The exit exams: Dedicated to my family and friends…

The end of specialty training is an eagerly awaited moment for a huge number of trainees across the globe. This important step is usually marked by a frequently dreaded “exit exam” where trainees are expected to prove their skills and competencies within their chosen specialty.

In 1996, a new exam emerged for Emergency Medicine (EM) trainees in the UK. Now well established, the Fellowship of the College of Emergency Medicine (FCEM), previously known as FFAEM (Fellowship of the Faculty of Accident and Emergency Medicine) marks the end of training for emergency physicians in the British Isles and Ireland. Candidates sitting the FCEM are challenged to five demanding exams including a management viva and critical appraisal paper. It is an academically and professionally recognised qualification that runs in parallel with a number of other EM qualifications worldwide.

Exam in progress

In the United States, EM residency graduates are expected to pass both a written qualifying exam and an oral certification exam as the final stepping-stone to achieve board certification through the American Board of Emergency Medicine (ABEM). The Australasian College for Emergency Medicine (ACEM) also follows suit offering a rather extensive six part exam comprising of three written and three clinical components.

These exams were previously voluntary, but are now almost universally mandated by most international colleges and have become an essential passport to a first consultant or consultant-equivalent post in EM.

The first part of our short series highlights the joys, frustrations and perceptions of a UK-based trainee who recently undertook the FCEM exam.

These emotive words however, could illustrate the experiences and feelings of any senior medical trainee reaching the end of their training programme.

Preparing for this exam has been a hugely emotional and exhausting time.

I believe that sharing some of this may lend a small and valuable incite into the emotional challenges that lie ahead for some of you.

A year ago when I set off on this journey I was oblivious. The first time you sit the FCEM it’s like having your first baby. Everyone warns you how tough it will be when the baby arrives… but you refuse to believe them. How hard can it be? I’ve done exams all my life, is this one really any different?

No, not really. It requires all the usual skills: organisation, commitment and the ability, like most other exams to learn lots of useless information. So what’s new? I’ve done that all before- a million times over.

Well for a start, I’m a hell of a lot older. It takes me twice as long to perform simple daily tasks leave alone memorising endless lists, lists of lists and mnemonics to remember the lists of lists.

I am also working a job where let’s face it, a good day is when you get home and need a short timeout before you can even begin to face a conversation with the other half, never mind sitting down at 10pm to summarise a hefty fifty-page guideline.

It is a massive exam and perhaps one of the most important in our career. As with all exams there is that fear of failure and the ultimate fear that you will be judged by all. If I fail, will everyone think I’m a bad doctor? No, of course not, but your exhausted and neurotic neurons convince you of this. The paranoia starts to takes over. I started to incessantly question every little thing at work and became frightened of discharging patients. Too much knowledge became a bad thing.

Most importantly for me was the impact on my personal life. I became a hermit. This wasn’t part of the deal surely? I knew it would take its toll on me, but my family too? My family have missed me. I’ve missed them.

What about those who have shared this journey with me? My surrogate family. The only people to have seen me as stressed as my own family and the only ones that can totally empathise with what you are going through- because they’re facing the daily struggles with you. They started out as revision colleagues, but somewhere along the way they have evolved into my closest friends.

Our patient family, supportive friends and tireless colleagues are our unsung heroes. Without their love and support we could not have completed this emotional roller-coaster. The FCEM.

A colleague said recently: “after the FCEM, whether you pass or fail, it changes you…” It sure did.

It’s over for me, and thankfully here in the UK this is one certificate that I am not expected to re-certify in.


Sivanthi Sivanadarajah/Janos P Baombe

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