I regularly get asked how to prepare for the MCEM and what the exam
actually entails so I thought I'd start this section with a bit of an overview of
the exam, some of the problems you'll face when revising and a few top
tips
Background to the Membership Exam
Ok, so the old style 'Casualty' exam was run by the Royal College of Surgeons of
Edinburgh and was known as the FRCS(A+E) - this exam was actually still
running up until about 2007 but has now been phased out so you'll no longer be
able to take it. You will see people around though who have both the MCEM and
the old MRCS(A+E) - don't be impressed by that, they're just showing off.
Following the formation of the Faculty of Accident and Emergency Medicine the
new exam was the MFAEM (guess what that stands for) and this came into being
within the last 6 or 7 years (I think). The format was identical to the current
MCEM, the only difference being the name change and a few more spelling
mistakes on the exam papers.
Now that the FAEM has achieved College status and become the College of EM
the exam has changed accordingly to become the Membership of the College of
Emergency Medicine (i.e. what you'll be doing soon). Anyone who took the exam
when it was the MFAEM automically changes to MCEM.
Are you with me so far? Essentially we've gone from MRCS(A+E) --> MFAEM -->
MCEM. And now comes the good bit........if/when our College achieves Royal
College status the exam will change yet again to MRCEM !
The only other thing to mention is that soon it will become impossible to be a
specialist in EM without having taken the College exams (MCEM and then
FCEM). This is of course a good thing for our specialty as we're starting to define
standards and demonstrate that to do our job requires specific skills and training.
So that's the background to the exam and how it all came about. Lets look at the
exam itself in a bit more detail.
MCEM Part A
This is the multiple choice question part of the exam. I won't lie to you, it's a bit of
pain (to put it mildly).
The stated aim of the part A is to test the basic sciences as they relate to
Emergency Medicine practice. Unfortunately as we see pretty much everything in
the ED this means that the exam covers a huge range of material. Probably the
best way to revise for this is to practice doing as many basic science MCQs as
you possibly can. Everyone works differently and has their own style of learning
but I would strongly suggest that you don't want to be trying to read large
anatomy and physiology textbooks cover to cover.
A far more efficient approach is to get hold of as many relevant MCQs as you
can (and they can be from anywhere - think laterally, borrow MCQs from the
FRCA part 1, MRCS and the MRCP) do them, look at where you messed up and
then focus on revising your weakest areas.
The key to this part of the MCEM really is just practicing doing MCQs over and
over again, seeing where you're going wrong and then focusing your revision on
those key areas. The more MCQs you do the better your chances in the exam.
I'm not convinced that courses are much help for the MCEM A (although you'll
have to decide that one for yourself) as it essentially comes down to hitting in the
books and lots of practice.
Key areas to look at (and which regularly come up):
Anatomy (upper and lower limbs, dermatones, nerve innervation of
muscles)
Physiology (renal, cardiovascular, respiratory)
Surface anatomy for key structures
Pharmacology (commonly used ED drugs and their interactions)
Obviously this is far from exhaustive but you need to understand all the above
topics very well.
MCEM Part B
The Part B is more about testing your ability to interpret investigations and
the practical application of knowledge. The structure used is the Short Answer
Question. The typical question involves giving you a piece of data (e.g. an XRay)
and then asking you for a diagnosis, questions about management of the
condition you've diagnosed and then potential complications.
The key here is detail. It's very easy to fail this part of the exam if you just answer
superficially. If you're given an ECG showing an actute STEMI for example then
you'll get almost no marks for just stating that there is ST elevation. You need to
be able to comment on the territory of the infarct, presence of reciprocal
changes, the presence or absence of any arrythmias etc... In a similar vein, when
asked about management, simply saying 'thrombolysis' wouldn't get you much
credit, whereas stating you'd thrombolyse with tenecteplase (and giving a specific
dosage, route of administration etc...) would earn you full marks.
Try to practice answering SAQ style questions as frequently as possible and do it
under exam conditions with a set time limit. People often encounter difficulties as
they don't use their time in an efficient manner and end up not being able to
answer all the questions. Remember that these are short answers, not essays.
Use bullet points where you can and be concise but specific.
MCEM Part C
The final hurdle and probably the most difficult section of the exam. The Part C is
all about demonstrating your clinical skills.
The exam format is typically a series of OSCE stations (between 15-20) - you
start at one station and rotate round them sequentially with around 8-10mins for
each station. A wide variety of subject matter is fair game for testing although
some things are pretty much guaranteed to be there (e.g. a life support scenario).
Remember that this is a Membership exam and so they really do expect a very
high standard (-I would certainly advise that your exam technique should be at
MRCP PACES level).
Stations encountered before:
- Psychiatric history taking
- Hip joint examination (but also could get hand, shoulder, knee, ankle)
- Examination of CVS / Resp / Abdominal / Neuro inc Cranial nerves then present
findings
- History taking (I had a patient with jaundice, had to take history then present
and answer questions on Ix and Mx)
- Consent for a procedure (e.g. thrombolysis)
- Practical skills (inserting a chest drain, urinary catheterisation, obtaining IO
access)
- Life support station (Paeds resus, choking adult etc...)
- Managing a difficult situation (e.g. 15 year old with probable STD - needed to
persuade mum to leave room)
- Communication skills - (e.g. explaining / demonstrating inhaler technique)
- Obs and gynae - PV / speculum exam
Anyway, you get the idea........!
No-one's ever quite sure of the best way of preparing for the Part C. What works
is, pretending it is simply another day in the ED and each station is just another
patient you are seeing (albeit with 2 examiners watching you). Although your
clinical skills and knowledge are obviously vital, you need to be confident and
able to give a polished performance - one of the things the examiners are
thinking is 'would I want this person as my Registrar?'
Use your day to day practice as revision - treat every patient you see on the
shop-floor as if they were in the exam and practice examining them thoroughly.
Ideally persuade an Specialist Registrar / Consultant to watch you doing it and
give you critical feedback afterwards.
In the actual exam focus on each station and forget about stations you think you
did badly on. You can have a horrendous start to the Part C but by putting it out
of my mind managed to go on and make up the marks elsewhere.
You'll come across some stations that you think seem very easy (e.g. one which
involved inserting a urinary catheter) but don't get lulled into a false sense of
security - you need to be absolutely flawless in your approach, remember to
explain to the patient what you're doing at all time and always remember simple
things like handwashing and patient privacy.
The exam itself is pretty fair. Having done the MRCP and the MCEM, the MCEM
is far more reflective of what you do on a day to day basis and feels a much
better test of your skills than, for example, the MRCP.
Problems with revising
1) Finding the time
This is never going to be easy - especially if you're working in EM where the
shifts are often at anti-social hours and leave you feeling too knackered to revise.
As with everything you have to find what works best for you. If you work best in
the morning then try to set aside an hour (or even half an hour) before going to
work or if you work best in the evening then try to find a similar period after work.
Avoid revising immediately before going to bed though.
2) Don't be over ambitious
You'll be tempted to plan things in too much detail and be over-realistic in terms
in what you can achieve in a given time-frame. It's much better to set limited
goals that you know you can manage rather than setting yourself impossible
targets (which when you fail to achieve them leave you feeling demoralised and
fed up). If you're planning a revision timetable then make sure you keep some
days free and allow for unexpected things to occur which might disrupt your
schedule.
3) Revising with friends
Some people find this useful, some don't. If you're going to do it make sure it's
with people who are just as focussed as you Have a plan for each revision
session and make sure everyone has clear goals and expectations.
4) Adapt your revision to the part of the exam you're taking
Sounds obvious but for the Part A it's mainly bookwork, Part B combines
bookwork with practicing making short notes on topics and Part C relies on
developing your clinical skills to a high standard (i.e. seeing patients not books!).
Oxford Handbook of Emergency Medicine
This is the core text for the exam. I really would try to learn it inside out and back
to front.
ECGs for the Emergency Physician (Mattu and Brady)
You'd be seriously unlucky to come up against an ECG in the exam which wasn't
covered by this fantastic, easy to read ECG textbook, written by the EM guru of
ECG interpretation Amal Mattu. The book is divided into two parts - the first is all
the essential, basic stuff and the second is more advanced ECG interpretation.
Surface Anatomy (Lumley)
Good for knowing your landmarks for various anatomical structures - questions
on surface anatomy occur relatively frequently in the part A especially.
The Emergency Medicine Manual (Dunn)
Probably a bit too much detail for the MCEM but useful revision text for the
FCEM. It's only available from the Australian publishers - so do a google search.
Practical Fracture Treatment (McRae)
Some useful info for the exam but probably more useful for day to day practice
on the shopfloor with clear concise information and nice diagrams/illustrations.
Useful Website
http://www.mcem.org.uk/
www.collemergencymed.ac.uk
Mr Varadarajulu Suresh FRCSEd FCEM
Consultant in Emergency Medicine
Columbia Asia Hospitals
Bangalore email : julusuresh@gmail.com
thank you dr. suresh ,... this article is of a lot of help ..... very comprehensive and succint ... it will help aspiring candidates like me to develop a study plan ...
what do you think are the prospects of MCEM in INDIA..
having been trained in a speciality for 3 years do they really get the recognition for their training?
not getting angry, there are no fellowships in critical care in the US after emergency medicine. the only fellowships you get are in peds EM, EMS, wilderness medicine, ultrasound in EM, international EM, hand surgery....
thats it.
Critical care fellowships are limited to internal medicine graduates...
believe me if you want to...
critical care is a part of training in EM.... and its essential to see, how you can further your care ... but its not a subset of EM.
I agree with Morpheus that Critical Care Training is a part of EM training. I am not in a position to comment on the training in US. However, it differs slightly in the UK
The College of EM does allow for a Dual Accreditation in Intensive/Critical Care Medicine and EM. What this means is that the trainee does undergo the stipulated training in Intensive Care and EM and is successful in his exit examinations (taken seperately). After completingsuch training one would be able to split their time between ICU and EM....
