Passing the MRCEM Intermediate Exam

Written by: Dr Anja Guldemond, Emergency Medicine ST1, North West

What is the MRCEM?

The MRCEM Intermediate is the second of three exams required for MRCEM membership. This guide covers when to sit the exam, costs, format, revision strategy and what to expect on the day, plus an honest account of how I revised for it and passed first time.

If you are training in Emergency Medicine in the UK, the MRCEM exams are mandatory and must be completed by the end of ST3. The exam before this one is the MRCEM Primary, and the final exam is the MRCEM OSCE.

Compared with the Primary, the Intermediate is far more clinical. The Primary focuses heavily on anatomy and physiology, whereas the Intermediate is about applying knowledge to clinical scenarios. Many people assume this makes it easier but I actually found it harder and revised more for it than I did for the Primary. Do not underestimate it!

When to Sit the Exam:

There are September and January sittings each year, and it is worth planning early.

To be eligible, you must have completed two years of postgraduate clinical experience at the point of application. For most people, this means completing F1 and F2. The application window usually opens around three to four months before the exam date, so you need to decide fairly early when you want to sit it.

I sat the MRCEM Intermediate in January 2026, which was the first sitting I was eligible for. I had already completed the MRCEM Primary in May 2025 during F2.

One of my reasons for choosing January was that many of my friends doing F3 years were revising for the MSRA at the same time, so we could motivate each other. I also preferred avoiding summer revision.

More broadly, there is no “perfect” stage of training to sit the exam. Plenty of people sit it during ST2, and an F3 year is also a great time if you already know you want to pursue Emergency Medicine.

The main piece of advice I heard repeatedly from colleagues was to avoid sitting it during an anaesthetics block. Getting your Initial Assessment of Competence (IAC) is already stressful and combining that with a major postgraduate exam would be difficult. Beyond that, timing largely comes down to personal preference and what fits best around work and life commitments.

Cost and Booking:

The exam costs £429 for RCEM members and £525 for non-members. If you are in Emergency Medicine training, you will already be an RCEM member through training. If you are taking the exam during an F3 year, it is usually worth joining RCEM anyway, as the reduction in exam fees more than offsets the membership cost.

Membership also gives access to RCEM Learning which I found to be the single best revision resource for the exam. If you are self-funding the exam you can also claim tax relief on the fee so keep your receipts.

The booking process is straightforward. You apply during the application window, wait for approval, and then receive a link to book your test centre roughly one month before the exam. Check your emails regularly around this time so you can secure the most convenient location.

Exam Format:

The MRCEM Intermediate consists of 180 single best answer (SBA) questions split across two papers. Each paper lasts two hours, with a one hour break between them.

The exam is mapped to Learning Outcomes 1-7 of the ACCS curriculum, and the breakdown of questions by curriculum area is available on the RCEM website.

The exam is broad, and topics can come from almost any area of Emergency Medicine. Compared with the Primary, there is much more emphasis on practical clinical decision making and less on memorising basic science.

How I Revised:

The best resource I used was RCEM Learning. I found the SBA practice questions extremely helpful. Alongside these, I worked through as much of the learning content on the site as possible.

My overall approach was little and often. Any spare minutes during the day became an opportunity to read an article or complete a section of the website, and over time that added up significantly.

I also used MRCEM success and FRCEM tutor. I worked through each question bank once and then repeated all the questions I initially got wrong until I could answer them confidently. I made very few notes beyond brief summaries of topics I repeatedly struggled with.

In my experience, most of the underlying knowledge is already familiar from medical school, foundation training and day-to-day clinical work. The challenge is learning how the exam asks questions and recognising common Emergency Medicine patterns.

A lot of advice online suggests revising for six months. I knew that approach would not work well for me because I would have lost motivation long before the exam. Instead, I revised more intensely over a shorter period.

I started around three months before the exam. The first month was relatively relaxed, fitting revision around work where possible, before increasing the intensity over the final two months. I had two and a half weeks of study leave and educational development timeimmediately before the exam which I used for full revision days.

Even during the final stretch, I still exercised regularly and made time to see friends. I was deliberate about not letting revision completely take over my life, and I genuinely think maintaining that balance helped me perform better on the day.

On the Day:

The exam is held in a Surpass Assessment Centre. Bring valid photo ID with you. You are also allowed to bring water and snacks into the exam, which I would strongly recommend.

Before the exam, have a rough timing strategy in mind for each paper so you do not end up rushing towards the end. My approach was to work through 50 questions, take a brief mental reset, and then push through the remaining questions in blocks.

During the one hour break, you are allowed to leave the centre. My exam was in a city centre, so I went out to get lunch, which worked well. If your centre is more remote, it is probably easier to bring food with you. Avoid eating anything unfamiliar, as you still have another two hour paper ahead of you.

During the exam itself, try not to overthink questions. If you are unsure, flag the question and move on. If you genuinely have no idea, make your best guess and continue rather than spending unnecessary mental energy on it. In most cases, returning to it later will not suddenly produce new knowledge.

Results:

Results are released on the date listed on the RCEM website and can be accessed through your RCEM account.

The results do not always appear on your portfolio immediately; mine took a few days to update. There is often an online queue when results are released, so expect delays accessing the website initially.

If possible, try not to be working clinically when results come out. Waiting for postgraduate exam results is stressful enough without also managing a busy shift.

Final Thoughts:

The MRCEM Intermediate is a hard exam with a low pass rate, and people underestimate it because it is clinical and they assume it will come naturally. Use RCEM Learning, do as many practice questions as you can, and give yourself enough time. If your weeks are busy, start earlier rather than cramming it all into a shorter window. Good luck!