FACRRM fellowship written exam — how are you managing the MCQ load alongside clinical shifts?
I'm in my second year of the training program and the fellowship exams are starting to feel very real. The MCQ component covers an enormous breadth — obstetrics, emergency medicine, mental health, Indigenous health, procedural skills. I've been trying to study 1.5 to 2 hours most evenings but between on-call shifts it's hard to maintain any consistency.
From what others in my cohort have said, the written exam pass rate sits around 65–70% on first attempt, which isn't terrible but it's enough to take seriously. The extended matching questions seem to be where a lot of candidates drop points — they test clinical reasoning under time pressure in a way that pure knowledge recall doesn't prepare you for.
I've been using the ACRRM learning platform and supplementing with AMC-style practice questions. The rural and remote context means some clinical priorities shift compared to urban-focused resources — wound management, retrieval coordination, limited-resource decision-making. Anyone else finding that FOAM resources like Life in the Fast Lane help more than the formal prep materials for the emergency sections?
Doing 40 MCQs a day for 8 weeks was what got me through. Doesn't matter if they're perfect questions as long as you're reviewing every wrong answer and understanding the reasoning. Spaced repetition with Anki on top of that kept the early material from fading.
The mental health section caught me off guard — a lot more pharmacology depth than I expected, especially around drug interactions in patients with comorbid physical conditions. I scored 58% on that domain in my practice run and had to do a serious catch-up in the last 4 weeks.
The obstetrics and paediatrics sections are weighted pretty heavily relative to how much time most of us spend on them in placements. I'd set aside at least 3 dedicated study weeks for those two domains alone if you're weaker on them.
FOAM resources are genuinely useful for the acute care sections. I used LITFL almost daily in the 3 months before my written exam and I'm convinced it helped with the reasoning-heavy EMQs. The key is pairing it with cases that have a remote context so you're not just thinking hospital-centric.
Quick update from my end -- I sat a practice block last weekend and pulled 68%, which honestly felt better than I expected given how scattered my prep has been. The Indigenous health and mental health sections are still my weak spots but I'm getting more consistent on the emergency and obs MCQs. I'm aiming to sit the real thing in November, so I've got about four months to patch the gaps.
If you're drowning in the breadth of it, I found it helps to stop trying to cover everything evenly. I spent two solid weeks just hammering the domains I kept failing on and my scores moved more in that fortnight than in the two months before it. Doesn't feel great abandoning the rest temporarily but it worked. Good luck -- sounds like you're putting in the hours which is more than a lot of people can say mid-program.
Honestly there was a point around month four where I nearly binned the whole thing. The MCQ breadth is just brutal and I kept feeling like I'd study emergency medicine for a week and then completely blank on my obstetrics knowledge. What actually saved me was accepting that I couldn't cover everything equally and just getting really honest about my weak spots. The Indigenous health and population health stuff especially — I'd been avoiding it because it felt abstract, but once I started drilling through practice questions like the ones at facrrm/questions/population health and indigenous health it started clicking in a way that passive reading never did.
The 1.5 to 2 hours you're doing is probably about right — I wasn't doing more than that either and I passed. The trick is not letting those sessions bleed into just re-reading notes. Active recall, even when it's uncomfortable, is the only thing that actually stuck for me. It's going to feel like you're behind basically the whole time. That feeling doesn't mean you're failing, it just means the exam is genuinely hard. Keep going.