Passing the FRCEM exams on your first attempt requires strategic preparation, not just hard work. With pass rates hovering around 47% for the Final SBA, understanding how to study effectively separates successful candidates from those requiring multiple attempts.
Understanding the FRCEM Exam Structure
The FRCEM Fellowship requires passing two distinct assessments that test different aspects of consultant-level competence in emergency medicine.
The FRCEM Final SBA
The FRCEM Final SBA is a comprehensive written examination assessing theoretical knowledge and clinical decision-making.
Exam Format:
180 single best answer questions in two papers
90 questions per paper with one-hour break
Four hours total (two hours per paper)
Approximately 80 seconds per question
Computer-based at Pearson VUE centers (transitioning to Surpass platform January 2026)
Questions are distributed across 12 Specialty Learning Outcomes (SLOs) from the 2021 RCEM curriculum. Understanding this distribution is crucial for efficient preparation.
The FRCEM Final OSCE
The OSCE evaluates practical clinical skills, communication abilities, and performance under pressure.
OSCE Structure:
16 stations, each lasting 8 minutes
1 minute reading time per station
Assessment domains: history taking, examination, procedures, communication, resuscitation
Pass requirement: Overall passing score AND at least one resuscitation station (mandatory from November 2025)
The OSCE tests your ability to lead as an Emergency Physician in Charge (EPIC), manage complex scenarios, and demonstrate safe, systematic approaches.
FRCEM SBA High-Yield Topics by SLO
Success requires strategic focus on high-weighted areas. Here's the official question distribution:
SLO Domain | Questions | Percentage (%) | Key Focus Areas |
|---|---|---|---|
SLO 1: Complex Stable Patient | 35 | 19.4% | Cardiology, Neurology, Respiratory, Endocrinology, Gastroenterology, Infectious diseases |
SLO 3: Resuscitation | 40 | 22.2% | ALS algorithms, Shock, Cardiac arrest, Toxicology, Palliative & end-of-life care |
SLO 4: Injured Patient | 35 | 19.4% | ATLS protocols, Major trauma, Head injury, Spinal injuries, Burns |
SLO 5: Paediatric Emergency Medicine | 30 | 16.7% | Safeguarding, Febrile infant, Respiratory distress, Weight-based dosing, Neonatal emergencies |
SLO 6: Procedural Skills | 13 | 7.2% | Sedation (adult & paediatric), Pericardiocentesis, NIV, Lumbar puncture |
SLO 7: Complex/Challenging Situations | 10 | 5.6% | Medicolegal, Mental Capacity Act, Safeguarding, Organ donation, Information governance |
SLO 8: Lead the ED Shift | 7 | 3.9% | Patient flow, Risk management, Clinical governance |
SLO 10: Research & Data Management | 10 | 5.6% | RCT design, Statistics, Diagnostic methodology, Systematic reviews |
SLO 11-12: QI & Leadership | Combined with SLO 8, 10 | - | QI methodologies, PDSA cycles, Complaint management, RCA |
Key insight: SLO 3 (Resuscitation) carries the most weight - prioritize ALS algorithms.
Build a Structured Study Plan
Most successful candidates follow a 6-month timeline:
Months 1-2: Foundation building
20-30 practice questions daily
Focus on cardiology, resuscitation, and trauma
Complete baseline mock exam
Months 3-4: Intensive practice
50-80 questions daily
Add paediatrics and professional topics
Weekly mock exams
Month 5: Refinement
Target weak areas from practice
Complete full 180-question mocks
Master statistics and research methodology
Month 6: Final preparation
Daily full mock exams
OSCE practice with colleagues
Light review only in final week
Need guidance? Contact us for personalized study advice.
Choose Quality Resources
Question Banks: Aim for 1,500-2,000 practice questions. Focus on quality over quantity—detailed explanations matter more than volume. Try StudyFRCEM's free demo to experience SLO-mapped questions with consultant-level explanations.
Essential Textbooks:
Oxford Handbook of Emergency Medicine
Paediatric Emergency Medicine (Cameron et al.)
Official Resources:
RCEM curriculum documents (free)
NICE guidelines for clinical protocols
Resuscitation Council UK for ALS updates
Practice Consistently
Daily question practice is non-negotiable. Start with 20-30 questions and gradually increase to 60-100 by your final month.
When reviewing:
Understand why the correct answer is best
Learn why each distractor is wrong
Identify knowledge gaps
Complete at least 5 full 180-question mocks under exam conditions before test day.
Avoid Critical Mistakes
Don't neglect statistics: SLO 10 provides predictable marks if you understand basic concepts like RCT design, p-values, and sensitivity/specificity.
Practice pacing: You have 80 seconds per question. Flag uncertain answers and keep moving.
Verbalize in OSCEs: Examiners can only mark what they hear. Think aloud and explain your clinical reasoning.
Use current guidelines: Verify your study materials reflect the latest NICE and RCEM protocols.
Exam Day Strategy
For the SBA:
Read the question stem before the clinical vignette
Eliminate obviously wrong answers first
Complete the entire paper before reviewing flagged questions
Use the break to rest, not to stress
For the OSCE:
Start each station with safety statements
Signpost your approach before examining
Don't be afraid to escalate—it shows good judgement
Keep communication clear and jargon-free
Frequently Asked Questions
How long should I study?
Six months with 2-6 hours daily is standard for most successful candidates.What's the minimum number of practice questions?
Aim for 2,000-2,500 high-quality questions with thorough review.Can I pass without doing mock exams?
Unlikely. Mock exams build stamina for the four-hour test and help you practice time management.What if I fail?
You can resit up to 4 times per component. Most candidates pass within 2 attempts with proper preparation.
Passing FRCEM first time requires dedication and smart preparation. Focus on high-yield topics, practice consistently, and use quality resources.
Ready to begin? Register with StudyFRCEM to access our complete question bank today.
