# ACEM fellowship written exam — study index Tailored to the **Fellowship Written Exam** (SAQ + SCQ, November 2026). Source material: FACEM Curriculum 2022 v4.11 (February 2026), Medical Expertise domain (pp 22–112), cross-referenced with a topic list compiled by a recent FACEM passer. ## How to use this - **★ = high yield** (flagged by the recent passer or recurrent in past SAQ themes). Hit these first and revisit. - **[BG]** = background/Primary-level content that occasionally surfaces in Fellowship SAQs as part of integrated questions. Don't re-study from scratch — revise via flashcards. - **[TS4]** = formally TS4-level content (mostly leadership/specialised). Lower yield for the written; defer or skim. - [[Tick boxes as you cover topics. Revisit ★ items at least three times before the exam]] ## What the Written tests (vs the Primary) The Primary tested basic sciences in isolation — pure anatomy, physiology, pathology, pharmacology. The Fellowship written tests **integrated clinical management**: aetiology → recognition → investigation → resuscitation → definitive treatment → disposition, with an explicit weighting toward time-critical, high-acuity, and special-population scenarios. SAQ paper themes that recur most years: ACS and arrhythmia, trauma (including paeds and elderly), sepsis and infection, toxicology and envenomation, paediatric resus, obstetric emergencies, environmental emergencies, mental health, complex airway, end-of-life and ethics, ED systems and quality. SCQ tests broader recall — including a thinner slice of Primary-level basic science. --- ## 1. Foundations — selective revision only [pp 22–38] Anatomy, physiology, pathology, pharmacology in their entirety belong to the Primary, not Fellowship. For the Written, focus on the basic-science items that have direct clinical leverage in SAQs. ### [[Anatomy worth revising]] ### [[Physiology worth revising]] ### [[Pharmacology worth revising]] ### [[Pathology worth revising]] --- ## 2. Principles of practice [pp 39–63] ### 2.1 Prehospital care - [ ] ★ [[Telephone advice]] — risk, structured handover - [ ] ★ [[Trauma arrival prep, prehospital communication]] - [ ] [[Patient transport]] — physiological effects, prolonged transfer - [ ] [[Mode of transport selection; off-site clinician advice]] ### 2.2 Initial emergency medicine care - [ ] [[Triage frameworks; ATS categories]] - [ ] [[Time-critical recognition; structured assessment of critically ill]] - [ ] ★ [[Generating provisional and differential diagnosis from minimal information]] ### 2.3 [[Resuscitation medicine]] ### 2.4 Focused assessment - [ ] [[Approach to abdominal pain, chest pain, headache, dyspnoea, syncope, dizziness, weakness, fever, altered mental state, back pain, agitation]] - [ ] ★ [[Atypical and subtle presentations in elderly and immunocompromised]] - [ ] ★ [[Pre-test probability and rational test selection]] ### 2.5 Analysis of investigations #### [[ECG]] (highest-yield SAQ topic) #### [[Imaging]] #### [[Pathology Tests]] ### 2.6 Ultrasound - [ ] ★ [[FELS]] — cardiac standstill, RV strain, tamponade, gross LV function - [ ] ★ [[EFAST]] — free fluid, pneumothorax, pericardial effusion - [ ] ★ [[AAA detection]] - [ ] ★ [[Lung]] — sliding, B-lines, consolidation, effusion - [ ] ★ [[Doppler for vascular access; DVT compression]] - [ ] ★ [[Formal pregnancy/gynae ultrasound]] — first trimester, ectopic - [ ] ★ [[Soft tissue, ruptured tendons and joints]] - [ ] [[US-guided procedures]] — peripheral and central access, femoral nerve block, FIB, pleural drains, ascitic drains, joint aspirations - [ ] [[Hepatobiliary, renal ultrasound]] ### 2.7 Treatment, 2.8 Observational medicine, 2.9 Documentation, 2.10 Disposition - [ ] ★ [[Goals of care and ceiling of treatment conversations]] - [ ] ★ [[Discharge risk assessment, especially elderly]] - [ ] ★ [[Inter-hospital transfer]] — safety, monitoring, communication - [ ] [[Medical handover frameworks]] (ISBAR, IMIST-AMBO) - [ ] [[Premature departure]] — risk assessment, documentation --- ## 3. Clinical management — by system This is the bulk of the SAQ paper. ### 3.1 [[Cardiovascular]] [pp 64–65] ### 3.2 [[Respiratory]] [p 66] ### 3.3 [[Gastrointestinal]] [pp 67–68] ### 3.4 [[Neurological]] [pp 69–70] ### 3.5 [[Ophthalmological]] [p 71] ### 3.6 [[ENT]] [pp 72–73] ### 3.7 [[Acute psychiatric and addiction]] [pp 74–75] ### 3.8 [[Toxicology and environmental]] [pp 76–78] ### 3.9 [[Endocrinological]] [p 79] ### 3.10 [[Haematological]] [p 80] ### 3.11 Oncological [p 81] - [ ] ★ [[Local tumour complications]] — acute spinal cord compression, upper airway obstruction, malignant pericardial effusion, SVC syndrome, Pancoast's, hyperviscosity - [ ] ★ [[Febrile neutropenia]] - [ ] ★ [[Immunosuppression and opportunistic infections]] - [ ] ★ [[Thrombocytopaenia and haemorrhage]] - [ ] ★ [[Paraneoplastic]] — undiagnosed malignancy, hypercalcaemia, SIADH ### 3.12 [[Renal and urogenital]] [pp 82–83] ### 3.13 Rheumatological [p 84] - [ ] ★ [[Arthropathies]] — crystal, inflammatory, degenerative - [ ] ★ [[Joint infections; arthrocentesis]] - [ ] ★ [[Systemic complications of rheumatological disease and treatment]] - [ ] ★ [[Hyperviscosity]] ### 3.14 Dermatological [p 85] - [ ] ★ [[Life-threatening]] — TEN, SJS, EM major, meningococcal rash, staph scalded skin - [ ] ★ [[Rash description and DDx]] — maculopapular, petechial/purpuric, vesicular/bullous - [ ] ★ [[Infections]] — herpes, viral exanthems, scabies, cellulitis, erysipelas, impetigo, fungal - [ ] ★ [[Eczema, psoriasis]] - [ ] ★ [[Allergic]] — urticaria, contact dermatitis, angioedema ### 3.15 [[Infectious disorders]] [pp 86–87] ### 3.16 Immunological [p 88] - [ ] ★ [[Anaphylaxis]] — recognition, adrenaline, refractory anaphylaxis, biphasic reactions - [ ] ★ [[Angioedema]] — histaminergic, ACEi-induced, hereditary (C1-INH) - [ ] ★ [[Allergic reactions]] — autoinjectors, action plans - [ ] ★ [[Vasculitis]] — Wegener's/GPA, polyarteritis nodosa - [ ] ★ [[Collagen vascular disease]] — Raynaud's, scleroderma, SLE, Reiter's/reactive arthritis - [ ] ★ [[Kawasaki disease]] - [ ] ★ [[Sarcoidosis]] - [ ] ★ [[Complications of immunosuppressants]] ### 3.17 [[Obstetric and gynaecological]] [pp 89–90] ### 3.18 [[Metabolic]] [p 91] ### 3.19 Orthopaedic [pp 92–94] #### Fractures and dislocations — high yield - [ ] ★ [[C-spine]] — assessment, imaging indications (Canadian C-spine, NEXUS), clearance - [ ] ★ [[C-spine including atlantoaxial, facet joint]] - [ ] ★ [[Spine]] — thoracolumbar - [ ] ★ [[Pelvis]] — types, binder application - [ ] ★ [[Hip]] — NOF fracture in elderly, traumatic dislocation - [ ] ★ [[Femur]] — shaft, supracondylar - [ ] ★ [[Knee and patella]] — fractures, tendon ruptures - [ ] ★ [[Tib-fib and ankle]] — Maisonneuve, ankle ligament/tendon injury - [ ] ★ [[Talus, calcaneus, midfoot]] - [ ] ★ [[Forearm, wrist, carpal bones]] (scaphoid) - [ ] ★ [[Phalanges; mallet finger; Boutonniere's]] - [ ] ★ [[Shoulder dislocation; AC joint disruption]] - [ ] ★ [[Elbow dislocation; pulled elbow]] - [ ] ★ [[Carpal-metacarpal injuries]] - [ ] ★ [[Humerus, scapula, clavicle]] - [ ] ★ [[Metatarsals]] - [ ] [[Dislocations and relocation techniques]] (general) #### Hand injuries — high yield - [ ] ★ [[Lacerations]] - [ ] ★ [[Nail injuries]] - [ ] ★ [[Extensor and flexor tendon injuries]] - [ ] ★ [[Mallet finger; Boutonniere]] - [ ] ★ [[Infection]] — paronychia, infective tenosynovitis (Kanavel signs) - [ ] ★ [[FB]] - [ ] ★ [[Amputation]] - [ ] ★ [[Nerve injuries]] - [ ] ★ [[High-pressure injection injuries]] - [ ] ★ [[Crush injury]] #### Soft tissue - [ ] ★ [[Shoulder rotator cuff]] - [ ] ★ [[Knee]] — cruciate, meniscal injury, Baker's cyst - [ ] ★ [[Bursitis/tendinitis of shoulder, elbow, knee]] - [ ] ★ [[Ankle ligament, tendon injury]] #### Other - [ ] ★ [[Infections]] — osteomyelitis, septic arthritis - [ ] ★ [[Overuse syndromes; CRPS]] #### Paediatric ortho — high yield - [ ] ★ [[Salter-Harris classification]] - [ ] ★ [[Elbow injuries]] (including supracondylar) - [ ] ★ [[Child with limp]] - [ ] ★ [[Bone dysplasia]] - [ ] ★ [[Connective tissue syndromes]] - [ ] ★ [[Inflammatory arthritis]] - [ ] ★ [[Metabolic bone abnormalities]] - [ ] ★ [[Osgood-Schlatter]] - [ ] ★ [[Perthes]] - [ ] ★ [[SCFE]] - [ ] ★ [[Transient synovitis]] - [ ] ★ [[DDH]] #### Splinting and immobilisation - [ ] ★ [[Limb splinting and plastering, shoulder immobilisation, knee immobilisation]] - [ ] [[Pelvic binder application]] ### 3.20 [[Trauma]] [pp 95–99] ### 3.21 [[Paediatrics]] [pp 100–104] ### 3.22 Geriatric emergency medicine [pp 105–107] - [ ] ★ [[Physiological changes of ageing]] - [ ] ★ [[Pharmacokinetic and pharmacodynamic changes; polypharmacy]] - [ ] ★ [[Frailty, pressure injury, falls, skin tears, chronic wounds]] - [ ] ★ [[Delirium]] — recognition, subtypes, management - [ ] ★ [[Cognitive, behavioural, mood disorders]] — dementia, depression, anxiety - [ ] ★ [[Toxicology in elderly]] — acute and chronic, intentional and unintentional - [ ] ★ [[Acute behavioural disturbance]] — non-pharmacological and pharmacological - [ ] ★ [[Geriatric trauma]] — falls, hip fracture, increased complication risk - [ ] ★ [[Atypical and subtle presentations]] - [ ] ★ [[Elder abuse and neglect]] — recognition, mandatory reporting - [ ] ★ [[Advance care directives, goals of care, substitute decision-makers]] - [ ] ★ [[End of life care in ED]] - [ ] ★ [[Discharge risk assessment, MDT review, RACF discharge]] ### 3.23 [[Procedures]] [pp 108–112] --- ## 4. Cross-cutting and exam-specific topics These don't sit in one curriculum section but cluster in SAQs. ### 4.1 ED systems, admin and statistics - [ ] ★ [[Triage frameworks]] (ATS); waiting room safety - [ ] ★ [[ED flow and performance]] — National Emergency Access Target, access block - [ ] ★ [[Patient safety frameworks]] — incident reporting, root cause analysis, M&M - [ ] ★ [[Quality and audit cycle]] - [ ] ★ [[Disaster and mass casualty]] — triage (SALT, START), command structure, AMPLAN - [ ] ★ [[Clinical governance and risk management]] - [ ] ★ [[Statistics for SCQ]] — sensitivity, specificity, PPV/NPV, likelihood ratios, NNT, NNH, p value, confidence interval, types of bias, study design hierarchy, GRADE - [ ] ★ [[Critical appraisal]] — RCTs, systematic reviews, diagnostic studies ### 4.2 Health advocacy and equity - [ ] ★ [[Cultural safety; Aboriginal and Torres Strait Islander health; Māori and Pasifika health]] - [ ] ★ [[Refugee health; vulnerable patient advocacy]] - [ ] ★ [[Domestic and family violence]] — recognition, mandatory reporting - [ ] ★ [[Sexual assault]] — forensic examination, chain of custody - [ ] ★ [[Child protection]] — mandatory reporting, NAI ### 4.3 Ethics, medicolegal, end-of-life - [ ] ★ [[Duty of care, negligence and medical ethics]] - [ ] ★ [[Consent and capacity assessment]] - [ ] ★ [[Mental Health Act]] (NSW 2007) application in ED - [ ] ★ [[Advance care directives, goals of care, substitute decision-makers]] - [ ] ★ [[Withdrawal and withholding treatment; family communication]] - [ ] ★ [[Coroner's role; reportable deaths]] - [ ] ★ [[Confidentiality, privacy, records]] - [ ] ★ [[Open disclosure]] - [ ] ★ [[Refusal of treatment; discharge against medical advice]] - [ ] ★ [[Donation after circulatory determination of death]] (DCDD) ### 4.4 Communication - [ ] ★ [[Breaking bad news]] - [ ] ★ [[Difficult conversations]] — death notification, mental health, sexual health - [ ] ★ [[Inter-professional communication; conflict management]] - [ ] ★ [[Handover frameworks]] (ISBAR, IMIST-AMBO) --- ## 5. Suggested study schedule (May–November 2026) ### May–June: foundations and exam orientation (8 weeks) Skim Foundations using flashcards (Anki, RememberThe Million, or SAQ basis sciences). Don't go deep on anatomy/physiology unless the gap is glaring — Primary content is rarely tested in isolation. Put bigger time into Resuscitation Medicine (2.3) and Analysis of Investigations (2.5). Read past SAQ papers without attempting yet. ### July–August: clinical management blocks (8 weeks) Two systems per week, in this order (high-yield first): 1. Trauma + ortho 2. Paediatrics + paediatric resus 3. Toxicology + envenomation + environmental 4. Cardiology + ECG 5. Sepsis + infection + immunological 6. Neuro + stroke + spinal cord 7. Obs + gynae 8. Endocrine + metabolic + renal For each, pair the curriculum topic list (★ first) with eTG, ANZCOR, ACEM policy, and a major reference (Tintinalli, Cameron, Dunn). Do at least three SAQs per system from past papers. ### September: remaining systems and cross-cutting (4 weeks) Respiratory, GI, ophthalmology, ENT, derm, haematology, oncology, rheumatology, psychiatry, geriatrics, procedures, statistics, ED admin, ethics. Rotate through SAQs, time-pressured. ### October: SAQ practice under timed conditions (4 weeks) Two full SAQs per week minimum. Mark against college reports. Identify recurring weaknesses; build targeted revision around them. Re-read ACEM policies on disaster, sedation, restraint, end-of-life. Re-do Anki on tox, ECG, ABG, weights and doses. ### Final 2 weeks Past papers only. No new content. Sleep, hydrate, and run procedure checklists daily. Review the FACEM written exam blueprint document and the candidate's report from the most recent sitting. --- ## 6. Recurring SAQ traps (worth a dedicated revision pass) - [[Hyponatraemia workup and correction rate]] - [[Status epilepticus refractory to first-line]] - [[Massive transfusion ratios and adjuncts]] (TXA, calcium, fibrinogen) - [[Anaphylaxis refractory to adrenaline]] - [[Pregnancy-specific drug choices and resus modifications]] - [[Paediatric drug dosing]] — adrenaline, fluids, antibiotics, anti-epileptics - [[Tracheostomy emergency algorithm]] - [[Tox: paracetamol nomogram pitfalls]] (staggered, modified-release) - [[Snake bite]] — VICC vs neurotoxic, early antivenom indication - [[Trauma in pregnancy]] — left lateral tilt, foetal monitoring, perimortem section - [[Burns]] — Parkland calculation, escharotomy, transfer criteria - [[Heat stroke vs NMS vs serotonin syndrome vs malignant hyperthermia]] - [[Posterior MI and isolated RV infarct recognition]] - [[Dialysis emergencies and complications]] - [[Sickle cell crisis]] - [[Diabetic foot infection, necrotising fasciitis recognition]] - [[Acute aortic syndromes]] - [[Subarachnoid haemorrhage workup post-CT]] - [[Cauda equina red flags]] - [[Septic shock]] — early bundle, antibiotic selection by source ======================================================================== [[Old Directory]] =============================================================================