ACEM Fellowship Written Exam Format Explained

The ACEM Fellowship Examination – Written (FEx Written) consists of two components sat on the same day: a Short Answer Question (SAQ) paper in the morning and a Select Choice Question (SCQ) paper in the afternoon. Both examinations are completed online at Cliftons centres (or other suitable venues) in major locations across Australia and New Zealand. You must pass both papers independently to pass the FEx Written overall.

Exam overview

The SCQ paper — Multiple Choice Questions

The SCQ paper contains 120 MCQs. Each question presents a clinical stem — usually a patient scenario — followed by four options. You must select the single correct answer. There is no negative marking.

These are Type A single-best-answer questions. Typically two of the four options will be clearly incorrect, while the remaining two will be plausible. The challenge lies in distinguishing between the best answer and a good-but-not-best answer. Questions are written by FACEMs in active clinical practice, and answers are referenced to recommended texts tempered by clinical experience.

Time management for the SCQ

With 120 questions in 180 minutes, you have 90 seconds per question on average. Some straightforward recall questions will take less time, freeing up time for more complex clinical reasoning stems. Flag difficult questions and return to them rather than getting stuck — every unanswered question is a missed opportunity.

Tips for MCQs

• Read the stem carefully and identify what is actually being asked before looking at options
• Eliminate obviously wrong answers first, then reason between remaining options
• If two options seem equally correct, look for the one most specifically supported by the clinical details in the stem
• Do not change your initial answer unless you have a clear reason — first instincts on well-prepared material are usually correct
• Ensure you answer every question — there is no penalty for incorrect answers

SCQ topic matrix

MCQs are selected according to a published topic matrix that ensures breadth of coverage and appropriate weighting of important topics. The number of questions per topic group is approximate and may vary slightly between sittings. Approximately 25% of all questions relate to paediatrics.

The SAQ paper — Short Answer Questions

The SAQ paper is completed in the morning. From the 2026.1 sitting, candidates receive 10 minutes of reading time before 3 hours of writing time. During reading time you may not take notes or type answers. The paper contains approximately 26 questions totalling 330 marks.

Questions are of varying length — some are short single-part questions while others are longer multi-part questions carrying more marks. Each question is typically built around a clinical vignette and asks for specific lists, management plans, investigation interpretation, or clinical reasoning. Topics appear in no particular order, reflecting the unpredictable nature of an ED shift.

A practice online SAQ examination is made available by ACEM to help you familiarise yourself with the format. The SAQ paper is tested by recently graduated FACEMs a couple of weeks before the exam date to ensure clarity and that the paper can be completed in the allocated time.

Tips for SAQs

• If asked to list a specific number of items, list exactly that number — additional answers beyond the requested number are disregarded
• If asked to state, keep each answer to a phrase or short sentence
• If asked to analyse an investigation or image, provide a structured description highlighting the most significant findings
• If asked to interpret, provide your conclusion after analysing the result
• Be concise and specific — do not write essays. Marks are awarded for specific correct points, not for volume of text
• Use the reading time to scan the entire paper, identify quick wins and long questions, and mentally plan your time allocation
• Time management is critical — it is better to write a reasonable answer for every question than a perfect answer for half of them

SAQ time allocation

With 330 marks in 180 minutes of writing time, you have approximately 33 seconds per mark. A 10-mark question deserves roughly 5.5 minutes; a 20-mark question roughly 11 minutes. Use the reading time to identify the highest-mark questions and plan your approach. Don't spend disproportionate time on low-mark questions.

Curriculum domains assessed

Not all eight domains of the FACEM Curriculum are assessed in the written exam. The FEx Written is blueprinted to test the following six domains:

• Medical Expertise — comprising at least 80% of the examination. Covers the Principles of Practice in Emergency Medicine and Clinical Management in Emergency Medicine sections of the curriculum.
• Prioritisation and Decision Making
• Leadership and Management
• Health Advocacy
• Scholarship (the scholarship component of Scholarship and Teaching)
• Professionalism

The remaining domains — Communication, Teamwork and Collaboration, and the Teaching component of Scholarship and Teaching — are assessed through workplace-based assessments (WBAs), in-training assessments (ITAs), and the Fellowship Examination – Clinical (OSCE).

What Medical Expertise means in practice

For the Medical Expertise domain, the ACEM preparation guidelines specify that you should be able to:

• Assessment: List history findings leading from an undifferentiated presentation to a diagnosis; list examination findings differentiating between similar presentations; select and justify investigations; analyse and interpret common investigation results
• Treatment and management: Provide details of common drugs, fluids and gases (dose, route, indications, contraindications, adverse effects); create a prioritised treatment plan including monitoring and procedures; demonstrate understanding of how emergency procedures are performed including indications, contraindications, and complications

Marking and standard setting

The FEx Written uses criterion-referenced standard setting, meaning the pass mark is based on question difficulty rather than a fixed percentage or a predetermined pass rate. The method used is called Modified Angoff: a panel of FACEM subject matter experts, trained in standard setting, independently estimates the probability that a “just at standard” candidate would answer each item correctly. These estimates are aggregated to determine the cut score.

A “just at standard” candidate is defined as one who has demonstrated a minimum or sufficient level of knowledge and understanding to ensure safe practice and meet core patient needs. The standard is set to the level of competence expected of a graduating consultant emergency medicine physician.

After psychometric analysis to ensure reliability and fairness, one standard error of measurement (1 SEM) is added to the cut score to produce the passing score. This is standard practice in high-stakes examinations and provides a quality assurance margin. You must achieve the passing score on both the SAQ and SCQ papers independently to pass the FEx Written.

Results and feedback

Results are released to candidates individually approximately 6 weeks after the examination. Results are then released to each candidate's registered Director of Emergency Medicine Training (DEMT) to enable the DEMT to offer support. Candidates and DEMTs receive notification from the College at least 24 hours before results are released.

Candidates who are unsuccessful receive written feedback on their performance. ACEM publishes a formal examination report on its website within several weeks of results release, containing information about the content and outcomes of that sitting. Unsuccessful candidates are encouraged to review their feedback alongside this report with their DEMT, a mentor, or a trusted supporter.

Exam day logistics

The FEx Written is held at Cliftons centres (or other suitable venues) in major cities across Australia and New Zealand. Both papers are completed online on computers provided at the venue.

• On arrival, you must register, show suitable identification, and switch off your mobile phone and all electronic devices
• Devices are placed in your bag and stored securely within the examination room — any candidate found with a phone or other device on their person may be disqualified
• You are required to leave the examination centre between the morning (SAQ) and afternoon (SCQ) papers
• No materials may be taken from the examination room on completion
• FACEM and Cliftons invigilators are present throughout, and an ACEM Examination Operations team member oversees each centre
• Paper copies of the examination are held on standby in case of unresolvable technical issues

Special consideration

ACEM's Exceptional Circumstances and Special Consideration Policy defines circumstances warranting special consideration. Applications must be submitted prior to the examination and as soon as relevant circumstances are known, or otherwise within 72 hours of the examination date. The policy is available on the ACEM website.

ACEM examination glossary

ACEM publishes a glossary of terms used in exam questions. Understanding these definitions precisely is important, particularly for SAQs where marks depend on answering what is actually asked:

How to prepare for each component

The SCQ component rewards regular question practice with fellowship-standard MCQs. Do questions under timed conditions (90 seconds per question), review explanations for every answer including those you get right, and track your performance by topic domain so you can target weak areas.

The SAQ component requires a different skill — practising structured written answers under time pressure. Past SAQs with model answers are published on the ACEM website (two per year), and the DEMT network maintains a bank of practice SAQs. Practise with a study partner who can provide feedback, and try writing your own questions as a revision technique.

For a comprehensive study strategy covering both components, see our preparation guide.