Changes to the Fellowship Exam 2018 #ACEMFEx

A number of small, but significant, changes are coming through in the fellowship exams from 2018 - you may have seen some of these advertised in the ACEM Examination Bulletin of December 2017. The significant changes are:

  • A change in examination dates form 2019.1 - see below
  • Twelve OSCE stations instead of 15 over a two-day period. Candidates need to be at least 'just at standard' (pass) for 8/12 to pass overall. This means that trainees must have a good breadth of knowledge and not to rely on knowing some things very well and somethings not well at all
  • All stations are "single" stations - no double-length sim stations. Sims may take the format of the candidate coming into a case that is already underway and they will have to continue managing or troubleshoot an obvious problem - see below
  • Reading time is now universally 4 minutes, with a 7-minute station as before. This means that candidates may be expected to digest more information outside the room and be expected to be 'ready to go' right from the start
  • The introduction of Standardised Case-Based Discussions - see below

The reduction in station number should mean that candidates will be able to sit the exam of their choice (when eligible), rather than being put on a waiting list to do the exam.

Changed Examination Dates

From 2019, the fellowship examination dates are being switched around, with the OSCEs now running earlier than the Writtens in each sitting. The OSCEs will now run in March and September, and the writtens will be in May and November. This was advertised in the February Trainee News.

This emphasises the "de-coupling" of the two parts of the exam, and provides a slightly longer window for preparation between written and OSCE (4 months). So one would sit, for instance, the 2019.1 written and the next OSCE would be 2019.2.

This change has been made to closer align College examinations with the training program term dates, allowing for more trainees to progress in cycle and better track their training. From a workforce point of view, this also separates the primary and fellowship exam periods out so fewer trainees require leave at the same time.

Standardised Case-Based Discussions

From OSCE 2018.1, a new station format will be introduced; the Standardised Case-Based Discussion (SCBD). There may be up to three SCBD stations in any Fellowship Clinical Examination from this time -  these appear to be very similar to the old-style Structured Clinical Examinations (SCEs), and are sold as "consultant-led case discussions".

Information about the SCBD with a sample SCBD station has been posted on the ACEM website. You can find this in the resources tab of the Fellowship Examination page. This may also be the time to go back through all of the pre-2015 fellowship exams to review previous SCEs.

Single Simulation Stations

An update on the conduct of single simulation stations has been released by the college. These will be focusing on Medical Expertise, Prioritisation and Decision Making and Teamwork domains:

In the simulation station/s, candidates are likely to be required to effectively deal with one or two important aspects of a particular clinical situation, given the time frame available.
The stations will commonly be in the context of the candidate arriving as the ‘Consultant in Charge’ to assist and lead the care of a patient in a dynamic and evolving situation as would occur if they were ‘called in to help’. Thus candidates may be required to provide care at any stage of the patient’s ED journey where a ‘problem’ could occur.

You probably won't get time to prepare your team or do a prolonged handover as in previous OSCE questions, and, in fact, may be expected to leap straight into action upon entering the room prior to any of these niceties.

Updated Glossary

An updated glossary of terms for the fellowship exam has also been made available. The important terms to consider in your approach to questions are:

  • Initial assessment = assessment at triage
  • Initial interventions = investigations and treatments done at triage
  • Resuscitation = all assessment and treatments done in a resuscitation room
  • Clinical assessment = history and physical examination
  • Investigations = bedside investigations (including ultrasound), imaging, laboratory investigations
  • Treatment = supportive treatment for the patient and specific treatment for a particular diagnosis
  • Disposition = where the patient is going once they leave the emergency department

More Resources

If you're getting ready to sit the fellowship, make sure you go through the resources in the Fellowship Examination Page. In particular for the OSCEs, look a the Information and Preparing For documents.

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