This workflow is for FACEM trainees who use Life in the Fast Lane (LITFL) as a reference and want to convert it into retrieval practice for the ACEM Fellowship. The key thing to understand up front is what LITFL is: a free, open-access clinical reference library and education resource, not a structured or adaptive question bank and not a Fellowship exam product. Read as prose, it is easy to feel productive and retain little. The principal limitation is that reading is not retrieval — so the job here is to turn what you look up into your own micro-questions, without copying its text or memorising passages.
What Life in the Fast Lane offers right now
The description below reflects LITFL's own pages, checked on 20 July 2026; confirm current content on litfl.com.
| Item | Position (20 July 2026) |
|---|---|
| Resource type | Free, open-access reference and education library (Creative Commons), not a structured Q-bank |
| ACEM Fellowship content | Curated MCQs (e.g. a core-text MCQ collection), practice SAQs with worked examples, and OSCE demonstration videos |
| Question volume | Curated and finite, not a large adaptive bank; some MCQs link out to external banks |
| Adaptive / AI features | None claimed; no personalised feed or automated marking |
| Price / access | Free to read under Creative Commons; some linked external resources may charge separately |
| Reference library | Extensive ECG, imaging, ultrasound and toxicology reference material |
LITFL's strength is breadth and clinical readability; its limitation, for exam purposes, is that it is a library, not a measurement tool. It will not tell you what you have covered or whether a rule has stuck. That is precisely the gap this workflow closes — and where a separate, unseen measurement layer earns its place.
The exam you are actually sitting
The ACEM Fellowship written examination is two 180-minute papers — a Short Answer Questions (SAQ) paper and a Single Choice Questions (SCQ, multiple-choice only) paper — six hours in total. The clinical examination is an OSCE of up to 12 stations, each 11 minutes (four minutes reading, seven minutes assessment), 132 minutes over two consecutive days. College-reported fees at the last-checked date were AUD $3,145 (written) and AUD $4,450 (OSCE); verify on acem.org.au. LITFL's OSCE videos and worked SAQ examples are useful models of the register, but they are demonstrations to learn from, not a scored assessment. Keep the official ACEM pages as your authority on format and blueprint, and treat LITFL as one reference among several.
Start from a gap, not an unbounded reading list
Open LITFL to answer a specific question, never to "read up on" a topic. The trigger should be a missed bank question or an identified blueprint gap: you got the management of a specific toxidrome wrong, so you look up that toxidrome. An unbounded reading list is how an evening disappears into interesting prose with nothing retained. A missed question gives the reading a target and an obvious stopping point.
Read only enough to resolve the uncertainty; capture the rule and its date
Read to the point where your specific uncertainty is resolved, then stop. Capture two things in your own words: the decision rule you were missing, and the date and source of the guidance (currency matters in emergency medicine, and a rule you learned two years ago may have moved). You are extracting a rule, not archiving a page. Resist the urge to keep reading adjacent sections because they are interesting; that is browsing, and browsing is not the job.
Close the resource and reconstruct from memory
This is the step that respects both learning science and LITFL's Creative Commons licensing: close the page and reconstruct, from memory and in your own words, the rule, its main exceptions and one discriminating feature that separates it from its nearest mimic. Writing it in your own words — rather than copying the prose — is what forces genuine processing, and it keeps you clear of lifting text. If you cannot reconstruct it, you have not learned it yet; reopen, and try again. A passage you can quote is not the same as a rule you can apply.
Build a fresh transfer question, not a copy
Now manufacture a micro-question that tests the same principle in a different context — change the age, the comorbidity, the setting or the presenting complaint so that recognising your own note will not answer it. This is the anti-memorisation move: if the only thing you can do is recognise the original example, you have learned the example, not the rule. Where you would rather test the principle on genuinely unseen items than write your own, this is exactly the role of an external measurement bank — iatroX (ACEM Primary level) can supply a fresh MCQ on the underlying basic-science point, so the transfer test is truly unseen.
Schedule a delayed retest and record whether the rule survives
Put the micro-question aside and retest after a delay — a few days, then longer. Record whether the corrected rule survives outside its original context. A rule that you got right immediately after reading but cannot reproduce a week later has not consolidated, and it goes back into the queue. This delayed, out-of-context retest is the difference between feeling you know something and being able to retrieve it in a station or on paper.
Cap reference time so reading cannot displace practice
Set a weekly ceiling on reference reading — a fixed number of hours — and hold to it. Reference resources are seductive precisely because reading is comfortable and question practice is not; without a cap, LITFL time quietly expands to fill the evening and crowds out the timed practice that actually moves your score. The library serves the questions, not the other way round.
A worked seven-day loop around clinical work
Here LITFL does one job — targeted reference lookup converted into micro-questions — while iatroX supplies unseen foundation measurement and a Fellowship bank plus observed practice carry the Fellowship-specific load. No proprietary-algorithm claims are made.
- Monday (25 min): a Fellowship-bank block; log every miss as a lookup target.
- Tuesday (20 min): LITFL lookups on two Monday misses; reconstruct each rule from memory; write one transfer micro-question each.
- Wednesday (20 min): an iatroX unseen MCQ block on the basic sciences behind those rules.
- Thursday (25 min): timed SAQ practice on a related topic, marked against a worked example.
- Friday (15 min): retest Tuesday's micro-questions; decayed rules re-queued.
- Saturday (40 min): full-length mixed timed block; new lookup targets logged.
- Sunday (10 min): delayed retest of last week's rules; weekly reference-time tally checked against the cap.
Three ways reference reading quietly fails
First, browsing instead of targeting. Opening LITFL to "read about" a topic, rather than to answer a specific missed question, is how a study hour becomes an interesting but untested tour of adjacent pages. Start every lookup from a gap and stop when the gap is closed.
Second, copying prose instead of rebuilding the rule. A passage you can quote is not a rule you can apply, and lifting text respects neither the licence nor your learning. Close the page and reconstruct the rule in your own words; if you cannot, you have not learned it yet.
Third, letting comfortable reading crowd out timed practice. Reference reading is pleasant and question practice is not, so without a weekly cap the reading expands to fill the time. Hold the cap, and treat the library as something that serves your questions rather than something that replaces them.
Continue, supplement, switch or stop
- Continue using LITFL as your reference layer if lookups are consistently converting into retained, transferable rules.
- Supplement it with a scored Fellowship question bank and observed OSCE practice, because LITFL provides no measurement of its own.
- Switch the balance towards timed practice if your reference-time cap keeps being breached and question volume is suffering.
- Stop looking up a topic when its rule survives delayed, out-of-context retests; move the effort to the next gap.
Frequently asked questions
Is Life in the Fast Lane enough for ACEM Fellowship on its own? No — LITFL is a free reference and education library, not a question bank or exam product, so it cannot on its own build or measure Fellowship readiness. It is excellent for looking things up and for its ECG, imaging and toxicology material, and its OSCE videos model the register well, but you need scored, timed question practice and observed clinical practice alongside it.
Which ACEM Fellowship component does Life in the Fast Lane not reproduce well? It does not reproduce the scored assessment of any component. Its curated MCQs and worked SAQs are learning aids rather than a measured bank, and its OSCE videos are demonstrations, not interactive practice. Use LITFL to understand and to model good answers, then get your actual SAQ and OSCE rehearsal from timed practice and observed stations.
How many Life in the Fast Lane questions should I complete per day for ACEM Fellowship? LITFL is not a daily-quota bank, so the number to track is the micro-questions you build from it — a realistic target is two or three converted rules per study day, each with a transfer question. The volume that matters for your score is your timed practice in a proper question bank, not the pages you read.
When should I stop using Life in the Fast Lane and move to mixed mocks? Keep LITFL as an on-demand reference throughout, but your assessment should move to mixed, timed mocks well before the exam. Reference reading should shrink as the exam approaches and timed, unseen practice should grow; a weekly reading cap is the mechanism that forces that shift.
How should I combine Life in the Fast Lane with iatroX without duplicating practice? Use LITFL to resolve a specific uncertainty and build a rule, then use iatroX (ACEM Primary level) to test that rule's foundation on a genuinely unseen MCQ, rather than re-reading the LITFL page. LITFL is the reference; iatroX is the measurement of the underlying knowledge; your Fellowship bank and observed practice carry the Fellowship-specific SAQ and OSCE work. No item is answered twice.
Editorial notes and references
Written by Dr Kolawole Tytler, NHS GP and founder of iatroX. Last checked 20 July 2026. LITFL's resource type, free Creative Commons access and content mix are drawn from its own pages (litfl.com) and were current at that date; some linked external resources may charge separately, so verify before subscribing. Disclosure: iatroX operates an ACEM Primary / foundation-level question bank; this article confines iatroX's role to unseen-MCQ measurement of the underlying knowledge and does not present it as a Fellowship SAQ or OSCE product, nor as a replacement for a clinical reference library. Corrections are welcome via the feedback route on iatrox.com. References: ACEM Fellowship examinations (acem.org.au); Life in the Fast Lane ACEM Fellowship exam library (litfl.com); Your Q-Bank Percentage Is Not Your Exam Score; What MCQ banks cannot prepare you for in ACEM Fellowship; the iatroX two-Q-bank rule.