Emergency Medicine Fellowship

Welcome to our new and updated Fellowship Examination page… 

HOT OFF THE PRESS

Download the latest recalls 2016:1 MCQ/EMQ Questions – CLICK HERE

Track and comment on the life of our guest trainee Dr Edward RêjéCLICK HERE

OVERVIEW

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 FACEM Chain of Survival
The FACEM Chain of Survival

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OUR REVISION NOTES

As part of a growing family of FOAMed web sites we share our Revision Notes for the FACEM examination.

The full download e-book (over 200 pages) can be found here:

COMPREHENSIVE REVISION NOTES 

by Dr Andrew Coggins FACEM

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With the new FACEM exam having a bullet point knowledge focus we also recommend:

THE FACEM ‘KNOWLEDGE’ 

by Dr Ed Burns FACEM

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Name Tags

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FACEM EXAM

  • 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. Feedback on your performance is key.  Seek multiple sources and types of feedback”

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THE NEW 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:

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.

THE CLINICAL 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:
    • 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.

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HISTORY

  • 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 medical education and training has led to major changes in FACEM, ABEM and FRCEM exams in the last few years.
  • The last FACEM Fellowship Examination in the “old” format took place in late October 2014.
  • 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.

FACEM Dinosaurs

  • So here is some old wisdom… You need to following to succeed:
    • Systematic Approach to Common Emergency Presentations
    • Broad knowledge of Emergency Medicine
    • Refined Communication Skills
    • Demonstration of ‘FACEM‘ level problem solving and decision making (The examiners have NOT changed and will have specific expectations of a prospective Emergency Specialist)
    • Lots of Practice Papers (sat in real time)
    • Use of professional and efficient language to describe your assessment and management
    • Candidates must have an understanding of what assessors (WBA) and examiners (FACEM exam) are looking for in order to achieve success
    • Seek feedback from your local consultants and colleagues
    • Adopting highly structured ‘bullet point’ approach with your responses at an early stage is advised 

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YOUR SUCCESS

Key Point“Success in the FACEM exam depends on both knowledge and technique.”

Therefore, our notes covered both exam technique and relevant content in a short hand format.

We suggest you make your own notes with the focus of your notes being on the on the likely content for MCQs and SAQs in the new format.

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.

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MUSINGS

  • An Unavoidable Fact:
    • Preparing for the WBAs and the FACEM exam will take a significant amount of time and effort… However, by sharing your experiences and using many of the excellent online resources that we have outlined  you can make some shortcuts to success.
  • The most important thing is to have a sensible plan and plenty of support from friends and family.

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BASIC APPROACH

  • 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)

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  • 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.
  • The latest information about the Exam is found by looking at the Training Examination Handbook:
      • Click Here (use “Control F” to search the PDF)

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SUGGESTED SHORTCUTS

(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

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  • 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…

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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.

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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):

2015:1 FACEM Exam “Golds” Recall Paper
2015:2 FACEM Exam “Golds” Recall Paper
2014 FACEM Exam “Golds” Recall Paper
2012 FACEM Exam “Golds” Recall Paper
2013 FACEM Exam “Golds” Recall Paper
2004 FACEM “Golds” Recall Paper
2010 FACEM “Golds” Recall Paper

 

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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:

New Format SAQ Cardiology Questions – CLICK HERE

Diagnostic Challenge Questions (VAQ) – CLICK HERE

More SAQ Questions – CLICK HERE

SAQ Mini-exam – 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 EXAMSTopics for the new format SAQ will be similar to the past questions but in the new structured format.

Rhetorical Point – “you should write as neatly as possible, and consider printing in capitals if your handwriting is hard to read (i.e. legible quality is more important that quantity)”

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Structure and answer ‘labelling with catchy openings’ is now less important than specifc knowledge in the new exam.  However, choosing and stating priorities as well as ‘catchy’ phrasing are still important.  Imagine an examiner reading your paper (number 55 of 100) at 2am.  How are your going to stand out and assure them you are consultant material?

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What are the High Yield Topics for the Written Exam?  Where should I start?

  1. ECG – have a look at our ECG Page for original VAQs and guide to ECG interpretation (this is 25% of the VAQ Exam)
  2. Resuscitation – as Emergency Physicians we need to be “expert in this area”
    1. Try these Cardio Questions (70 minutes) – Click Here
  3. X-Ray – Especially Chest and Orthopaedic X-rays
  4. CT Scans – Especially CT Head, CT Abdomen and CT Chest (single axial slices)
  5. Airway – Advanced Airway Questions occur commonly (not usually standard ‘RSI’ – see our revision notes Page 12)
  6. Toxicology – We suggest you make a list of common poisonings that have come up in prior exams.  Have a global approach to ‘Tox’ Presentations
  7. Administration – classic questions come in the FACEM on various admin topics

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CLINICAL SKILLS ASSESSMENTS

The “OSCE” Examination

The best site we have found discussing the new OSCE is ‘Adelaide EM’ – Click Here

For a recently created FACEM OSCE Examination – Click Here

We have developed a list of OSCEs (password required) – Click Here   

(Click Here to obtain a password)

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WBA Case 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

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WBA Mini-CEX

The short cases are being replaced by the WBA “MINI-CEX” from 2015 but clinical history taking and abbreviated examination can also be tested in the OSCE.

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 short case exam is basically a bit of theatre.  You need to learn the lines as if you are an actor in a play…

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Short cases are a “nerve wracking” undertaking (reflected by the historically poor pass rate in the old FACEM exam short cases).

The MINI CEX will be a challenging part of the WBA because a similar level of competence to the old short case will be expected by the assessors.

The Equipment recommended for a short case is standardised – essentially what you can carry on the floor.  For the new WBA and OSCE you will be dressed in scrubs and not a suit.  While you won’t need your own briefcase full of equipment it might be a nice ‘touch of tradition’ for your DEMT to keep one for use in the department for WBAs.

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Gone has the old brief case, come has the IPAD

 

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 Clinical 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

Spend time examining normal patient a few days before your 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’

For example, you have a Mini-CEX next week – we suggest that you go to the general ward of your hospital and do 2 or 3 normal cranial nerve examinations – then have a cup of tea.  Case practice is extremely draining compared with book work for the SAQ.   Later on, go and see patients in the ED or neurology ward (the patients who DO have abnormal ‘signs’). Do these cases with an Emergency Physician and seek specific feedback on your performance.

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“.

You need to know these exams (with an acceptable degree of variability) quite well. You should not have to think about the next step of the exam or history routine.

When you have done 15 or more cases you will find that you can adapt your approach to history and examination for the specific patient – this will impress the WBA assessor and/or OSCE examiners.  To help you start off there are well produced videos demonstrating the short case routines are online – CLICK HERE

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YOUR OWN RESOURCES

Make your own Fellowship ‘Car-Casts’

  • 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).  My ‘CarCasts’ are VERY “rough around the edges” so they are more here as demonstrative example of what you can do to add variety to your revision during your commute to work)

If you find them useful I suggest you make your own (see below):

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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’

Making a Revision CarCast

(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

Export your CarCast as a Music File

(5) Listen to your CarCast on the way to work

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Other Recommended Exam Resources

EmergencnyPedia 2015 Top LinksCLICK HERE

NSW HETI – CLICK HERE

Life in the Fast Lane – CLICK HERE

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We wish you all the best with your exam and WBA preparations!

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12 thoughts on “Emergency Medicine Fellowship

  1. Hey Andrew. I just got around to looking through your site. This is amazing! You have done a fantastic job – really well set out and answers all the questions everyone wants to know preparing for the exam. Thanks so much!

  2. Hi Andrew, many thanks for putting these resources online. I am sure you have spent countless hours in putting them together and shed a lot of blood and sweat in the process. Thanks very much for making them available to us trainees. Much appreciated !!!🙂

  3. Obviously the new FACEM Exam is imminent for 2015 with the last exam in the current format to take place on the 25th of October.

    The plan for this page is to adjust the content for the new exam:

    1) modified VAQ
    2) MCQ
    3) OSCE

    we will endeavor to update this page between now and the end of 2014.

    The other content from this page will be moved to a new page about the “continuous assessment” of the curriculum which will replace the short and long cases.

  4. Nice Job – you need some more SAQs in the new format. Good job with the MCQ recalls – keep them coming

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