Hello and welcome to my blog. I served a tertiary Emergency Department in Malaysia, and recently qualified for the Membership of Royal College of Emergency Medicine (MRCEM) by examination. Many people have asked me about the process, so I decided to write this blog to provide some guidance. My advise is based on the application process as of 2017, and may not reflect any updated changes in later years, so do check the official RCEM website (www.rcem.ac.uk) for confirmation.
For those unfamiliar, the MRCEM is a 3-part UK postgraduate exam for eligibility into higher specialty training in Emergency Medicine, similar to MRCP for Internal Medicine or MRCS for Surgery. As of 2018, the MRCEM is now a gateway into the new FRCEM parallel pathway for specialisation as an Emergency Physician (see here and here). Following MRCEM, you will then have to meet several criteria and be eligible to sit for the 4-part FRCEM Finals exam which will then enable you to be registered on the National Specialist Register.
The MRCEM may also be used to boost your CV when applying for the local Masters programme. In fact, it is a named extra component on the Master’s programme applicant scoresheet, gaining you more points for each part passed. Entry into the MMed for EM programme is becoming increasingly competitive each year (2017 ratio 3-4:1), and qualifying candidates often differ in scores by mere decimals, so that little extra may make a huge difference.
For HOs and district MOs, passing at least FRCEM Primary (previously known as Part A) will help you secure a place in emergency departments with specialists so that you can be properly trained and supported for Masters. Had I not taken the exam, I may be in Paediatrics now! (Nothing wrong with paeds, but I already had my mind set on EM since my undergraduate years).
The exam is also recognised for entry into emergency medicine training programmes in UK, Ireland and Singapore, but there are many more hurdles to overcome when applying for training overseas. Many have done it though, so it is not impossible.
As mentioned earlier, the MRCEM is a 3-part exam, specifically called FRCEM Primary, FRCEM Intermediate (SAQ and SJP), and MRCEM OSCE. They were previously called MCEM or MRCEM Parts A, B & C, but underwent major overhauls in the format and content over the last 3 years, so many reference books and question banks are still not reflective of the current exam style.
The FRCEM Primary is now a Single Best Answer MCQ paper on basic science. There are 180 questions to be answered over 3 hours. Questions are usually in the format of USMLE, where a clinical scenario is given, and you are asked a basic science question related to the scenario. For example:
A man sustained a deep knife wound across the cheek. Which of the following features of facial nerve injury would not be present?
A. Loss of forehead wrinkling
B. Drooping of the lip
C. Loss of taste to the anterior 2/3rd of the tongue
E. Loss of nasolabial fold
The FRCEM Intermediate now has 2 parts – Short Answer Question and Situational Judgement Paper, of which only the SAQ is required for the MRCEM. The SAQ comprises of 60 clinical scenarios with subquestions worth a total of 3 marks per case. Questions may be on clinical knowledge, practice guidelines, laws, or ethics. For example:
Picture shows a lateral foot X-ray with a fractured calcaneum.
This patient is a construction worker who fell from 2 stories and landed on his feet.
i) Describe the Boehler’s angle in this X-ray. What is the significance? 
ii) What other injuries would you look out for? List 4. 
You have just discharged a patient who had a seizure. You overhear that he intends to return to work as a bus driver.
i) According to the DVLA, how long must a person with a first seizure abstain from driving Group 2 vehicles? 
ii) According to the DVLA, how long must a person with recurrent seizures abstain from driving Group 2 vehicles? 
iii) If the patient does not heed your advise, what is your role in notifying the DVLA? 
Lastly, the MRCEM OSCE has 18 stations on various clinical, teaching, communication and ethical scenarios. Each station is 8 minutes long and scored according to a marksheet, examiner impression and patient impression.
After passing all 3 exams, you will be eligible for membership by examination, and will have your name submitted for approval, which may take up to 15 weeks. Once approved, you pay the membership fee, and you are now a title holder.
I will talk about each component in more detail in another post, so stay tuned!
I have not included the FRCEM Finals in my blog as I have yet to sit them myself. But stay tuned over the years.