How to Pass the ACEM Fellowship Exam 2015 and beyond

ACEM trainees and fellows will be aware that the ACEM Fellowship exam (FEx) is changing in 2015. The reasons behind these changes have been and continue to be discussed in other forums so I’ll try not to harp on it too much. However, the decision has been made and we will have a new fellowship exam in 12 months time.

The new format of the exam will be divided into 2 discrete assessments, a FEx Written and FEx Clinical.  Eligibility to sit each section of the exam has been outlined by the college and can be found within the depths of the ACEM website. For current trainees, a flowchart outlining the transition arrangements is available

The changes to the exam are being made with the intention of making it more relevant, more objective and more fair. The college has said that new format exam will focus more on the content of knowledge and skills rather than technique and that candidates should therefore prepare themselves by focusing on attaining consultant level knowledge and skills. Good idea.

The point has also been raised that with the pass mark for the exam being in the order of 50-60% that candidates may as well toss a coin, that it’s a random process. Heads or tails. Pass or fail. Personally I think this is complete nonsense.

I do accept that the pass mark of 50-60% for the exam is lower than ideal. There are a number of reasons for this, some known and some unknown, but randomness is not one of them. I hope that ACEM doesn’t believe that the candidates who have passed (or failed) the current exam have done so by chance. I hope that future candidates don’t believe that their success at the exam is determined by chance. I know my candidates don’t. They are aware that their likelihood of success is for the most part determined by how well prepared they are. This is one thing that will not change with the introduction of the new exam.

What is difficult for me and others who prepare trainees for the fellowship exam is that we don’t yet know what the exam will look like, other than having been given a broad framework (under the tab ‘2015 onwards’). If this is difficult for supervisors it must be downright frightening for trainees planning to sit the exam from 2015 onwards.

What I’d like to do is give prospective fellowship candidates some advice for preparing for the fellowship exam. I believe it will be valid whether you are preparing for the current exam or the new exam format. There are already a number of great resources for advice in preparing for the fellowship exam.I would encourage you to check out tjdogma, EDExamEmergencyPedia, and this other site to find a list of even more helpful websites

My advice comes from a combination handed down, borrowed, and observed ideas from a number of sources including some of those above and from my previous teachers and colleagues. There’s a significant overlap between what follows and what you may find from other sources. That is to say, I’m not presenting anything original here but I do think it is solid advice. Am I qualified to give such advice? Sort of. But I am not an exam expert. I am not a prize winner. I do however work full time in an emergency department, I am also a DEMT and I have been helping trainees prepare for the exam over the past 4 years. I will admit that I feel less and less like an imposter with each sitting of the exam and each successful candidate.

My 10-Step Guide to Fellowship Exam Success

Click each point for further explanation

You need to be ready

It’s a consultant level exam. Currently trainees are required to be in the final 12 months of training to be eligible. From 2015 trainees will be eligible to sit the FEx written after they have completed the early phase of WBA’s, potentially in the first half of advanced training. Although we haven’t seen examples of the new written questions yet we are told that it will be examining consultant level knowledge. I would put it to you that if you are not operating at or close to the level of consultant in your daily clinical work on the floor then you aren’t ready to sit the exam.

Get advice from lots of people

Use the resources you have available to you, whether that is friends and colleagues who have just sat the exam, or recent FACEM consultants in your ED and nearby departments, through to ACEM examiners and the Professor of Emergency Medicine. Just be aware that you need to collect all this advice, digest it and find out how best you can use it. For example, while the Prof. is an examiner and has a clear idea about how a particular question should be answered or what is required he (she) has not actually sat the exam for some time and so advice on your day by day preparation may be better to come from other sources. In the end you have to work out what works for you.

You need to have your life sorted out

The road to the exam has to be clear. Obstacles created by family, friends, marriage, birth, death, moving house, new jobs and natural disasters are not ever going to be able to be completely avoided, however I do think its a good idea to rethink the timing of your exam if you can see one of these obstacles looming up ahead. That being said, there are numerous accounts of trainees being successful in their ascent of Mt FACEM, while juggling a new baby, living out of a car, and training for a marathon. It’s just probably that their road may have been easier to not take on all of these things at the same time.

You need to have a comprehensive study program

This is where some preparation at the start is really important. You want to make sure that when you start studying 6 months, 12 months or 18 months out from the exam that you know that by the end of it you will have covered the whole of emergency medicine. There are obviously limits to what can be covered and in how much detail depending on the time you set yourself. You should set a clear start date well in advance and plan a timetable to cover the whole curriculum. Following a study timetable with a like minded group of trainees is invaluable.

Study hard

It should go without saying that you need to put in the effort to be successful in this exam. You have to be disciplined. Trainees who approach their preparation for the exam with the intention of “seeing how it goes” invariably find out that it doesn’t go well. It’s true there is an element of quality not quantity when you are studying. Good quality study (I lost count of the number of times I fell asleep in a textbook – at 3 o’clock in the afternoon) is important. You need to make sure that you are getting bang for your buck when you are in study mode, but you also need to spend a lot of time at your desk. The exact number of hours you need to be at it will be variable for everybody, but for me it was something like 3-4 hours on a work day and 6+ hours on a day off. Believe it or not this does leave some time in your day for eating, sleeping and other necessary bodily functions.

You need knowledge

I know some people who have a ridiculously vast amount of knowledge on the topic of emergency medicine. Thankfully, you don’t need to know this much to pass the exam. However, as others have said, you do need to read the recommended texts, maybe not all of them because you wont have the time, but you do need to read one or more cover to cover. What is perhaps more important in terms of knowledge for the fellowship exam is the gaps. You need to be able to recognise,  identify and manage the gaps in your knowledge. Hopefully your organised and structured approach to your study will ensure that the gaps in your knowledge are small and manageable, not massive gaping holes.

Keep working in ED

Controversial, but I think an important part of preparation for the exam comes from the experience of working in the emergency department environment during your study because you can apply your book learning on an immediate and regular basis and this reinforces what you are studying. I think this point is underestimated by trainees who feel that going half time will mean better preparation. In my experience it often doesn’t. Sure the hyperbaric registrar position does provide a certain amount of free time during your day – and that’s great, you just need to make sure you are using it effectively.


You need to practice doing exam questions. Certainly with the current exam, and no doubt it will be the case with the new exam, doing practice questions is an extremely important part of your exam preparation. If you combine knowledge acquisition with practice questions from day one you will be in a much better position come exam day than leaving all the practice to the latter stages of your preparation. Talking with a trainees it surprises me that sometimes they put off practicing things like MCQ’s and VAQ type topics like ECG’s and ABG’s until they “have more knowledge”. You’ve got to practice. Real questions. To time. From the start.

Take time off from study

My favorite part of study. Taking time off from study. You still need to live life, walk the dog, go for a run, take the kids to the zoo, go out to dinner, whatever. Obviously this conflicts with point 5 but is a really important part of coping with the stress and hard work of exam preparation. Advice given to me which I tried to follow was to take one whole day off a week. No study. Enjoy yourself. You may decide to split this up over a couple of days and allow yourself a break. It gives you an incentive to work hard knowing that your planned day off is on the horizon.

You have to “get it”

This is a hard one and probably a little unhelpful because you can’t force yourself to “get it” if you don’t. The bottom line is that often people who pass the exam in general, “get it” and people who don’t pass the exam “just don’t get it”.  Everybody who has prepared candidates for the exam will know what I’m talking about. Exactly what “it” is is not something which easy to define. It’s taking the theoretical knowledge and being able to apply it in a rational, practical way at the level of an emergency medicine specialist. You could describe it as an understanding, an awareness of strengths and limitations or even a zen-like state of enlightenment. Hopefully all the preparation, hard work and practice will lead you to achieve this by the time you sit the exam. This is possibly the most important step in the guide.

Final thoughts – This advice may seem a bit nebulous, unfortunately that’s because it is. Often what is required to pass this thing only becomes apparent after the event. That is what happened to me anyway.

Hope that helps.

Disclosure – I am currently co-DEMT in my department and am on the ACEM Fellowship Exam OSCE working party

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Emergency Physician, FACEM. Sir Charles Gairdner Hospital |@JmsWntn | Linkedin

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