Tips: Javeria

It is MCQ-based now. Topics remain the same as FRCEM Intermediate with more focus on management. As it is SLO-based, there are a set number of questions for QIP and critical appraisal as well. 

For preparation, the sources are:

1. FRCEM Success for FRCEM Intermediate (make sure to either subscribe or find access to the latest MCQs as guidelines have changed in 2021-22 for many topics, and FRCEM Success is updated for this).

2. Guidelines (NICE guidelines for topics like sepsis, fever in under-fives, DKA, miscarriage, STEMI and NSTEMI, heart failure, and NICE CKS are really helpful. CKS doesn't open outside the UK, but they are covered in FRCEM Success as well).

3. Critical appraisal (FCEM Critical Appraisal book if you have time, otherwise there are notes of 20-30 pages which you can read).

4. QIP (A 4-5 page document by RCEM).

5. RCEM guidelines on frequent attenders, ED crowding, and management of investigation reports.

6. People find it useful to read all RCEM learning SBAs.

7. Bromley Emergency course for FRCEM SBA.

Sources for learning:

1. FRCEM OSCE Stations Book/MRCEM OSCE Stations Book (really small difference between the two; only one to two scenarios are more in FRCEM OSCE communication stations and in resus stations, after every station they give one to two alternative scenarios, just the initial bit of each).

2. Bromley Emergency FRCEM OSCE course.

3. RCEM guidance on ED crowding, management of investigation results, complaint management, frequent attender, end of life care toolkit.

4. RCOG guidance on chickenpox exposure in pregnant women, needlestick injury BASH guidelines.

5. Resus Council ALS algorithms, PALS/APLS algorithms, neonatal resuscitation algorithm.

6. Mastering Emergency Med for psych station and communication skills helps as well. Toxicology either from Mastering Emergency or revision notes for FRCEM Primary.

7. For critical appraisal, notes I am sharing plus FCEM Critical Appraisal book (at least just read the chapter relevant to the exam article) and read the article thoroughly, should know the study type, internal validity, external validity, and things mentioned in the checklist of that specific study type in FCEM book.

Scenarios are again according to SLOs:

1. CRITICAL APPRAISAL: They send you the article 1 month ago, so enough time to prepare.

2. My strategy again was to find out the study type of the article and read the chapter from the Critical Appraisal FCEM book for that study type and see its checklist as well.

3. Read the article thoroughly so that you know what's happening in the study because they ask vague questions like how did they conduct the study.

4. Read the critical appraisal notes for terms which are not cleared by reading the book.

5. Practice and discuss with a study partner.

MANAGEMENT AND LEADERSHIP STATIONS:

1. Prioritisation stations are very common in OSCE.

   • Deal with these stations as you deal with crowding at your own workplace.

   • RCEM ED overflow guidance can help you.

   • The trick is to utilise all areas, identify the sickest patients needing immediate management. Sometimes they put distractors like a person screaming to go home and saying he will complain as he is a medical director, etc., don't get distracted by that. Sometimes they make all areas so busy that you don't have space, so utilise chairs and corridors. Rooms can always have a screen and accommodate more than one patient. Cohorting of patients can be done who present with similar symptoms.

2. Conflict Resolution/Complaint management:

   • MRCEM OSCE checklist will help in these and then practising with a study partner.

3. Disaster management:

   • They can or cannot be there, can be a comprehensive station like a disaster call, or there may be small parts being assessed like Triage in disaster. This can be a viva sort of station. MRCEM OSCE book checklist again will help in this station.

4. Difficult referrals.

5. Safeguarding scenarios including both adults/children.

RESUSCITATION STATIONS:

• Will be 3 in number; you need to pass at least 2 of these. They can be codes starting from periarrest situations or arrest situations or can be a resus skill like RSI. Can be a station where you have to discuss on the phone about a patient in resus and direct another person to do it.

PAEDS:

• Can be anything from resus, history exam, skills, and safeguarding.

For OSCE, make sure to practise a lot with colleagues.

Dr. Javeria Ahsan

• FRCEM, FCPS, MBBS