ACEM publishes a short report after every Primary Written Examination. Each one gives the cohort size, the pass rate, the pass mark, the cohort mean, median and range, the mean score in each of the four subjects, and the number of questions removed after review. Lined up across nineteen sittings, the reports show something a single one cannot: the exam did not get harder in 2022. The bar moved.
Pass rates for every sitting, 2017.1 to 2026.1
The Primary is one paper of 360 multiple-choice questions sat as two three-hour sessions on the same day. A single pass rate is reported. Until 2022.1 a candidate passed by reaching the overall passing score. From 2022.2 a candidate must reach the overall cut score plus one standard error of measurement and a minimum standard in each of the four subjects. That change is the dividing line in every table on this page.
| Sitting | Date | Candidates | Passed | Pass rate | Pass criteria |
|---|---|---|---|---|---|
| 2017.1 | Feb 2017 | 197 | 152 | 77.2% | Overall score only |
| 2017.2 | Aug 2017 | 259 | 200 | 77.2% | Overall score only |
| 2018.1 | Feb 2018 | 168 | 149 | 88.7% | Overall score only |
| 2018.2 | Aug 2018 | 247 | 215 | 87.0% | Overall score only |
| 2019.1 | 8 Feb 2019 | 182 | 134 | 73.6% | Overall score only |
| 2019.2 | 2 Aug 2019 | 202 | 177 | 87.6% | Overall score only |
| 2020.1 | 7 Feb 2020 | 169 | 138 | 81.7% | Overall score only |
| 2020.2 | 2 Oct 2020 | 231 | 222 | 96.1% | Overall score only |
| 2021.1 | 5 Feb 2021 | 208 | 192 | 92.3% | Overall score only |
| 2021.2 | 6 Aug 2021 | 255 | 232 | 91.0% | Overall score only |
| 2022.1 | 11 Feb 2022 | 160 | 147 | 91.9% | Overall score only |
| 2022.2 | 5 Aug 2022 | 176 | 130 | 73.9% | Overall + subject minimum |
| 2023.1 | 10 Feb 2023 | 139 | 102 | 73.4% | Overall + subject minimum |
| 2023.2 | 4 Aug 2023 | 222 | 157 | 70.7% | Overall + subject minimum |
| 2024.1 | 9 Feb 2024 | 159 | 113 | 71.1% | Overall + subject minimum |
| 2024.2 | 9 Aug 2024 | 224 | 156 | 69.6% | Overall + subject minimum |
| 2025.1 | 7 Feb 2025 | 185 | 110 | 59.5% | Overall + subject minimum |
| 2025.2 | 8 Aug 2025 | 304 | 190 | 62.5% | Overall + subject minimum |
| 2026.1 | 13 Feb 2026 | 235 | 198 | 84.3% | Overall + subject minimum |
| 2017.1–2022.1 (overall score only) | 2,278 | 1,958 | 86.0% | ||
| 2022.2–2026.1 (overall + subject minimum) | 1,644 | 1,156 | 70.3% | ||
| All 19 sittings | 3,922 | 3,114 | 79.4% | ||
What actually changed in 2022.2
Two things are visible in the reports. The first is the wording: from 2022.2 every report states the new criteria and reports an "examination cut score (includes 1 SEM)" rather than a "passing score". The second is the number. The pass mark, expressed as a percentage of the marks available, was between 58% and 62% in ten of the eleven sittings before the change. In every sitting since, it has been between 63.6% and 66.0%.
The cohort did not change. The mean score as a percentage of available marks was 70.8% across the old sittings and 70.3% across the new ones. Candidates in 2024 were scoring what candidates in 2019 scored. The distance between the average candidate and the pass mark, however, halved: from 36 marks on average to 19.
| Sitting | Pass mark | Cohort mean | Mean minus pass mark | Lowest score | Highest score | Items removed |
|---|---|---|---|---|---|---|
| 2017.1 | 209/359 (58%) | 237.0 (66%) | +28.0 marks (7.8%) | 138 (38%) | 313 (87%) | 1 |
| 2017.2 | 208/358 (58%) | 239.0 (67%) | +31.0 marks (8.7%) | 140 (39%) | 313 (87%) | 2 |
| 2018.1 | 209/351 (60%) | 247.6 (71%) | +38.6 marks (11.0%) | 163 (46%) | 303 (86%) | 9 |
| 2018.2 | 212/358 (59%) | 255.5 (71%) | +43.5 marks (12.2%) | 154 (43%) | 329 (92%) | 2 |
| 2019.1 | 237/356 (67%) | 254.2 (71%) | +17.2 marks (4.8%) | 158 (44%) | 315 (88%) | 4 |
| 2019.2 | 218/353 (62%) | 256.2 (73%) | +38.2 marks (10.8%) | 148 (42%) | 315 (89%) | 7 |
| 2020.1 | 218/355 (61%) | 247.7 (70%) | +29.7 marks (8.4%) | 153 (43%) | 308 (87%) | 5 |
| 2020.2 | 215/352 (61%) | 260.5 (74%) | +45.5 marks (12.9%) | 172 (49%) | 322 (91%) | 8 |
| 2021.1 | 214/353 (61%) | 256.7 (73%) | +42.7 marks (12.1%) | 163 (46%) | 313 (89%) | 7 |
| 2021.2 | 219/354 (62%) | 255.6 (72%) | +36.6 marks (10.3%) | 146 (41%) | 316 (89%) | 6 |
| 2022.1 | 204/352 (58%) | 249.9 (71%) | +45.9 marks (13.0%) | 160 (45%) | 308 (88%) | 8 |
| 2022.2 | 232/352 (66%) | 249.5 (71%) | +17.5 marks (5.0%) | 145 (41%) | 315 (89%) | 8 |
| 2023.1 | 233/356 (65%) | 254.9 (72%) | +21.9 marks (6.2%) | 165 (46%) | 315 (88%) | 4 |
| 2023.2 | 223/348 (64%) | 243.9 (70%) | +20.9 marks (6.0%) | 143 (41%) | 316 (91%) | 12 |
| 2024.1 | 230/350 (66%) | 247.9 (71%) | +17.9 marks (5.1%) | 155 (44%) | 313 (89%) | 10 |
| 2024.2 | 225/350 (64%) | 241.7 (69%) | +16.7 marks (4.8%) | 135 (39%) | 307 (88%) | 10 |
| 2025.1 | 227/344 (66%) | 239.0 (69%) | +12.0 marks (3.5%) | 150 (44%) | 312 (91%) | 16 |
| 2025.2 | 222/349 (64%) | 235.0 (67%) | +13.0 marks (3.7%) | 148 (42%) | 308 (88%) | 11 |
| 2026.1 | 225/351 (64%) | 258.0 (74%) | +33.0 marks (9.4%) | 177 (50%) | 320 (91%) | 9 |
Across all nineteen sittings the pass rate correlates almost perfectly with the gap between the cohort mean and the pass mark (r = 0.96). It correlates negatively with the pass mark itself (r = −0.63) and only moderately with how well the cohort scored (r = 0.59). The 2019.1 sitting shows the same mechanism before the rule change: that year the passing score was set at 67% of marks, the highest of the old era, and the pass rate dropped to 74% despite a normal cohort mean. When the pass mark is high, the pass rate is low, and the cohort's ability has surprisingly little to do with it.
2025: the two lowest sittings on record
The 2025.1 (59.5%) and 2025.2 (62.5%) sittings were the worst in the series, and the reports show why. In 2025.1 the pass mark was 66% of marks, the highest since 2019.1, and 16 questions were removed after review, the most in any sitting. The average candidate finished just 12 marks above the line. In 2025.2 the cohort was the largest ever recorded (304 candidates) and had the lowest mean since 2017 (67.3%); the pass mark was lower (63.6%) but the gap was still only 13 marks. Physiology and pharmacology scores were both below 67%, the weakest subject results in years.
Then 2026.1 recovered to 84.3%, the best result since the criteria changed. The pass mark was unremarkable (64.1%), but the cohort mean was 73.5%, the highest since 2020.2, and the lowest individual score in the cohort was 177 of 351 (50%), the highest floor in the series. Whether that reflects a stronger or better-prepared cohort, or a paper that suited them, the report cannot say.
What score to aim for
The practical reading of nineteen sittings is straightforward.
- The pass mark has been 63.6% to 66.0% under the current rules. Treat 66% as the line; the highest since the change was 66.0% in 2025.1.
- Since 2018 the cohort mean has been 67% to 74%. A candidate scoring at the cohort average has passed every sitting on record, but since 2022.2 the margin has been thin: 3.5% of the paper in 2025.1, or about 12 questions.
- Consistently above 70% on matrix-aligned practice questions puts you above the pass mark in every sitting in this series with a margin of at least 13 questions.
- Every subject counts on its own. The overall score is no longer enough; see the subject analysis for the minimum-standard rule and the one sitting in which the subject floors were published.
The arithmetic of the day. 360 questions in 360 minutes is one minute per question, with no allowance for review. Candidates who spend three minutes on a hard anatomy image are borrowing two questions' worth of time from later in the paper. The reports show that up to 16 questions are removed after each sitting because they performed badly psychometrically, so a question that seems unanswerable may not count. Answer it and move on.
Other things the reports show
- No difference between February and August. Average pass rates are 79.4% and 79.5%. August cohorts are larger (236 candidates on average against 180).
- Cohort size has no relationship to the pass rate (r = −0.02). The largest cohort (304 in 2025.2) had one of the lowest pass rates and the second largest (259 in 2017.2) had an average one.
- Extended matching questions are gone. Reports up to 2021.1 describe the paper as MCQs and EMQs; from 2021.2 they state that all 360 questions are now MCQs.
- More questions are being removed after review. An average of 5 items per sitting were excluded under the old criteria and 10 under the new, with a high of 16 in 2025.1. The reports give no reason. For candidates the effect is that the paper is marked out of 344 to 356, not 360.
- The spread of scores is wide. The lowest score in each cohort has been 38% to 50% of marks and the highest 86% to 92%. Nobody is approaching full marks, and there is no need to.
- The timetable is fixed. The exam is held on a Friday in early to mid February and in early August, in Adelaide, Auckland, Brisbane, Melbourne, Perth and Sydney. The one exception was 2020.2, moved to October and spread across extra regional centres during the pandemic. Results have been released 12 to 14 days after the exam in every sitting since 2019.
How the Primary compares with the Fellowship written
The two written exams behave differently. The Fellowship written exam is decided by the SAQ paper, where the average candidate sits almost exactly on the pass mark and pass rates have hovered around 60% to 70% for years. The Primary was, until 2022, a comfortable exam for the average candidate, with the cohort mean ten points above the line. It is now a moderately comfortable one with a five-point margin and a per-subject trap. The advice is the same in both cases: know where the line is, and prepare to clear it with room to spare rather than to reach it.
Sources and method
Figures are transcribed from Appendix 1 (current sitting) and Appendix 3 (historical statistics) of the ACEM Primary Written Examination Reports for 2019.1 through 2026.1, which together cover every sitting from 2017.1. Percentages of available marks use the "total possible score" after item exclusions. "Mean minus pass mark" is the published cohort mean less the published passing or cut score. Correlations are Pearson's r across the 19 sittings. The reports do not publish a standard deviation, per-subject question counts, or (except in 2022.2) the per-subject minimum standard. ACEMCQ is independent of ACEM and this page is not endorsed by the College.
Frequently asked questions
What is the pass rate for the ACEM Primary written exam?
Across 19 sittings from 2017.1 to 2026.1, 79% of candidates passed (3,114 of 3,922). Since the pass criteria changed in 2022.2 the rate has been lower: 70% across eight sittings, ranging from 59.5% (2025.1) to 84.3% (2026.1). Before the change it averaged 86%.
What score do you need to pass the ACEM Primary written exam?
The pass mark is set by standard setting after each exam and has been between 63.6% and 66.0% of available marks in every sitting since 2022.2. You must also reach a minimum standard in each of the four subjects. The cohort average has been 67% to 74% in every sitting since 2018, so a candidate scoring consistently above 70% on matrix-aligned practice questions is above the line in every sitting in this series.
Why did the ACEM Primary pass rate drop in 2022?
From the 2022.2 sitting a candidate must reach the overall cut score plus one standard error of measurement and a minimum standard in each subject. The published pass mark rose from about 61% of marks to about 65%, while the cohort average did not change. The pass rate fell from 92% in 2022.1 to 74% in 2022.2 and has averaged 70% since.
When is the ACEM Primary written exam held?
Twice a year, on a Friday in early to mid February and early August, in Adelaide, Auckland, Brisbane, Melbourne, Perth and Sydney. It is 360 multiple-choice questions across two three-hour papers on the same day, and results are released about two weeks later.