RCPSC Emergency Medicine: question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Adult resuscitation and critical care in EM — sepsis, ACS, arrhythmias, anaphylaxis
• Major trauma — ATLS framework, damage control, massive transfusion, neurotrauma
• Paediatric emergencies — PALS, fever in under-5s, paediatric trauma, NAI
• Toxicology — paracetamol, salicylate, recreational drugs, opioid overdose, withdrawal
• Environmental emergencies — hypothermia, hyperthermia, drowning, electrocution, altitude
• Cardiology emergencies — ACS pathway, arrhythmias, cardiac tamponade, aortic dissection
• Respiratory emergencies — PE, asthma, COPD exacerbation, tension pneumothorax
• Neurological emergencies — stroke (thrombolysis/thrombectomy), seizures, headache red flags
• Surgical and abdominal emergencies — appendicitis, AAA, perforation, ischaemic bowel
• Mental health in EM — suicide risk, agitation management, capacity, MAID consultations
• Obstetric and gynaecologic emergencies — ectopic, PPH, eclampsia, peripartum collapse
• EM procedures and ultrasound — focused US, central access, airway, joint reductions
• CanMEDS roles, ethics, EM leadership, palliative ED
• Indigenous health, cultural safety, social determinants in Canadian EM context

Drawn from the RCPSC EM Objectives, CAEP (Canadian Association of Emergency Physicians) position statements, and item density in iatroX.

• Sepsis bundles — Surviving Sepsis Campaign 2021, source control timing, antibiotic timing within 1 hour for septic shock, fluid resuscitation (30 mL/kg), vasopressor selection (norepinephrine first-line)
• ACS pathway — ESC/CAEP NSTEMI invasive timing (<24h GRACE-guided, <2h high-risk, immediate for ongoing ischaemia), STEMI thrombolysis vs primary PCI, DAPT considerations
• Trauma — Major Haemorrhage Protocol activation, 1:1:1 ratio, tranexamic acid within 3 hours (CRASH-2), pelvic binders, recognition of tension pneumothorax (decompression at 4th-5th ICS mid-axillary)
• Paediatric resuscitation — PALS algorithms, weight-based drug dosing (adrenaline 10 mcg/kg IV/IO), recognising the deteriorating child, fever in under-5s (Canadian Paediatric Society guidance)
• Stroke thrombolysis — extended windows per WAKE-UP/EXTEND, thrombectomy criteria (large vessel occlusion), posterior circulation stroke recognition, Canadian Stroke Network framework
• Toxicology — paracetamol nomogram and staggered ingestion, salicylate dialysis criteria, opioid overdose (naloxone), benzodiazepine reversal cautions, antidotes (NAC, fomepizole for methanol/ethylene glycol, digoxin-Fab)
• Mental health in ED — suicide risk frameworks, agitation management (verbal de-escalation, IM medications), Canadian Form 1 involuntary admission, capacity assessment for refusal of urgent treatment, MAID consultations in ED
• Indigenous health in EM — recognising barriers to care, cultural safety, providing trauma-informed care, working with Indigenous Liaison Workers, understanding intergenerational trauma in clinical presentations

Observations from recent RCPSC EM candidates. Verify against current Royal College Objectives of Training, CAEP guidelines, and Canadian specialty society guidance.

Candidate-reported observations — not official guidance.

1. CCFP-EM vs RCPSC EM — these are DIFFERENT certifications via different colleges. The RCPSC EM exam is for the 5-year specialty training pathway. CCFP-EM is for the 2+1 family medicine + EM enhanced training pathway and is administered by the CFPC. Different exam structures and Objectives.
2. Applied oral preparation — explain priorities, team roles and communication in the supplied scenario, then respond to the examiner's additional information.
3. Procedural reasoning — practise indications, equipment and decisions in case discussion. Use appropriate observed workplace training for physical performance; the published applied assessment is structured oral.
4. Canadian vs US guidelines — CAEP and Canadian Cardiovascular Society recommendations differ subtly from ACEP/ACC. The RCPSC EM tests Canadian standards. Confusing the two is a common error.
5. Mental health and Form 1 — Ontario Mental Health Act Form 1 (Application for Psychiatric Assessment) and provincial equivalents in other provinces. Recognising indications, completing correctly, and ED management of involuntary patients.
6. MAID (Medical Assistance in Dying) — recognising the Canadian framework, eligibility criteria, EM physician role (not typically the prescribing physician but may need to advise on access to services), updated rules following the 2024 expansion of eligibility.
7. Indigenous health under-preparation — RCPSC has explicitly emphasised Indigenous health. EM specifically deals with disproportionate Indigenous representation in trauma and acute presentations. Cultural safety in high-stakes encounters is examined.
8. Toxicology nomograms — paracetamol thresholds at 4h vs staggered, salicylate dialysis at varying levels, sodium-channel blocker overdose recognition (sodium bicarbonate). Commonly muddled under exam time pressure.

A pragmatic phased approach used by recent RCPSC EM certificants, integrated with PGY-5 clinical rotations.

1. Months 1–4

   Foundation pass across all 14 blueprint topics. 30 questions/day with the iatroX adaptive engine. Read CAEP position statements, Surviving Sepsis 2021, ATLS, PALS materials. Daily ECG and imaging interpretation.

2. Months 5–8

   Targeted weak-area drilling. Map Canadian-specific protocols (CAEP traumatic cardiac arrest, Canadian C-Spine Rules, PERC, Wells score). Daily toxicology and Canadian Form 1 / MAID framework practice.

3. Months 9–11

   Practise written answer production using the official response examples and current paper instructions. Rehearse structured oral scenarios with feedback and review knowledge errors against relevant Canadian sources.

4. Month 12

   Review unresolved written and oral-case difficulties. Rehearse the published 20-minute applied stations, explain decisions clearly and confirm your individual Royal College appointments.

Dedicated RCPSC Emergency Medicine question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

This is the Royal College Emergency Medicine specialty examination. Confirm eligibility and examination timing for your own training or assessment route with the College; it is separate from CFPC Emergency Medicine certification.

Canada has TWO routes to emergency medicine practice. RCPSC EM is the 5-year specialty training pathway with certification via the Royal College. CCFP-EM is the 2-year Family Medicine residency + 1-year EM enhanced skills, with certification via the College of Family Physicians of Canada. Different exam structures, different scopes of practice, both lead to EM practice in different settings.

Written and applied components. The official written examples include short-answer tasks; check the discipline-specific format for full paper arrangements. The applied examination is structured oral, with six 20-minute content stations, no additional reading time and three minutes between stations.

Use iatroX questions and explanations to strengthen Emergency Medicine knowledge and clinical decisions, then explore difficult reasoning with Tutor. Practise constructed written answers and structured oral responses separately using the Royal College examples and suitable feedback.

Once per year. Confirm 2026 dates and application windows on the Royal College website (royalcollege.ca).

The Royal College has explicitly emphasised Indigenous health as a CanMEDS Health Advocate competency. EM specifically deals with disproportionate Indigenous representation in trauma and acute presentations. Cultural safety in high-stakes encounters, recognising barriers to care, trauma-informed care, and working with Indigenous Liaison Workers are examined directly.

EM physicians are not typically prescribing physicians for MAID but may encounter MAID-eligible patients in the ED. The exam may test recognition of the Canadian MAID framework, eligibility criteria, the EM physician's role in advising on access to services, and recent expansions to eligibility. Updated rules following 2024 changes are particularly important.

Full RCPSC Emergency Medicine bank access is included in all-access. Up to 10 new sample questions per day are shared across exams, with no account required. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.