FRCEM - a guide for overseas emergency medicine doctors

  • May 12, 2020

FRCEM is a crucial step when working towards either CCT or CESR in Emergency Medicine. 

International Medical Graduates (IMGs) from any country in the world can sit some of the FRCEM examinations, provided certain eligibility criteria are met. For overseas doctors attaining FRCEM is not a route to GMC registration and you are better suited to the MRCEM pathway. These are summarised below along with a broad look at the following topics:

What is FRCEM?

Fellowship of the Royal College is awarded to candidates who pass three examination components. 

There have been a few changes to the MRCEM and FRCEM examination structure over the last few years, as such there are currently two routes to an accreditation in Emergency Medicine, both leading to RCEM Membership.

These two routes are:

  • Membership of the Royal College of Emergency Medicine (MRCEM)
  • Fellowship of the Royal College of Emergency Medicine (FRCEM)

As of August 2018, applicants beginning the process will be able to sit one set of exams leading to the award of Fellowship of the Royal College of Emergency Medicine (FRCEM).

FRCEM is one of several different routes an overseas emergency medicine doctor can take full GMC registration. Read our blogs on acceptable postgraduate qualifications and PLAB if you are unsure what route to take.

For doctors who wish to take more senior roles reflective of their current practice, IMG Connect advise that MRCEM or FRCEM would be the best route to take.

Understand the MRCEM pathway in this article above.

FRCEM Examination route:

The Fellowship Examinations consists of the following components:

  • FRCEM Primary Examination
    • one, three-hour written paper
  • FRCEM Intermediate Certificate
    • Short Answer Question Paper (SAQ)
    • Situations Judgement Paper (SJP)
  • FRCEM Final Examination 
    • Critical Appraisal (Short Answer Question Paper)
    • Quality Improvement Project (QIP)
    • Clinical Short Answer Question Paper
    • Objective Structured Clinical Examination (OSCE) 

Eligibility for overseas doctors:

FRCEM Primary:

To be eligible you must hold a Primary Medical Qualification (PMQ) that is recognised by the GMC for registration purposes.

FRCEM Intermediate:

To be eligible you must hold a PMQ recognised by the GMC, have completed an equivalent to the UK Foundation Programme and have passed FRCEM Primary Examination after 1st August 2016.

You will also be eligible if you have been granted exemption from the FRCEM Primary as a result of obtaining MRCS or MRCSI after 1st January 2012.

FRCEM Final Examination:

To be eligible you must have FRCEM Primary and FRCEM Intermediate Certificate, attained after 1st August 2016. However, the requirements make it incredibly dififcult to attain outside of the UK - so you are best advised to attain MRCEM, work in the UK and then work towards FRCEM whilst practicing in the NHS.

The examination is conducted in English and candidates are advised that IELTS Level 7 is the expected standard for completion of the FRCEM examinations. Remember, you will need to have a pass of 7.5 average in all areas of IELTS to complete your GMC registration.

FRCEM Primary Examination:

The FRCEM Primary Examination is mapped to the Emergency Medicine 2015 Curriculum. More detailed information is provided in the RCEM Basic Sciences Curriculum (June 2010).

The exam consists of one 3-hour paper of 180 single best answer questions (SBAQs) so you must choose one best answer from a choice of five feasible answers. 

The paper will examine all the domains of knowledge in the Basic Sciences Curriculum including:

  • Anatomy
  • Physiology
  • Pathology
  • Microbiology
  • Pharmacology
  • Evidence Based Medicine

FRCEM Intermediate Certificate:

FRCEM Intermediate Certificate is comprised of two papers:

Short Answer Question paper (SAQ):

A single 3-hour paper of 60 questions, each worth 3 marks. 

Unlike single best answer questions (SBAQs) you will not have the advantage of having a list of options to choose from. Instead you will have to compose your answer independently.

The blueprint for the FRCEM intermediate is as follows:

Curriculum Category


Common Comptences


Clinical Presentations – Core Major & Acute Presentations 


Anaesthetic Comptences CT1&2


ICM within ACCS


Acute Presentations – Additional Adult ST3


Paediatric Presentations – Makor & Acute Presentations 


Practical Proceedures (ACCS)




Situational Judgement Paper (SJP):

A two-hour paper of 120 single best answer questions.

This written paper is designed to test your ability to understand & respond appropriately to real world clinical situations, assessing you against the Common Competencies in the Emergency Medicine Training Curriculum 2015

FRCEM Final Examination:

From August 2018 the FRCEM Final consists of the following components:

  • FRCEM Critical Appraisal (Short Answer Question Paper) 
  • FRCEM Quality Improvement Project (QIP) 
  • FRCEM Final Clinical Short Answer Question Paper 

Each component tests individual skill sets and as such may be sat independently.

FRCEM Critical Appraisal:

A 90-minute Short Answer Question Paper.

FRCEM Quality Improvement Project (QIP):

This replaced the CTR from 1st August 2016.

The QIP is a written submission that should be completed whilst working in Emergency Medicine at a level above ST3 or SHO. It should focus on quality improvement in Emergency Medicine, and may focus on either adult or paediatric Emergency Medicine.

Any candidates who have not been awarded FRCEM by 31st July 2018, irrespective of any previous passes in CTR, are required to pass the new FRCEM QIP.

Clinical Short Answer Question paper (SAQ):

The SAQ is a 3-hour paper consisting of 60, 3-mark questions.

A summarised blueprint for the FRCEM Final SAQ is as follows.  A fuller version can be found on the RCEM website here.

HST Major and Acute Presentations

25 questions

Additional Paediatric Practical Procedures

3 questions

Practical Procedures (HST)

11 questions


3 questions

Clinical Presentations - Core Major & Acute Presentations

6 questions

Common Competencies

2 questions

Anaesthetic Competences CT1&2

1 question

ICM within ACCS

1 question

Acute Presentations - Additional Adult ST3

2 questions

Paediatric Presentations - Major & Acute Presentations

3 questions

Practical Procedures (ACCS)

3 questions


The exam is set in a practical setting and tests your ability to apply knowledge & experience directly to patients – rather than reciting learned knowledge.

The exam consists of 16, 8-minute stations with one minute provided in between stations for reading time.

As with many other final stages to Royal College exams – FRCEM Final OSCE will make use of manikins or actors and you will be observed by an examiner after being presented with a clinical case to assess. Examiners will not engage with you – only observe and mark.

A brief summary of the curriculum for OSCE is found below:




Core Acute





Core Major


Common Competencies


Common Competences


Anaesthetic Competences


Paediatric Resuscitation



Paediatric Acute


Paediatric Major


HST Major


HST and Adult Acute


Practical Skills


Paediatric Practical Skills


Non-technical Skills 

As an overseas candidate where can I take the exam and how much will it cost me?

Examination and application dates are regularly updated by the Royal College and can be found here. Dates for 2020 have not yet been released – IMG Connect will post these as soon as they become available.

Please remember, applications made outside of the application period will not be accepted.




FRCEM Primary

Short Answer Question Paper



Iceland, Malaysia, Oman, India


FRCEM Intermediate Certificate




Iceland, Malaysia, Oman


FRCEM Intermediate Cert.




Kuala Lumpur



Clinical SAQ




Critical Appraisal SAQ











How can I apply?

All applications are made online and links to all application forms and windows are available here. It is worth noting, the application can take some time to complete so it is always advisable to apply well in advance of the deadlines.

Please remember, applications submitted after the application period will not be accepted. 

How do I prepare for each exam and what resources are available?

With lots of resources available online, we have discussed with IMGs the best place to start looking for materials relating to the exams. Most IMGs recommended starting with the Royal College, who have created useful resources to help you to prepare for the exams. 


Applicants are tested on a range of common and important disorders in Emergency Medicine as set out in the Emergency Medicine Training Curriculum 2015.

We recommend getting to know the curriculum as early as possible and using it as a road map for your study plan. 

Information Packs:

These provide detailed information for the relevant examination components so that you can best prepare for your studies and what to expect on the day:

SAQ Blueprint:

The blue print for the new Intermediate SAQ exam can be found on page 8 of the FRCEM Intermediate examination pack, downloaded from the RCEM website here.

SJP Blueprint:

A blue print of the new Intermediate SJP exam can be found on page 11 FRCEM Intermediate examination pack, downloaded from the RCEM website here.

Sample questions: 

Test your knowledge using example questions from the current exam syllabus provided by the Royal College, see below:

Glossary of Terms: 

The royal college uses many terms that may cause confusion, so take plenty time to understand the terms and definitions used in this guide. Candidates are expected to be rigorous in their use of these terms.

Glossary of terms used in RCEM exams.

Examination Report:

The Royal College recently began to publish reports on the performance of those sitting FRCEM examinations. Below is the first report published and helps to break down results for those in training and those out of training. 

2018 Examination report.

Online resources: 

There are lots of resources online, such as videos on YouTube, FRCEM courses and useful reading materials. We think that these are a great addition to your study plan, just be sure to check your sources. 

For a useful overview of how to prepare for exams, including advice on study groups, online community support, best use of online resources & Royal College materials and courses, take a look at our blog: IMG Connects Top Tips for exam preparation.

As ever at IMG Connect we believe in preparation. In order to succeed in the clinical exam, IMGs have told us that it is vital that you practice your clinical examinations as frequently as possible, preferably under the supervision of a senior colleague. This will give you confidence in approaching and examining patients with examiners present.

Should I take a course to prepare for the OSCE?

Whilst it is not essential to take a course when preparing for the MRCEM or FRCEM OSCE - there is no doubt it will help your preparations both technically and mentally, and should be considered an investment towards your future career plans. Have a read of our blog on recommended MRCEM courses for Emergency Medicine doctors.

Passed? What next? 

First of all, congratulations! After you have passed all parts of FRCEM you will have be on a firm path towards attaining your Specialist Registration in Emergency Medicine. FRCEM is not a route for GMC registration as doctors will already be in the UK, however those attaining MRCEM can do so from outside of the UK, and use MRCEM as a route to GMC registration.


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