MRCEM Taken After Today No Longer Valid for FRCEM Final

Congratulations to the batch who passed their MRCEM OSCEs held in June 2018! You are the last batch who are eligible for FRCEM Final without sitting for SJP.

Beyond this, the FRCEM Intermediate Certificate (SAQ + SJP) becomes the standard criteria for all to be eligible for Final examinations.

There will continue to be a MRCEM OSCE for those interested in obtaining the title, but it is no longer a compulsory exam.

What does this mean for us? Well, PGMSS insists that we need to have MRCEM to register with them for eligibility into the FRCEM structured training programme, unless you somehow already have an active GMC Registration (then you only need Int Cert). This is possible if you were previously a UK medical student who converted your student registration to doctor. I am not sure if you can reactivate it now if you didn’t back then, so better ask the GMC and let me know so I can include it here.

Anyway, I think the OSCE will still be hosted regularly, at least in India, as it is necessary for GMC Registration. With the MTI programme still in place, Indian and Pakistani trainees still need to register with the GMC in order to do their attachment in UK, and for now, only MRCEM is recognised for that. It is unlikely that FRCEM Int Cert will be recognised for registration, as the GMC mandates a clinical skills exam component. Otherwise people will flock to do FRCEM instead of PLAB just to get into UK.

Oh yes, one last note on FRCEM Final eligibility, you must have minimum 7 years experience (including HO) to apply. I apologise if I mislead anyone into thinking you can become an EP within 6 years after medical school if you take this route.

FRCEM Intermediate SAQ

Formerly known as MRCEM Part B, the FRCEM Intermediate SAQ is now a written exam comprising 60 scenarios, each with question stems totaling up to 3 marks. It is, in my opinion, the most difficult of the 3 MRCEM exams, because it tests on a wide range of care that would normally be delegated to primary teams in Malaysia, a lot of OT/Anaesthesia knowledge that majority of ED MOs never got to experience, and a lot of administrative, legal or ethical frameworks that only UK doctors would be familiar with.

Applicants may notice that there is something called FRCEM Intermediate Certificate, for which you have to sit for an additional exam called the Situational Judgement Paper (SJP). It is an ethics exam where you rank best choice of action for each scenario. For now, it can only be taken in the UK and is not relevant to foreginers as it is not required for the purpose of obtaining MRCEM. You can try it if you want, though.

Application

There are a lot more pre-requisites for this exam than the FRCEM Primary. First, you must have passed the FRCEM Primary. Second, you must have completed housemanship. Third, you must have an emergency physician whom you have worked with for at least 3 months support you for this exam.

Again, you apply through the RCEM website. The exam is usually held in March and September, but application windows open about 3 months before. Check the dates here.

You’ll need to supply the following documents before the closing date:

– MMC full registration certificate (original and translated)

– Alternative Certificate of Foundation Competencies (completed and signed by an emergency physician who has worked with you for at least 3 months)

The ACFC is a checklist detailing all the knowledge, skill, communication, ethics and professional competencies expected from a UK Foundation Officer (their version of HO) who would be eligible to sit for this exam. It is available here and should be dated no less than 3 years from the exam date. It is 8-10 pages long with tiny wordings requiring signatures every row. Please give your EP plenty of time and roti canai to go through it. More than one EP can sign it, but there must be a main supervisor whom the RCEM will contact. Make sure your EP puts down an e-mail address they actually check!

You will be asked to choose an exam centre. The nearest is India, which has many centres, but the cheapest flights are usually to Chennai or Hyderabad. Regardless of where you choose, there will be an admin fee of RM1000+ to be paid to the exam centre on top of the exam fee of £305. If you take the exam in UK, you do not have to pay an admin fee, but travel costs are significantly higher.

After that, there will be a period of waiting as the RCEM checks your documents and contacts your supervisor. Make sure your main EP provides an active email address that is regularly checked.

Once your application is approved, you will be asked to pay the exam centre admin fee by foreign telegraphic transfer, and both RCEM and your exam centre will issue you the confirmation letters.

Your headache isn’t over yet.

India Travel Visa

Unfortunately, you cannot willy-nilly fly to India and just walk through customs to get a chop. You must apply for a visa before you travel, either eVisa or Regular Visa. Both applications can be accessed here. (Be wary of scam sites that look very similar.)

E-visa can be done fully online, and thus has the advantage of convenience and speed. The process takes only 3 days, and they sometimes do it overnight or over the weekend. There is also a separate counter for eVisa at the airport, bypassing the much longer regular visa queue. However, it is only valid for 3 months from date of approval, so don’t apply too early. Once used, the visa remains valid for 60 days, and you can enter India a 2nd time within that period, which is usually not long enough to sit for MRCEM OSCE. You are limited to only two applications per year, then you have to apply for regular visa.

Regular visa requires several visits to the Indian embassy in KL or Penang for submission and collection. The good thing is it grants you a slightly longer validity period for about the same price, so you can use the same visa to sit for OSCE. To apply for the regular visa, you again visit the visa website and download the application form for regular visa. Complete that form and compile your documents, then drop them over at your nearest Indian Embassy. They’re quite fast, so you can expect to hear back within the promised number of working days.

Don’t forget to bring a copy of your visa when you fly!

Chennai

I took my FRCEM SAQ in Chennai, so I am only able to discuss this.

The exam hall is usually in the nursing college next to the Ambattur Road Apollo Hospital. The exterior is hot and humid like Malaysia, but the exam hall is as cold as Singapore’s NUS exam hall, so again, gear up with a jacket and heat pads.

Logistics will probably be your biggest challenge. The exam centre is far from the city centre, about an hour away, and there are no lodgings near it. The nearest that I could find was Oyo Rooms Preetham Nivas, which is still 15-30 minutes drive away from the exam centre.

Speaking of transport, taxis and took-tooks are notorious rip-offs, scammers and double-crossers, and they often don’t know the way. Fortunately, Uber and Ola are reasonable options there, but you’ll need mobile data, which I could not find there. I usually use an uber to get to the exam centre, then bite my lips as I pay double to get back with a took-took. The airport is about 30-40 minutes from the city centre, so your best option is to catch a taxi. Government taxis are the safest because you pay a fixed sum up front, but they will still harass you for extra pay when they get you to your destination. Sorry, need to back track, before you even get onto the taxi, the driver’s assistant will demand tips for leading you to the taxi. Prepare LOTS of 50-rupee bills; you will be doing this a lot, everywhere.

Food in Chennai is priced equivalently or cheaper for the Malaysian pockets, and tastes familiar since they’re largely Tamil dishes. I never got traveler’s diarrhoea either, so the people who wrote the chapters on traveller’s diseases probably just have paper guts (haha!). Try their kopi tarik; really nice and costs <RM1 a cup.

FRCEM Intermediate SAQ

Finally, we reach the part you went through all that trouble for. Let me refresh your memory. 180 minutes to complete 60 scenarios, each with variable number of questions requiring short answers that will total up to 3 marks. Scenarios may call for clinical knowledge, procedural knowledge, basic science knowledge, ethics, laws, admin and protocol, etc.

The possible topics are very very broad. Going in without much intel since I was again among the guinea pig batch as they fine tuned the exams, I resorted to studying the clinical components for other college exams ie MRCP, MRCS, MRCOG, FRCA, etc. Fortunately, by now there have been many precedences and I think one can easily search for the many available MRCEM Telegram study groups to obtain the past questions.

My advise is to be very textbook. I know Malaysian practice tends towards inserting size 28-32Fr chest tubes for spontaneous pneumothoraces, but the UK guidelines does needle aspiration first and then proceeds to size 14-16Fr chest tubes if needle aspiration fails.

The few ethics and legal questions will also trip Malaysian candidates. If you are confident in your clinical knowledge then these won’t be enough to pull you under the fail line. But if you want the extra confidence, feel free to visit the GMC website on Good Medical Practice, and read on the Mental Health Act 2005 and some driving license guidelines on the DVLA website.

Results

Like the other papers, your results will be out in 3-4 weeks from the exam day. Look up the Results page in the RCEM website. Look for your candidate number and beside that will be your result – either Pass or Fail. Another 2-4 weeks later, you will receive feedback on your performance, in comparison with your cohort.

Good luck!