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Primary Exam - Written

Preparation for the Primary Written Exam

 

What have you got yourself in to?

Ok, so this is the first of exam you will sit during your ED training. In TS1 you need to sit and pass the Primary written and VIVA exams, as a requirement (among other things) to progress into TS2.

The written component of the Primary Examination is an MCQ-based exam, with 360 questions in total over 2 papers, sat on the same day. The subjects covered are Anatomy, Physiology, Pharmacology and Pathology.

So how do you prepare?

There are tonnes of online resources and advice online about how to best prepare. Preparation will depend on you – how you best study and learn.  Below is a list of resources, ideas and links that might help.  Take the resources that work best for you. Please let me know if there are any resources you come across that you think I should add.

1st Step -  Commit!

As annoying as it is, to pass an exam you need to commit to giving up some time, make a plan, commit to a timetable that works for you and is realistic, and go for it. This often involves planning with your family and friends that you will be in study mode for at least 6 months, and that you may need to set up supports to do this.

How much time? That depends on you. You l likely need 6-12 months, depending on other life commitments and FTE, building periods of revision/catch-up into it - designed for nightshifts and those occasional weeks when you just can't.

2st Step - Where to start.

ACEM Primary exam resources page

Please do look through this.

Most importantly

  • Look at the Guide to the Primary exam.
  • Look at the matrix.
  • Look at the syllabus with Level of Assessment (LOAs).
  • Look at the booklist

 

 

 

 

Understand the LOAs

  • You should start with LOA 1 topics and know these well.
  • LOA 2 topics are also important.
  • do look at LOA 3 topics- still need to cover but can do more briefly.

Understand the Matrix

  • At the time of writing the below is the current Primary Exam matrix (please cross check this with the college guidelines above)
  • Again, this can help guide your focus to the most important topics to cover – they often crossover with LOA 1+2 topics

 

3st Step - Prepare your resources

Timetables

There are a few accessible timetable suggestions – these don’t work for everyone but can be helpful when studying with others so that you cover similar things at similar times.

Suggested timetables

 

ERexam.org also has a 22-week study timetable with associated notes. It is simplified / bare bones. Some may find this useful.

 

A tip from a previous successful candidate – look at the timetable and customise it to your work schedule, the days you have off and the time you expect to study. Are you someone who can study after a day shift? Or before an evening? Be realistic about what you can do. Don’t plan to study during nightshifts – unlikely to recall what you learn then. Use that time to sleep / clean your house/ do the garden or anything else you’ve been neglecting.

 

Textbooks

There is no substitute for reading the prescribed textbooks.

 

Please look at the list here: in the section “Foundations of Emergency Medicine”

All MCQs/SCQs are directly referenced to the books in the curriculum.

Many questions are from the tables - practically these are the easiest questions to write. They of course also come from the text.

Some notes:

  • Anatomedia – not a textbook but an online resource that the college can give you access to (usually given when you join the college). The latest college position is that anything in Anatomedia is also up for examination in the exam – this may be more for the VIVAs but potentially for the written exam as well.
  • West’s Physiology – don’t forget this one – often referenced in the exam
  • Goodman and Gilman’s Pharmacology – I’m not sure anyone reads this in detail, it’s listed but likely not worth it unless there is something you really don’t understand.

MCQ Resources

There are 2 paid resources that are commonly used:

  • iMeducate – feedback is that this is the better resource and more reflective of the questions on the exam.
  • Medexhub – another bank of MCQs. Feedback is that these tend to be harder and less reflective of the exam.

It is a good idea to join at least one of these early and use ongoing MCQ practice as a guide to tell you how you are progressing in your study. Some people prefer to read the books and then try the MCQs, some prefer to use the MCQs as a driver to study – do what works for you.

ACEM has practice MCQs under the resources page listed above.

  • 4 x 1.5hr MCQ exams, in same format as exam.
  • I suggest you do these in the last 6 weeks of preparation, as you ramp up to be ready for the day.

Recently I came across this. It seems to be another paid MCQ website set up by FACEMs. I’m not sure of the quality as have had no trainees use it yet.

Another site with MCQs, listed per topic, is this at improvingedcare.com

Set up a Study Group

I know study groups aren’t for everyone, but they are a great idea to help to keep on track, share learning and resources, and really is vital for the VIVA exam to follow.

 

Other Resources / Think about the way you learn.

Everyone learns in their own way – so find yours.

While the books are where the questions come from, it isn’t always the best way for everyone to learn.

Remember that varying up the way you learn, including the type of input (visual, audio, verbal practice etc) can help to consolidate memory. Starting VIVA prep from the beginning – talking it out loud – can help with retention. Studying with a group / teaching each other is also great for knowledge retention.

HETI, again, have an excellent summary of online resources here great summary of resources here. More resources, mostly mentioned by the HETI team, are below.

Other resources include:

  • Concise editions of the textbooks, and flashcards (we have some of these in the DEMT office).
    • If you prefer concise texts – this book has been recommended by a previous prize winner: Basic physiology for anaesthetists (Chambers, Huang and Matthews). I havn’t vetted it myself.
  • Other accessible study notes
    • Doctors writing
    • “Fancy notes” – chat to the DEMTs – we can share a link to these
    • Emergencypaedia – some notes and brief presentations on important topics.
    • “Darwin notes” – I’m not sure what these are, there are rumours that these exist. Let me know if you come across them.
  • Online tutorials
  • Youtube – there are many resources, of varying quality. See the HETI resource link above for some. A couple recommended here:
  • Podcasts / Audio episodes
    • Acemprimarypodcast is really the only one out there. Not every topic is covered, but the big ones are and can be good to listen to while moving. They also have some written summaries to go along with it.
    • ICU primary prepcast – covers many of the topics, but does have an ICU primary focus.
  • On-the-floor learning
    • Think about the anatomy you are reviewing – XRs, CT scans, wound repairs etc. Talk it out loud
    • Think about the drugs you are giving – indications, mechanisms of action, dosing, side effects
    • Look at ECGs, VBGs, CXRs and describe them.

4th Step – Do the work.

 

Self- explanatory

 

And in the last 6 weeks

  • Try to ensure you are mixing up your MCQ questions on imeducate/medX hub – not just doing subjects you have recently read
  • There are 4 practice MCQs 1.5hr exams on the ACEM website, in same format as exam. It’s time to start doing these
  • We will sit a practice written exam in the Bendigo teaching space – just to get those exam nerves firing

You should be aiming to pass 70% of the MCQs you are practicing to comfortably pass the exam.

 

5th Step – Do the exam.

So what will that look like?

Questions on the day

The written component of the Primary Examination contains up to 360 questions in total.

  • It consists of 2 x 3-hour papers of up to 180 questions each, held over the course of one day.
  • 1 min /question
  • The questions are made up of Select Choice Questions (SCQ) or specifically, Multiple Choice Questions (MCQ) only.
  • The questions in both papers are mixed across the 4 topics - Physiology, Pharmacology, Anatomy and Physiology.  Overall, there will be an even spread (ie. 90 questions for each topic)
  • The exam is computer based. You answer the MCQs as you go along. There will be a summary in the corner of the screen of the questions. You can flag questions that you are unsure of. Still put in an answer and you can link directly back to these questions once you have completed the exam.
  • The online ACEM practice exam is designed to show you the exact format that you will be expected to use on the day. Please do this prior to the real exam.

Some Anatomy SCQs in the examination may use visual props and images.

A note about old question examples and what has changed:

  • There are many MCQ banks out there that may not be exactly in the style of the exam. This is ok - if anything they tend to be a bit harder, which will make it easier on the day. To update the banks takes and extraordinary amount of time, so don't expect them all to be current.
  • You may find that some old primary written sources have EMQs (Extended match questions) - these are now no longer part of the primary exam.
  • You may find many examples of the older style of MCQ - short stem and wordy answers. This has also changed - the MCQs now tends to have longer stems and shorter answers.
  • They also have tried to phase out negative questions (eg. Which ARE NOT found..)
  • They style of question should allow you to know what the answer is by the time you finish the stem before you look at the answers.

The Exam Centre

The written exam is at Clifton's - in Collin's Street, Melbourne.

As always, please read the most recent advice forwarded by ACEM prior to the exam about what to expect on the day, as there can be occasional modifications.

On arrival you will need to registrar with identification. Watches (all types), phones and other devices will be placed in your bags and left in a secure place for the entire exam process.

Your exam will have FACEMs, ACEM staff as invigilators.

You will be placed in a room with other candidates and will have a designated computer and desk. You will be provided with a pen and a paper which you may use to take notes during the exam (this will be left at the centre; you may not take it home). You may bring earmuffs (the typing can be noisy).

Please note that you are required to remain in the examination room for the duration of the examination time, even if you complete your examination early.

You can bring lunch/snacks to have between the 2 sessions, but no area to keep it cool. In Melbourne there is a 7/11 just nearby where you can grab food as well.

How is it marked?

As from the 2022.2 Primary Written Examination, to pass the PEx Written, a candidate must achieve:

  • an overall score at or above the cut score plus 1 standard error of measurement (SEM), and
  • a minimum standard in all subject areas, where this is defined as scoring at or above the subject cut score minus 1 SEM.

Prior to the 2022.2 exam there was not a minimum standard in all 4 areas, you just had to pass overall. The consensus is that the pass rate, which was previously very high, may drop a bit from 2022.2 onwards.

What is this cut score? ACEM defines it below:

For the SCQ paper, the standard setters individually and as a group, determine the percentage of ‘Just at Standard’ candidates who would be expected to correctly answer each question. The mean of these scores gives the raw cut score for the SCQ examination. A ‘Just at Standard’ candidate is defined as one who has demonstrated a minimum or sufficient level of knowledge and understanding to ensure safe practice and to be able to meet core needs of the patient.

The pass rate (not mark) for the 2022.2 written exam was 84.7%

The pass rate for the 2023.1 written exam was 73.4%.

The pass rate for the 2023.2 written exam was 70.1%

When do you get the results?

  • The ACEM document above says 6 weeks. For the 22.2 and 23.1 exams it was 13 days exactly.
  • You get a notice generally the night before stating that it will be released around midday the following day. The DEMTs get this notice too. The DEMTs also get an email later that same day formally notifying them of their trainees' results.

Ok, that’s it. If you’ve made it here, look at you! Please note I have done my best to collate all the information about this exam that I can. If you find any inaccuracies, please let me know, and let me know if there is anything else that should be added.

Prepared by Dr Yvette Bassin, FACEM, co-DEMT, Bendigo Health. Nov 2023

ybassin@bendigohealth.org.au

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