ACEM Primary Examination

The Primary Examination is a test of the basic sciences of anatomy, pathology, physiology and pharmacology. The candidate is expected to show an understanding of the subject matter and demonstrate their ability to apply their knowledge to the practice of emergency medicine.

Eligibility &
Dates and Fees
Future Changes
& Help

Image: ACEM Primary Exam
The Application Process

In order to be eligible to apply for the Primary Examination, candidates must:
  • Be a registered and financial trainee of the College (see registration deadlines in the 'Dates and Fees' tab)
  • Hold current registration to practice medicine in Australia or New Zealand
  • Submit the Application Form by the closing date (applications are now closed). 

For each attempt at the Primary Examination, a fresh application must be made and the relevant examination fee paid.

The examination may be attempted at any stage during Provisional Training.  It is not necessary for Provisional Training time to be completed before the examination is undertaken.


Key dates for the Primary Examination application will be strictly adhered to. If a candidate fails to present for any part of the examination, or withdraws from any part of the examination after the application closing date, they are not entitled to a refund. Please see the application form for key dates.

To withdraw from the Primary Examination, please complete the Withdrawal Form
The Primary Examination is held twice annually. Applications must be received at the College office in Melbourne by close of business on the closing date specified.
Special Note:

All ACEM Primary Exam vivas will now take place in Melbourne at the AMC National Test Centre until another suitable location is established.

Examination Must be registered as a trainee Applications
Closing Date and
Withdrawal Deadline
PE 2017.1 6 Jan 2017 25 Nov 2016 17 Feb 2017 All regions 23-24 Mar 2017 Melbourne 20 Jan 2017
PE 2017.2 23 Jun 2017 29 May 2017 11 Aug 2017 All regions 14-15 Sep 2017 Melbourne 7 July 2017

Primary Examination Fees 2017 Amount (AUD)
Written: Online Integrated SCQ Examination $1690
Oral: Integrated Viva Examination $1475



The objective of the Primary Examination is to ensure that as a trainee, you have the required level of knowledge and understanding of the four basic sciences of anatomy, pathology, physiology and pharmacology - insofar as they relate to emergency medicine. This is to ensure your further learning and development towards a career as an emergency medicine physician. 

The examination is criteria-referenced, which means that as a candidate, you are required to reach a predefined level of performance to pass the examination rather than a fixed percentage of candidates being successful.  

Exam sittings

Two sittings of the Primary Examination are held annually, and are comprised of:

  • an online written examination (held regionally) 
  • ​an oral examination (held in Melbourne).

The written and oral components of the examination are held approximately six weeks apart.

Online Written Examination

The written component of the Primary Examination will be an integrated examination. It will contain up to 360 questions in total, made up of Select Choice Questions (SCQ): Multiple Choice Questions (MCQ) and Extended Matching Questions (EMQ).

The exam will be split into two papers of up to 180 questions each, with each paper having a time limit of three hours, and held over the course of one day:

Examination Day Breakdown Primary Exam  Total testing time Number of items
Morning Paper 1 180 minutes 180
Afternoon Paper 2 180 minutes 180

Each ‘subject’ (e.g. anatomy, pathology, pharmacology, physiology) will comprise approximately 25 per cent of the questions. The blueprint will describe topic coverage by a subject using approximate percentages of questions rather than by exact numbers of questions.

Use of Scenarios

With integrating the examination, many of the questions (but not all) will be linked by a clinical scenario to demonstrate the clinical relevance of the topic. Each question that follows a scenario will be from the one subject, however, the set of questions that are associated with this scenario may be from one or more of the four subjects. For example, a scenario of a patient with asthma may have two MCQs relating to respiratory physiology, two MCQs relating to asthma pathology, one on medications used in asthma, and one on lung anatomy.
Obtaining a Pass

In order for you to pass the SCQ examination, you will have to reach the overall passing score, as set by the Angoff method. There is no minimum number of questions required to be correct in each subject to pass, as long as a candidate reaches the cut score.
A pass in the Primary Examination is awarded upon obtaining a pass in both the written and Viva omponents individually.

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 (e.g. options related to the theme), and a number of stems requiring a response chosen from the list. In the ACEM format, you select one best option from the options provided (which could be up to 25 options).

The proportion of MCQs to EMQs in each paper is not fixed. A selection of example EMQs is available to view in the Resources page.
For more information on the integrated written examination, see the Future Changes page.

Oral Examination - Integrated Viva

The oral examination comprises four, ten-minute integrated Vivas, examined on one day. Each Viva assesses the four basic science subjects. 
You are required to obtain a scaled score of five (5) or greater out of 10 in at least two of the four integrated Vivas. You must 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. 
Viva results will be released online on the Results page (Member login required) on the Wednesday following the last day of the exam.

Clinical Building Blocks

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

As a Primary Exam candidate, you will be expected to label, describe and analyse abnormal ABGs, X-rays ECGs etc. For example you may be shown an ECG and 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. 

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 examination.

A panel of subject matter experts make a judgement of the expected performance of a borderline candidate for each examination question. These judgements are then combined to calculate a cut score for the paper.

This ensures that over time the same standard is required to pass each examination. Therefore, as a trainee, you are not disadvantaged in the event the difficulty of questions vary from one examination to another.

Change to the number of exam attempts

Commencing from the beginning of the 2018 training year, the number of attempts at each examination required to be passed as part of the ACEM Specialist Training Program will be limited to three (3).


That is, as a trainee, you will have a maximum of three attempts at each examination:

  • the Primary Written Examination
  • the Primary Viva Examination
  • the Fellowship Written Examination
  • the Fellowship Clinical Examination (OSCE). 

This means that if you don't pass an examination within the three attempts available, you will be recommended to the Specialist Training and Assessment Committee (STAC) for removal from the training program. 


Attempts made at any of the four examinations that have not resulted in the examination in question being passed prior to the 2018 training year will not count towards the allowed three attempts. 

Please note that the current training time limits still apply. Provisional training must be completed within five (5) years and all training requirements must be completed within 12 years from the time of registration as a trainee.

Integration of the ACEM Primary Exam (Written) from 2017


In 2017, the four topics currently presented in the Written Primary Exam as separate papers will be integrated into a single exam. This means that instead of Four (4) Select Choice Question Papers (Multiple Choice and Extended Matching Questions) in pharmacology, physiology, anatomy and pathology, you will take one combined paper containing both types of questions and covering all four topics.

The final structure and timing of the revised format exam is currently being worked on. This information will be provided when finalised.

In the ACEM training program we encourage you as a trainee to strive towards the highest standards of excellence in your study.

We want the course to encourage you to study clinical science that is relevant and directly applicable to the practice of high quality emergency medicine. As such, we are continuously refining and improving the ACEM Primary Exam.

Our aim is to design the exam so that when you study and prepare for it, you are learning clinically-relevant material that is directly applicable to work as an emergency medicine physician. We strive to avoid assessments in which trainees are tested on isolated facts.

The goal is for you, as a trainee, to consolidate your knowledge in the most important areas – this includes studying the science that is either frequently needed in the ED or that is uncommon but highly, clinically important. Patient care depends on a sound knowledge of all subjects which can be drawn on as relevant and applicable to the patient’s situation. 

Transition arrangements

We are providing early notice of this change to ensure that the transition in exam format is as smooth as possible and that you are not disadvantaged.

Current ACEM Provisional Trainees have three (3) more sittings under the existing format to complete the requirements of the Written Primary Exam.

From 2017.1, all candidates will be required to undertake the revised written exam format irrespective of their previous Primary Exam outcomes. Please note that if, at the time of transition, you have completed the entire written exam successfully, you will be eligible to proceed to take the Viva.
Preparation for the new exam format

All exam candidates should continue to study pharmacology, anatomy, physiology and pathology as they apply in the emergency medicine setting.

Learning to apply this knowledge to the Clinical Building Blocks, which were introduced in the 2015.1 Viva, serves as a good preparation for the current Viva format. In the future, preparing around Clinical Building Blocks will help you to prepare effectively for both the integrated SCQ and Viva formats. As always, you are encouraged to talk to your DEMT to discuss examination plans and preparation strategies.  
RPL review

A review of Recognition of Prior Learning (RPL) at ACEM is currently underway. All potential candidates are advised to check with the College at the time of application.

There will be no RPL applicable to the ACEM SCQ Primary Exam from 2017.1. 
Preparing for the Primary Exam

The following documents have been created to help you prepare for the exam, the resources contain information on the code of conduct, marking scheme and results. Candidates are requested to fully familiarise themselves with the information contained in each PDF. Information on what to wear and what to bring is on the Structure tab.

The Primary Examination is blue printed to the ACEM Curriculum Framework. References that may be of assistance to trainees are taken from Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7th edition. However, these chapters are by no means the only reference that the trainee can use and trainees are encouraged to use other relevant references to assist them in their preparation.

Chapter Title Page/s
19 Acid-Base Disorders 102
20 Blood Gases 112
21 Fluids and Electrolytes 117
22 Cardiac Rhythm Disturbances 129
226 Anemia 1457
227 Tests of Hemostasis 1460
228 Aquired Bleeding Disorders 1464
229 Clotting Disorders 1470
264 Initial Evaluation and Management of Orthopedic Injuries 1786-1789

Important notices

Changes to Number of Exam Attempts

Best of Web EM Reviewed Resources

The following resources have been reviewed by at least two ACEM members for clinical accuracy, educational merit and technical competency. They have been recommended for exam preparation and self-directed learning.

Icon: websiteEmergucate
Authors: Dr Colin Parker, Dr Prathibha Shenoy, Dr John Larkin,  Dr Anand Senthi and Dr Ioana Vlad, Australia, free 

Reviewer 1, FACEM, SA-Image: 4 star rating
"Good cases with targeted learning points."

Reviewer 2, FACEM, VIC-Image: 3.4.4 rating
“This is a great resource particularly for trainees or educators for reviewing interesting radiology and ECGs. Good for self-directed learning and teaching preparation.”


Target audience: Trainees
Educational use: Exam preparation (Fellowship), Exam preparation (Primary), Teaching resources, Self-directed learning
Curriculum domain: Medical Expertise, Scholarship and Teaching

Back to the top  
Icon videoEric's Medical Lectures 
Eric Strong, YouTube Channel, USA

Reviewer 1, FACEM, QLD-Image: 3.4.4
"Information given in easy to follow manner. Learning objectives discussed at the beginning. Youtube based - easy to navigate. Able to discuss and ask questions at the bottom." 

Reviewer 2, FACEM, VIC-Image: 4.3.4
"Good review source for Fellowship candidates, and refreshing update for a wide range of College members."


Target audience: FACEMs and Trainees
Educational use: Exam preparation (Fellowship), Exam preparation (Primary) Self-directed learning, Teaching resource
Curriculum domain: Medical Expertise, Scholarship and Teaching

Back to the top

Icon: websiteLife in the Fast Lane
Website, Australia, free

Reviewer 1, FACEM, QLD-Image: 5 star rating
"The BEST resource that I have come across in the recent past. Well maintained, user friendly website with EXCELLENT structure. Highly recommended to ALL Emergency/critical care doctors, nurses & students."

Area of concern
Some content may be opinion based.

Reviewer 2, FACEM, WA- Ratings 5.4.4
"A very useful resource particularly for exam preparation for FACEM Fellowship. Good ECG section. Clinical cases are useful for review and self-directed learning."


Target audience: All ACEM members 
Educational use: Self-directed learning, Exam preparation (Primary and Fellowship), Teaching resource
Curriculum domain: Medical Expertise, Communication, Scholarship and Teaching

Back to the top

Icon: websiteSTEM 
Simulation Training Emergency Medicine
Australia, free

Reviewer 1, FACEM, NSWImage: 3.4.3 rating
"Short, up-to-date summaries of relevant ED topics, highlighting some of the more controversial issues in relation to these topics. Includes video demonstrations, attachments to journal articles and helpful guidelines."

Area of concern:
The website is a work in progress, I think it still needs to expand on it's current subject matter.

Reviewer 2, FACEM, QLDImage: 3.4.4
"A wide variety of interesting and practical learning topics. Aimed at a more junior level of staff, topics are accessible and useful for every day emergency medicine practice."


Target audience: Trainees and non-specialist doctors
Educational use: Exam preparation (Primary), Teaching resource, Self-directed learning
Curriculum domain: Medical Expertise, Scholarship and Teaching 

Back to the top

More Best of Web EM resources  

If you would like more information about the ACEM Primary Examination contact the Assessment Team at E: