Passing the MRCEM Primary exam

By Stuart Nickerson, Emergency Medicine ST1 North West

The MRCEM Primary exam is a key milestone for anyone pursuing Emergency Medicine in the UK. This guide breaks down when to sit the exam, costs, booking tips, format, and what to expect on the day. It also shares practical revision strategies, including question banks, high-yield topics, and study planning, helping you prepare effectively, reduce stress, and maximise your chances of passing first time.

The Membership of the Royal College of Emergency Medicine (MRCEM) exams are a key milestone for anyone pursuing a career in Emergency Medicine in the UK. The MRCEM Primary is the first of three exams you must pass for MRCEM membership and this is a requirement by competency by the end of ST3. It is followed by the MRCEM Intermediate (SBA) and then the MRCEM OSCE.

The Primary exam focuses on the scientific foundations underpinning emergency medicine covering anatomy, physiology, pharmacology, microbiology, and pathology. While this content will feel familiar from medical school (well the start of medical school!), the expected knowledge around clinical application is higher.

I chose to sit the MRCEM Primary early during my first year of specialty training (ST1) aiming to get ahead of the exam burden.

Timing

One of the main decisions is when to sit the exam and there’s no perfect answer and never a good time to start studying! The exam is run twice per year with a sitting in April and October. Something to note is that the booking period is only open for 1 week four months before the exam date, so if you are planning to go for it make sure it has your reminder set.

Three main options would be:

• FY2 - maybe during a slightly less strenuous rotation. Pros would be you’re closer to the medical school knowledge, good for interviews and you get it “out of the way” before a new hospital, new job and new portfolio.

  
  

• FY3 - if you are doing one this may arguably be the sweet spot if you have more control over your time.

  
  

• Early ST1 - as I did. It worked well as I had a bit more structure, knew I was committed to EM, and could approach revision with a clearer goal. I would not have wanted to leave it much later as I think the exam burden grows and it's nice to have a bit of a buffer if results don't go your way.

The bottom line is go for it when it suits you and when you can make time for it.

Cost + Booking.

The cost of the exam is significant and in line with many other colleges' prices. As with all exams you may need to resit and this cost can increase quickly so being prepped for this as a worse case scenario is sensible.

Small tips

The exam is reduced in cost as an MCREM member (Member UK - £429 vs Non-member UK £525). Membership is significantly cheaper when in Foundations years and this saving more then covers membership fees plus all the added benefits the a RCEM membership allows you with access to RCEM learning which is great. So I would definitely bear this in mind when booking the exam. All other details for costs and booking details can be found at: https://rcem.ac.uk/exam-calendar-fees/.

Tax relief can be claimed on exams so get on this and keep your receipts!

The exam is booked through RCEM website. This is where to get information for the booking window and then exam date. Once your place is confirmed you will get a link to book the actual test centre appointment - time and preferred location roughly one month prior to the exam. So look out for emails at this time to ensure you get your desired location and time.

Exam Format and Content

MRCEM Primary consists of a single paper, 3 hours with a 10 minute break that you can opt out of if desired. 180 MCQs and questions are mapped to the basic sciences curriculum underpinning Emergency Medicine, including:

• Anatomy

• Physiology

• Pharmacology

• Microbiology

• Pathology

• Evidence-based medicine and statistics

The exact numbers and break downs can be found on the RCEM website however a large proportion of the exam focuses on anatomy and physiology, particularly in clinically relevant contexts such as trauma, airway management, and cardiovascular and respiratory function

Revision Strategy

Everyone revises differently, but a few things made a big difference for me.

Questions, questions, questions

This is the most important thing. The exam breadth is large and question banks helped me spot patterns, identify weak areas and get used to how questions are asked. I used MRCEMSuccess and have heard other colleagues recommend this as well. The RCEM learning also offers example questions and is a great resource.

Improve understanding.

I focussed on key concepts and high yield topics and nailed down the anatomy and physiology. For this I used Gray's anatomy flashcards and the textbook feature on MRCEMSuccess

Keep notes simple

I like short bullet points focused on areas of weakness. Not pages and pages that you struggle to review.

Be realistic

I would say a rough guide would be 3–4 months revision, start slow and build up gradually. At the start revisions can feel pretty slow and disheartening but you will get into it and familiarise yourself again with these basic sciences! I found cramming for this exam useful and helped me with remembering the 'facts'. You are allowed to use 5 study days from your 30 day allocation in ST1 for the exam so if you are in that situation take them!

On the day

Remember the exam is sat at a professional test centre. Book a time and location that works for you; arrive early, bring valid ID, expect strict exam conditions and remember they are facilitating a number of different exams not just the Primary so invigilators are not able to really help you with any exam specific queries.

General tips:

Pace yourself 180 questions feels long.

Don’t dwell too long on difficult questions. Use the save and highlight functions and go back to 50/50s at the end.

Use the break properly to pause and reset.

Waiting for Results

Results come out as per the schedule online (around 5 weeks) but I actually found my portfolio updated before that! Try not to overthink it  i know this is easier said than done but once it’s done, it’s done. Enjoy having a wee bit more free time in the evenings again!

Conclusion

The MRCEM Primary is a tough exam not because it’s trying to catch you out but because of the breadth of knowledge. It's mostly things that you will have learnt but that you may not have used / accessed in a while and refreshing all of this is time consuming (but quite rewarding!).

It’s very doable with planning, revision and lots of question practice. Most importantly don’t compare yourself to others or feel pressured to sit it at a certain time. Everyone’s training path is different. When you get this exam done is a nice first step forward in Emergency Medicine training, and it definitely feels good to have it behind you.

Good luck!