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Overview of MRCEM/FRCEM

  • October 08, 2020

The Royal College of Emergency Medicine offers a range of examinations which will lead to the award of the Membership of the Royal College of Emergency Medicine (MRCEM) or the Fellowship of the Royal College of Emergency Medicine (FRCEM) of the College.

In August 2018, those two separate examination routes were updated and merged to create a single suite of examinations. Now, the successful completion of all exam components will lead to the award of Fellowship of the College (FRCEM). However, candidates who do not want to complete the entire suite of exams will still be able to obtain Membership by Examination (MRCEM).

Once you have achieved either FRCEM or MRCEM both qualifications will be considered an acceptable GMC postgraduate qualification, thus eligible for registration.

The FRCEM examination suite consists of the following exams:

  1. FRCEM Primary Examination - £310
  2. FRCEM Intermediate Certificate
    a. Short Answer Question Paper - £305
    b. Situational Judgement Paper - £200
  3. FRCEM Final Examination:
    a. Critical Appraisal (Short Answer Question Paper) - £300
    b. Quality Improvement Project (QIP) - £150
    c. Clinical Short Answer Question Paper - £240
    d. Objective Structured Clinical Examination (OSCE) - £420

For those aiming to complete MRCEM, the exam suite is:

  1. FRCEM Primary: (or MRCEM A before August 2016)
  2. FRCEM Intermediate SAQ (or MRCEM Part B Before August 2016)
  3. MRCEM Part OSCE (previously called part C) - £450

Please note that candidates who have been awarded MRCEM prior to August 2018 are eligible to sit the FRCEM Final Exams and are not required to complete the FRCEM Intermediate SJP.

1. FRCEM Primary Examination

The FRCEM Primary Exam is a direct replacement for the MRCEM Part A exam and will continue to assess the RCEM Basic Sciences Curriculum. The paper is three-hours long and contains 180 single-best answer questions.

The exam is conducted in English and candidates are advised that IELTS Level 7 is the expected standard for completion of all FRCEM examinations. There have been some content changes from the old MRCEM Part A exam that you should note. First, there are no longer any clinical scenarios or biochemistry questions. Second, Haematology is still present but it has been merged with the Pathology section.

Exam composition:

  • Anatomy (60 questions)
  • Physiology (60 questions)
  • Pharmacology (27 questions)
  • Microbiology (18 questions)
  • Pathology (9 questions)
  • Evidence-Based Medicine (6 questions)

How do I prepare for FRCEM Primary Exam?

We advise that you start preparing for your exam at least 6 months in advance and the Royal College recommended textbooks should help you cover each of the areas tested in the exam. The two topics which account for two-thirds of the marks are Anatomy and Physiology so it would be logical to focus most of your revision on those two areas. Nevertheless, do not neglect the other topics – it is important to cover all areas.

            What is a single-best answer question?

In MRCEM Part A, the exam asked multiple-choice questions however, they have now changed the FRCEM Primary Exam to ask single-best answer questions. The examiner will now be testing your order of thinking, such as application and evaluation of knowledge, rather than a true or false style question that was previously used.

A standard single-best answer question will typically have three parts:

  1. A statement or a clinical scenario
  2. The question
  3. The answer options, which will include one single correct answer


2. FRCEM Intermediate Certificate

The FRCEM Intermediate Certificate has replaced the MRCEM Parts B and C. The FRCEM Intermediate Certificate is awarded on completion of the following:

  1. Short Answer Question (SAQ) paper which compiles of 60 3-mark short answer questions in 3 hours
  2. Situational Judgement Paper (SJP) consisting of 120 single-best answer questions in 2 hours

What is the FRCEM Intermediate Short Answer Question (SAQ) Paper?

The exam will last for 3 hours and you will be asked 60 3-mark questions and will cover the 2015 Emergency Medicine Curriculum.

Please note that all MRCEM Part B passes received before August 2012 are deemed time expired. All candidates are allowed a maximum of six attempts for the FRCEM Intermediate SAQ Paper and previous attempts of the MRCEM Part B exam will not be counted towards your attempt at the new paper.

Exam test areas:

  • General Medicine
  • Toxicology
  • Trauma and Orthopaedics
  • Paediatrics
  • Surgery
  • Anaesthesia
  • Ophthalmology
  • ENT
  • Maxillofacial Surgery
  • Obstetrics and Gynaecology
  • Ethics and Law

What are short-answer questions (SAQs)?

A short-answer question will require you to formulate an answer based on the information given in the question without having the advantage of having an option to choose from. Typically, they will pose as a clinical scenario followed by a list of questions that requires specialist knowledge.

How do I prepare for the Intermediate Short Answer Question (SAQ) Paper?

The FRCEM Intermediate Exam does not require as much volume of knowledge as the FRCEM Primary Exam, but it is still a difficult and challenging examination. Most of the questions will take on the form of data interpretation, such as blood tests, an X-ray or an ECG. Similarly, to the Primary Exam, we advise that you start preparing at least 6 months in advance to your exam. In addition, it is important to practice answering questions under timed conditions to give you a realistic experience of what to expect in the exam.

What is the FRCEM Intermediate Situational Judgment (SJP) Paper?

In Autumn 2017, the FRCEM Intermediate Situation Judgement (SJP) Exam replaced the MRCEM Part C. The FRCEM SJP Exam will last for two hours and the paper will consist of 120 single-best answer questions. Please note that candidates will be permitted a maximum of six attempts for the SJP and previous attempts at the MRCEM Part C Exam will not be counted towards the number of attempts.

The SJP will present you with hypothetical but realistic clinical scenarios and you will be asked to choose the most effective action from a series of potential answers. The questions will assess you against the Common Competencies Emergency Medicine Training Curriculum 2015 and will test you in the following areas:

  1. Patient Focus (25 Q’s)
  2. Problem Solving (15 Q’s)
  3. Decision Making (15 Q’s)
  4. Team Working (25 Q’s)
  5. Time Management (10 Q’s)
  6. Self-Awareness (10 Q’s)
  7. Professional Integrity (10 Q’s)
  8. Professional Development (10 Q’s)

Please note that as the exam is relatively new and doctors have limited experience taking it – there is little information on what to expect from the exam – but we will keep you updated where we can.


3. FRCEM Final Examination

FRCEM Final Examination:
a. Critical Appraisal (Short Answer Question Paper) – 90 minutes
b. Quality Improvement Project (QIP) – completed during ST4-6
c. Clinical Short Answer Question Paper – 3 hours of paper of 60, 3-mark questions
d. Objective Structured Clinical Examination (OSCE) – 16, 8-minute stations

Please note that as each component tests different skills and knowledge all candidates will be able to apply and sit each exam independently. 

Critical Appraisal (Short Answer Question Paper)

Topic areas:

  • Major and Acute Presentations
  • Paediatric Practical Procedures
  • Practical Procedures
  • Ultrasound
  • Core, Major and Acute Presentations
  • Common Competencies
  • Anaesthetics Competencies
  • ICM within ACCS
  • Acute Presentations -

FRCEM Final OSCE Curriculum Areas Assessed:




Core Acute





Core Major


Common Competences


Common Competences


Anaesthetic Competences



Paediatric Resuscitation


Paediatric Acute


Paediatric Major


HST Major


HST and Adult Acute


Practical Skills


Paediatric Practical Skills


Non-Technical Skills

What should I expect in my FRCEM Final OSCE Exam?

Your OSCE Exam will be very similar to the PLAB 2 Exam. The purpose of the exam is to test your ability to apply your knowledge and experience to the care of patients, rather than examining your ability to remember facts.

During the exam, you will find different scenarios at each station which will consist of an actor or manikin playing the patient and you will be observed by an examiner, either in person or via a remote camera. The exam will not be recorded and typically examiners do not intervene, except in limited circumstances.

Remember not to talk to other candidates or write down any details about the exam while you are taking it. You cannot bring books, a mobile phone or a smartwatch into the exam.

Can I sit the FRCEM overseas?

The Royal College runs several examinations overseas (India, Singapore, Oman and Iceland). For further details on sitting your exam overseas visit the Royal College’s Page.


BDI’s Advice to help you pass

  1. Preparation is key – It is important to give yourself over 6 months to revise for each exam and that you revise thoroughly and comprehensively as all the exams are very tough.
  2. Utilise the curriculum – The Royal College’s 2015 Curriculum will strongly aid you in your revision. Although the document is very large it is very representative of the exam content – an opinion of those who have taken all the exams.
  3. Use varied revision resources – Using a mix of online revision resources, textbooks and perhaps a revision course will help you keep your learning varied and thus you will be more likely to obtain the information you are learning.
  4. BDI Resourcing work closely with “FRCEM Exam Prep” who are the longest established and most experienced provider of online revision courses for the Royal Collee of Emergency Medicine (RCEM) examinations. Access to courses starts from £35.

If you are an IMG who wants to relocate to the UK and work for the NHS then send your CV to [email protected] – and one of our Specialist Advisers will be happy to guide and support you through your journey to the UK. We look forward to hearing from you!


“The Royal College of Emergency Medicine”. (2018). FRCEM Primary Examination Regulations and Information Pack.

“The Royal College of Emergency Medicine”. (2018). FRCEM Intermediate Certificate Examinations Regulations and Information Pack. 

“The Royal College of Emergency Medicine”. (2018.) FRCEM Final Examinations Regulations and Information Pack. 

“Medical Exam Prep”. (2018). Tips for the FRCEM Primary.

Please note that this information is just a guide and for detailed information on the FRCEM exam please contact the Royal College directly.

Originally posted: 03/05/2018
Updated: 08/10/2020


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