ACEM Primary Exam – additional information from the DEMT

Welcome to the SCGH Primary Exam Preparation

There is a new structure to the primary exam. All 4 MCQ papers must be completed before you receive an invite to the VIVA component. The order and amount of subjects you do per MCQ exam have not changed. The VIVA component consists of 4 integrated vivas. Each viva is made up of 4 questions (one for each subject) relating to a common theme.


1.   Clinical Orientated Anatomy- Moore-7th edition

2.   Basic and clinical Pharmacology- Katzung-12th edition

3.   Pathologic basis of disease—Robbins-9th edition (new)

4.   Review of medical physiology- Ganong 24 edition

5.   Clinical Atlas of Human Pathology- Mcminns 6th edition (vivas)

6.   Respiratory Physiology, the essentials: West 9th edition


It is a good idea to go to the UWA anatomy dept and hire a box of bones for 6months.

We have MOST of the anatomy models that may appear in the VIVA exam. They are located in my office. They can be used at any time but MUST not leave the dept.

Each week reflects how many MCQs will appear from the subject matter. It gives you an idea of how much effort to spend on the material. There are very big sections which only have a few MCQs so you need to specific selective with some of the material

Because the vivas are now integrated, I have arranged the teaching weeks of cardiovascular and respiratory to incorporate all 4 subjects consecutively followed by a revision week. This will give you a feel of an integrated viva.

EMQs, abnormal ECGs, ABGs and Xrays are new additions to the exam. See below for a full explanation from the ACEM website

I will give you additional material which will help you in your preparation when we start the program or earlier if you want. Just come and see me. Bring a flash drive.

Here is a list of useful ACEM Primary Exam Resources

Good luck!!



MCQ Exam:
Multiple Choice Questions (MCQ)
The multiple choice questions are “type A” questions: choose the one most correct response from four options.

Extended Matching Questions (EMQs)
Each set of EMQs comprise a theme; a list of possible options (i.e. options related to the theme), and a number of stems requiring a response chosen from the list.  In the ACEM format, trainees select one best option from the options provided (which could be up to 25 options).

Each subject paper will contain a mixture of both MCQ and EMQ question types. The proportion of MCQs to EMQs in each paper is not fixed. A selection of example EMQs is available to view in the Resources tab.  It is likely that the proportion of EMQs will expand over time. Once a written examination for a subject has been passed, it does not have to be attempted again.


Integrated Viva:
The oral examination comprises four integrated vivas; each viva assesses the four basic science subjects. The examination is held over one to two days. Candidates are required to obtain a scaled score of 5 or greater out of 10 in at least two of the four integrated vivas and have a total score of 20 or greater out of 40 at the one examination in order to pass the viva component of the examination and successfully complete the Primary Examination.

Props such as bones, normal X-rays and anatomical models may be used in the integrated vivas; however pathology specimens are not used.

Candidates may have to give a description including a basic analysis of pathological ABG’s & ECG’s. Please note that the candidate will not have to diagnose the abnormalities. For example, the candidate may be shown an ECG and told it is from a patient having a STEMI, they then may be asked to work out which area of the heart is infarcting and explain why the ECG changes are present from a physiological point of view. This level of knowledge is included in the current curriculum and current exam texts however, given the change in emphasis, it is important trainees are made aware.

Primary Exam candidates will be expected to label, describe and analyse abnormal ABG’s, X rays ECG’s etc. For example, the candidate may be shown an ECG, they would be expected to identify that it shows a STEMI and then explain the physiology underlying these changes. These changes will reflect the activities and expectations of trainees in the workplace who are at a level to sit their Primary Examination.

Candidates can sit the viva as many times as required within the timeframe for completion of provisional training time requirements.

Success in the Primary Examination is necessary to progress to ACEM Advanced Training.


Standard Setting:
A standard setting workshop is held before each examination where the modified Angoff method is used to determine the ‘cut score’ (or pass mark) for that exam. A panel of subject matter experts collaborate to make a judgement of the expected performance of a borderline candidate for each exam question. These judgements are then combined to calculate a cut score for each paper. This ensures that, over time, the same standard is required to pass each examination, and therefore, trainees are not disadvantaged when, by random chance, the questions in an individual examination are easier or harder, than in other sittings.