The ACEM Fellowship written examination runs to six hours and contains two quite different papers: a multiple choice paper, which most candidates prepare for extensively, and a short answer paper of around thirty questions in three hours, which most candidates prepare for by doing more multiple choice questions. That does not work, and it is the single commonest reason capable emergency physicians fail this exam. Selecting a correct option and producing a complete, prioritised, correctly dosed answer under time pressure are different skills, and only one of them is trained by a question bank. Confirm the current format with ACEM, since components and timings are periodically revised.
Key takeaways
- The written examination has two papers, and the short answer paper is the one candidates neglect.
- Around thirty short answer questions in three hours gives you roughly six minutes each, with parts within each.
- The papers are now computer-based, so you must practise typing structured answers against the clock.
- Examiner reports return repeatedly to the same themes: prioritisation, specific doses, and disposition.
- Recognising an answer and producing one are different skills, and only production is tested here.
Six minutes, and it goes quickly
Do the arithmetic before you plan your preparation.
Roughly thirty questions in one hundred and eighty minutes is about six minutes per question, and each question typically has several parts requiring structured short responses rather than a single answer. Some questions carry more weight than others.
Six minutes is not long to read a scenario, decide what matters, structure a response, and type it completely. Candidates who have never done it under time pressure discover on the day that their answers are half-finished, and the most common failure mode reported after the paper is not ignorance. It is incompleteness.
What the examiners keep saying
The themes that recur in examiner feedback are consistent, and they tell you exactly what a scoring answer looks like.
Prioritisation, in the right order. An answer that lists everything you would consider, in no particular order, scores poorly against one that says what happens first, and why. The structured resuscitation sequence exists for a reason and the examiners expect to see it, not as a ritual but as evidence that you know what kills the patient first.
Specific doses, routes and timings. Not "give adrenaline" but the dose, the route and the concentration. Not "fluids" but what, how much, and how fast. Vagueness reads as uncertainty, and the marking rewards specificity because emergency practice requires it.
Disposition. Where does this patient go, and why, and what happens if they deteriorate? This is the task that defines the specialty, and it is the one candidates most often omit because they have run out of time, having spent it on the diagnosis.
Write for those three, deliberately, and a great many marks look after themselves.
Practise producing, not recognising
The core discipline, and it is uncomfortable, which is why almost nobody does it.
Multiple choice practice is enjoyable, it produces a rising percentage, and it trains recognition. Short answer practice is unpleasant, produces no satisfying number, and trains production.
So set aside dedicated sessions in which you write. Take a scenario, set a timer for six minutes, and produce a complete, structured, dosed answer. Then compare it with a model answer, and count what you missed.
You will find, initially, that you knew almost everything you failed to write down. That gap between what you know and what you can produce in six minutes is the entire subject of your preparation, and it does not close by reading.
You are typing now, so type
A practical point that catches people.
The written components are delivered by computer. That means your answers are typed, not handwritten, and typing speed and typing accuracy under pressure are now part of your performance.
If you type slowly, that is a fixable, mechanical problem that will cost you marks in an exam where incompleteness is the commonest failure, and it is worth addressing directly rather than hoping.
Practise on a keyboard, in the format you will actually use, so that on the day the mechanics are invisible and all your attention is on the medicine.
Structure your answer before you write it
Thirty seconds of planning saves three minutes of prose.
Read the question and identify what is actually being asked, then note the headings you will answer under before you type a word. Resuscitation priorities. Investigations that change management. Specific treatment with doses. Disposition. Safety-netting, where relevant.
A structured answer under clear headings is easier to mark, easier to score, and, crucially, easier to complete, because you can see what remains and allocate your remaining minutes to it.
Candidates who begin typing immediately produce fluent prose that misses whole marking points, and then run out of time.
Answer the whole question
The most avoidable loss in the paper.
If a question has four parts and you write beautifully on the first two, you have forfeited the marks in the other two, and no amount of quality in the first half compensates.
So allocate time within the question, and move on when your allocation is spent. A partial answer to every part will almost always outscore a perfect answer to half of them, because the marks are distributed across the parts and not concentrated in the ones you found interesting.
Watch the clock at the level of the individual question, not just the paper.
Do not neglect the Australasian content
Finally, the calibration point, which matters more in emergency medicine than in most specialties.
The examination is set in Australasian practice, and there is content that simply does not exist elsewhere. Envenomation, and specifically the Australian snakes and spiders, along with the antivenom decisions that follow, is examined and cannot be learned from North American or European sources.
More broadly, Australasian guidance defines the correct answer: the local antibiotic guidance, the local resuscitation guidance, and the local toxicology advice. A candidate whose reflexes were built on another system's protocols can produce a confident, well-structured, thoroughly incorrect answer, and it is a calibration failure rather than a knowledge failure.
Where iatroX fits
iatroX's ACEM bank builds the underlying clinical knowledge and the emergency reasoning the examination rests on, with an adaptive engine that targets the domains where you are genuinely weak and spaced repetition to hold the doses, thresholds and toxicology detail that decay fastest. Missed questions can be opened in the Socratic Tutor, which asks you to reason and articulate before it explains, and that articulation is a genuinely useful bridge towards a paper that requires you to produce rather than recognise. Use it for the knowledge, and then do the timed writing yourself, because nothing substitutes for that. Try it with free sample questions at iatroX. For the task framework this examination shares with emergency medicine generally, see stabilisation, diagnosis, treatment or disposition.
Frequently asked questions
What is the format of the ACEM Fellowship written examination? Two papers across roughly six hours: a multiple choice paper, and a short answer paper of around thirty questions in three hours, each question typically containing several parts requiring structured short responses. Both are now delivered by computer.
Why does a question bank not prepare me for the SAQ paper? Because a bank trains recognition and the short answer paper tests production. Selecting a correct option and producing a complete, prioritised, correctly dosed answer in six minutes are different skills, and only the second is being examined.
What do examiners consistently look for? Prioritisation in the correct order, specific doses, routes and timings rather than vague generalities, and a clear disposition decision. Those three themes recur in examiner feedback, and writing deliberately for them earns a great many marks.
What is the commonest reason candidates lose marks? Incompleteness. Candidates typically knew the material they failed to write down, having spent too long on early parts of a question and run out of time. A partial answer to every part almost always outscores a perfect answer to half of them.