Author: Charlotte Davies / Editor: Nikki Abela / Codes: CC21, CC23 / Published: 28/08/2018

It’s nearly time for the FRCEM final SAQ, and to help we’ve updated one of our old posts (FCEM tips by @Fraz65), and added a few more pearls of wisdom. These suggestions may be helpful for the intermediate SAQ too – some of them are pretty generic.

The Alison Gourdie Medal

Alison Gourdie was a highly respected Emergency Physician and by all accounts would have been a major figure in the development of the specialty. She had just been appointed to her first Consultant position at Stirling Royal Infirmary when she died tragically in a Himalayan plane crash at the age of only 34. The Alison Gourdie Medal has been awarded in her honour since 2004 for the top performance in both MCEM and FCEM. I was fortunate enough to win the medal for FCEM in 2013/14 (it wasn’t FRCEM then).

Anyone who has passed the fellowship exam knows that it takes over about a year of your life. Thats if you’re lucky and make it through first time. The (now defunct) CTR involved months of painful revision and corrections. The exams then take six weeks to complete so its a long and intense period.

I had rather carelessly left all five parts of the exam until a few months before my CCT date, and returned from a registrar position in Melbourne shortly before the SAQ. Whilst I hit the books regularly whilst working on my tan, I made the extra investment on several revision courses and signed up to all manner of websites.

The critical appraisal was first up at the end of April, followed by the SAQ. The questions ranged from the frankly bizarre (spider bites?) to the commonplace (sepsis and glaucoma). After that, there were five to six weeks until the OSCE and vivas. The OSCE took place in the Royal College of Anaesthetists; it was fairly similar to MCEM but tougher overall, with many more communication stations. It went pretty well but I’ve still got no idea how to insert a wrist block, and the informed consent station still has me baffled.

I took the Kings management course a couple of weeks before the (now not used) exam and got as much practice as I could. I learned to use phrases that I never knew existed before (doctor in difficulty, information gather). My CTR was criticised so badly at the Birmingham FCEM course that I wondered if there was any point in turning up for the exam! It seemed to go OK on the day though, and then it was all over. I headed off into Leeds for some champagne and sushi and an anxious month-long wait until the results would be released.

I was on holiday in Italy in July when I found out that I’d passed all five components of the FCEM. It was a huge relief after months of self-doubt and stress. Two months later the College emailed me to tell me that I’d won the Alison Gourdie Medal. It was totally unexpected and I thought that they must have made some sort of mistake. I had never won anything of an academic nature before. In fact, I hadn’t won anything of any nature before so I was absolutely delighted. I attended the awards ceremony in December and it was the biggest honour of my career to be presented with the medal at the Royal Festival Hall.

My top five tips for approaching the FCEM:

1) Use a wide range of media to source knowledge. Podcasts like EM:RAP and websites such as Hippo:EM are great resources and it doesnt feel like real studying.
2) Splash the cash and attend as many courses as you can. The knowledge gained on these goes well beyond the exam, and the cost is offset by not having to pay to re-sit.
3) Start your QIP early, and get it ripped apart by someone who knows what they’re doing. Email the lead authors of your main papers to get opinions on future developments. Print everything out and have it colour-coded in a folder. This looks slick and professional and means that you wont get caught out on the day.
4) RCEMLearning is a high-yield resource that involves contributions from College examiners. Do as many modules as you can and copy and paste notes onto Evernote to read later.
5) Beg, borrow and steal past exam papers and topics. Do as many as you can. Book learning is good for reference, but the breadth of knowledge required is too broad for this to be valuable on its own.

2018 Update

We’re not examiners, so these tips all come from our personal experience of sitting the SAQ — we found that the hardest thing was actually just knuckling down to revision. Please add your tips, hints, and resources in the comments section, or on Twitter.

Before the Exam:

– Revise properly and don’t convince yourself watching Holby City counts as revision! There’s a blog on Time Management – you could read it…or that might count as procrastination.
– consider forming a revision group, and writing a question bank together. The final SAQ examination is designed to test your knowledge, as well as your clinical reasoning and logic. When writing questions try to write questions that have clear answers, test thinking rather than purely knowledge, and are of an expected knowledge level (not esoteric).

We’ve suggested that you write questions because:
– writing helps you think about “the mind of the examiner”
– writing the question helps you revise that curriculum area
– it means everyone has more questions to revise from
– questions need an educational answer, and relevant links – a good way of “filing” your revision notes.

– know the syllabus- the exam information pack has lists of how many questions will be from each curriculum area. There WILL be paediatrics and there WILL be ultrasound.
– revise carefully.
– practice writing with a pencil. Not typing on a computer. Writing. In pencil.
– do as many mock questions as possible – RCEMLearning has so many SAQs, and some of these themes might be replicated in the exam. When you’ve done all of the RCEM SAQs…consider doing the RCEM cases. They’re not SAQs but they’re still testing and informative.
– Twitter is great for keeping up to date and hearing what is topical, so it’s worth a quick look at. However…don’t let it distract you.
– mental rehearsal – Imagine yourself sitting, and passing the exam. Imagine, and practice, sitting the exam under timed conditions – see how well you speed read, and speed write. As well as mentally rehearsing these things, actually rehearse them- do a timed paper.
– use the glossary to help your interpretation of any questions.

On the Day:

– stay calm – know your triggers. If other medics stress you out, stay away. If cramming stresses you out don’t do it. If you like to keep busy and cram – go for it.
Power pose – it’ll help your confidence.

In the exam

– time is against you.
– read the question, then the information.
Sometimes questions say “blah blah blah fox sat on mat. Patient sudden onset headache. Blah blah blah. You think you know what it is and you’ve wasted a lot of mental effort getting to this point. Then the question ends “you think it’s pituitary apoplexy“.
Reading the question helps you to know what information you need from the stem.
– If you can’t answer a question, skip it out – mark it somehow, and come back to it at the end. You might know the answer – but if you think about it for 5 minutes, you might not get to the end of the paper to reach the question you certainly will know the answer too.
– 3 hour exam. 60 questions, each with 3 parts. Thats a minute per “part” – three minutes per question.
– work out the times before hand – at 11am, I will be on question 22 etc.
– if there’s an image, look at the stem, as the clinical stem may tell you what you will see in the image.
– if you don’t know, power guess. If it’s a foot x-ray…liz franc. If it’s an emergency drug…ketamine or adrenaline. There’s no negative marking – so anything is better than nothing!!
You need to be on at least question 20 by the hour mark.

After the Exam
– know what de-stresses you. If you need to talk about the exam…go to the pub with medics. If that makes you panic…go to the pub with non-medic friends.
– what’s done is done – wait for results to come out.

Good Luck!!

    The SAQs

RCEMLearning has nearly 100 published SAQs. If any of the SAQs your revision group write are excellent, consider completing the SAQ template and submitting it for publication.

Here are a few of our favourite SAQs.
The acutely injured knee
The Collapsing Child
Feeling unwell in pregnancy, what a headache!
Clubbing in Cambridge
The twitching tot
A Challenging SVT
Salicylic Stress
Doin the tack shed bluess
The Swirl sign, you must act now!

Here are some of our favourite cases
In a bit of a jam
The curious incident of the wolff in the nighttime
Maternal Sepsis
A sickle for your thoughts
The limping child
A pox on it
Hot above the collar
A whole can of worms
If you go down to the woods today
The constraints of hip x-ray
Too much whiskey?
Air Head

Leave a Reply