You’re six to eight weeks out, the curriculum still feels enormous, and you want a focused list of what to drill rather than another generic “revise everything” pep talk. That’s what this article is for: a triaged top ten high-yield topics in FRCEM SBA, mapped to the actual RCEM blueprint weighting, written by people who’ve sat the paper and now teach it. See also our guide to the FRCEM Final SBA blueprint topic weighting.
None of this replaces the curriculum, RCEM guidelines, or your question bank reps. Used right, it tells you where the marginal hour of revision buys you the most marks. See also our guide to the best FRCEM SBA question bank for 2026.
TL;DR. If you only have time to drill five areas, hit these in order: resuscitation and the peri-arrest patient (the single biggest SLO weight), ECG and acute coronary syndromes, sepsis and the deteriorating adult, major trauma decisions, and paediatric emergencies. Together these cover roughly 110 of the 180 questions. Then layer toxicology, airway, procedural sedation, RCEM-specific guidance (mental health, safeguarding, major haemorrhage) and the small but predictable research/QI/leadership block on top.
Why bother with a high-yield list at all?
The FRCEM SBA samples the entire 2021 curriculum, so technically every topic is “in.” But the blueprint published in the FRCEM Regulations and Information Pack fixes how many questions sit under each Specialty Learning Outcome (SLO). When you know the weights, you can stop revising as though everything is equal — because the College has already told you it isn’t.
The other reason is more practical. Most candidates around the six-week mark have already done one full pass of RCEMLearning and a question bank or two. What they need now isn’t more breadth; it’s a sharpened second pass over the topics that earn the most marks per hour. The list below is that second pass.
What does the RCEM blueprint actually weight?
From the current FRCEM Regulations and Information Pack, the 180-question paper splits as follows:
- SLO 3 — Resuscitate and stabilise (40 questions) — the single biggest bucket. Peri-arrest physiology, ALS, post-ROSC, when to stop.
- SLO 1 — Care for the stable adult ED patient (35 questions) — the medical “front-door” SBA: chest pain, breathlessness, abdo pain, headache, the works.
- SLO 4 — Injured patients (35 questions) — major trauma plus single-system injuries, burns, orthopaedics.
- SLO 5 — Children (30 questions) — neonate to adolescent, including complex needs.
- SLO 6 — Procedural skills (13 questions) — sedation, regional, line and chest drain decisions.
- SLO 7 — Complex/challenging situations (10 questions) — capacity, end-of-life, conflict, safeguarding.
- SLO 10 + 11 — Research and QI (10 questions combined) — stats, critical appraisal, QI methodology.
- SLO 8 + 12 — Leadership and management (7 questions combined) — flow, governance, incident response.
SLOs 3, 1, 4 and 5 alone are 140 of the 180 marks. The “top 10 high-yield topics in FRCEM SBA” below all sit inside those four buckets, with two deliberate exceptions (research/QI and the leadership “small but reliable” block) because skipping them is how strong candidates lose easy marks.
What are the top 10 high-yield topics in FRCEM SBA?
Each topic below has roughly the same structure: why it matters for marks, what tends to be tested, and the single learning outcome we’d push you to drill first.
1. Resuscitation, ALS and the peri-arrest patient (SLO 3)
This is the largest blueprint bucket by a clear margin and the area where consultant-level judgement is most obvious to an examiner. Expect questions on shockable versus non-shockable rhythm management, reversible causes worked through systematically, post-ROSC oxygenation and BP targets, refractory VF strategy and the increasingly tested decisions around when to stop resuscitation.
Drill first: Walk through the current Resuscitation Council UK adult ALS algorithm out loud, including the post-ROSC bundle (SpO2 94–98%, normocapnia, MAP target, 12-lead, targeted temperature management decisions). If you can teach it without notes, you’ll answer most of the SLO 3 SBAs cleanly.
2. ECG interpretation and acute coronary syndromes (SLO 1 + SLO 3)
ECGs show up across both the “stable” and “resus” buckets, so this single topic earns marks in two SLOs. Examiners favour STEMI equivalents (posterior MI, de Winter T waves, Wellens’), bradyarrhythmias requiring pacing, tachyarrhythmias where the rate-control versus rhythm-control decision actually matters, and the chest-pain SBA where the trick is in the troponin trajectory rather than the rhythm.
Drill first: The RCEM ACS guideline and the High Sensitivity Troponin (hs-cTn) 0/1 and 0/3 hour rule-out pathways. The exam loves the patient whose first troponin is “borderline.”
3. Sepsis, septic shock and the deteriorating adult (SLO 1 + SLO 3)
Sepsis questions are not the SIRS-based ones you may have memorised in MRCEM. Current FRCEM SBAs test the NICE NG51 risk-stratification model, the Sepsis 6 bundle within an hour, and the awkward edge cases: the immunocompromised patient who looks well, the neutropenic sepsis pathway, when to escalate antibiotics, and the lactate that does not clear after fluids.
Drill first: NICE NG51 high/moderate-risk criteria and the RCEM sepsis toolkit. Be very clear on when broad-spectrum antibiotics get given within one hour versus four, because that’s a frequent SBA discriminator.
4. Major trauma decision-making (SLO 4)
SLO 4 is 35 questions and the trauma element rewards UK-specific pathway knowledge, not generic ATLS recall. Expect questions on the major haemorrhage protocol, tranexamic acid timing, permissive hypotension thresholds, blunt versus penetrating chest trauma decisions, pelvic binder use, and the C-spine clearance algorithms (NEXUS, Canadian C-spine, NICE head and neck injury guidance).
Drill first: The NICE NG39 major trauma recommendations together with the RCEM major haemorrhage and TXA position. Memorising “1g IV within 3 hours” alone is not enough — the question will frame it as a logistics or refusal-of-blood scenario.
5. Paediatric emergencies and the unwell child (SLO 5)
Thirty questions on children, sampled across age groups, with a heavy bias towards the conditions that genuinely kill or maim: paediatric sepsis, DKA (the under-fives are a favourite), status epilepticus, bronchiolitis versus viral wheeze versus asthma, the fitting neonate, NAI recognition, and the febrile under-three workup. APLS-style management algorithms are tested but tucked inside more nuanced “what do you do next” stems.
Drill first: The RCPCH paediatric DKA pathway, BTS asthma in children, and the NICE feverish illness in under-fives traffic-light tool. If you can answer “is this a green, amber or red child?” instinctively, the SLO 5 questions get a lot shorter.
6. Toxicology and the poisoned patient (SLO 1)
Toxicology is small in absolute question numbers but a guaranteed presence and a high-density mark opportunity if you’ve drilled it. The reliable hits are paracetamol (including the new staggered overdose pathway and the SNAP 12-hour regimen where it’s used), TCA overdose and sodium bicarbonate criteria, opioid overdose and naloxone titration, beta-blocker and calcium-channel blocker overdose, salicylate, iron, and the patient who took “everything in the cupboard.”
Drill first: The TOXBASE paracetamol nomogram and management decision tree. Then layer the cardiotoxic drugs — they are reliably tested and answered confidently by very few candidates.
7. Emergency airway, RSI and procedural sedation (SLO 3 + SLO 6)
The airway block tests judgement before kit. Expect questions on the predictably difficult airway, apnoeic oxygenation, choice and dose of induction agent in the haemodynamically compromised patient, post-intubation sedation and analgesia, and the failed airway algorithm. Procedural sedation overlaps heavily: fasting status, ASA grade, choice of ketamine versus propofol versus a combination, monitoring requirements, and the consenting/escalation steps if it goes wrong.
Drill first: The RCEM procedural sedation in adults guideline plus the DAS (Difficult Airway Society) failed airway algorithm. Both are common SBA stems.
8. Mental health, capacity and the agitated patient (SLO 7 + SLO 1)
A small but stable cluster of questions that punish weak preparation. The themes are rapid tranquillisation thresholds and drug choice, Mental Capacity Act versus Mental Health Act in the ED, assessing suicide risk and the patient who wants to self-discharge, restraint and the use of police powers, and the safeguarding referral pathway. The “right” answer almost always tracks a UK-specific framework (MCA, MHA, NICE NG10, RCEM mental health toolkit).
Drill first: The MCA 2-stage test, the Section 5(2) versus Section 136 distinction, and the RCEM acute behavioural disturbance guideline.
9. Environmental, ENT, ophthalmology and “small print” emergencies (SLO 1 + SLO 4)
Candidates underestimate this block and lose marks they shouldn’t. Expect questions on hypothermia (passive vs active rewarming, ECMO criteria, when to stop), drowning, electrical injury, burns referral criteria, epistaxis management ladder, peritonsillar abscess, acute angle-closure glaucoma, central retinal artery occlusion, and the painful red eye differential. Each topic is small; together they’re four or five marks that strong candidates collect almost automatically.
Drill first: The British Burn Association referral criteria and the RCEM ophthalmology learning sessions. Both are short and high yield.
10. Research, statistics, QI and the leadership block (SLO 10 + SLO 11 + SLO 8 + SLO 12)
Seventeen questions combined — almost 10% of the paper — and the single most under-prepared area on the exam. Candidates who lose first-time-pass margins usually lose them here. Expect questions on study design (sensitivity, specificity, PPV, NPV, NNT, likelihood ratios), basic statistical tests, p-values and confidence intervals, PDSA cycles and QI methodology, governance after a serious incident, duty of candour, the structured debrief, departmental flow metrics, and the leadership scenario where the right answer is “escalate to the consultant in charge.”
Drill first: The RCEMLearning critical appraisal dictionary, plus a single pass through a QI methodology primer (a Model for Improvement + PDSA explainer is enough). The marks here come from recognition, not deep theory.
How do these topics map back to the blueprint?
The rough mapping looks like this:
- SLO 3 (40Q): Topics 1, 2 (shared), 3 (shared), 7 (shared)
- SLO 1 (35Q): Topics 2 (shared), 3 (shared), 6, 8 (shared), 9 (shared)
- SLO 4 (35Q): Topics 4, 9 (shared)
- SLO 5 (30Q): Topic 5
- SLO 6 (13Q): Topic 7 (shared)
- SLO 7 (10Q): Topic 8 (shared)
- SLO 10 + 11 + 8 + 12 (17Q): Topic 10
If you drilled only topics 1–5 you’d cover the bulk of approximately 140 questions. Topics 6–9 protect against the curriculum-spanning “wide net” SBAs that examiners use to discriminate between candidates clustered around the cut score. Topic 10 is the cheap-but-easy-to-miss block.
What does cohort feedback say actually comes up?
Recall threads on r/doctorsUK and r/emergencymedicine, plus debrief discussion in the RCEMLearning guide to conquering the FRCEM SBA, converge on a fairly consistent picture from recent sittings:
- Multiple paracetamol overdose stems per sitting, often staggered or unclear timing
- Several paediatric SBAs that hinge on age and fluid maths rather than diagnosis
- Major haemorrhage logistics (blood product ratios, refusal of blood, paediatric weight-based dosing)
- “What’s the next investigation/management” rather than “what’s the diagnosis”
- RCEM-specific guidance — when the right answer comes from an RCEM toolkit and not a NICE/SIGN one
- At least one classic ECG (Wellens’, de Winter, posterior MI, RV infarct) per paper
- A capacity or rapid-tranquillisation question that punishes UK-policy ignorance
None of that should change your top-ten list. It does tell you to spend your last fortnight rehearsing decision-making, not memorising rare-diagnosis trivia.
How should you actually drill these in the last six weeks?
A simple structure that maps onto the list above:
- Weeks 6–4: Topics 1–5, one per long study day. Do every relevant RCEMLearning session, every related SBA in your bank, and write three questions yourself per topic. Writing questions is the single highest-yield revision activity Mark Brown and the prize winners in the RCEMLearning guide both endorse.
- Weeks 4–2: Topics 6–9, half a day per topic, with question-bank review focused on the SLO codes you’re weakest on. Layer one full timed 90-question paper per week.
- Final fortnight: Topic 10 (research/QI/leadership) in two short sittings, plus a pure RCEM guidelines sweep — sepsis, ACS, procedural sedation, mental health, safeguarding, major haemorrhage, paediatric DKA. Two full 180-question timed simulations to build endurance.
You should be averaging at least 65–70% on your final mock papers in the last fortnight. If you’re under that, the issue is almost never knowledge — it’s exam technique on long, two-step SBA stems. Slow down, read the actual question before the stem, and trust the first answer your clinician brain reaches.
What about the rest of the curriculum — can you really skip it?
No. This is a high-yield triage list, not a permission slip. The blueprint samples across the whole 2021 curriculum and you will see questions on dermatology, environmental medicine, geriatric emergencies, palliative care, obstetric emergencies and ultrasound. The point of the top ten high-yield topics in FRCEM SBA is that they earn the marks that pass the exam first time. The breadth questions earn the marks that turn a borderline pass into a comfortable one — they’re worth doing, but not at the cost of nailing the core.
Frequently asked questions
Is the FRCEM SBA actually harder than the MRCEM Intermediate SBA?
Yes — measurably. The stems are longer, the distractors are more homogeneous, and the right answer often relies on a UK guideline threshold rather than basic recall. Candidates who walk in expecting “MRCEM with bigger numbers” tend to underperform.
How many questions do I need to answer per hour?
Ninety questions in 120 minutes per paper, so a touch over 75 seconds each. Aim to be on question 22 by the hour mark and question 45 by 80 minutes, leaving 40 minutes to finish and review flagged questions.
Should I use RCEMLearning or a paid question bank?
Both, but if you have to choose one, RCEMLearning. The College’s own sessions and SBAs are the closest mirror of the exam standard, and several recent prize winners credit it as their primary resource. Paid banks are useful for additional reps and for stretching weak areas.
How much time should I spend on research and statistics?
Around 5–8% of your total revision time — proportionate to the 17-question block but no more. Recognising sensitivity vs specificity, PPV/NPV behaviour at different prevalences, likelihood ratios, NNT, p-value interpretation and confidence intervals is enough. Don’t disappear into a stats textbook.
Do I need to memorise drug doses?
Yes for the time-critical ones — adrenaline (adult and paediatric), amiodarone, magnesium, calcium, naloxone, flumazenil, tranexamic acid, intralipid, atropine, adenosine, glucagon, hydrocortisone, the rapid-tranquillisation drugs and the common antibiotics in the RCEM sepsis pathway. Beyond that block, the exam usually gives the drug and tests the decision around it.
How important are imaging and ECG questions?
Very. You’ll see ECGs in roughly half the cardiac SBAs and an image stem in 10–15% of the total paper. Practise interpreting against the clinical stem, not in isolation.
What’s the single most under-prepared topic?
Research methodology and QI. It’s small in question numbers but a guaranteed presence, and candidates almost universally leave it to the last week. A focused two-hour pass through the RCEMLearning critical appraisal dictionary plus a PDSA primer banks marks that other candidates simply give away.
How long before the exam should I stop learning new content?
Seven to ten days. The last week is for consolidation: timed papers, RCEM guideline re-reads, weak-area drilling, sleep and exam logistics. Trying to learn a brand-new SLO in the final week tends to displace recall of areas you already know.
What’s the best YouTube resource right now?
Dr Sajjad Pathan’s channel is cited repeatedly by recent passers for high-yield walkthroughs and SBA-style explanations, particularly for research and statistics. Use it as a supplement, not a replacement for written revision. See also our guide to a 6-month FRCEM SBA study plan template.
I’ve failed once. Should I change strategy?
Probably not your resources, but almost certainly your structure. Most second-sit candidates know enough; they fail on technique and on under-drilled blocks like research, mental health and the rarer trauma scenarios. Re-do timed mocks weekly, target the SLOs you scored lowest on, and join a study group — the people who buddy up and write questions together pass at noticeably higher rates.
What’s the next step?
If this article gave you a sharper picture of where to spend your last six weeks, the natural next step is to start drilling against exam-standard SBAs mapped to the same blueprint. You can browse our full revision programme and timed mock papers at emfinalexams.com.
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