Exam Tips
How to Balance MRCEM Revision with Working in Emergency Medicine
Preparing for the MRCEM while working in Emergency Medicine can be particularly difficult.
ED work does not fit neatly into a Monday-to-Friday routine. Your rota may include long days, evenings, weekends, twilights and nights, sometimes with rapid changes between them. A busy shift can be physically tiring as well as mentally demanding, and there may be very little enthusiasm left for anatomy, guidelines or practice questions when you finally get home.
The answer is rarely to force yourself to study for several hours after every shift. For most doctors, that quickly becomes unsustainable.
A better approach is to build your revision around the reality of Emergency Medicine: use your better days for demanding work, accept that some shifts will leave little capacity for study and make consistent use of shorter periods when they are available.
Here is how to make MRCEM preparation work alongside a difficult ED rota.
Accept That ED Weeks Are Not All Equal
One of the biggest mistakes when planning for the MRCEM is expecting yourself to study the same amount every day.
A week containing several normal daytime shifts is very different from one containing twilights, weekends or a run of nights. Your revision plan should recognise that from the outset.
Rather than setting a rigid daily target, think about what you want to achieve across the week.
You might have a relatively productive week where you complete several focused sessions and a much lighter week when the rota is difficult. That is not a problem provided you are making progress over time.
Consistency across several months matters far more than maintaining a perfect daily streak.
Start Early Enough to Allow for Bad Weeks
Starting early is particularly valuable in Emergency Medicine because interruptions are almost inevitable.
There will be exhausting shifts. You may finish late. Nights can disrupt several days rather than simply the hours you spend at work. Illness, annual leave and life outside medicine will also intervene.
If every week of your revision plan is already filled to capacity, one difficult run of shifts can put you badly behind.
Starting earlier lets you work at a more sustainable pace.
During the first part of your preparation, concentrate on understanding the syllabus, covering core topics and beginning regular practice questions. As the examination approaches, you can gradually increase the intensity.
This is usually much easier than trying to compress most of your preparation into the final few weeks.
Plan Around Your Rota, Not Around an Ideal Week
A conventional revision timetable often assumes evenings and weekends are predictably available.
In Emergency Medicine, they frequently are not.
When you receive your rota, look ahead and identify three types of day:
- Days where you are likely to have good concentration
- Working days where a short revision session may be realistic
- Nights, post-night days or particularly demanding shifts where significant revision is unlikely to be useful
Put your hardest work into the first category. That might mean anatomy or physiology for the MRCEM Primary, or a difficult clinical topic for the MRCEM SBA.
Use ordinary working days for smaller question sets or reviewing material you have already covered. And give yourself permission to do very little on the third group of days.
A revision plan becomes much more sustainable once it stops pretending every day is interchangeable.
Do Not Build Your Revision Around Post-Shift Willpower
It is easy to imagine that you will finish an ED shift, eat dinner and then complete two productive hours of revision.
Sometimes you will.
After a particularly busy shift, however, you may have spent eight or ten hours making decisions, processing information, dealing with interruptions and managing sick or distressed patients. Your ability to learn complex new material may simply be poor.
Instead of making long evening sessions the foundation of your preparation, use them selectively.
After work, consider something manageable:
- 10 to 20 practice questions
- Reviewing questions you previously answered incorrectly
- Revisiting a short tutorial
- Reviewing a small set of notes
- Going over a single weak topic
Twenty genuinely focused minutes can be more valuable than ninety minutes spent reading without retaining much.
Treat Nights Differently
Night shifts deserve their own revision strategy.
Trying to maintain your normal study schedule through a run of nights is rarely sensible. Sleep and recovery should take priority.
If possible, complete important revision before the run of nights begins. During the nights themselves, do not depend on finding quiet periods in the department to study. Some shifts may offer them; many will not.
On a post-night day, sleep is the priority.
Once your sleep pattern begins to normalise, restart with something relatively easy before returning to more demanding study.
Do not try to “repay” every missed revision session immediately after nights. That can simply turn one tiring week into two.
Move the genuinely important work to another day and let the lower-priority tasks go.
Make Practice Questions the Backbone of Your Preparation
Practice questions are particularly useful for doctors working shifts because they divide naturally into manageable blocks. You do not need a free afternoon to complete ten or fifteen questions.
More importantly, questions force active recall and quickly reveal which areas actually need more work. But avoid becoming obsessed with the number of questions completed.
For every incorrect or uncertain answer, ask why you struggled:
- Was there a fact you simply did not know?
- Did you misunderstand the clinical scenario?
- Did you miss an important clue?
- Were two answers difficult to distinguish?
- Did fatigue or rushing contribute to the mistake?
Then read the explanation and clarify the underlying topic.
Ten questions studied properly can sometimes teach you more than fifty completed rapidly.
As the examination gets closer, larger timed sets become increasingly useful, but early preparation should be about learning as much as scoring.
Let the ED Become Part of Your Revision
Emergency Medicine has one major advantage when preparing for the MRCEM: much of the clinical syllabus walks through the department every day.
A patient with atrial fibrillation, an overdose, a septic child, a dislocated shoulder or an unusual ECG can all reinforce exam knowledge.
When you encounter something that exposes a gap in your understanding, make a quick note.
Later, look it up.
Ask yourself questions such as:
- What would the exam expect me to do next?
- What guideline determines this management decision?
- What finding would alter my treatment?
- What complication am I trying to prevent?
- What would make one answer more appropriate than another?
You do not need to turn every patient into a revision exercise. That would be exhausting.
But regularly connecting clinical experience with exam knowledge makes the material easier to remember and is particularly valuable for the MRCEM SBA.
Remember That the Primary and SBA Need Different Approaches
Your strategy should also reflect which MRCEM examination you are taking.
The MRCEM Primary contains a substantial amount of basic science. Anatomy, physiology and pharmacology may not be reinforced reliably by day-to-day ED work, so these subjects often need deliberate study away from the department.
The MRCEM SBA is much more closely connected to clinical practice.
Working in Emergency Medicine therefore gives you a useful foundation, but clinical experience alone is not enough. The examination still requires knowledge of specific management pathways, guidelines, uncommon presentations and details that may not arise frequently during your own shifts.
Use clinical work to provide context, but use structured revision to make sure you cover the full syllabus.
Keep Your Resources Under Control
One of the easiest ways to waste limited revision time is to use too many resources.
You do not need five question banks, several textbooks, multiple sets of somebody else's notes and dozens of bookmarked websites.
Choose a small number of resources and give each one a clear role.
For example:
- A question bank for active practice
- Tutorials or a concise reference for understanding difficult topics
- Your own short notes for repeated revision
- RCEM or other authoritative guidance when you need to check current management
This becomes especially important when you are working shifts.
If you unexpectedly have thirty minutes available, you should be able to start studying within a minute or two rather than spending half the time deciding what to use.
Keep a Running List of Weak Areas
As you work through questions, maintain a simple list of topics that repeatedly cause problems.
Do not turn it into another enormous revision document.
A short list might include:
- Paediatric fluids
- Brachial plexus
- Pacemakers
- Burns calculations
- Pregnancy emergencies
- Acid-base interpretation
- Poisoning and toxidromes
- Poisoning and toxidromes
When you have a good study session available, choose something from that list.
Over time, remove subjects as they improve and add new ones as they appear.
This makes your revision increasingly personalised rather than repeatedly covering material you already know.
Use Small Pockets of Time, But Do Not Fill Every Pocket
Shift work can create unusual fragments of free time. You may have thirty minutes before a late shift, time on public transport or an unexpected gap during the day.
Some of these are useful opportunities for a small set of questions or a quick review. But resist the temptation to turn every spare minute into revision.
Not every commute needs a podcast. Not every meal break needs flashcards. Not every day off needs a question bank.
You are still allowed to have time in which you are not either working in Emergency Medicine or preparing for an Emergency Medicine examination.
That space is part of what makes the rest sustainable.
Protect Sleep, Exercise and Life Outside Medicine
When revision pressure increases, sleep and exercise can begin to feel expendable. They should not be.
This is especially important for doctors already working irregular shifts. Emergency Medicine places enough pressure on sleep without voluntarily sacrificing more of it for revision.
A tired doctor is unlikely to learn efficiently, and exhaustion eventually affects both revision and clinical work.
Protect some evenings and days off completely.
Exercise, see friends and family, spend time outside and do things that have nothing to do with medicine.
Passing the MRCEM matters, but allowing the examination to consume every non-working hour for several months is rarely the best way to achieve it.
Arrange Study Leave and the Exam Period Early
As soon as you know your examination date, look at the surrounding rota. Do not wait until the final few weeks to discover that you are rostered for nights immediately before the exam. Make study-leave requests early and discuss difficult rota clashes as soon as possible.
Ideally, protect some time close to the examination for activities that are difficult to fit around normal shifts:
- Full timed question sets
- Mock examinations
- Focused work on your weakest subjects
- Consolidation of important notes
- Review of commonly confused guidelines or facts
Study leave works best when it consolidates preparation that is already underway rather than being expected to rescue several months of postponed revision.
Increase the Intensity Gradually
Your revision does not need to look the same three months before the exam as it does ten days before it.
Early on, concentrate on coverage and understanding.
In the middle phase, increase question volume and begin revisiting weak areas.
Closer to the examination, use more mixed and timed questions, repeatedly review mistakes and focus increasingly on the information you are most likely to forget.
This gradual increase is much easier to sustain alongside an ED rota than trying to operate at maximum intensity from the beginning.
Know When to Change the Plan
Review your progress every few weeks. Look at what you have actually completed rather than what your timetable says you should have completed.
If you repeatedly fail to achieve the workload you planned, the answer may not be to work harder. The plan may simply be unrealistic. Reduce the volume and protect the highest-value activities.
Similarly, if one subject remains consistently weak, give it dedicated time rather than hoping it will improve through occasional mixed questions.
A good revision plan is adaptable.
The objective is not to execute a beautiful timetable. It is to arrive at the examination having covered the syllabus, practised enough questions and retained enough energy to perform well.
Final Thoughts
Preparing for the MRCEM while working in Emergency Medicine is difficult because the problem is not simply a lack of hours.
ED shifts can disrupt sleep, concentration and life outside work. Some weeks will contain plenty of useful revision time and others may contain almost none. Plan for that reality rather than fighting it.
Start early enough that difficult weeks do not derail your preparation. Build your revision around the rota, use practice questions regularly, learn properly from your mistakes and let the patients you see reinforce the clinical syllabus.
Reduce your expectations during nights and exhausting runs of shifts. Protect sleep and recovery. Then make good use of the days when your concentration is better.
You do not need to study every day to prepare effectively for the MRCEM.
You need enough good-quality revision, repeated consistently over time, alongside a working pattern that allows you to remain functional both in the examination and in the Emergency Department.