellowship – NOT addressed so far.
    – We WILL hold the policy makers at the highest and intermediate levels ultimately, legally responsible for the collective misconduct and irresponsibility delivered.
    – The prospect of looming class action in the minds of the misled and infuriated (includes former members). This is THE VERY UGLY..
    – Selected candidates considering advanced legal directives.
    – Lack of regular registrar positions for the excessive numbers of failed consultant-level registrars.
    – The system is at breaking point (and accelerating). Nobody saw it becoming this bitter.
    – Await Lew’s slew! The winds of ISQ (2013 & 2014, deja vu) are coming. You have been warned.

    – What will be deemed on pending failed, but conscientious and didactically trained candidates – the training program, educators and accredited hospitals for training were not up to standard??

    – Yes, a state of INDEBTEDNESS to trainees remains.

    Where to from here? How do we prepare for the next step?
    This is raw.
    Hold back the champagne bottle.
    ………….and it doesn’t end here!

    Change https://www.change.org/
    Campaigns By You https://you.38degrees.org.uk/

    Go ahead, make my exam!

  39. It is with deep regret that some of us have become disillusioned with ACEM in regard to its role as the responsible body for coordinating the fellowship OSCE examination and to oversea emergency medicine training programme
    The recent 2016A OSCE results were out and unfortunately the shame of an examination that it has become continues unabated. It was clear from the first OSCE examination that lack of quarantine and repeating questions/themes on successive days had opened avenues for some candidates to be aided with prior knowledge of the examination before taking part in the actual examination itself. Regrettably, ACEM continued this bungled approach into the second and third examinations. We don’t know whether these omissions were intentional on the part of the powerful or not, or ever discussed by the examination committee or not – but they seem so basic it would be concerning if this was not discussed.
    This reckless way of examination candidates in a high stakes examination was unacceptable . Having bungled and made a mess of the examination process the college has consistently done the following 2 things that are extremely disturbing in their perceived thought process and the impact on number of families. The college has managed the situation (no doubt with the help of lawyers of course by placing the blame on others and not its flaws in examination process. This is a disturbing lack of accepting responsibility by the college for its failed style of examination. Too open to exploitation by reducing the pass rate from the +70% of first examination to 55% in the hope that those that it states to have passed did actually pass by themselves. This has been reduced further to 53/125 candidates on the last examination. This UNFORTUNATELY IS NOT A SOLUTION –it is FACE SAVING TACTIC by a college not equipped nor capable of dealing with an important mandate of protecting the examination.
    Our concerns that follow from part B are the lessons that people affected differently will perceive about the college’s response to its overt and mind boggling bungling of the examination process
    1) If you pass after cheating – you have learnt that cheating can and will be rewarded. There were rumours of candidates exhibiting this kind of behavior from the first examination, and the wPw ECG is a perfect example of that cohort. The college preaches safety in the answers it expects from us as candidates. I would dare to say the college has been very unsafe in the way it has handled the examination process
    2) If you fail after having worked so hard for months on end- your biggest lesson is —the College is unable to level the playing field for you. You are on your own. And it is just so unfair. We have worked so hard to be here. To have that dream taken away from us in that way is hard to take. The college should equal the playing field by providing an exam that does not give advantages to a certain population group. Others unfortunately it appears may have been tempted to level the playing field for themselves. It was with utter dismay, shock, anger and disbelief to find out that the College in its wisdom thought its a good idea to repeat the examination questions from D1/2 to D3/4. Some of us believed the college had learnt from its failings from the first 2 sittings. Sadly, either the college cannot learn or is just unwilling to learn. This in itself raises a number of serious ethical questions

    1) should we continue to vest our trust in this flawed examination process?
    2) what is the college’s responsibility and liability to candidates who genuinely believe they have been
    failed by the flawed examination process (that some even within the committee are believed to have flagged as not meeting the accepted standards)?
    The fact that only a 42.5% (please see other college pass rates) can pass this exit examination is an unfortunate reminder of how low the College itself has also sunk in trying1) punish the poor hardworking candidates who cannot cheat
    2) reward those able to cheat
    3) refuse to see and appreciate it role in all this fiasco the OSCE has become
    I think what was even more pathetic was the attempt by the College to investigate itself – but reading in between the lines a chance for it to protect itself by engaging a lawyer.
    Honestly how can a well-run college only manage to get 42% of its exit candidates through to becoming fellows? All the other colleges in Australia appear to have passing averages close to 70%. Even the RCEM of which our examination is suposedly based upon does not have such a pass rate
    a) Are the Registrars really that bad and unsafe? If so, what is contributing to it and why is the college not doing anything to improve or rectify this? In the corporate world if at the end of a production process, lets says canning fruit for example – and the company was throwing away 58% of the produce- there would be an independent investigation with the Chief Executive officer being forced to resign.
    b) Are emergency departments safe environments for patients to be left in the care of these obviously poorly performing and unsafe registrars (if you infer from the 58% failure rate)? It would appear EDs should have consultants 24hrs of the day as its final product is so poor it can only guarantee 42% of it being safe. Would this then require ACEM to declare emergency medicine training as becoming a national problem?
    c) Does it mean our DEMTs are really that bad at giving us advice on passing the examination? Are they just getting us through our WBAs inappropriately? I doubt it.
    d) It is also very concerning and disheartening that there is a group of candidates that seems to
    disproportionally contribute to the failure group – and these are candidates from smaller hospitals and IMGS. This is sad.
    All we are asking from you as a DEMT is to be an advocate for the voiceless candidates who are too scared to reveal themselves due to fear of victimization. Raise your voice in objection to this flawed examination process. Quarantine alone is not going to be enough. Playing around with the same themes is not going to be enough either.

    The current examination process unfortunately
    A) punishes candidates who are unable to obtain an unfair advantage
    B) taints the achievements of those who have passed unaided
    C) rewards some cheating candidates
    D) portrays the poor leadership we have – which fails to protect all its candidates and provide an
    examination process that confers an equal playing field to all its candidates but inexplicably is quick to lower the pass rate.
    It is on very good record that the scoring was re-looked at again approximately 24hrs prior to the results being released – someone tampered with these results to suit the College’s agenda- and still no apology for giving us a flawed examination process. If this is true then it points to the examination pass mark being fluid contrary to what the college has suggested in the past that this would truly a statistical mark without human contamination or manipulation.
    Over the last 3 OSCE examination sittings, the college
    1) can never be sure that all those it passed – did actually pass without unfair advantage– it will never be able to say so- never However, the College can be sure that due to its failure to provide an examination process that protects all candidates. it has failed a significant number of candidates who should have passed. It should never be the responsibility of the candidates to safe guard the examination process. This has not worked. If the same situation is present in October- the college as some of you have known, it for years will have a difficult time existing.

    1. Dear Rachael Kevin
      Thanks for bringing up this issue.
      Also thanks to Andrew for publishing this on his website.
      Like you i am also suffering OSCE nightmare.
      I am also frustrated, angry, depressed and have been to the lows i don’t wish even for my worst enemies.
      Like you i have also thought about conspiracy theories but i don’t think they are true.
      I feel its not correct to paint everyone with same black brush, i still believe most people who have passed the osce are clever( not necessarily more intelligent).
      I think the OSCEs have disadvantaged people like me whose first language is not ENGLISH.

      College has made things worst by providing unhelpful, late, useless feedback. From this feedback there is no way of knowing what we did wrong in simple history taking stations like chest pain which is our bread and butter.
      We have only ourselves to blame because instead of posting letters to DEMTs we should unitedly talk to college and ask for a better and timely feedback. We should ask why the overall result is about 40% and there is such wild swings from 75% to 55% to 40%. The result in other countries like US, Canada is consistently 70% to 75%.
      It seems that the job market is dictating the results. As we all know there are very few Consultant jobs around the country and college wants to limit the number of Unemployed FACEMs. But if it is true its a very unfair and incorrect process.
      I suggest
      Instead of wasting time ranting we should ask these difficult Qs from College in a decent and organised manner.
      Without that i don’t think we will get anywhere.

  40. Ed Reje was planning on writing a piece about the OSCE mentioning some of the point you guys have raised. However, he is lazy prick and may never get round to it. He has, however, scribbled down a few thoughts and passed them on. We should acknowledge that Dr Coggins is once again taking a few risks in letting Ed post his thoughts (if you can call them that) on this blog.

    “I think the college is continuing their long and proud tradition of blaming the candidate and not the exam. One thing the college did well with the old exam was provide detailed feedback about the candidates performance in the written exam. At the moment there is zero useful feedback given to the candidate about their OSCE performance. Some people have now failed the OSCE 3 times and have no idea why. I can’t imagine how frustrating it must be to work your arse off, fail and have no idea why. Even worse, they have no idea about what they need to change in order to pass if they sit again. Examiners have muttered about lack of knowledge, talking over / not listening to the actor and even an authoritarian attitude of some of the candidates. Well, if you are going to blame the candidate then you need to provide detailed individualized feedback so that the candidates can make the necessary changes to both their exam preparation and OSCE technique.

    Some candidates have complained that they only had 1 examiner for some stations. This is unacceptable for a number of reasons. It would be quite easy for an examiner et the end of a long day to drift off and miss things. An examiner might have trouble with a candidates accent or even just take a dislike to a candidates mannerisms. You must have 2 examiners in a fellowship exam.

    For the first 3 OSCE exams, the same questions were used through out the week. This was a real “elephant in the room” situation as the college knew it was a problem but they refused to admit it (at least publically). I was told by one examiner that you’d be mad to try and find out what the questions were because it could place you at a disadvantage if something was changed. That’s right – the OSCE is the only exam in the history of the world where it is a disadvantage to know the questions before hand. With respect, that’s bullshit. If I knew that the paed’s sim was going to be trauma, than I have a huge advantage over the other candidates. It was obvious in the first OSCE that some people at the end of the week knew the questions. I’m a bit vague on the details but I think there was an ECG station where it was WPW on some days and Brugada on other days. Some candidates then described the wrong ECG. Frankly, if you don’t look at the ECG in front of you, then your a fucking moron and deserve to fail. None-the-less it is a) crazy to assume that people aren’t going to tell other candidates the questions and b) lazy / unprofessional not to have enough questions prepared so that you don’t have to recycle them. This whole issue reached a predictable boiling point in the 3rd OSCE when a male candidate attempted to bully a female candidate into telling him the questions.

    If I was in charge (and God help us all if I was) then I would not have the final exam assess a candidates communication skills. These guys have been practicing as doctors for many years and for most it is too late to change the way they interact with patients. Besides, if it were a problem on the floor, shouldn’t it have already been detected and dealt with? If your going to test communication skills, do it early in some-one’s training when you can actually do something bout it. And as an aside, whilst interacting with patients is clearly important, it is not the be all and end all. I know several FACEM’s who are worth their weight in gold but are pretty crap at talking to patients. Thus, if I was in charge I would add some old style SCE questions and even a couple of “sit down and have a chat with a college” stations such as “tell me about your approach to low risk chest pain” or ” tell me how you would work up a pregnant woman for a PE” or “what are you thoughts about the role of LP in the work up of a SAH”.

    Just as an aside, can some one tell me why we have WBA’s and OSCE’s that assess the same thing? (taking a history, examining a patient, doing a procedure) Is this a tacit admission that neither ways really works? I’ve heard through the grapevine that some examiners are suggesting that the WBA’s need to be marked harder in order to prepare people for the OSCE. Well here’s a better idea – GIVE THEM FEEDBACK!!

    So to summarize
    1) I still believe in the new exam
    2) stop placing all the blame on the candidates
    3) give detailed, practical and individualized feedback (How I hear the college ask? Well that’s your fucking problem – you the one’s who came up with the idea of OSCE’s. Worst case scenario (and totally impractical) would be to film them. The candidate can then watch his performance and discuss it with an actual examiner)
    4) if you going to run the exam over several days, use different questions. (It’s not that hard to write an OSCE)

    The candidates have shown that they are willing to work hard to pass this exam. The college needs to meet them half way.

    Eddie Rege

  41. Honestly this new exam is such a joke.

    Was the screenshot a blank, or did you get no feedback!?!

    I just think that a 40% pass mark for a practical exam like this is a real concern and that the level expected compared to locally marked WBA is extreme.

    They really need to have 2 examiners or at least some quality control for such a high stakes exam

    1. Eddie
      i was just reading ur comments.
      U r so clever with words, why don’t u help us write a letter to college and we will ( or atleast some of us) will sign it.

  42. Letter to college for better feedback from SA trainees. Was posted here but taken down due to request. (CENSORED BY THE COLLEGE!)

    Summary was a request for increased feedback for Failing OSCE candidates. this seems completely reasonable to us…

  43. IF people don’t know.College has put the exam report on the website.
    Its equally rubbish and unhelpful.

  44. How about the latest 2016.2 Written exam report?? 50% pass rate. We started with 88% for the first ‘new’ exam….Thanks for the all the complaining over here. It’s had the opposite effect. Cheers.

    1. Anyone who failed the 2016.2 written should have an honest look at their own performance before blaming it on a blog post from 18 months ago.

      My interpretation of events is that the first written exam was a clusterfuck and the college knew it. The examiners were angry, the DMT’s were angry, the candidates were apoplectic and there was even talk of suing the college (which was just a tad over-dramatic). As a result the college lowered the pass rate, replaced at least one person involved in designing the new exam and tinkered with the exam format. They are now more confident in the exam and are marking it to a higher standard.

      1. agree, except that the threats to sue over the 1st exam were in no way over-dramatic .. Not even in the slightest. A low pass rate in that shambles that was called an exam would have resulted in a substantial class action with an very solid claim.

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