Passing the FRCEM SBA and OSCE exams on your first attempt requires strategic preparation, not just hard work. With pass rates hovering around 47% for the Final SBA, understanding how to study effectively separates successful candidates from those requiring multiple attempts.

Understanding the FRCEM Exam Structure

The FRCEM Fellowship requires passing two distinct assessments that test different aspects of consultant-level competence in emergency medicine.

The FRCEM Final SBA

The FRCEM Final SBA is a comprehensive written examination assessing theoretical knowledge and clinical decision-making.

Exam Format:

  • 180 single best answer questions in two papers

  • 90 questions per paper with one-hour break

  • Four hours total (two hours per paper)

  • Approximately 80 seconds per question

  • Computer-based at Pearson VUE centers (transitioning to Surpass platform January 2026)

Questions are distributed across 12 Specialty Learning Outcomes (SLOs) from the 2021 RCEM curriculum. Understanding this distribution is crucial for efficient preparation.

The FRCEM Final OSCE

The OSCE evaluates practical clinical skills, communication abilities, and performance under pressure.

OSCE Structure:

  • 16 stations, each lasting 8 minutes

  • 1 minute reading time per station

  • Assessment domains: history taking, examination, procedures, communication, resuscitation

  • Pass requirement: Overall passing score AND at least one resuscitation station (mandatory from November 2025)

The OSCE tests your ability to lead as an Emergency Physician in Charge (EPIC), manage complex scenarios, and demonstrate safe, systematic approaches.

FRCEM SBA High-Yield Topics by SLO

Success requires strategic focus on high-weighted areas. Here's the official question distribution:

SLO Domain

Questions

Percentage (%)

Key Focus Areas

SLO 1: Complex Stable Patient

35

19.4%

Cardiology, Neurology, Respiratory, Endocrinology, Gastroenterology, Infectious diseases

SLO 3: Resuscitation

40

22.2%

ALS algorithms, Shock, Cardiac arrest, Toxicology, Palliative & end-of-life care

SLO 4: Injured Patient

35

19.4%

ATLS protocols, Major trauma, Head injury, Spinal injuries, Burns

SLO 5: Paediatric Emergency Medicine

30

16.7%

Safeguarding, Febrile infant, Respiratory distress, Weight-based dosing, Neonatal emergencies

SLO 6: Procedural Skills

13

7.2%

Sedation (adult & paediatric), Pericardiocentesis, NIV, Lumbar puncture

SLO 7: Complex/Challenging Situations

10

5.6%

Medicolegal, Mental Capacity Act, Safeguarding, Organ donation, Information governance

SLO 8: Lead the ED Shift

7

3.9%

Patient flow, Risk management, Clinical governance

SLO 10: Research & Data Management

10

5.6%

RCT design, Statistics, Diagnostic methodology, Systematic reviews

SLO 11-12: QI & Leadership

Combined with SLO 8, 10

-

QI methodologies, PDSA cycles, Complaint management, RCA