The ascent of Mt FACEM

Objectives

1. Describe the six parts of the ACEM Fellowship Exam and the competencies they aim to assess

2. Outline steps you can take early in your training to prepare yourself for each of these in advance

3. Outline strategies to optimise your preparation for the exam in your final year of training

ACEM Fellowship examination 2012

Eligible to sit when in final year of training + 4.10 completed.

Six part exam 3 written papers 3 clinical sectionsMCQ / VAQ / SAQ LC / SC / SCE

Each section graded out of 10Must pass 2 written papers to be invited to the clinicalsMust then pass at least two clinical sections

5 or 6 sections and 30 or more marks OR4 sections and 32 or more marks required to pass overall

Mt FACEM

Intrepid trainee

Think of your early training as the initial journey to base camp…

VAQs

8 questions in 80 minutes, often comprised of 2 ECGs, 2 Xrays, 2 laboratory investigations and 2 photos.One or two part questions

Very time pressured, test your ability to recognise and interpret a wide range of data. (just like a shift at work!)

This is one part to target early in your training!

VAQs 2

Collect ECGs, share them constantly at work, seek them out, get your bosses to test you. Become adept early. Many texts and online sources available as well

You must become slick at CXR/head CT/common trauma Xray

Same for lab investigations! Learn your lists – high K/low K, HAGMA, etc

Learn and routinely use the right terminology (medspeak) so it’s just the natural language for you at work and in exams.

MCQs

60 “type A” questions in 100 minutes, which aim to test breadth of factual knowledge of the curriculum.

Hard to prepare specifically for this in early years, but whenever possible try and ask “why” as often as possible of your colleagues, consultants and other specialties.

Try and build a broader understanding of your part, and of what comes next in the patients you manage.

SAQs

8 questions in 130 minutes, aiming to test deeper knowledge of assessment and management, and prioritisation issues at a consultant level.

Hard to prepare for this early in training, success here very dependent on good writing technique honed by regular practice of the common question types

Long case

One patient to see in 35 minutes, then 5 minutes to organise presentation followed by 20 minutes with a pair of examiners to present and discuss the patient.

Tests ability to take a history/examine and synthesise the information in a timely manner. Must be able to discuss the issues raised at a consultant level, and formulate appropriate management and disposition plans

Early in training, must learn these skills and practise concise and accurate handover of a wide variety of patients. On floor teaching with consultants very valuable here

Short cases

4 short examination cases are seen over 40 minutes, aiming to assess your ability to perform a structured, adequate examination, then present and discuss your findings. Typically, CVS / Neuro / Resp / Paed cases

Develop good examination technique early then you won’t have to learn it later!

Must learn to be accurate / systematic / organised in your approach.

SCEs

6 SCE stations in 60 minutes with 3 minutes reading and 7 minutes with each examiner pair. A wide range of management subjects, procedures, administrative issues etc are explored to test the candidates abilities at a consultant level. May also interact with a professional actor to test your communication skills.

Again, early in training, try to constantly practise the skills of identifying and prioritising the key issues raised in each patient.Then try to anticipate where the clinical situation might lead for better or worse and what you might do about this

Develop a good handover technique.

Nearly there…

Summary of tips for early training

• Become adept at ECG/CXR/CT/Pathology interpretation

• Routinely use the right terminology(Learn it from your colleagues in all the specialties around you)

• Ask questions of your consultants and other specialists“Why…?”“What will you do next with my patient..?”“What options do we have, how do we decide ?”

• Constantly strive to identify key issues early in each patient you see – prioritise these and anticipate where they might lead….

So, the final year…on to the summit!

Choose the exam you will do and commit to it. Then create as much order as you can in your life generally for the year leading up to it

Consistent structured approach, cover the whole curriculum, always better if you can do this in a group

Practise each component of the FE as you work through the syllabus , although LC/SC can be safely left to later stages

Identify “key issues” in every patient you see at work, and be able to prioritise/discuss them

Carefully choose the texts/resources that you intend to use. There are many excellent online resources that make texts less central

MCQs

Practise regularly / systematically each week. Wide range of sources for these including texts / online / ACEM website

Write at least two MCQs each week yourself and share with colleagues

Do a practice exam of 60 MCQs at least once

Plenty of time in this section, but a good technique gained from the above will minimise simple misread errors etc

VAQs

Always practise them to time – can be valuable to do multiple props just doing key points in 4 or 5 minutes. Many good online sources

Check past papers / examiners as a guide to the props typically used in the FE and how they are presented

Write in headings / point form. No time for preambles / tables etc

Try very hard to get your maths right (use reading time for calculations)

Better answers have correct terminology, and qualifier adjectives (eg mildly, severely, dangerously…)

Underline/highlight important stuff

SAQs

Must practice essay technique for this section, learning an approach that works for each of the common question types (Describe, discuss etc)

Must focus on learning to just answer the question as asked

Brief “key points” / opening statements

Legibility important, sections and headings look good in your answer and aid marking

Practise doing them to time, on the standard ACEM paper format and doing more than one in a row!

Long case

VERY important to do this well – easiest section to get marks

Must practise this skill to make it polished and professionalAim to finish your presentations around 12 – 15 minutes maxHighlight “diagnostic” versus “management “ issues, or active/inactive problems.

The key issues raised by each long case will often predict the examiners line of questioning – you can anticipate these and look slick!

Try to seek out examiners at other sites from your own to test you out beforehand.

Short cases

These usually require LOTS of practice, but can be left until later in your preparation – many don’t start until after writtens

Learn each of the commonly encountered examinations until you don’t have to think about what comes next

Be respectful, gentle and professional with patients

Make up your own examination kit of equipment and use it

As for long cases, seek out examiners to observe and test you

SCEs

Very time pressured section again, you must practise the ability to do multiple SCEs in a row, and do at least one full set of 6 in a practice exam setting if possible (whilst dressed in your exam outfit and feeling uncomfortable)

During reading time, try and anticipate where the SCE might be headed..

Write your own in your group, but many available from previous exams and examiners

Look and sound like a respectful junior consultant

Tips for your final training year

Consistent, structured approach to curriculum in a group with good teachers the ideal

Practise each written component and SCEs each week in the format it will be asked in your exam

Expose yourself AMAP to examiners ()

Aim to reach scores of at least 6 or more consistently

Stay sane! – maintain (at least some of) your normal life

Atop Mt FACEM!