Build the plan around what the exam tests

The ACEM Primary is a pre-Fellowship assessment of foundational sciences and their application to emergency medicine. It typically includes written components and structured oral or viva-style assessment. Candidates need to explain mechanisms, interpret data and apply core principles to acute presentations under time pressure. Check the ACEM website for current examination information; do not assume that a practice schedule or question style is an official format.

The study method below uses eight weeks as a workable cycle, not a prediction of how long you need. It assumes about seven to nine hours a week across four sessions. If you have more time, add another question-and-review session rather than extending every session. If you have less, keep the retrieval and timed-answer practice and reduce the amount of new material.

Use the same cycle throughout: retrieve key facts without notes, explain the mechanism, apply it to an emergency presentation, then review what you could not explain. Keep answers structured: signpost the issue, prioritise what matters, and justify the decision with physiology or pharmacology.

Set up your revision boards and due queue

Start with material you already use: lecture slides, PDFs and photographed notes. Sort it into boards with short sections, rather than making one large board for all foundational science. Useful sections might include acid–base, cardiovascular physiology, respiratory physiology, renal handling, pharmacology and cellular injury. Preserve the units and reference ranges shown in your source material, and check them against reliable clinical references where needed.

The due queue is a prompt to retrieve facts before rereading. Clear the cards that are due, then use any remaining time for a question or spoken explanation. A queue in MySummaries can be organised by board like this:

Due today
Acid–base and ABGs12 due
Cardiovascular physiology8 due
Respiratory physiology5 due
PharmacologyClear
An illustrative due queue for four ACEM Primary revision boards.

A board on acid–base interpretation might look like this:

ACEM Primary Acid–base and ABGsStudy
Core physiology and clinical applicationAcid–base and ABGs5 sections · 3 columns
Start with the pH
  • Typical arterial pH reference range: 7.35–7.45; use the reporting laboratory's range
  • Acidaemia and alkalaemia describe the measured pH, not the underlying cause
Oxygenation and ventilation
  • PaO₂ describes dissolved oxygen tension; saturation describes haemoglobin oxygenation
  • PaCO₂ is a useful measure of alveolar ventilation, interpreted in clinical context
Primary change4 due
  • Respiratory: PaCO₂ changes in the direction that explains the pH
  • Metabolic: bicarbonate changes in the direction that explains the pH
  • Check whether compensation is appropriate; do not label a mixed disorder from pH alone
Apply it to the presentation

State the primary disorder, identify a likely mechanism, then link it to the patient's acute problem and immediate safety concerns.

Anion gap

Calculate as Na⁺ − (Cl⁻ + HCO₃⁻), using values in mmol/L. Interpret against the local laboratory range and consider albumin when relevant.

An illustrative revision board showing how one ABG topic can be divided into retrievable sections.

Use your own notes as the source of truth for course-specific detail. Each board should help you answer a question, not simply reproduce a lecture. For a definition or formula, record the exact wording or units you need. For a mechanism, make the links explicit: what changes first, what changes next, and how that affects the patient.

An eight-week plan you can start this week

Each session includes a defined task and an output. Use a timer, close your notes for the retrieval part, and record unresolved points for the next session. The plan gives four sessions each week; for example, distribute them across weekdays and the weekend to suit your roster.

Week 1: Find the gaps and organise the material

  • Session 1 — 90 minutes: Attempt a short mixed set of foundational-science questions without notes. For each uncertain answer, record the topic and whether the problem was recall, mechanism, data interpretation or application.
  • Session 2 — 90 minutes: Build three initial boards from your own material: acid–base, cardiovascular physiology and respiratory physiology. Divide each into sections you can test yourself on.
  • Session 3 — 60 minutes: Explain five core concepts aloud, each in two minutes or less. Use a clear opening, a mechanism and an emergency-care link. Review your notes afterwards and mark missing steps.
  • Session 4 — 90 minutes: Reattempt the questions you missed. Write one sentence on why the right answer is right and one on why your most tempting alternative is wrong.

Week 2: Acid–base, gas exchange and ventilation

  • Session 1 — 90 minutes: Practise ABG interpretation. For each example, identify pH, primary process, compensation and whether more than one process may be present. Show your calculations and units.
  • Session 2 — 90 minutes: Review oxygen transport, ventilation and gas exchange from your course material. Draw the causal chain from a change in ventilation or perfusion to the data you would expect.
  • Session 3 — 60 minutes: Give three timed spoken explanations: a primary respiratory disorder, a primary metabolic disorder and a possible mixed disorder. State what extra information would change your interpretation.
  • Session 4 — 90 minutes: Complete a mixed question set and update the board only where your answer exposed a missing fact or unclear mechanism.

Week 3: Cardiovascular physiology and shock

  • Session 1 — 90 minutes: Rebuild the relationships among heart rate, stroke volume, cardiac output, preload, afterload and contractility from memory. Check each relationship against your notes.
  • Session 2 — 90 minutes: Apply those relationships to acute hypotension. For each case, explain the likely physiological problem, what findings would help distinguish causes and what could make the situation unsafe.
  • Session 3 — 60 minutes: Interpret basic cardiovascular data or ECG material from your course resources. Say what you can conclude and what the data do not establish.
  • Session 4 — 90 minutes: Answer short written prompts under time pressure. Mark whether you prioritised, explained the mechanism and linked the science to the presentation.

Week 4: Renal physiology, electrolytes and pharmacology

  • Session 1 — 90 minutes: Review renal handling of sodium, water, potassium and hydrogen ions. Practise explaining how a change in handling can produce a measured abnormality.
  • Session 2 — 90 minutes: Build a pharmacology board around classes and mechanisms relevant to your syllabus. For each drug or class, include mechanism, expected physiological effect, important risks and the clinical context in which those matter. Check specific dosing and contraindications against current local references.
  • Session 3 — 60 minutes: Explain three electrolyte or drug-related problems aloud, using the order: key finding, mechanism, immediate risk and clinical implication.
  • Session 4 — 90 minutes: Review missed questions and make cards only for facts that need repeated retrieval, such as a definition, relationship, unit or mechanism.

Week 5: Integrate physiology with acute presentations

  • Session 1 — 90 minutes: Choose two acute presentations from your study material. For each, connect the observed signs or results to the underlying physiology rather than reciting a differential list.
  • Session 2 — 90 minutes: Practise interpreting graphs, calculations, ABGs and basic ECG findings from your resources. Explain the trend, units and clinical significance.
  • Session 3 — 60 minutes: Record a short viva-style answer to a prompt. Use headings such as concept, mechanism, ED relevance, interpretation and implications. Listen back for unclear priorities or unnecessary detail.
  • Session 4 — 90 minutes: Do a mixed timed set. Review each answer against your own notes and identify the single most important correction.

Week 6: Practise concise written and spoken answers

  • Session 1 — 90 minutes: Complete a timed written practice set using questions based on your course material. Practise answering the question asked before adding context.
  • Session 2 — 60 minutes: Mark your responses for structure, scientific accuracy, application and units. Make a correction list, not a rewritten set of notes.
  • Session 3 — 90 minutes: Do a viva-style practice session. Ask a study partner to interrupt with follow-up questions, or record yourself answering and then respond to likely challenges.
  • Session 4 — 60 minutes: Revisit due cards and explain the weakest two concepts without looking. If you cannot connect mechanism to clinical relevance, return to the source notes.

Week 7: Use results to target weak areas

Review performance by topic rather than relying on how familiar a section feels. A picker in MySummaries can direct the next session towards the board section with the most repeated errors:

New lecture
How long have you got?5 min10 min15 min20 min
ABG compensationCardiac outputRenal potassium handling

ABG compensation · Struggling — several cards were missed and recent practice answers did not explain whether compensation was appropriate

Suggest lectures
An illustrative topic picker prioritising a weak section for a short revision lecture.
  • Session 1 — 90 minutes: Choose the weakest topic from your practice results. Relearn only the part you cannot explain, then close your notes and retrieve it.
  • Session 2 — 90 minutes: Complete a timed set weighted towards weak areas, with a few familiar topics mixed in. This checks whether you can switch between topics under time pressure.
  • Session 3 — 60 minutes: Repeat the viva recording from Week 5 using a different prompt. Compare structure, accuracy, prioritisation and concision.
  • Session 4 — 90 minutes: Correct every missed point and make a short list of topics still uncertain. Do not treat a high score as proof of mastery if you cannot explain the reasoning.

A weak-area report in MySummaries can help separate recurring gaps from isolated slips. Its counts describe your practice activity, not the frequency of topics in the official examination:

Where marks go missing
48%ABG compensation5×
64%Cardiac output and preload4×
82%Oxygen transport6×
An illustrative report ranking practice sections by marks earned and attempts recorded.

Week 8: Consolidate and protect time for recovery

  • Session 1 — 90 minutes: Complete a mixed, timed practice set with written and spoken responses. Match the time pressure to your own preparation goals; do not infer official timing from this plan.
  • Session 2 — 60 minutes: Review errors and rehearse the corrected mechanisms aloud. Check formulas, definitions, units and any thresholds in your notes.
  • Session 3 — 60 minutes: Run a final retrieval session across your key boards. Focus on the questions you still hesitate over, not on rereading everything.
  • Session 4 — 45 minutes: Prepare a one-page list of prompts and relationships to revisit. Stop adding new topics and keep the session light enough to maintain sleep and concentration.

Adjust the cycle using evidence

At the end of each week, record three things: the topics you can explain without notes, the errors you repeated, and the next practice task. If you are consistently missing the mechanism, return to the source and draw it. If you know the mechanism but lose marks in application, practise a case-based answer. If the problem is time, use shorter answers with explicit signposting rather than speaking faster.

How MySummaries helps

MySummaries turns your PDFs, slides and photographed notes into revision boards, then uses those boards for spaced-repetition cards, practice questions and spoken viva practice. Use it to maintain the cycle above and target sections that your own attempts show need work. Open MySummaries.