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  • Writer's pictureHector Thomson

Acing the ACEM Exams: Fellowship Written

Josh Monester & Hector Thomson


Welcome to our Acing the ACEM Exams series where we unlock the key study habits, resources and top tips from recent successful exam candidates. Recent exam successfuls, Josh Monester and Hector Thomson have crafted their tips into this epic post.

 

Disclaimer: There is no right way to study for this exam, there are as many approaches as people who have sat. Every person will tell you their way was the “best” way. Our way worked for us; it definitely won’t be everyone’s cup of tea: take it with a pinch of salt. 

 

What are your top tips for the exam?

  • Pick a date to sit and commit to it. Most people suggest at least 12 months of study.

  • It’s a long slog. Keep a focus on stuff that recharges your batteries.

  • Read the f***ing question. (RTFQ became a mantra and served us well) 

  • Read all the documents on the ACEM website. Understand what specific terms mean (eg management ≠ assessment/investigations).


The best piece of advice given to me:

Josh:

From my friend and boss Claire Gorham in Darwin: “Show them how much you know!” It shifted my focus from panic to acknowledgement that actually I do know lots and have put in the work.


Hector:

Read The Resilience Shield. An evidence-based look at resilience written by three SAS veterans, one of whom was a military doctor. It introduced me to Pomodoro timing (25-minute chunks followed by a 5-minute break) and a whole host of other techniques to make sure I stayed sane.


So how does the actual process work?

Time commitment: 

A rough ballpark is that you should put in at least 1000 hours of high-quality study to pass the exam. This means approximately 20 hours a week for 50 weeks. Plan far ahead how you’re practically going to do this: strategically consider rotations, life events, leave, and working part-time.

  • Many people (including us) chose to work part-time in the lead-up to the exam. In the three months before sitting, Josh worked 0.75, Hector worked 0.5. We both worked full-time before this. The key point here is the ability to put in the hours.

  • Family and friends: Get your friends, family, significant other etc on board about the time commitment you’ll need to put in, and make plans early to remain human. Holidays, date nights, sleep-ins etc are extremely important, so don’t neglect these. 


Content:

You need consultant-level knowledge. Use the Study Guide for Medical Expertise (page 39 of the curriculum), print this off and cross it off as you go. You need to be able to talk like an expert in all of the “expert” level domains. This is an exit exam.

 

☝️ Read that again: no really, read the Study Guide ☝️

 
Style:

Develop this early by doing past questions. Learn how to be concise and precise in your answers. No wasted words. You are the consultant.


Timing:

The 3-hour SAQ is very time-pressured. It will go down to the wire. However, don’t worry about this at the start. As you get more confident and do more papers you’ll pick up the pace and learn the time a 12 or 18-mark question will take you. We aimed to finish with 15 minutes to review questions. 


Toxicology: 

There is a HUGE amount of content to cover here. Don’t defer it. We suggest doing a little every week alongside other content.


Tracking your study time

Josh:

The giant nerd in me wanted to track my study, so I used toggl. It helped me reflect on weeks where I did more or less study and why. Below is a screenshot of my study hours over 12 months: the most important point here is that there are times you’ll do more or less due to life continuing to happen. This is okay!


Hector:

I put a massive whiteboard above my desk and wrote out all the topics I wanted to cover. Then I would tick them off as I went. It seems daunting at first but it is motivating to see the progress. I also ticked off the topics in the Medical Expertise Guide to make sure I was covering everything. 



What was your rough timeline for study?

14-16 months out: 

The contemplation phase: pick a date and commit, buy/find the books (hard copy or PDFs), talk to your DEMT and friends who have recently sat the exam. Plan your rotations. Read all the documents on the ACEM website, plan a study timetable and when you’ll sit AFEM.


12 months out:

Start studying according to your timetable. Build your knowledge base and get used to the type of questions. You should aim to cover all the content in the first six months.

  • Review a few past questions on EDvivas

  • Read the relevant chapters in Dunn (or you can use Cameron or Tintinalli)

  • Make ankis or study notes (depending on your style)

  • Do some MCQs

  • Re-do the SAQ questions (and see how much you've learned!)

  • A little tox per week: aim for 2-3 topics alongside your other content study.

  • Own the ABG: 2-3 cases per week (if you've not done so already)

6-4 months out:

Form your study group if you haven’t got one already. Do lots of questions and mark each other’s papers. Get used to giving and receiving feedback.

  • We did the Geelong papers as one-hour papers to start with. Do these to time. Aim to cover all 30 over about 10 weeks (equivalent to a full paper per week). These are tried and tested. 

4 months out:

Start doing fully-timed 3-hour SAQ papers. Get these marked by FACEMs, if you can, or someone who has recently passed. 

  • Using the list on DoctorsWriting, we met at the library, did a paper in the morning, treated ourselves to lunch and then marked it in the afternoon.


3 months out:

Sit your hospital’s practice exam. Use this as a go/no-go point to make sure your medical expertise is up to scratch. After this point, technique and timing can be improved, but if you’ve got massive knowledge gaps in medical expertise it’s hard to compensate. 


2 months out:

At least weekly 3-hour papers.

  • We started doing the formatted papers on the ACEM Website to exam conditions (old Monash and NSW Practice papers).


1 month out:

Aim for 2-3 papers per week to time.

  • Last week: Almost there… You’ve done the work. Taper your study and rest up!



 

Pitfalls

  • Not giving yourself enough time to study.

  • “I’ll see how I go”. Inevitably people who said this deferred their attempt.

  • Not reading the f***ing question. (RTFQ)

 

Anki

There is a huge amount of content to learn for this exam. We committed to using Anki (but any flashcard program will do). Spaced repetition is damn effective. There are some days you’ll hate your Anki deck, but we promise it’s worth it. 


What textbooks/resources would you recommend?

There is so much out there. Be careful using non-college recommended texts or resources. You might disagree with an answer but the college will mark from the texts. 


Textbooks
  • Dunn - this is the mainstay of your study. Bullet points and searchable. Digestible. Many questions are based on Dunn.

  • Cameron - good for an overview early, the tables get used for questions. Excellent legal/admin chapters. Perhaps not detailed enough for full SAQs.

  • Tintinalli - excellent for deep dive, but presents bricks of text which are impenetrable. Good for details in tables.

  • Rosen - we didn’t use at all.

  • Own the ABG - MUST read in full early in your study.

  • Tox Handbook - MUST have a copy. Gold dust. Use the latest edition (4e).


Online
  • ACEM Policies and modules: there are several policies and guidelines (eg access block, mentoring, cultural competency) - read at least once. They will come up!

  • Doctors Writing - central location for all practice exams, has an excellent summary “EMIndex” for revision to check you haven’t missed anything big. 

  • Geelong papers: excellent one-hour papers. We loved these.

  • EDVivas: You’ll love-hate this website from your Primary. Can search the FEx questions by topic. Use this in your first six months of content study.

  • ECG Weekly: Weekly 10-15 minute videos on core ECG topics by dreamboat and ECG guru Amal Mattu. $26 USD per year subscription. Highly recommend it.

  • LITFL Top 150 ECGs

  • LITFL Top Tox cases 

  • EM:RAP: Pricey but good for the commute to work 

  • EMCQPractice: Full MCQ papers and a useful “study series” with MCQs by topic. Costs $$ and difficult exams, but worthwhile overall. 


Courses
  • AFEM: See below

  • Many other courses which we can’t speak to as we didn’t do. 


How did you study for MCQs?

  • Nobody really talks about these, because the pass mark is higher. It’s very difficult to study for as you’ll often be tested on minutiae. 

  • The MCQ book by de Alwys gives a good guide to the style of questions, however is now a little dated in its content. 

  • DoctorsWriting has some widely published recalled questions from previous years which you must do. Read: must do.

  • We found the MCQ exam more difficult/challenging to prepare for, but the pressure here is on the specific medical knowledge and reading the question. Much of the content here comes from Dunn: so make this the mainstay of your MCQ study.



When to sit AFEM? 

(Disclaimer: We’re not affiliated with AFEM in any way, but have done the course.)

The AFEM Course is run in Brisbane with a virtual option twice a year (Feb and Aug). It’s an excellent review of high-yield topics and gives you the opportunity to do a full SAQ and MCQ exam in a single day. The first 50 applicants get their SAQ paper marked, so sign up early. 


There are two approaches to when to do the course:
  • 9 months out from your exam: This gives you the perspective of the breadth and depth of what you need to know. People say it can be overwhelming this far out. Do it this way if you want more structure early in your study.

  • 3 months out from your exam: This is the way we did it, more as a check to make sure we hadn’t missed any core content, and to benchmark ourselves against a high-quality SAQ exam.


 


The three normal points of panic:

It seems to be a universal experience: everyone experiences these panic moments, and then wonders if anyone has ever felt like this before. 

  1. 1 month into study: “OMG there is so much content to cover I will never be able to study this.” (You will.)

  2. 6 months into study: “OMG these papers are so difficult, how am I ever going to be slick enough to pass?” (You need more practice but will get there.)

  3. 1 month out: “OMG am I going to fail? Have I just wasted a year of my life on study?” (You've never had better medical knowledge in your life and will smash it.)


You’re allowed to freak out. Take a (guilt-free) day off. Talk to your study group or mentor. Let your support people know. Do something for yourself. 

 

Final Thoughts

Enjoy becoming a better doctor. (Why did no one teach me about ARVD earlier?) This is the best your knowledge of emergency medicine will ever be. 

Josh & Hector


 


HECTOR THOMSON

Emergency Registrar

Hector is a post-fellowship exams ED trainee currently working at Adult Retrieval Victoria. He enjoys shoulder dislocations, trauma, rugby union, fresh pasta and good gin. He doesn’t like vague allergies or cats.



JOSH MONESTER

Emergency Registrar

Josh is a senior emergency medicine registrar with Alfred Health, having crash-landed back in Victoria after a protracted “working lap” of the country, dodging sharks in WA and chasing waterholes in the NT. He works to fuel his ice cream habit, but is driven by his love of trauma, ultrasound and medical education.


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