How to prepare for MRCEM Primary (Written Exam)

Membership of the Royal College of Emergency Medicine (MRCEM) curriculum consists of three components MRCEM Primary, MRCEM Intermediate SBA, and MRCEM OSCE. The elements are designed to test skills, knowledge, and behaviour in training. You must complete all three elements to enter Emergency Medicine training and be awarded membership by examination.

A&E doctors need to progress through emergency medicine speciality training on their journey to work as a consultant in the UK. The difficulty faced is that you must complete multiple exams and components to enter the speciality training program alongside busy training rotations, ARCP, work and personal commitments. We’ve searched the internet and spoken to former candidates to create a one-stop guide for all of your MRCEM resources and guidance. If you want to be in with the best chance of passing your MRCEM exams on the first try, you’ve come to the right place.

All you need to know about MRCEM Primary

How do I get into Emergency Medicine training?

The entry requirements into emergency medicine training are a completed medical degree (undergraduate or postgraduate) and 2 years of foundation training. A trainee can then start emergency training via a few different routes:

  • Through the acute care common stem (ACCS) and complete core training, CT1-CT3, before entering into higher speciality training (HST)
  • Entry into HST is also possible via the run through programme, ST1-ST6.
  • It is also possible to carry out the first 3 years in ACCS training in a different acute speciality or in surgery and enter ST3 via a defined route of entry into emergency medicine (DRE-EM)

Entry into ST1/CT1 is very competitive and candidates need to complete MRCEM by examination to progress into ST4 higher speciality training.

If you are a doctor and looking for Emergency Medicine locum or permanent opportunities, you can browse our A&E vacancies.

Who needs to sit the MRCEM exams?

Trainees in GMC-approved, UK training programs are required to complete the MRCEM examinations to progress to ST4 emergency medicine training. You can sit the exams at any time from FY1 but need to pass all three before you can progress to higher speciality training.

The GMC considers an examination pass to be current so long as you enter or re-enter an approved training program within seven years of passing the exam. International Medical Graduates (IMGs) from any country in the world can sit the MRCEM examinations which allow them to enhance their career progression or enter EM training in the UK. MRCEM is also a prerequisite for those wanting to gain FRCEM in the future.

Examination requirements for the award of MRCEM after August 2021

  • MRCEM Primary SBA or FRCEM Primary or MRCEM A between August 2012 – August 2016
  • MRCEM SBA or FRCEM Intermediate SAQ or MRCEM B between August 2012 – August 2016
  • MRCEM OSCE after August 2012

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How to prepare for MRCEM Primary

The MRCEM Primary is the first step towards the Royal College of Emergency Medicine (RCEM) fellowship. In this guide, we explain the eligibility for applying, exam-style, what to read, how to prepare, how to apply, and more.

What is the format of the exam?

The new MRCEM examination structure was introduced in August 2021 and consists of the following components:

  • MRCEM Primary Single Best Answer (SBA)
  • MRCEM Intermediate Single Best Answer (SBA)
  • MRCEM Objective Structured Clinical Examination (OSCE)

The MRCEM Primary examination is a Single Best Answer (SBA) paper, replacing the FRCEM Primary. The examination comprises 180 questions to be answered in three hours. This format means there will be five options, one correct answer and plausible alternatives. You will need to choose the best answer of the five possible options to be awarded one point. This exam tests basic sciences with a limited clinical focus.

How much does it cost?

At the time of writing this, the price of the exam was as follows:

  • MRCEM Primary – £330

How do I register?

You can apply for the MRCEM Primary exam directly on the RCEM website. Online applications for all examinations will open at approximately 10 am (GMT time) on the application opening date listed on the exam information page, in the dates and fees section. Applications close automatically at 5.00 pm (GMT time) on the listed closing date.

Am I eligible to apply for MRCEM Primary?

You will need to hold a medical qualification approved by the GMC for registration purposes or candidates registered with an international medical qualification will be required to upload a copy of their current medical registration.

How can I prepare?

The MRCEM Primary examination is the new name for the FRCEM Primary examination from August 2021. The MRCEM Primary examination is mapped to the RCEM Basic Sciences Curriculum (June 2010) and the 2021 Emergency Medicine curriculum. The SBA format has remained the same since the introduction of the 2016 FRCEM primary exam. The consensus is that the first MRCEM exam is difficult with low pass rates, so preparation is key. The preparation for this exam is broken down into understanding the curriculum which will be tested, spending a sufficient amount of time on the areas where the points are weighted more heavily and practising exam-style questions.

Curriculum Preparation

Reading through the RCEM Basic Sciences Curriculum and the Emergency Medicine Curriculum is a daunting thought due to the volume but it’s crucial to review this from the start of your revision.The RCEM Basic Sciences Curriculum is highly representative of the content that is found in the exam and should form the centrepiece to structure your revision. Keeping this alongside your study materials will allow you to cross-reference the information you do need to know and the things you don’t which will save you time navigating textbooks and further reading. The below areas are tested in the following proportions:

  • Anatomy (60 questions)
  • Physiology (60 questions)
  • Pharmacology (24 questions)
  • Microbiology (17 questions)
  • Pathology (9 questions)
  • Evidence-Based Medicine (10 questions)


Online revision guides and testimonials from doctors recommended a minimum of 3 months but ideally 6 months to get a good grip of the basic sciences with a focus on anatomy and physiology. The longer you give yourself to prepare the less intense the volume of revision will be. The rotation you are doing alongside your revision can be an advantage when it comes to studying. Whilst it might seem appealing to hit the books during your daytime ward-based rotations, it may be better to coordinate these rotations when you need to practise verbal diagnosis and presenting for your objective structured clinical examination (OSCE).

Some doctors have used their FY1 year as they are still in the revision mindset from medical school to sit their MRCEM Primary. This method would allow you to stagger MRCEM Intermediate SBE and MECEM OSCE over the next four years of study so there is no gap to continue through to ST4 training and also allows time for any resits (which we shouldn’t need with the right preparation). With the entry into ST1/CT1 so competitive, any MRCEM exams already passed could be advantageous.

“I feel 6 months with work and 2-3 months without working would be helpful. It took me 1 month to clear MRCEM primary as at that time I had just completed my graduation”

Dr. Khan


When it comes to selecting further reading, this is where a good understanding of the curriculum will really help you. Former candidates agree that within the anatomy section of the examination, the upper and lower limb sections tend to be more heavily weighted.

The best resources to structure your study are the RCEM curriculum guides as follows:

  • Basic Sciences Curriculum
  • RCEM Curriculum

Further reading and resources

  • Anatomy: Teach Me Anatomy
  • Physiology: Physiology at a Glance

Question Banks

High volumes of question bank practice are cited as the preferred study approach for this exam, particularly if pushed for time. This gives you time to familiarise yourself with the question style which in turn will allow you to work through them at a pace that should allow you to clear the 180 questions in 180 minutes. The time and energy using question banks are much less however in your career and in some tricky exam questions, an understanding of the concepts will be needed so it is best to combine this method with additional reading.

  • MRCEM Success
  • FRCEM Tutor


YouTube is an invaluable free study resource where you can focus on anatomy and physiology videos. Plexuses, upper and lower limb anatomy are easily accessible by searching “anatomy” or “MRCEM”.

Practice Exam

In the last month of revision, focus heavily on practice exams. This will give you the confidence to get through the 180 questions in the set time frame.

Top tips for revision

  • The smaller subjects can be easier to get to grips with and, on occasion, a little more interesting than the anatomy and physiology curriculum, but it is a mistake to spend too much time on them
  • Some questions require you to make a diagnosis and choose an answer based upon this diagnosis, this is where further reading to understand the principles will be advantageous rather than just relying on question banks.

At A&E Agency, we’re passionate about the quality of our people and proud of the services we provide. You can find more information about MRCEM Intermediate SBA and MRCEM OSCE <How to prepare for MRCEM OSCE (Clinical Exam) blog> or for any other information or guidance, register today with Pulse. Our team are here to help doctors find great work opportunities in the UK. If you are a doctor and looking for Emergency Medicine locum or permanent opportunities, you can browse our Pulse vacancies

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