ACEM Fellowship Written common mistakes
ACEM Fellowship Written · Understand the traps and how to avoid them.
Spending disproportionate time on one difficult SAQ sub-part and leaving later questions or sub-parts with blank or truncated answers, so marks that were easily available are never attempted.
Candidates treat each question as a pass/fail hurdle and become cognitively 'locked in' trying to retrieve an obscure detail, losing track of the marks-per-minute economics of a written paper where every sub-part carries allocated marks.
What to do instead
Before the exam, rehearse a strict per-question time budget derived from marks allocated (roughly one minute per mark), and practise a 'flag and move' rule: if a sub-part is not progressing within its budget, write a one-line holding answer, flag it, and return only after all questions have been attempted. Do at least two full-length timed mocks under exam conditions to internalise the pacing.
Writing long narrative prose answers that bury the required facts, so the examiner cannot locate the key management steps within the response.
Clinical training rewards comprehensive narrative communication; candidates carry this habit into a marks-driven written paper without recognising that examiners mark against a checklist of discrete points and will not hunt for embedded answers.
What to do instead
Convert every answer into a structured list or table format: bolded headings matching the question's verbs, then short bullet points, one idea per line. Practise rewriting past answers into 'examiner-friendly' form and self-mark against a checklist to see how many points were present but invisible.
Misreading the directive verb and answering the wrong question, for example giving a full management plan when asked only to list differential diagnoses, or describing pathophysiology when asked for immediate actions.
Under time pressure candidates skim the stem and pattern-match to a familiar topic, and the directive verbs (list, outline, describe, discuss, justify) are treated as interchangeable when they carry different mark allocations and expected depth.
What to do instead
Adopt a fixed reading routine: underline the directive verb, the target population, and the setting in every question before writing. Build a personal glossary of what each verb demands (list = bare points; outline = brief explanation; discuss = reasoned argument with pros and cons) and apply it deliberately in practice papers.
Answering only the first part of a multi-part question and omitting later sub-parts, particularly the 'and justify your reasoning' or 'what would you do next' components.
Sub-parts are often separated by page breaks or numbering that is easy to overlook, and candidates relax once they have produced a satisfying answer to the clinical scenario, assuming the question is complete.
What to do instead
Before writing anything, count and number all sub-parts on the answer page and tick each off as it is completed. In practice, deliberately attempt questions with four or more sub-parts and train the habit of re-reading the stem after finishing to confirm every component has been addressed.
Presenting management plans that omit safety-critical elements such as senior or consultant escalation, ICU or theatre involvement, and documented reassessment or observation criteria.
Candidates focus on the intellectually interesting diagnostic and therapeutic steps and treat escalation, disposition, and review as assumed background rather than examinable content, reflecting how these steps are often implicit in real clinical work.
What to do instead
Use a memorised management template for every scenario: resuscitation and stabilisation, focused investigation, specific therapy, escalation and referral thresholds, disposition (ward, HDU, ICU, theatre, discharge), and a documented review or safety-net plan. Apply the template to every practice question so the safety elements become automatic.
Giving vague, non-quantified answers where the question expects specific drug doses, routes, rates, or timeframes, such as writing 'give appropriate antibiotics' or 'give calcium' without dose and indication.
Day-to-day practice relies on protocols and pharmacy support, so exact figures are not always actively recalled; candidates also fear stating a wrong number and default to safe-sounding generalities that earn no marks.
What to do instead
Build and repeatedly test a one-page emergency drug card covering the doses, routes, and rates for the agents the syllabus expects (for example adrenaline in arrest and anaphylaxis, calcium and insulin for hyperkalaemia, magnesium, naloxone, antidotes). Write the number even when uncertain, since a partially correct specific answer usually scores better than a vague one, and review errors after each mock.
Failing to interpret and act on the provided investigations, either ignoring abnormal values in the stem or listing every possible test rather than the focused next test and its likely result.
Candidates read the stem as a prompt for a differential diagnosis and then generate a generic workup, rather than treating the supplied results as data that must be explicitly interpreted and linked to the management decision.
What to do instead
In every answer, include a short explicit interpretation line ('the potassium of 6.8 with peaked T waves indicates hyperkalaemic emergency requiring immediate stabilisation') before stating the next action. Practise questions where the stem contains results and rehearse naming the single most useful next investigation with the finding that would change management.
Producing unstructured, undifferentiated differential diagnosis lists that mix common, serious, and irrelevant conditions without prioritising the immediately life-threatening options.
Candidates equate length with marks and generate exhaustive lists from memory, without applying a framework that forces consideration of the 'can't miss' diagnoses first, which is what the marking scheme rewards in emergency scenarios.
What to do instead
Use a consistent anatomical or systems framework for differentials and always lead with the life-threatening causes, explicitly labelled. Practise generating a maximum of eight prioritised differentials per scenario, with a one-line justification for the top three, and self-mark against the framework rather than counting items.
Handwriting, layout, and labelling are so disorganised that answers run together across sub-parts, corrections are illegible, and the examiner cannot attribute content to the correct question.
Candidates underestimate how much marking depends on quick legibility under time pressure, and they write corrections over existing text rather than striking through cleanly, having never practised the physical task of writing at speed for three hours.
What to do instead
Practise full papers in longhand on the actual answer format, using clear question numbers, generous spacing, and a single clean strike-through for errors. Deliberately practise writing legibly at speed for extended periods to build endurance, and leave a blank line between sub-parts.
Leaving answers blank when uncertain rather than committing to a reasoned best answer, and failing to review flagged questions before time expires.
Candidates fear being penalised for wrong answers or feel they have nothing useful to write, so they abandon marks that partial credit would have awarded; poor time management then leaves no review window at all.
What to do instead
Adopt a rule that no sub-part is left empty: write the safest reasonable action, the reasoning behind it, and what would confirm or refute it. Reserve the final ten per cent of exam time for a structured review pass over flagged items and any unanswered sub-parts, and rehearse this in every timed mock.