FRCEM - a guide for overseas emergency medicine doctors
- August 19, 2022
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 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?
- FRCEM Route
- Eligibility for overseas doctors
- FRCEM Primary Examination
- FRCEM Intermediate Certificate
- FRCEM Final Examination
- As an overseas candidate where can I take the exam and how much will it cost me?
- How do I apply?
- How to prepare and what resources are available
- Passed? What next?
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 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
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:
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 |
Questions |
|
Common Competences |
7 |
|
Clinical Presentations – Core Major & Acute Presentations |
18 |
|
Anaesthetic Competences CT1&2 |
4 |
|
ICM within ACCS |
2 |
|
Acute Presentations – Additional Adult ST3 |
6 |
|
Paediatric Presentations – Makor & Acute Presentations |
11 |
|
Practical Procedures (ACCS) |
12 |
|
Total |
60 |
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
- FRCEM OSCE
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 |
|
Ultrasound |
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 |
FRCEM Final OSCE:
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:
|
Stations |
Curriculum |
|
1 |
Core Acute |
|
2a |
Resuscitation |
|
2b |
|
|
3 |
Core Major |
|
4 |
Common Competencies |
|
5 |
Common Competences |
|
6 |
Anaesthetic Competences |
|
7a |
Paediatric Resuscitation |
|
7b |
|
|
8 |
Paediatric Acute |
|
9 |
Paediatric Major |
|
10 |
HST Major |
|
11 |
HST and Adult Acute |
|
12 |
|
|
13 |
Paediatric Practical Skills |
|
14 |
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.
Please remember, applications made outside the application period will not be accepted.
|
Examination |
Location |
Fees |
|
FRCEM Primary Short Answer Question Paper |
UK |
£310 |
|
Iceland, Malaysia, Oman, India |
£390 |
|
|
FRCEM Intermediate Certificate SAQ |
UK |
£305 |
|
Iceland, Malaysia, Oman |
£385 |
|
|
FRCEM Intermediate Cert. (SJP) |
UK |
£200 |
|
Kuala Lumpur |
£200 |
|
|
FRCEM Final Clinical SAQ |
UK |
£300 |
|
FRCEM Final Critical Appraisal SAQ |
UK |
£240 |
|
FRCEM Final QIP |
N/A |
£150 |
|
FRCEM Final OSCE |
London |
£420 |
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.
Curriculum:
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 blueprint 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 blueprint 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:
- Primary – sample questions
- Intermediate Certificate – sample SJP questions
- Final – successful QIP
- Final – unsuccessful QIP
- Critical Appraisal Questions – Advice to Candidates
- Critical Appraisal – Most Frequently Offered Answers
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.
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 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 the UK, and use MRCEM as a route to GMC registration.
For the latest news and updates on all things emergency medicine, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation.
Relevant Jobs
A hospital in Yorkshire is looking for a Consultant in Emergency Medicine with an interest in trauma care and emergency medicine leadership. The Emergency Department comprises a team of consultants and is supported by a large team of middle-grade doctors. This Emergency Medicine job is open to both international applications and UK-based doctors, though those with European Specialist or FRCEM are most encouraged to apply.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
Full GMC registration with a licence to practice and at least six months of obtaining a CCT in Emergency Medicine, CESR, or European Specialist Qualifications are required for this role, and anyone with an interest in trauma care and clinical leadership should apply.
CORE DUTIES OF THIS ROLE
- Provide high-quality emergency care to patients in the ED, including trauma cases.
- Lead the clinical team and oversee the Emergency Physician in Charge (EPIC) role.
- Engage in departmental audits and participate in clinical governance and quality improvement projects.
- Provide clinical supervision and mentoring to junior doctors and trainees.
LIFE IN YORKSHIRE
The hospital is located in a picturesque region, with local towns offering both urban and rural living options. The area boasts excellent schools, transport links, and a wide range of leisure activities. Yorkshire has historical significance as a former center of the wool industry and offers rich industrial heritage alongside beautiful countryside.
HOW WILL IMG CONNECT SUPPORT YOU?
When applying with IMG Connect you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We\'ll support you with:
- CV Preparation with a bespoke session with one of our specialists
- Application support with expert knowledge of NHS specialisms & recruitment practice
- At least two video calling interview preparation sessions
- Contract and offer negotiations for salary, relocation packages, tenure and more
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you through all the way to starting your new role including:
- Document gathering and checking COS and Visa Application support if applicable
- Support sourcing short- and long-term accommodation
- Travel Arrangements Family support for finding schools and any other aspects of pastoral care.
An excellent health service is looking to appoint an Emergency Medicine Consultant. This is a great opportunity to further your medical career in the UK. This NHS job offers CESR Portfolio Pathway support, and international applications from IMGs are welcome.
The Emergency Department sees over 45,000 patients annually, with 25% of attendances being children. As a Trauma Unit and part of the Wessex Trauma Network, the department features a robust clinical governance process and an active audit program. This progressive department actively uses ultrasound in diagnostics and is developing a regional blocks program.
Health Service
Working for this health service is professionally rewarding, offering high-quality, patient-centered care. Their clinicians lead in developing and managing services, supported by strong links with UK specialists. With a generous study leave budget, doctors are encouraged to pursue further education. Exciting developments include a new general hospital and a new mental health inpatient unit. They foster strong relationships between mental health, primary, and secondary care, promoting joint learning and teaching in their modern education center.
The health service, separate from the NHS, is an integrated, taxation-funded system, free at the point of delivery, managed by the Health and Community Services Department. This is a unique opportunity to help shape an integrated care system with closer political engagement than in the UK.
Department & Team
The Emergency Department operates with dedicated consultant presence from 8 am to 10 pm Monday to Friday, and 10 am to 4 pm on weekends, supplemented by on-call service beyond these hours. A team of 24/7 middle-grade physicians supports the department, alongside a rotating roster of 15 junior doctors comprising F2s, GPVTS doctors, and Clinical Fellows.
Comprehensive specialty support is available on-site throughout the day and night, including medicine, anaesthetics, paediatrics, and obs & gynae, with senior orthopaedic and surgical specialists accessible both during regular hours and on-call. The department boasts continuous access to imaging services, including cross-sectional imaging, ensuring prompt diagnostics. Facilities include a 3-bedded resus area with a dedicated paediatric resuscitation cubicle, an 8-bedded Majors area with half of the beds in isolation, designated paediatric and minors examination rooms, and specialized facilities for eye examinations.
Continued Professional Development
The service job offers further training & accreditation within psychiatry, including CESR Portfolio Pathway Support, access to specialty training, and the opportunity to develop sub-specialist interest. The post holder will have ample opportunities to develop knowledge, skills, and experience through attendance at relevant courses, conferences, and locally organized CME events. Health & Community Services supports Continuing Medical Education with time and financial support, offering study leave of 30 days in 3 years, and an annual study leave allowance.
Life in the area
Living in the area presents significant financial benefits. The flat income tax rate is notably advantageous compared to the U.K., and they provide a generous public sector pension scheme that isn\'t constrained by U.K. lifetime or annual contribution limits. The Consultant Contract closely mirrors the U.K. model but offers higher incremental levels. Incremental progression is automatic from points 1 to 17 on the pay scale based on satisfactory performance, while formal applications are necessary for points 18 to 20.
Am I eligible for this role?
UK based candidates:
• Experience in Emergency Medicine
EEA candidates:
• Experience in Stroke Medicine
• European Specialist Qualification
Non-EEA candidates:
• MRCP UK
• Experience in Stroke Medicine
An excellent opportunity has arisen for Specialty Doctors in Emergency Medicine to join an NHS Foundation Trust that is dynamic and dedicated to providing great service to their patients. The site that is ideally located near stunning blue flag beaches. The Emergency Medicine team boasts extensive experience and expertise in supporting doctors through the CESR programme. The current CESR programme includes a customized professional development plan tailored to meet the individual needs of each doctor, with available placements in Critical Care, Anaesthetics, Acute Medicine, and Paediatrics.
This is a unique opportunity for Specialty Doctors seeking to advance their careers within the NHS in the UK. Successful candidates will have the option to participate in this CESR support programme, further enhancing their professional growth. Don\'t miss this chance to explore NHS jobs that offer both career progression and an excellent quality of life. Overseas applications from experienced Specialty Doctors and Consultants are welcomed.
What is the NHS Foundation Trust like?
The NHS Foundation Trust is a district general hospital trust managing three hospitals. The Trust serves the different towns, delivering a broad range of medical services. They are performing at a good level across their services and continuously provides huge opportunities and benefits to the way they deliver patient care. The Trust focuses on delivering excellent general hospital services, serving a population of approximately 750,000 with the help of more than 9,000 staff members. The hospitals have around 1,100 beds in total, offering services including General Medicine, General Surgery, Neurology, Rheumatology, Gastroenterology, Dermatology, Gynaecology, and Paediatrics.
The Trust achieved foundation status in 2005 and, in October 2020, merged two of its hospitals to create a new organization, establishing one of their hospitals as the emergency care site and another as the planned care site. The Trust remains dedicated to continuous improvement, striving to provide high-quality, patient-centered care across all its facilities.
What is the department & team like?
The Emergency Medicine Department is a highly advanced and well-equipped unit, dedicated to providing emergency care. The department is staffed with a robust team of consultants and junior doctors, ensuring round-the-clock expertise and comprehensive patient care. The team is proficient in managing a diverse range of emergency cases, including trauma, cardiac emergencies, respiratory issues, and other urgent medical conditions. With access to advanced diagnostic tools and treatment facilities, they provide immediate and effective care for all patients.
The facilities within the department include modern resuscitation bays, dedicated observation units, and specialized treatment areas for both adults and children. These state-of-the-art resources enable them to handle high patient volumes efficiently and effectively. On average, the Emergency Medicine Department manages a significant number of emergency cases each year, reflecting its critical role in the region\'s healthcare system. Their commitment to delivering high-quality, patient-centered care is unwavering, supported by their experienced team and cutting-edge facilities.
Career Development & Opportunities Available
With an extremely active education/teaching programme supported by the consultant team, there is opportunity to work towards and complete CESR, get involved in active research and many aspects of CPD. Participation in research and educational activities will be encouraged.
- Attractive salary and relocation package
- Training and development opportunities
- CESR support for those eligible
- Tier 2 Health and Care Visa (sponsorship for the whole family)
- Guidance regarding the CV and full interview preparation
- Assistance regarding the GMC registration, visa, accommodation and transportation by an experienced onboarding specialist
- Complete IMG Relocation service from start to finish of process
Nestled along England\'s picturesque south coast, the area offers a unique blend of urban amenities and coastal charm. Doctors enjoy proximity to both bustling city life and tranquil seaside retreats. Residents indulge in sailing adventures around harbour or stroll along its sandy beaches. The area boasts reputable schools and universities, nurturing young minds for future success. Transportation links are robust, with easy access to neighboring cities like Bournemouth and Southampton, as well as major airports. Housing options range from waterfront apartments to quaint cottages, catering to varied tastes and lifestyles. Poole epitomizes the quintessential coastal living experience.
Am I eligible for this role?
UK based candidates:
- Experience in Emergency Medicine
- Experience in Emergency Medicine
- MRCP
- MRCP
- Experience in Emergency Medicine
An outstanding opportunity for experienced Consultant in Emergency Medicine to join an NHS Trust that is committed to providing the best quality care to the people of East Sussex by attracting and recruiting passionate people who share this commitment. This Trust is one of the largest employers in the region and their members and staff are dedicated professionals whose work is varied, challenging and makes a real difference to people’s health and well-being.
The post is suitable for candidates holding specialisation in the EEA, or for experienced IMGs looking to complete CESR.
WHAT IS THE NHS TRUST LIKE?
The Trust is one of the largest organisations in the country and they employ over 6,000 dedicated staff with an annual turnover of £380 million who provides service to 525,000 people that live within the area. Their services are mainly provided from two district general hospitals, both have Emergency Departments and provide care 24 hours a day. They offer a comprehensive range of surgical, medical and maternity services supported by a full range of diagnostic and therapy services.
The role of the NHS Trust is to provide the best possible healthcare service to patients, who come first in everything the organisation does. Safe patient care is the Trust's highest priority. They will provide high quality clinical services that achieve and demonstrate optimum clinical outcomes and provide an excellent care experience for patients. The employees will be valued and respected. They will be involved in decisions about the services they provide and offered the training and development that they need to fulfill their roles.
They will operate efficiently and effectively, diagnosing and treating patients in timely fashion and expediting their return to health. They will use their resources efficiently and effectively for the benefit of their patients and their care to ensure our services are clinically, operationally, and financially sustainable.
WHAT IS THE DEPARTMENT & TEAM LIKE?
The Emergency Department is a team of consultant that focuses on being on top of taking care of their patients. The department is open for hours a day, seven days a week for those seeking treatment for an urgent problem that may be caused by an accident or an illness. In the last year, there were 130,000 visits in their department.
Urgent Treatment Centres are being in developed nationally with the aim to provide same day ‘urgent treatment’ operating in a fully integrated way with the local community. The department has a vision is to provide an urgent care stream from the front door of the Emergency Department and develop innovative interoperable ways to ensure that the patients receive the right care at the right time and in the right place.
WHAT IS LIFE LIKE IN THE REGION?
The region has a natural beauty. Sussex has some fantastic natural features such as the Seven Sisters National Park, and many areas of outstanding natural beauty that include the medieval heathland and forests of the High Weald. It also has beaches and harbours where people can go to during their dayoffs.
Besides its natural beauty, there's a rich array of accommodation options, ranging from the five star Grand Hotel on Eastbourne seafront to quaint B&Bs set amid beautiful Sussex countryside. East Sussex offers a rich array of culture, with art galleries such as the Jerwood Gallery in Hastings and the Towner Gallery in Eastbourne and an array of theatre and entertainment venues such as the De La Warr Pavillion in Bexhill, Congress and Deveonshire Park Theatres in Eastbourne and the White Rock Theatre in Hastings.
WHAT OPPORTUNITIES ARE AVAILABLE TO YOU?
The combination of clinical practice and first-class academic connections means that medical professionals have a wide range of opportunities to develop their careers and achieve their aspirations. You will have access to leadership, teaching, educational and research opportunities for Continued Professional Develop (CPD).
If you are a new consultant you will receive mentoring and support from medical leads as well as access to a large peer group of enthusiastic and high-caliber Consultants.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
- Experience of working in Emergency Medicine
- European Specialist Qualification in Emergency Medicine
Non-EEA Candidates:
- FRCEM
- Experience of working in Emergency Medicine
UK based applicants
- Experience of working in Emergency Medicine
- Within 6 - 12 months of completing CCT
A fantastic opportunity for specialist in geriatric or elderly care medicine to settle into their first consultant post and work towards their CESR application, if that is the intention.
The hospital will consider senior consultants with no UK experience who are not on the UK specialist register for geriatric medicine.
The Geriatrics department is a small and manageable size with a 28 bedded inpatient ward and various other outlier beds.
Currently no formal geriatric outpatient services are offered with the exception of a Parkinson's / Movement clinic. The department will be looking to develop these in conjunction with skill set of a successful applicant.
The Geriatrics department comprises 3 consultants in elderly care medicine supported by 15 specialty registrars, 9 core medical trainees and FY2's and 9 FY1's working full shifts for GIM on call.
Each consultant will be offered a budget and 30 days of study and professional leave over each 3 year period to pursue their career development activities. Furthermore there is an active Postgraduate Medical Centre which acts as a focus for contract between doctors at all levels an in all disciplines.
Consultants will be encouraged to actively participate in teaching and training of juniors throughout their tenure.
Requirements of this position are:
- MRCP
- IELTS or OET
- Experience working at consultant grade in elderly care
Senior geriatric medicine specialists looking to work towards their CESR application or secure their first consultant role in the NHS are encouraged to apply