MRCEM Primary Tips

The first step in the MRCEM examination is the MRCEM Primary examination.
The MRCEM Primary Exam Breakdown
The paper is three hours long and comprises 180 single best answer questions. The examination is conducted in English, and candidates are advised that IELTS Level 7 is the expected standard for completion of the MRCEM examinations. 
The exam concentrates on basic sciences and is based on the Royal College of Emergency Medicine Basic Sciences Curriculum
The RCEM Basic Sciences Curriculum should be the centerpiece of your revision.
The RCEM Basic Sciences Curriculum is highly representative of the content that is found in the exam and should form the centerpiece of your revision. 

The following areas are tested in the following proportions:

  • Anatomy (60 questions)
  • Physiology (60 questions)
  • Pharmacology (24 questions)
  • Microbiology (17 questions)
  • Pathology (9 questions)
  • Evidence-Based Medicine (10 questions)
Preparing for the MRCEM Primary
Getting a good grip of the basic sciences takes a great deal of time, and candidates should start preparing at least six months before the examination. A robust textbook covering each of the areas should be used, and this should form the basis of your initial revision. Some suggested texts can be found on the Royal College of Emergency Medicine website.
It would be wise to focus the majority of your revision on anatomy and physiology, which together account for two-thirds of the marks available in the examination. The anatomy syllabus is vast, and most candidates find this the most challenging aspect of the exam to get to grips with. This is where a good understanding of the curriculum will really help you. An example of this is that there are very few muscle attachments that are required knowledge in the examination, but a large number of candidates spend valuable time memorising these. The curriculum is very clear in advising on what is not required knowledge, and it is essential to pay attention to this advice. Most former candidates agree that within the anatomy section of the examination, the upper and lower limb sections tend to be more heavily weighted, and this is also worth considering when planning your revision.
Be regimented on the amount of time that is spent revising the four subjects that are tested in smaller quantities. These can be easier to get to grips with and, on occasion, a little more interesting than the anatomy and physiology curriculum, but it is a mistake to spend too much time on them.
Candidates often underestimate the amount of revision required to prepare for the MRCEM Primary examination, and it is a good idea to start at least six months before the exam.
Candidates often underestimate the amount of revision required to prepare for the MRCEM Primary examination,
and it is a good idea to start at least 6 months before the exam. 
Once you have started to get to grip with the basics of each topic, it is sensible to start to supplement your learning with regular question practice using resources such as our website.
Try to isolate areas of weakness and concentrate on these areas; spend less time on your areas of strength. It is a good idea to use your performance in questions as a benchmark of your knowledge base in each area of the curriculum and use this as a means to support your revision planning. By the time each of you has qualified as a doctor, you will already have sat numerous exams and developed your own preparation methods. It is a good idea to keep using the revision methods that you are used to when preparing for this exam. It is very important not to underestimate the amount of work that is required and to spend plenty of time preparing!
The MRCEM Primary Question Style
The questions in the MRCEM Primary exam are single best answer questions (SBAs)
Single best answer questions are probably the most commonly encountered question style currently encountered in medical exams. They require convergent thinking and the ability to come up with a single answer to a set problem. It is easier for the examiner to test higher-order thinking, such as application and evaluation of knowledge, in an SBA than in the true/false style questions previously used in the old MRCEM exam a few years ago.

Standard format SBA questions usually have three parts:

  1. A statement or a clinical scenario that the question will be asked about
  2. The question itself
  3. The answer options, which will include one single correct answer
An example of a standard SBA question is shown below:
A patient has suffered an injury to their arm that has damaged the inferior posterior cutaneous nerve of the arm.
The sensory function of the radial nerve:
Which of the following best describes the sensory area supplied by the inferior posterior cutaneous nerve of the forearm? Select ONE answer only.
A. The medial half of the palm
B. A tapered strip of the middle portion of the posterior forearm
C. Part of the posterior aspect of the upper arm 
D. The posterior surface of the lateral three and a half digits and the associated areas of the palm
E. The lateral aspect of the palm
Answer: B. A tapered strip of the middle portion of the posterior forearm

In this question, an intimate understanding of the anatomy of the radial nerve is required. The sensory function of the radial nerve is provided by its four main sensory branches:

  1. Inferior lateral cutaneous nerve of the arm – supplies the lateral aspect of the anterior upper arm between the deltoid and the elbow
  2. Posterior cutaneous nerve of the arm – supplies part of the posterior aspect of the upper arm
  3. The posterior cutaneous nerve of the forearm – supplies a tapered strip of the middle portion of the posterior forearm
  4. The superficial branch of the radial nerve – supplies the posterior surface of the lateral 3 ½ digits and the associated areas of the palm 
Sensory function of the radial nerve © Medical Exam Prep
General Approach to Answering SBAs
The answer options will contain one single correct answer and several other distracting options. The question commonly asks for the ‘single most likely’ answer or ‘which single statement is true’. In many SBAs, several of the answer options are correct, but only one will be the ‘best’ answer.
It is generally good to read the question first, which will allow you to see what the main emphasis of the question is. Then scan the answers so that you know what particular kind of answer is required. Finally, read the statement or scenario at the start of the question.
Within the statement or scenario, there will be many valuable clues to point you towards the correct answer. It is worthwhile highlighting or underlining these clues whilst reading the scenario. Some scenarios will include clues such as examination findings and/or results of investigations. Try to highlight anything that is abnormal. 
In addition to the correct answer, each SBA will usually contain at least one or two answers that are highly unlikely or obviously wrong. There are then often one or two plausible answers, and these serve as the main distracters within the question. Cross out and eliminate the answers that are obviously incorrect so that you have narrowed your choices.
A good way of practising SBAs in the run-up to an exam is to cover up the list of answers and attempt to formulate an answer without the answers to guide you. By attempting to remember key facts from your memory in this way, you can augment your ability to recall the information later. This strategy is not recommended in the exam, though, as on the day itself, you will need every advantage that you can get!
Some SBAs require multiple cognitive steps in order to reach the correct answer. These sorts of questions are used to discriminate the best candidates. Typically, you will be required to make a diagnosis and choose an answer based upon this diagnosis.
If time allows, review the questions and answers again after finishing the exam, as it is possible that you may have misread some questions on the first attempt. When you are unsure of the answer, it is usually best to stick to your first instinct and not be tempted to change the answer on re-reading.
Good luck with your exam preparation!
Header image used on licence from Shutterstock

What Doctors Are Saying

" Got my results of the exam today. I have passed on my first attempt. Just wanted to thank you people. Your question bank was a huge help for me. Thank you very much. Looking forward to getting your help for the next part as well. Cheers. " Dr. Hasitha Gunasekara, Emergency Medicine Doctor, Sri Lanka
"I did not study from any books, I only studied from the FRCEM Exam Prep site. It is absolutely enough for the exam, I want to tell everyone that if they want pass the Primary exam smoothly there is no need to study from any other source. Only subscribe and answer the questions and read the explanations. If you need help you can send to the admin team and they will answer you within hours. Thank you FRCEM Exam Prep! " Dr. Nashat, Emergency Medicine Doctor, Qatar
"I used your website to prepare for my FRCEM primary and passed last December. Thank you for the in-depth question sets. " Dr. Ayodele, Emergency Medicine Doctor, Wales