The FRCEM Final SBA is mapped to the RCEM 2021 curriculum across multiple Specialty Learning Outcomes (SLOs). Not all SLOs carry equal weight — and knowing where the marks are is the first step to a strategic revision plan.
SLO 3, 4, 1 and 5 combined account for 78% of the exam. That's 140 out of 180 questions. If you're not prioritising these four, you're leaving marks on the table.
Key topics: Cardiac arrest, arrhythmias, sepsis, shock, anaphylaxis, ACS, PE, status epilepticus, DKA, HHS, major haemorrhage.
~40 Qs · 22%Exam tip: ECG questions require interpretation before you reach the management answer. Go beyond tachy/brady — know cardiac arrest special circumstances (hypothermia, poisoning, pregnancy, electrolyte disturbance), HOCM, Wellens syndrome, and toxicology-related arrhythmias. Anaphylaxis: know the refractory algorithm — IV adrenaline infusion, glucagon in beta-blocker patients, observation period for biphasic reactions. Major haemorrhage: understand when TEG/ROTEM guides product selection vs empirical 1:1:1.
Key topics: Head injury (NICE NG232), C-spine (NICE guidelines), burns, major haemorrhage, chest trauma, abdominal trauma, pelvic fractures, compartment syndrome, traumatic cardiac arrest.
~35 Qs · 19%Exam tip: Know the decision points, not just the broad steps. FAST negative does not exclude injury — it misses retroperitoneal and hollow viscus injuries. Resuscitative thoracotomy: penetrating trauma, witnessed arrest, signs of life within 10 mins. TXA: within 3 hours of injury — know the time window and the distinction between CRASH-2 (haemorrhage) and CRASH-3 (TBI).
Key topics: Toxicology, ophthalmology, cardiology, neurology, O&G, dermatology (drug reactions, angioedema, necrotising fasciitis), ENT, haematology, infectious diseases, oncological emergencies.
~35 Qs · 19%Exam tip: SLO 1 is as large as Trauma — don't underestimate it. Toxicology is reliably tested: know your toxidromes cold and antidote selection (N-acetylcysteine, naloxone, atropine, digoxin-specific antibodies, hydroxocobalamin, glucagon for beta-blocker OD). Ophthalmology: acute angle closure glaucoma — red, hard, painful eye with nausea and visual halos; don't miss it as migraine. Aortic dissection: sudden tearing pain — go straight to CT aorta.
Key topics: Neonatal resus (NLS 3:1), neonatal sepsis, congenital heart disease, paediatric rashes (viral exanthems — measles, rubella, chickenpox, parvovirus, HFM — HSP, SJS/TEN, meningococcal), safeguarding, BRUE, bronchiolitis, croup, Gillick competence.
~30 Qs · 17%Exam tip: Rash recognition is high-yield — know SJS/TEN (mucosal involvement, Nikolsky sign), HSP (purpura + arthralgia + abdo pain), and viral exanthems including transmission routes and isolation requirements. Non-pathological rashes matter too — mongolian blue spot in a safeguarding context. Cyanotic neonate = duct-dependent until proven otherwise → prostaglandin E1. Paediatric DKA: cerebral oedema is the main risk — restrict fluid rate and monitor GCS closely. Gillick competence applies from any age, not just 16.
Key topics: Procedural sedation (adult + paediatric), POCUS, local anaesthesia max doses, chest drain, lumbar puncture, joint aspiration.
~13 Qs · 7%Exam tip: Sedation questions have consistently low pass rates. Know drug doses, fasting guidance (clear fluids 2h / food 6h), monitoring requirements, discharge criteria, and complications — laryngospasm, apnoea, paradoxical reactions. POCUS: know how to improve poor image quality (probe, depth, gain, positioning) not just what pathology looks like. LP anatomy: L3/L4 or L4/L5 interspace, iliac crest landmark. LA max doses: lidocaine plain 3mg/kg, with adrenaline 7mg/kg; bupivacaine 2mg/kg.
Key topics: Mental Capacity Act, Mental Health Act, safeguarding, consent, end of life care, organ donation.
~10 Qs · 6%Exam tip: Know the legislation, not just the concept. MCA 4-stage capacity test, best interests decision-making, LPA vs Court of Protection. MHA: Section 2 vs 3 vs 136. DNACPR means do not resuscitate only — not do not treat. Safeguarding: if in doubt, always refer.
Key topics: Sensitivity/specificity, NNT, RCTs vs cohort studies, p-values, confidence intervals, audit cycles, PDSA methodology.
~10 Qs · 6%Exam tip: Candidates skip these and blank under pressure. NNT = 1/ARR — not relative risk reduction. High sensitivity = good rule-out (SnNOut); high specificity = good rule-in (SpPIn). A 95% CI that crosses 1.0 (for RR/OR) or 0 (for difference) is not statistically significant, regardless of p-value.
Key topics: Patient flow, risk management, complaints, major incidents, escalation frameworks, handover principles.
~7 Qs · 4%Exam tip: Fewer questions but straightforward marks if you've covered the guidance. Know your major incident framework and the principles of safe handover.
This exam tests consultant-level decision making
This is not a test of whether you know the first step of ALS. It's a test of what you do when the standard algorithms fail — when to consider ECMO, when to stop resuscitation, how to manage refractory anaphylaxis, when it's safe to discharge after anaphylaxis. These are the decisions your senior registrars will look to you for answers on, and the exam is designed to reflect that.
The nuances of algorithms matter. Know the high-yield ones — ALS (special circumstances), APLS, sepsis, major haemorrhage, DKA — well enough that the branching logic is automatic. The exam will push you past the first step into the territory where experience and preparation separate the candidates who pass from those who don't.
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