The Critical Appraisal FCEM exam

If you are planning on being an emergency physician in the UK then you will probably be thinking about trying to get through the FCEM exam. At the current time that means that you are going to have to pass the critical appraisal component. This is a 90 minute written exam which you have to pass if you want to get those magical post nominals and your ticket to a consultant post. But…..

…….lots of people fail the critical appraisal exam. Why?

Well, because they don’t answer the questions obviously, but it’s perhaps a bit more complex than that as having seen some of the answers and having done loads of practice sessions over the last few years there are common errors that candidates make. So, here are a few tips on how to get through the exam, these are my thoughts alone and they do not represent anyone else (and especially not the College).

1. Read the online guide to the critical appraisal. Have a look at past questions and common errors. Notice how often the same errors seem to get made in each round of exams!

2. Practice, practice, practice. If you don’t read papers on a regular basis then start now. You really need to do this in a group so if you don’t have a journal club start one. There are loads of models out there, choose something that works for you. This link is our original model from 1998!!! which is still not a bad way to start.

3. Don’t try and be clever. Lots of people want to use big words and technical terms when the question doesn’t ask for it. If  you get asked to explain something e.g. blinding, then explain it. Don’t try and list 15 sorts of Bias that blinding hopes to avoid. Just answer the question in terms that you would use to a colleague (the examiners are your future colleagues so explain in those terms).

4. Look at the size of the area on the sheet given for the answer. If the answer area on the form is a small box the clue is that the examiners are looking for a short answer. If you find yourself writing outside of the allocated space you are either a – writing with a crayon or b – missing the point of the question.

5. A major part of the exam is writing an abstract which will have been blanked out. This can be tricky and it’s easy to get waylaid. My advice is to use the standard Objectives, Methods, Results, Conclusions format. Make sure these link up! Crazy people have an objective that does not match the results, which is a separate point to the conclusion. Don’t do that. Start with the Aim as stated by the authors. This will give you the objective AND tell you what you should be looking for in terms of the principal finding for the results, that then leads nicely into giving you a conclusion.

6. There will only be two sorts of papers. Theraputic (prob an RCT) or diagnosis. Focus your practice and learning on these types of papers.

7. Learn some basic stats terms that you can explain to a colleague. You don’t need to know hard stuff but the basics should be there. If you want a basic guide to stats for crit app then you can listen to a few old stats lectures we put together specifically for people aiming at getting through a critical appraisal test. Stats 1 ; Stats 2 They are bit old and were early attempts, but if you find them useful that’s great.

8. Don’t talk about stuff you don’t understand. Randomly inserting words that you think might be relevant without understanding them rarely helps.

9. Write clearly. Candidates in a VIVA can explain if something is unclear. In a written exam you have to be able to read and interpret what is on paper. Make sure it makes sense.

10. Write like a pharmacist, not like a doctor. If it cannot be read, it cannot be marked. Similarly one quote I do like from recent feedback is self explanatory

• Many candidates wrote correct statements – but they were not relevant to the answer…..

So. It’s not a difficult exam if you already do critical appraisal as part of your practice and if you regularly read papers. It’s an easy exam to pass, but also easy to fail if you try and be too clever or technical.