My Experience with FRCEM Primary

The FRCEM Primary is the first MRCEM exam, and is making its way to become the commonest external paper held by ED MOs in Malaysia, especially Masters applicants. It is a basic science exam similar to PIAEM, although many have remarked that the FRCEM Primary is more difficult due to its wider scope of topics. It is quite common to see PIAEM applicants taking FRCEM Primary as both exams are held about 1 month apart.

The exam is held twice a year, usually June and December. The nearest exam centre to us is Kuala Lumpur.

My first advice for you is to plan ahead and don’t miss key dates.
You must first register an account on the RCEM website. Most of the details required are straightforward, and it’s free.

Next, you wait for the opening date for application for the FRCEM Primary, which is available here and updated regularly. Be aware that the application date usually closes 4 months before the actual exam date.

All you need for registration is £310.00 and upload a copy of your current MMC registration (provisional or full). Our MMC cert is in Malay, so candidates have to submit both the original and a translated copy. Translation has to be done by a credible authority, which means:

– High Court
– Malaysian Translator’s Association (MTA/PPM)
– Institut Penterjemahan dan Buku Malaysia (ITPM).

Commissioner of Oath or independent translators are not accepted, unless they are certified by any of the 3 authorities mentioned. Translating the certificate takes about a week and costs ~RM50.

During the application, you will be asked to select your preferred exam centre. They force you to provide a first and second choice, but historically everyone has always gotten their first choice. The exam centre is in KL; exact venue I do not know; candidates do update me please.

After you apply, the RCEM should update you within a month of your application if they need further documents. Make sure you look out for that because they can reject your application if you don’t respond and you will have to wait for the next sitting 6 months later. If all is well, they will send you a confirmation letter and your exam placement a month before the exam date.
Exam Content and Preparation

The exam format consists of 180 Single Best Answer MCQs, covering:

  • 60 questions on Anatomy
  • 60 questions on Physiology
  • 60 questions on Pharmacology, Microbiology, Pathology, and Statistics

The (not very specific) curriculum can be found here (pg 7). Official sample questions are available here. You can definitely get a better picture from question banks and the Revision Notes book.

Questions usually begin with clinical context then zoom in on a relevant basic science question from it. For example:

This patient presented with progressively severe shortness of breath following a week of fever and cough. You treat him for severe pneumonia and, anticipating respiratory failure, have intubated him. He weighs 70kg. What initial tidal volume will you set for this patient?
A. 70ml
B. 140ml
C. 250ml
D. 420ml
E. 700ml

You are treating a patient for myocardial infarction in cardiogenic shock and have started him on noradrenaline. Which of the following best represents the adrenoreceptor activity of noradrenaline?
A. Only α effects
B. α = β effects
C. α > β effects
D. β > α effects
E. Only β effects

Disclaimer: These are simulations in the same style, but not the actual questions that appeared in my exam.

The pass mark is not fixed, but is based on the Angoff method, which means ‘what a panel of examiners feel minimally qualified candidates should be able to achieve’. I suggest a safety line of >65% to be considered a pass. Usually around 33% of candidates pass this exam. When I sat it in 2016, the pass mark was 54% and around 35% of candidates passed. But subsequent batches needed >60% to pass and had about the same pass rate.

Personally, I felt the level of knowledge required is a bit more than undergraduate basic science exams, and with less time. The nearest comparison I can think of is USMLE Step 1, except Step 1 has way more depth in biochemistry and pathology, but less in anatomy.

My practice questions were:

  • Get Through MCEM Part A (still in the old true/false format)
  • FRCEM Exam Prep
  • FRCEM Success
  • MRCP/MRCS Part 1 practice questions that I scavenged off my MOs (MRCS is very good for anatomy, MRCP is good for the rest)

My reference texts were:

  • General: Revision Notes for MRCEM Part A (latest version says FRCEM Primary), First Aid for USMLE Step 1 (whichever year is fine)
  • Anatomy: Clinical Anatomy by Harold Ellis
  • Physiology: Constanzo Physiology + Guyton & Hall for cardio, respi, renal
  • Pharmacology: Rang & Dale
  • Pathology: Robbins Basic
  • Microbiology: Made Ridiculously Simple

If it looks like I read a lot, it’s because I had 2 years of HO to prepare, and I only used them for details I didn’t understand as I did the practice questions. Those on a tighter schedule should focus on anatomy and physiology, then use Revision Notes to cover the rest.

I did the practice questions and read the revision notes, anatomy, and physio texts at least twice. That still didn’t prepare me for the tricky or trivia questions, but I saved a lot of time on straightforward ‘know or don’t know’ questions.

Clutch time started around 1 month before the exam, during which I just did 3-hour exam simulations or studied Revision Notes. Fortunately, I was floating at the time, and my department was considerate enough that they didn’t give me much responsibilities except that I show up to punch in and help around when it’s really busy.
The Exam Day

As of June 2018, the exam will no longer be held in Singapore. Instead, Kuala Lumpur will be the new SEA centre for Primary from December 2018. Would appreciate if candidates can update me on this.
After the Exam

The RCEM will release the results on their website and to your email about 3-4 weeks after the exam date. They will first inform you if you have passed or failed. About a month later, they will send you feedback and the breakdown of your performance.

Good luck!

Published by

Code 001

Previously served in a West Malaysian ED, I became an MRCEM diploma holder in 2018. I started this blog to help those interested in pursuing the exam, whether to aid in their Malaysian Masters in EM application or the new FRCEM Parallel Pathway. Feel free to ask questions under the relevant posts.

11 thoughts on “My Experience with FRCEM Primary”

  1. Hi, would like to ask… Do houseman eligible to take FRCEM primary exam? Or have to wait till obtained full MMC number ?


    1. Yes you are. Many people have applied with provisional registration. It helps to secure your position in an ED too.


      1. hello thank for the informative sharing. I would like to ask for Frcem primary, if we requested to take it oversea(malaysia). where would it be and how can we pay for the local fees


  2. Hi how r you?…hope you are doing well…may i ask something..usually how long does it take for the frcem website to confirm our registration for the exam….i have completed my registration and made payment last week (deadline is 5ht september), but still havent heard if it is accepted or not..kindly help me out on this…thanks


    1. Sorry, I stopped receiving notifications when people comment, so I did not notice you until now. I’m not sure if your problem is resolved, but I will answer based on my experience. I was informed regarding errors in my application about a week after the closing date. I rectified the problems and received confirmation of placement about a month before the exam date.


  3. Hi Doctor.Thanks for your sharing, but I would like to ask can a medical graduate who is currently waiting for housemanship takes primary?


    1. At this point of time, based on exam information from the RCEM website (which you should check again yourself when you intend to apply), you can apply if you graduated from a medical school recognised by the GMC and hold a medical registration with an assigned number.


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