FACEM Fellowship Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for advanced trainees sitting the FACEM Fellowship Exam in the next twelve months. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary. It now covers 21 colleges because trainees from each specialty asked us to build for them. The FACEM Fellowship Exam curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The Australasian College for Emergency Medicine (ACEM) sets the Fellowship Examination as the final hurdle before specialist registration as a FACEM. The exam has two separate components: a written paper made up of short answer questions, and a 12-station Objective Structured Clinical Examination. Both must be passed for Fellowship. Trainees usually attempt them in the same sitting, although the components can be sat separately within the college's defined validity window.

The written paper (Short Answer Questions)

• 10 SAQs in 180 minutes, roughly 18 minutes per question
• Variable marks per question, with the paper worth a maximum of 360 marks. A typical SAQ is worth 30 to 40 marks across multiple sub-parts
• Computer-based, delivered at approved test centres or via the college's nominated platform (confirm format with ACEM ahead of your sitting)
• Tests emergency medicine knowledge at consultant level, with a strong emphasis on prioritisation, specific drug doses, and disposition
• Calculator policy: an on-screen calculator is provided where required for the paper

The OSCE

• 12 stations across the OSCE, each 11 minutes long: 4 minutes reading time, then 7 minutes of structured assessment
• Stations span six recognised types: clinical management, communication, teaching, physical examination, clinical synthesis, and structured case-based discussion (SCBD)
• Examiners use a station-specific marking guide. Each station is graded independently and aggregated for the OSCE result
• Live role-players are used for communication and physical examination stations. Teaching and SCBD stations use the examiner as the junior doctor or peer
• Sittings are run twice yearly. Confirm dates and venues on the ACEM website

Pass marks and standardisation

The college does not publish a fixed numerical pass mark for the FACEM Fellowship Exam. The standard is set with reference to examiner judgement and modified Angoff or borderline-regression methods, depending on the component. Pass rates vary by sitting and are published by ACEM after each round. As of 2026, treat any single percentage as a rough guide only and read the published examiner reports for genuine signal on what is being marked down.

Independent components, separate sittings

The written and OSCE components are graded separately. If you pass one and fail the other, you re-sit only the failed component within the validity window the college sets. Most trainees aim to sit both in the same round because the curriculum overlap is high and the OSCE communication and teaching stations draw on the same underlying clinical knowledge as the SAQs. Splitting the components is usually a response to a specific weakness rather than a default choice.

What the college actually tests

The FACEM Curriculum 2021 (v4.11, updated February 2026) defines 206 mapped learning objectives across 30 curriculum sections. Twenty-three of those sections are medical presentations, ranging from cardiovascular through trauma to geriatric emergency medicine. Seven are professional competency domains: Prioritisation and Decision Making, Communication, Teamwork and Collaboration, Leadership and Management, Health Advocacy, Scholarship and Teaching, and Professionalism. Every SAQ stem and every OSCE station maps to one or more of these objectives.

The breadth is genuinely large. A few clusters come up disproportionately based on examiner reports and past papers. These are seven of the highest-yield areas to anchor your preparation.

1. Resuscitation and time-critical management

Cardiac arrest with shockable and non-shockable rhythms, post-resuscitation care including targeted temperature management, RSI in the crashing patient with specific drug doses, and paediatric resuscitation with weight-based dosing. Examiner reports keep flagging the same problem: candidates know the algorithm but cannot state the specific dose, route, and timing under pressure. "Give adrenaline" is not enough. "Adrenaline 1 mg IV every 3 to 5 minutes" is what scores.

2. Trauma and major haemorrhage

Damage control resuscitation, the 1:1:1 transfusion ratio, TXA 1 g within 3 hours, the criteria for activating massive transfusion protocols, traumatic brain injury management, pelvic binders, and FAST scan interpretation. Trauma SAQs and OSCE stations test prioritisation. Candidates who lead with secondary survey detail before the airway has been secured score poorly. ABCDE is not a checklist for the answer; it is the order in which you write.

3. Toxicology

Paracetamol overdose with the Rumack-Matthew nomogram and the NAC protocol (150/50/100), tricyclic antidepressant toxicity with sodium bicarbonate for QRS widening greater than 100 ms, toxic alcohols (methanol, ethylene glycol, the osmolar gap, fomepizole), Australian snake envenomation with pressure immobilisation and antivenom selection, and salicylate toxicity with alkalinisation and dialysis indications. Toxicology is a perennial SAQ. Specific antidotes, doses, and the role of the Poisons Information Centre must be in the answer.

4. Paediatric emergencies

The febrile child with an age-based approach to serious bacterial infection, paediatric airway emergencies (croup, epiglottitis, foreign body), neonatal duct-dependent lesions and prostaglandin, DKA in children with a careful fluid protocol because of cerebral oedema risk, and non-accidental injury recognition with mandatory reporting obligations. Paediatric stations in the OSCE often test communication with a parent as much as the clinical reasoning. The marking schemes specifically reward age-appropriate language and clear rapport with the family.

5. Toxicological and behavioural emergencies

Acute behavioural disturbance with droperidol 10 mg IM, alcohol withdrawal with CIWA-guided benzodiazepines and Wernicke's prophylaxis, deliberate self-harm with a clear medical and psychiatric pathway, excited delirium recognition, and the involuntary admission framework under the relevant Mental Health Act. The OSCE communication stations frequently sit at the intersection of toxicology and psychiatry. Capacity assessment, de-escalation, and structured handover to mental health services are recurring marking points.

6. Cardiology and respiratory emergencies

STEMI with a clear reperfusion strategy and time targets, NSTEMI risk stratification with TIMI or GRACE, acute heart failure and pulmonary oedema with NIV, GTN, and diuretics, broad-complex tachycardia differentiation, aortic dissection, acute severe asthma with the salbutamol-magnesium-aminophylline ladder, COPD with controlled oxygen and NIV criteria, and pulmonary embolism with Wells, CTPA, and the indications for thrombolysis in massive PE. These are bread-and-butter SAQs and they reward specificity.

7. Communication, teaching, and the SCBD station

Breaking bad news (unexpected death, catastrophic injury), medical error disclosure to a patient or family, non-accidental injury reporting, capacity and consent for procedures, and complaint or impaired-colleague management. Teaching stations sit alongside these: walking a junior through ABG interpretation, ECG analysis, RSI steps, or the ATLS primary survey. The SCBD station tests reflective practice on a near-miss or missed diagnosis. Candidates who treat the OSCE as a clinical knowledge test alone struggle here. The college is testing the consultant role, not just the encyclopaedia.

Common pitfalls that fail candidates

• Leaving SAQ sub-parts blank. The single most common comment in published examiner reports. Even a partial answer scores. An empty box scores zero.
• Vague, non-consultant phrasing. "Manage the airway" or "give fluid" do not score. The expected register is specific: drug name, dose, route, frequency, and what you would re-assess.
• Missing disposition. Almost every SAQ marking guide includes disposition (admit, ICU, transfer, discharge with follow-up). Answers that stop at acute management lose marks they did not need to lose.
• Burying the critical step. If the airway is unsafe, the airway goes first. SAQs that detail laboratory findings before they have stabilised the patient signal a candidate who has not internalised prioritisation.
• Ignoring time windows. Thrombolysis in stroke at 4.5 hours, PCI in STEMI within the local network's time target, NAC initiation timing for paracetamol. These windows belong in the answer.
• OSCE: treating communication stations as clinical questions. The role-player is not a question stem. They want to be heard, acknowledged, and given a clear plan. Marks come for the human contact as much as the medicine.
• OSCE: failing to structure teaching stations. A junior doctor station is not a quiz; it is a teaching encounter. Set the agenda, check baseline knowledge, deliver structured content, then check understanding.

A realistic study timeline

The right run-up depends on your full-time-equivalent clinical workload, how comfortable you already are with the breadth of the curriculum, and how early you started revising. Three sample plans, in rising order of comfort.

Nine-month plan (8 to 10 hours per week)

This suits a trainee working full-time clinically with significant non-work commitments who wants slow steady coverage rather than a sprint.

• Months 1 to 3. Walk through the FACEM curriculum systematically. Cover three or four sections per week from the medical presentations group (3.1 to 3.23). Build a flashcard deck as you go and answer 30 to 50 MCQ-style or recall items per week to surface gaps.
• Months 4 to 6. Add SAQ practice. Aim for two timed SAQs per week (18 minutes each), marked carefully against a model answer. Begin OSCE practice with one station per week, ideally with a study partner or a simulator that plays the role.
• Months 7 to 8. Past paper SAQ mocks under timed conditions. OSCE practice scales to two or three stations per week across the six station types. Identify weak curriculum sections and target them.
• Final month. Two full timed SAQ mocks (10 SAQs in 3 hours). One full 12-station OSCE mock, ideally over a single day to build stamina. Final polishing on high-frequency presentations: trauma, paediatric resus, toxicology, communication.

Six-month plan (12 to 15 hours per week)

The standard plan for most candidates. Tight enough to keep momentum, long enough to cover the curriculum properly.

• Months 1 to 2. Walk through every curriculum section. Cover one or two sections per week. Build the flashcard deck. 50 to 80 recall items per week.
• Months 3 to 4. SAQ practice becomes the main work. Three to five timed SAQs per week, marked carefully. Maintain recall practice. Start OSCE practice at one to two stations per week, mixing clinical and communication.
• Month 5. First full timed SAQ mock (10 SAQs, 3 hours). OSCE volume doubles. Two to three stations per week with verbal feedback, ideally including SCBD and teaching stations.
• Final month. Two more SAQ mocks under exam conditions. One full 12-station OSCE mock. Final round of weak-area practice and station-type rotation.

Four-month plan (18 to 22 hours per week)

The compressed plan. Doable if you are part-time clinical or have a study leave block, painful otherwise.

• Month 1. Speed-read the curriculum. Two to three sections per week, focused on weak areas. Heavy recall volume from week one (100+ items per week). Begin SAQ practice in week three.
• Month 2. Timed SAQs daily or every second day. OSCE practice begins twice a week. Target the six station types, not just clinical management.
• Month 3. Full timed mocks start. SAQ mock weekly, OSCE mock fortnightly. OSCE practice three times per week with verbal feedback.
• Final month. Polish weak areas. Two SAQ mocks, two full OSCE mocks, daily station practice. Sleep and wind down for the last 48 hours.

When to start each component

• Recall and MCQ-style items: from week one. They build curriculum recall and surface weak areas faster than reading.
• Timed SAQ stems: from month two at the latest. The 18-minute discipline takes practice. Untimed SAQs for the first two weeks are fine; after that, write to the clock.
• OSCE stations: from month three at the latest, even on a four-month plan. Verbal performance under pressure needs reps. Reading about communication does not transfer.
• Past papers and full mocks: last six to eight weeks for both components. Earlier than that and you have not yet covered enough ground for the result to be meaningful.

Weekly study split that holds up

Most candidates run into trouble because their week is shapeless and the work that feels easy crowds out the work that matters. A simple template that works: two SAQ sessions per week of 60 to 90 minutes each, two OSCE sessions per week of 60 to 90 minutes each from month two onward, one curriculum reading session tied to whichever weak section emerged from the practice, and flashcard reps in the background as ten-minute blocks between patients or on commutes. Protect your OSCE slot the way you protect a clinical commitment. If you let it move, it stops happening.

Track what you got wrong, not what you got right. Keep a running list of missed key features by curriculum section. After a month you will see two or three sections that come up repeatedly and you can target them directly.

The single biggest mistake people make

You leave OSCE practice until the last six weeks. The written paper feels concrete and tractable, so you grind SAQs first because the feedback is immediate and the score is a number. Then you wake up two months out, realise you have never run a timed station under exam conditions, and try to compress all your OSCE work into the run-in.

The OSCE is not a knowledge test. It is a performance under time pressure with someone watching, and the only way to get fluent at it is to do it badly thirty times before you do it well. You need the muscle memory of opening with rapport, structuring the encounter, demanding consultant-level specificity from yourself out loud, summarising back, and closing with a clear disposition. All of that inside seven minutes after four minutes of reading. That muscle memory takes months to build, not weeks.

Start OSCE practice in month one or two of your run-up. Even one station a week is enough to keep the skill alive. You can practise with a registrar peer, with a remote partner over voice, or with an OSCE simulator that plays the role and marks against the station type. The point is reps. By the time you sit, the seven-minute structure should feel automatic and your conscious bandwidth should be free for the clinical reasoning.

How PRIMEX helps

• The SAQ grader generates FACEM-format SAQs and marks each response with examiner-style feedback against the marking points, including the doses and disposition steps that examiner reports flag. Open the ACEM Fellowship page on PRIMEX to see the format.
• The OSCE simulator runs a 12-station round with voice mode, plays the patient, family member, or junior doctor live, and marks against the six station types using a structured debrief. Open it from the OSCE feature on the ACEM page.
• The curriculum tracker maps every study note and flashcard to the 206 FACEM Curriculum 2021 learning objectives, so you can check coverage rather than guess at it.
• Ask PRIMEX is a clinical question tool that pulls answers from the emergency medicine study notes and references the source guidelines. Available inside the app.

Frequently asked questions

Related study guides

• ACEM Primary 2026 Study Guide
• CICM Fellowship 2026 Study Guide