Welcome to our new and updated Fellowship Examination page…
FACEM EXAM – HOT OFF THE PRESS
Download the latest recalls 2016:1 and 2016:2 MCQ/EMQ Questions
Track the life of our guest Emergency trainee Dr Edward Rêjé – CLICK HERE
Our OSCE Crash Course (“The Last Stand” – suitable for early the last minute preparation) REGISTER INTEREST HERE
We hope the resources below will be useful to anyone working in an Emergency Department (ED) or Intensive Care Unit (ICU) looking for rapid revision of popular topics. The information presented is based on our shared experiences in approaching postgraduate assessments. The content on this page is apologetically Australasian in viewpoint but should be generalisable to most countries.
- If you are looking for an overview about Emergency Medicine Training – CLICK HERE. If you are already in an Emergency Medicine training program and thinking about future assessments read on…
The full download e-book (over 200 pages) can be found here:
by Dr Andrew Coggins FACEM
With the new FACEM exam having a bullet point knowledge focus we also recommend:
by Dr Ed Burns FACEM
- Fellowship Examinations such as the ‘FACEM‘, ‘FRCEM‘ and ‘ABEM‘ have become a mainstay of assessment and accreditation for advanced trainees in Emergency Medicine.
- Top picks for online resources to help with these challenging examinations on our LINKS page. There are also a number of links on this page that you will find of use in your exam studies, new Work Based Assessments (WBA) and everyday ‘on the floor‘ clinical practice.
The new OSCE is a massive barrier. You need to start practicing OSCE ‘acting‘ early – both on the floor and in your study group.
Feedback on your performance is key. Seek multiple sources and types of feedback
THE 2 ASSESSMENTS
- In Australia and New Zealand the WBA have now replaced the older components of the ACEM fellowship assessment process following a Curriculum Review Project (CRP) completed in 2013. Similar changes have occurred in the UK.
The new Australasian FACEM exam is summarised as follows:
(1) THE WRITTEN EXAM
Can be sat much earlier in training than in the past – Application and Eligibility
- Multiple Choice Question (MCQ) – essentially similar to the old exam component (questions below) with the addition of Extended Matching Questions (EMQs)
- Short Answer Question (SAQ) – highly controversial following recent sitting
- Consists of 30 questions in one paper over 180 minutes
- 1 question should be about 6 minutes in duration (but there can be ‘double‘ and ‘triple‘ questions. (NB This threw a lot of candidates off in their timing in the inaugural sitting of the exam in February 2015)
- Timing appears to be one of the main challenges with the new exam format and even when the teething problems of the new format subside this is likely to be difficult for candidates.
- Essentially, instead of essay style questions most new SAQ questions will have between 2 and 6 parts or sections requiring short structured responses. A stapled answer booklet is provided for you to write on.
- Consists of 30 questions in one paper over 180 minutes
(2) THE OSCE EXAM
- Objective Structured Clinical Examination (OSCE)
- We are still waiting for the first OSCE although the college has issued some sample OSCES and we have made some of our own for you to practice.
- Workshops and Resource Pages are springing up around Australia and New Zealand to try to help with preparing for the OSCE and simulating the experience.
- Candidates are understandably very nervous.
- What we do know is that the format will be similar to the Royal College of Emergency Medicine (FRCEM) OSCE:
- OSCE Videos – Click Here
- Essentially there will be up to 20 OSCE stations in 2 sittings of 10 stations. While there are “10 stations” one will be a rest station. 10 x 10 minutes OSCEs means the exams will last 200 minutes in all. You will get 3 minutes reading outside exam room and 7 minutes in exam room usually with two examiners who do not interact and do not give feedback. The marking sheet for the OSCE will be “very similar” to the Work Based Assessment marking sheets.
- Our friends at Life in the Fast Lane have also outlined their thoughts on success in the new exam for 2015 and beyond.
- There is an overall trend across post graduate education to adopt continuous assessment of competency rather than on a single high stakes assessment that determines a candidates ability to progress. This trend in education and training has led to changes in the FACEM, ABEM and FRCEM exams in recent years.
- While changing the old assessment model is the ‘end of an era’, many of the principles relevant to exam success in the old systems will still apply. At the end of the day the ‘college committees’ and ‘examiners’ are the same people.
So here is some old wisdom… You need to following to succeed:
- Systematic Approach to Common Emergency Presentations
- A broad knowledge of Emergency Medicine
- Adopting highly structured ‘bullet point’ approach
- Refined Expert Level Communication Skills
- Demonstration of ‘FACEM‘ level thinking and decision making
- Lots of marked practice papers (sat in real time)
- Use of professional language to describe assessment and management
- An understanding of what assessors (WBA) and examiners (FACEM exam) are looking for in order to achieve success
- Feedback from your local consultants and colleagues
PRACTICAL TIPS TO GET STARTED
“Success in the FACEM exam depends on both knowledge and exam technique.”
We suggest you make your own notes with the focus of your notes being on the on the likely content for MCQ and SAQ
We saved A LOT of time using Medical Applications (and not textbooks) for quick reference during study sessions. You can look up the information much faster electronically even if you are not an expert with computers. We particular recommend using WIKEM on your tablet or smart phone – WIKIEM is essentially like the ‘Dunn’ textbook (short notes) taken from Tintinalli and Up to date and therefore just perfect for quick recaps at the touch of a button.
- The most important thing is to have a sensible plan and plenty of support from friends and family.
- While studying make sure to give yourself a pat on the back and a break once in a while… (not to mention an nice cup of tea or coffee to prevent too many caffeine withdrawal symptoms)
- Unlike undergraduate exams, this exam requires a ‘Marathon like‘ effort over a long period of time, often with family, financial and full-time work commitments
- It’s a very important exam but your life outside the exam is also important – not only that – but short breaks may actually help you do well in the exam (Starling’s curve = too much stress = reduced performance)
- Take advice from your consultants and colleagues seriously
- You should ask honestly whether you are ready to sit. Consider bringing forward or delaying your first attempt at the exam after taking this advice.
- In the exam read the Question carefully and watch your time
(1) Use a rapid revision technique to look up answers – one option is to use online textbooks or journal articles in PDF or similar electronic format:
- Once the file is open use the CONTROL F (Find) function on your computer to rapidly search for the information on the page (this saves hours of looking through Index pages of large textbooks)
- In New South Wales (Australia) free textbooks with search functions are available at C.I.A.P. (most health services around the world have similar local access)
- ‘CONTROL F’ search can be used using our notes (in PDF format above) to rapidly search for relevant content
(2) It may seem obvious but read the question both carefully and from the examiners point of view. Why have they made up this question? Be suspicious of double negatives and long winded stems (*which are usually wrong). Try writing a few (maybe 5 or 10) MCQs yourself to get in the examiners mindset.
(3) Share your recalled questions with each other. Many hospitals have banks of MCQs and I-MEDUCATE has a variety of questions for a subscription rate membership…
(4) Have a study group of like minded candidates for both the written and clinical examination (choose wisely). Support each other in your local study group
- Key Exam Tip – Keeping to Time
- In the MCQ exam your will find there is a lot of spare time whereas in all other parts of the exam you will find yourself under significant time pressure.
- The exam rewards consistency so avoid spending extra time on any on question or point in order to score 100 percent.
- If you spend more than the allotted time on a question, especially in the written exam you will risk failing the exam, not through lack of knowledge, but just on missing a question…
- While it’s VERY tempting to change answers in the MCQ with the extra time you have we suggest NOT doing this unless you ‘read the question wrong’ or are ‘certain you made a mistake’. Invariably, your first guess is the best percentage answer to write down in the exam…
Multiple Choice Questions (MCQ)
- Historically, the MCQ components of the FACEM Fellowship exam have had a very high pass rate (in the range of 90% or more). These will now be marked and assessed on a computer.
- In recent exams this pass rate has gone down (the reason for which is not entirely clear).
- Regardless of the pass mark, the MCQ and New EMQs are an opportunity to get a good mark and create a ‘buffer’ for having an off day in the SAQ component.
MCQ and EMQ Practice Questions
After coming out of my Exam I wrote down as many MCQs as I could… You can ask your peers to do the same.
Here are some ‘gold’ recall questions from previous Fellowship exams (a limited number of repeats are likely):
Short Answer Questions (SAQ)
Our suggestion is that timed practice SAQs become part of your daily revision at an early stage. Here are some questions to get you started:
SAQ Resus and Cardiology Questions – CLICK HERE
SAQ Challenge Questions – CLICK HERE
More Practice SAQ Questions – CLICK HERE
SAQ Full Practice Exam 1 (2016) – CLICK HERE
Practice questions for the new format exam appear to be hard to obtain in great numbers.
The topics are likely to be similar to old exams so it would be worth covering many of the old topics in your revision.
A Full List of old style Fellowship Questions can be found here – FACEM PAST EXAMS. Topics for the new format SAQ will be similar to the past questions but in the new structured format.
Rhetorical ‘Must Do’ – “you must write as neatly as possible, consider printing in capitals if your handwriting is hard to read (i.e. legible quality is more important that quantity)”
Structure and answer ‘labelling with catchy openings‘ are now less important than specific knowledge in the new exam.
However, choosing and stating priorities as well as ‘catchy’ phrasing are still important. Imagine your examiner reading your paper (number 55 of 150) at 2am.
How are your going to stand out and assure them you are consultant material?
- Classic – old school tips on SAQ writing technique – Question Labelling
- Recommendation – a great face to face help was Don Liew’s course in Melbourne
High Yield Topics – Where should I start?
- ECG – have a look at our ECG Page for original VAQs and guide to ECG interpretation (this is an important part of the SAQ and OSCE exams)
- Resuscitation – as Emergency Physicians we need to be “expert in this area”
- Try some Cardiology SAQ Questions (70 minutes) – Click Here
- X-Ray – Especially Chest and Common Orthopaedic X-rays
- CT Scans – Especially CT Head, CT Abdomen and CT Chest (single axial slices)
- Airway – Advanced Airway Questions occur commonly in the SAQ and OSCE (not usually a standard ‘RSI’ – see our revision notes from page 12-16)
- Toxicology – We suggest you make a list of common poisonings that have come up in prior exams. Have a global approach to ‘Tox‘ Presentations
- Administration – classic questions come in the FACEM on various admin topics
CLINICAL SKILLS ASSESSMENT
The “OSCE” Examination
Best of web – discussing the new OSCE is ‘Adelaide E.M.‘ – Click Here
Start off – For a recently created FACEM OSCE Practice Exams – Click Here
(Click Here to obtain a password)
WBA – Case Based Discussions
The long case has been replaced by the WBA “Case Discussion” since 2015.
Case discussions for WBA will require similar skills to the old long case exam
OSCE Examination and WBA MINI-CEX
The short cases are being replaced by the WBA “MINI-CEX” but clinical history taking and abbreviated examinations can still be tested in the OSCE exam.
In the OSCE Clinical Examinations will still be expected to be of a high standard: “Physical examination is an important skill for Emergency physicians and may be examined in the Fellowship clinical exam (OSCE). Advice to trainees preparing for the 2015.1 OSCE is that they should refine and rehearse their physical examination skills in the real context of Emergency Medical practice. In an OSCE station, their physical examination should be tailored to the clinical scenario and patient as presented in the station. Where instructed, candidates should perform an appropriate and focussed examination, as would be expected if faced with a similar case in the emergency department.”
Mini-Clinical Evaluation Exercise (Mini-CEX) for WBA will require similar skills to the old ‘short cases’ in terms of professionalism and communication. A WBA or ‘short case’ is basically a bit of theatre. You need to learn the lines as if you are an actor in a play…
The OSCE examination and history stations are be a challenging because a similar level of competence to the ‘old short case’ may be expected by the assessors/examiners.
The equipment recommended for a WBA or OSCE is standardised and should be provided on the day. Essentially what you can easily access on the ED floor. For the new WBA and OSCE you will be dressed in scrubs and not a suit.
Revising Efficiently for OSCEs and WBAs
The style of revision and energy levels required for the WBA and Clinical Exam are quite different from the Written Exam. Studying for this part involves lots of waiting around (thinking of ways to make use of this time is helpful). In addition, the highly pressured nature of the OSCE Exam means that you have to practice ‘your act’ before the big day. Be imaginative about revising and ask for constant feedback.
Our number one piece of advice for Short Exams and Mini-CEX assessments is to ‘get slick’ by seeing lots of normal patients on the floor. Spend time examining normal patient a few days before a WBA so you don’t have to think about the next step of your examination routine. The same rules apply for revising for the OSCE.
Get into good everyday habits, rather than ‘fake it to make it’ (at the last minute).
The lines required to act out the common Mini-CEX and OSCE ‘play’ exams are the ten or so main examinations found in “Talley and O’Connor“.
If you feel really stuck to help you start off there are well produced videos demonstrating the short case routines are online – CLICK HERE
MAKE YOUR OWN REVISION RESOURCES
Flash Cards (#thebluntdissectionthebluntdissection)
- Thrombolytics for AMI
- Contraindications to Thrombolysis
- Sgarbossa Criteria (AMI w/ LBBB)
- Chest Pain Descriptors Associated With AMI
- Chest Pain Risk Stratification
- TIMI Score / Risk
- San Francisco Syncope Rule (“CHESS” mnemonic)
- ECG in Syncope
- CHADS-VASC Score
- Infective Endocarditis (organisms)
- Infective Endocarditis (High-risk conditions)
- Duke Criteria (Diagnosis of Infective Endocarditis)
- Paediatric DKA Management
- Hyperthyroidism + Thyroid Storm
- Hypothyroidism + Myxoedema Coma
- Adrenal Insufficiency
- Common Eye Complaints
- The Red Eye
- Angle Closure Glaucoma
- Ruptured Globe / Penetrating Eye Injury
- Elbow Xray
- Elbow Dislocation
- Shoulder Dislocations
- Shoulder Relocation Techniques
- Distal Radial Fractures (Colles, Smith & Barton)
- Forearm Fractures
- Scaphoid Fracture
- Scapholunate Dissociation
- Lunate & Perilunate Dislocations
- Ottawa Knee Rules
- Ottawa Ankle Rules
- Lower Leg Compartments
- Lower Leg Fractures
Renal + Electrolytes.
- Causes of acute renal failure
- RIFLE criteria
- Indications for haemodialysis
- Sodium & Free-water correction
- Causes of rhabdomyolysis
- Hypotensive dialysis patient
- Osmolar Gap
- Anticholinergic Syndrome
- Cholinergic Crisis
- Neuroleptic Malignant Syndrome
- Serotonin Syndrome
- Dialysable Drugs
- Cervical Spine X-rays
- NEXUS Low-risk Criteria
- Canadian C-spine Rules
- Penetrating Neck Trauma (Hard & Soft Signs)
Make your own Fellowship ‘Car-Cast’
- We suggest making your own Car-casts to help your revision (especially if you have a long drive to work)
- My ‘Car-Casts’ were thrown together to play in my car on the way to work (my commute was between 30 and 60 minutes each way for the 9 months before the exam). Despite the pain of listening to your own dour drone I found it was a helpful way to revise important aspects for the exam that I was finding difficult to remember!
- Car-Casts, along with listening to the multitude of excellent Podcasts available online (such as EMRAP and EMCRIT), are an excellent way to keep up your study in the car as well as add variety to your revision.
Why not sharpen up your knowledge in the car?
(*Please note that the corresponding ‘questions’ referred to in the Car-Cast Downloads are found in the FACEM Revision Notes document (use ‘Control F to search the PDF document).
The ‘CarCasts’ I made were VERY “rough around the edges” but i genuinely thought they helped me in the exam with recall. So they are here as demonstrative example of what you can do yourself to add some variety to your revision during your commute to work:
5 Easy Steps to make your own ‘CarCast‘
(1) On your Mac Computer Open ‘Garage Band’ (Type in ‘Garage Band’ into the finder to locate the program). You can use a similar program on a PC
(2) Select New File a by clicking on ‘New Project’
(3) Record your ideas on a particular revision topic
(4) Save your work as a music file using the ‘Share‘ Tab and ‘Export Podcast to Disc‘
(5) Listen to your CarCast on the way to work
Other Recommended Exam Resources
EmergencyPedia 2016 Top Links – CLICK HERE
NSW HETI – CLICK HERE
Life in the Fast Lane – CLICK HERE
We wish you all the best with your fellowship exam and WBA preparation!