Purpose

The SCE demonstrates candidates’ ability to problem solve and ‘think on their feet’. As with every other part of the examination, you will be expected to demonstrate the capacity to be a FACEM, not a registrar. You must remain calm, handle any situation with an approach that encompasses what is common and what is commonly deadly, consult where appropriate and arrange safe disposition.

Format

Six stations are completed sequentially over one hour (10 minutes per station). For each station, there is three minutes to get to the station and for reading time sitting outside the examination room, followed by seven minutes with two examiners. During the reading time candidates are provided with written material, a ‘prompt’ of some sort, to read, but no writing is allowed. The first question may also be provided with this written material. During the time with the examiners, one will lead while the other scribes on a preformatted sheet. After seven minutes, you will be directed to sit outside the next room where the reading material for that station will be ready.

SCEs are usually conducted in an outpatient area or similar facility that has been used the previous day for the long and short cases. Sets of six stations are arranged together, with candidates moving around in a circular fashion like a game of musical chairs. Because the same questions are used for all candidates, those presenting early are isolated until the last group begins. Check your timetable and be prepared to wait if you are in the first groups.

The SCE topics may cover the entire curriculum. You should anticipate at least one paediatric, one medical (including poison/toxins) and one surgical (including trauma) topic. You should also expect at least one skill/equipment station and one administrative scenario. Since 2007 there has been a communication station, with actors playing various roles. Each station has a number of sections the examiners will work through. It is therefore likely that these sections will be presented in combination (e.g. paediatric resuscitation from poisoning while managing distressed parents and considering non-accidental injury). Anything is possible, including being asked to demonstrate use of equipment and/or a skill. If it can happen at work and be assessed in seven minutes, it can be in the SCE!

Th e reading material provided will be relevant to the case at hand, but this does not mean that the case cannot take a sudden turn in a different direction. Again, this is the way it is in the world of emergency medicine.

Preparation

The SCE is relatively easy to prepare for. However, the scope of material that can be used in the exam is enormous. Our suggestion is to practise SCEs from each area of the curriculum, paying particular attention to what is common and what is commonly deadly. Administrative issues and communication feature in many SCEs. Be aware of this when preparing for the SCE. To become familiar with the format, talk to examiners, your DEMT and anyone who has done the exam and read the past papers on the College website. Worked examples for each major area are presented at the end of this chapter, while Table 7.1 outlines a list of key topics to prepare for. Although this list is long, it is not exhaustive. Note that ‘communication’ SCEs may involve junior or senior staff, administration, VIPs, other colleagues and/or relatives. All of the ‘administration’ topics are also well suited to testing communication.

When preparing with other candidates, take delight in the experience if you manage to prepare a SCE that exposes an area of the curriculum they have not covered. If you are on the ‘receiving end’ of this experience of being ‘caught out’ in a practice SCE you have the opportunity to think about how you will handle that situation in the future. If the same situation comes up in the actual SCE (or in real life), there will be a little voice recorder playing in your head from your practice debrief during which you decided the best (or better) way to address the issue.

On the day

By now you will have become familiar with getting to the venue on time and settling yourself down. The hour of the exam will go quickly once you get in to it. Introductions will be brief. Usually you will be asked whether you have read and understood the scenario. This also serves to let you know which of the examiners is going to lead and which is scribing. From this point on anything is possible, so be prepared for sudden changes in direction — not surprised or alarmed. A good FACEM handles stress well and is never fazed! Some SCEs will involve actors or equipment. Deal with these as you would at work.

Sample SCEs

The following are some worked examples of the types of scenarios that may be encountered in the SCE. One example is given for each major category along with a mix of other issues. This framework could be used to develop your own practice scenarios. There is usually no shortage of colleagues eager to take part in communication roleplaying!