Start with the stage you are preparing for
MRCEM/FRCEM is a pathway, not one single exam format. The assessments evaluate applied emergency medicine knowledge and clinical decision-making; depending on the stage, candidates may face written assessments, structured clinical or viva-style stations, or a combination. Do not assume that another candidate’s timetable or account of a particular paper applies to your stage. Check the current Royal College of Emergency Medicine (RCEM) website for the official format, syllabus, regulations and candidate guidance.
The shared preparation challenge is applying knowledge under pressure. You need to recognise immediate threats, decide what happens first, choose investigations that will affect management, and make a safe plan for onward care. In a station, that reasoning must also be audible and organised. In written work, it must be concise enough to show the decision rather than a list of everything you know.
Build your preparation around three questions:
- What is dangerous here? Identify life-threatening possibilities and the red flags that would change your response.
- What happens first? State immediate actions before slower investigations or background detail.
- Where does the patient go next? Make a clear decision to admit, discharge, observe or refer, and include escalation and safety-netting where relevant.
Make the exam format a study task
Before planning sessions, write down the assessments that apply to your stage using the current official information. For each one, note the task type, the knowledge or skills it tests, and how you will practise it. Avoid relying on unofficial claims about question numbers, timings or pass marks; confirm any such details with RCEM.
Then match practice to the task. For written assessments, practise retrieving facts and applying them to cases, rather than only rereading guidelines. For clinical or viva-style stations, speak your decisions aloud and rehearse prioritised answers. If your stage includes more than one type of assessment, keep both in your weekly plan. A strong knowledge base alone will not show whether you can communicate a plan or make safe decisions in a timed scenario.
A useful station structure is a set of headings, not a script. For an acute case, consider immediate actions and safety, focused history, examination, investigations, management, and disposition with follow-up or safety-netting. For communication, ethics or systems scenarios, organise your response around the situation and stakeholders, relevant principles, options and actions, escalation, and documentation. Select only the headings that fit the case, and lead with the most time-critical point.
Build a revision board from your own material
Bring together the notes you trust for the topics in your stage’s syllabus: teaching slides, personal notes, and relevant clinical guidance. Keep the source and date visible so you can check material that may have changed. Divide each topic into decision-sized sections: recognition, immediate assessment, investigations, treatment, escalation and disposition. A section should help answer a clinical question, not just name a broad subject.
For example, an acute asthma board should make the initial assessment and treatment easy to retrieve, while separating severity clues from later management and disposition. MySummaries can turn your own source material into a board; a board on this topic ends up looking like this:
- Assess severity immediately — look for exhaustion, altered consciousness, poor respiratory effort and a silent chest.
- Record oxygen saturation, respiratory rate, pulse and peak expiratory flow when the patient can perform it.
- A normal or rising PaCO₂ in a severely breathless patient is concerning; obtain blood gases if life-threatening features or poor response.
Do not delay treatment for tests. Use peak flow to assess severity and response if feasible; consider blood gases for life-threatening asthma or poor response. Chest radiography is not routine: request it when a complication or alternative diagnosis is suspected.
- Oxygen if hypoxaemic; titrate to a target saturation of 94–98% in most adults.
- Salbutamol 5 mg by oxygen-driven nebuliser for a severe attack; repeat according to response and local guidance.
- Add ipratropium bromide 500 micrograms nebulised for acute severe or life-threatening asthma.
- Admit if symptoms or physiological abnormalities persist, treatment response is inadequate, or there are other clinical concerns.
- Before discharge, confirm sustained improvement and provide an appropriate treatment and follow-up plan.
- Explain when to seek urgent help, check inhaler technique and arrange follow-up in line with current local guidance.
- Give prednisolone 40–50 mg orally as early as possible; use IV hydrocortisone if oral treatment is not possible.
- If response is poor, seek senior help and consider IV magnesium sulphate 1.2–2 g over 20 minutes.
- Involve critical care early for life-threatening features or deterioration despite initial treatment.
Keep a short core checklist
For each topic, reduce your notes to a small “must not miss” checklist: the cues that change urgency, the first actions, the important escalation point, and the disposition decision. Keep the complete source notes nearby. The checklist is for retrieval and practice, not a replacement for checking current clinical guidance.
The core for the asthma board is not a full protocol. It is a quick test of whether you can recall the dangerous features and essential steps. MySummaries can extract that kind of checklist from a board; the core here is:
Practise the decision, then mark the reasoning
For a clinical or viva-style station, practise with a spoken answer rather than silently composing an ideal response. Start by stating what you would do immediately. Then explain the focused assessment and tests that will change your next step. Finish with management, escalation and disposition. Say why an action is needed, especially where the case contains a red flag or a risk of deterioration.
Record practice when possible. Review whether you named the immediate danger, whether your order made clinical sense, and whether you clearly stated where the patient would go. A common weakness is giving reasonable treatment but never making a disposition decision. Another is listing tests without saying what a result would change. Do not treat a platform score as an official exam mark: it is feedback on the practice answer, not the College’s marking scheme.
MySummaries can mark a recorded practice response against its own examiner criteria. In this example, the patient has severe asthma with inadequate response to initial nebulisers; the score and feedback below are platform feedback, not an official MRCEM/FRCEM result.
Examiner
A 28-year-old with asthma remains very breathless after initial nebulised treatment. Talk me through what you would do next, how you would assess response and where you would send the patient.
You recognised the need for ongoing urgent treatment and senior help, but did not lead with a complete immediate safety assessment.
ImproveOpen with ABCDE, monitoring, oxygen if hypoxaemic and an explicit call for senior support while treatment continues.
You identified exhaustion and a silent chest as serious features but did not explain the significance of a normal or rising PaCO₂.
ImproveState that a normal or rising PaCO₂ in a severely breathless patient is concerning, not reassuring.
You proposed reassessing peak flow and considering a blood gas, but left the trigger for imaging unclear.
ImproveSay that a blood gas is appropriate with life-threatening features or poor response, and that chest radiography is targeted to suspected complication or alternative diagnosis.
You described escalation and ongoing treatment but left the admission decision conditional rather than explicit.
ImproveState that persistent symptoms, physiological abnormality or inadequate response requires admission and senior-led ongoing care.
You mentioned a senior review but did not say how you would explain the plan or involve the patient.
ImproveExplain the immediate concern and plan in plain language, check understanding and seek consent where practicable.
A strong answerI would reassess ABCDE immediately, continue monitoring and call a senior clinician because the response has been inadequate. I would look for exhaustion, altered consciousness, poor respiratory effort and a silent chest, and check oxygen saturation and peak flow if the patient can perform it. I would continue bronchodilator treatment, add ipratropium for a severe or life-threatening attack, and ensure systemic corticosteroid has been given. With life-threatening features or poor response, I would obtain a blood gas, consider IV magnesium sulphate and involve critical care early. Persistent symptoms or physiological abnormality means admission, with a clear handover and explanation to the patient.
That is a MySummaries station, filled with MRCEM/FRCEM material. Yours is written from your own notes. Start free
Use audio for retrieval, not background listening
An audio review can help you revisit a board while travelling or between sessions, but listening alone is passive. Pause at a decision point and answer before hearing the next part: What makes this case life-threatening? Which action happens first? What finding changes disposition? Then check the source notes, particularly for treatment details that may have changed.
MySummaries can read back a board as an examiner-style lecture; this asthma segment focuses on linking severity to the next action:
Transcript · tap any word to jump there
Start with the patient, not the peak-flow number. Look for exhaustion, altered consciousness, poor respiratory effort and a silent chest. At the same time, assess oxygen saturation and begin immediate treatment where needed. A normal or rising PaCO₂ in someone who remains severely breathless is a warning sign: it should increase your concern, not reassure you.
Next, reassess after treatment. Record the clinical response and peak flow if the patient can manage it. If the response is poor, involve a senior clinician; consider blood gases when features are life-threatening or treatment is not working. A chest radiograph is for a suspected complication or alternative diagnosis, not a routine step that delays care.
Finally, state the destination. Persistent symptoms, ongoing physiological abnormality or inadequate response needs admission and an appropriate level of senior review. If discharge is being considered, make sure improvement is sustained and the patient has a suitable treatment, follow-up and safety-netting plan. In a station, say these decisions out loud and explain what would make you change course.
A repeatable weekly method
Use a cycle that makes every study session produce something you can test:
- Select one syllabus topic. Check it against the official guidance for your stage and collect your own notes from reliable sources.
- Organise the board. Separate recognition, immediate actions, investigations, management, escalation and disposition. Mark uncertain or outdated points for checking.
- Retrieve before rereading. Use flashcards or a blank-page recall exercise for doses, thresholds, contraindications and decision points. Check every clinical detail against a current source.
- Apply it to cases. Answer written or viva-style cases in the format required by your stage. Practise stating priorities and the reason for each important decision.
- Review the misses. Record the precise missing point, correct it from your notes, then test it again in a later session. If the same error recurs, rewrite the relevant board section so the decision is easier to retrieve.
For each practice answer, review three things: whether you prioritised correctly, whether your reasoning was explicit, and whether your plan ended with safe escalation or disposition. Keep a list of recurring errors, not just a total score. Use the official RCEM material to confirm what assessment tasks your stage includes, and current clinical guidance to verify practice details.
How MySummaries helps
MySummaries turns your PDFs, slides and photographed notes into revision boards, then uses those boards for spaced-repetition flashcards, written practice, examiner-style audio and recorded oral practice. For MRCEM/FRCEM preparation, use it to organise your own emergency medicine notes, practise prioritised case answers and revisit the specific points you missed.