FRCEM SBA exam paper structure and question count

TL;DR: The FRCEM SBA is 180 single best answer questions split across two 2-hour papers (90 questions each), with a compulsory 1-hour break between papers. Total seat time is about 5 hours including the break. From January 2026 it is delivered by Surpass Assessment at test centres worldwide (Surpass replaced Pearson VUE), or by online invigilation in exceptional circumstances. Standard set by modified Angoff + 1 SEM, no negative marking.

If you are sitting the FRCEM Final SBA — sometimes still called the “written”, the “Final written”, or by registrars old enough to remember it, the legacy “SAQ” — you need to know exactly what the paper looks like before you sit your first timed mock. The format dictates pacing, the blueprint dictates what to revise, and the test centre vendor change in 2026 has shifted booking logistics. Here is exactly what you are walking into and how to use that shape to plan your revision.

What is the structure of the FRCEM SBA?

Two papers, two hours each, 90 single best answer questions per paper, with a one-hour break in the middle. That is the entire skeleton. There is no negative marking, no extended matching, no short-answer free text — every question is a clinical stem with five options where one is the single best answer.

RCEM split the exam into two papers when the SBA replaced the legacy SAQ in August 2021. The break is fixed and supervised — you cannot reduce it to start paper 2 early, and you cannot extend it. If you are at a Surpass test centre you can leave the room, eat, use the toilet, and re-check in. If you are sitting by online invigilation you may leave your desk only during the official break, never during a live paper.

Both papers are sampled from the same single curriculum blueprint, so paper 2 is not a different exam — it is the second half of the same 180-question instrument. There is no expectation that paper 2 will be “harder” or “easier” than paper 1, and no examiner ever sees how you scored on paper 1 before paper 2 begins.

Paper-by-paper breakdown

That works out to 80 seconds per question on average. Most candidates report finishing each paper with 10-20 minutes to spare and using it to revisit flagged questions. The on-screen interface lets you flag questions to return to and shows a navigator panel with answered, unanswered, and flagged statuses so you can budget time mid-paper.

How is the FRCEM SBA blueprint weighted?

The blueprint maps every question to a Specialty Learning Outcome (SLO) from the 2021 Emergency Medicine curriculum. Adult acute care, resus, trauma and paediatrics together account for 140 of the 180 questions — about 78% of the paper. The remaining 40 questions cover procedures, complex situations, leadership, management, research and quality improvement.

Question count by SLO

RCEM does not tell you which paper a given SLO will appear in — see our breakdown of the FRCEM Final SBA blueprint topic weighting. Treat both papers as a single sampled instrument — research and stats can show up at question 12 of paper 1 or question 78 of paper 2. Within each SLO, descriptors are drawn from across the curriculum, so SLO1 alone covers everything from allergy and cardiology through to oncological emergencies, pain and sedation, and palliative care. SLO5 paediatrics is its own block of 30 but paediatric resus also feeds into SLO3, meaning paeds-weak candidates take a double hit.

Practical implications of the blueprint

The blueprint is published openly in the FRCEM Regulations and Information Pack so candidates can plan revision against it. Two patterns are worth noticing:

• Resus + trauma + adult acute + paeds = 78% of the marks. Anything you do to strengthen these four areas pays back proportionally.
• Procedures, governance, leadership, research and QI = 22%. Each is small individually but together they decide borderline passes. They are also the areas candidates most often neglect, which means a few hours on RCEM best practice guidelines, statistics definitions and root-cause analysis methodology buys easy marks.

How is the paper delivered — Surpass, Pearson VUE, or online?

From January 2026 the FRCEM SBA is delivered by Surpass Assessment. Surpass replaced Pearson VUE as RCEM’s theory exam vendor at the end of 2025. The paper itself, the question count, the timing and the blueprint did not change — only the test centre network and the booking journey did.

You apply through your RCEM account roughly 12 weeks out, RCEM reviews eligibility for around 3 weeks, then Surpass emails you with a 3-week window (typically 5-8 weeks before the exam) to book your test centre. Common UK Surpass sites include London, Manchester, Birmingham, Edinburgh, Leeds, Belfast and Cardiff. International sites cover the Gulf (UAE, Saudi Arabia, Kuwait, Oman, Bahrain, Qatar, Jordan), India (Bangalore, Chennai, Hyderabad, Kolkata, Mumbai, New Delhi), Pakistan (Islamabad, Lahore, Rawalpindi), Bangladesh, Sri Lanka, Malaysia, Singapore, Egypt, Australia, Canada and the US among others.

Online invigilation is offered in exceptional circumstances only. It requires two devices (a computer and a separate phone or tablet as a second camera angle to capture you from the side), a stable internet connection and a private room. You email exams@rcem.ac.uk to request it and complete a system check with Surpass before exam day. RCEM’s published preference is the test centre route for the smoother experience.

On exam day, candidates are asked to arrive 30 minutes before the scheduled start. Late candidates are not admitted and forfeit the exam fee — there is no flexibility on this. Accepted ID includes passport, driving licence, government photo ID, biometric card with photo, or PVC-format Aadhar.

How is the FRCEM SBA marked and standard set?

One mark per correct answer, zero for wrong or unanswered — there is no negative marking. So if a question stumps you, guess. The maximum score is 180.

The pass mark is not fixed. It is set by a modified Angoff method: a panel of examiners reviews each question and estimates what proportion of a minimally-competent FRCEM-level candidate would get it right. Those estimates produce a cut score for that specific paper. One Standard Error of Measurement (SEM) is then added on top, which gives the published pass mark for that sitting.

In practice the pass mark hovers in the 105-115 mark region (roughly 58-64%). The October 2024 paper had a pass mark of 108. You will not see a percentage on your results — you see your raw score and the pass mark for that sitting. The +1 SEM is a deliberate hedge against measurement noise: it raises the bar a touch above the bare Angoff cut score to reduce false-positive passes.

Because the pass mark moves, trying to hit a percentage target in mock papers is the wrong heuristic. The right heuristic is to consistently score above the equivalent of around 115/180 in timed practice, which gives you a buffer for the inevitable harder-than-expected sitting.

When are the FRCEM SBA sittings in 2026?

There are two sittings per year. The 2026 dates are:

• 20 May 2026 — applications closed 25 February 2026, results released 24 June 2026.
• 7 October 2026 — applications open 1 July 2026, close 8 July 2026, results released 11 November 2026.

Application windows open at 10am UK time and close at 4pm UK time seven days later. There are no late applications. Results land approximately five weeks after the exam date in your RCEM account; results are not given out by phone or email.

How much does it cost and who can sit it?

For 2026, the FRCEM SBA fee is £429 for UK members, £485 for international members, £525 for UK non-members and £609 for international non-members. RCEM membership has to be paid at least 24 hours before the application window opens to access the member discount — buying membership the same morning will not work.

You are eligible to sit if you obtained MRCEM (by examination) within the last seven years, or hold the FRCEM Intermediate Certificate within the last seven years, plus the clinical-experience criteria set out on RCEM’s eligibility page. For UK and Irish trainees that means at least 12 months FTE of Emergency Medicine training at ST4/ST5 or equivalent. You get a maximum of four attempts at the FRCEM SBA. You can sit the FRCEM SBA and FRCEM OSCE in either order, and you must pass both within seven years of the first pass to be awarded FRCEM.

What does the paper feel like on the day?

Plain language from candidates who passed: the paper is broad rather than deep. Expect rashes, ECGs, paediatric red flags, toxicology, statistics, governance vignettes and a steady drip of curriculum guidelines (RCEM best practice documents, NICE, sepsis bundles, the major haemorrhage protocol). Many questions are situational judgement dressed as SBA — the right answer is the safest, most patient-centred next step, not always the most clinically aggressive one.

The two-paper split helps. Most candidates use the one-hour break to eat, walk, drink water and reset — not to revise. Trying to cram between papers usually backfires because paper 2 is sampled from the same blueprint as paper 1, so notes will not predict the next 90 questions. The break also exists for practical reasons: 4 hours of continuous high-density SBA work is cognitively brutal, and concentration collapses past hour 3 if you do not protect it.

The recurring complaint from candidates is the perceived gap between the curriculum on paper and the questions in the room — unusual presentations, rare conditions, statistical phrasings that feel pedantic. The recurring tip from prizewinners is the same: stick to one solid question bank (RCEMLearning is the only resource officially endorsed by the College), work through it twice, and pair it with the RCEM best practice guidelines. Resist the temptation to add three more banks; coverage breadth is less useful than mastery of one.

Key facts to commit to memory

• Total questions: 180 single best answer.
• Structure: 2 papers x 90 questions x 2 hours.
• Break: 1 hour, mandatory, between papers.
• Time per question: ~80 seconds.
• Negative marking: None.
• Delivery from Jan 2026: Surpass Assessment test centres worldwide; online invigilation by exception.
• Standard setting: Modified Angoff + 1 SEM.
• Pass mark guide: ~108/180 in recent sittings (varies per paper).
• Sittings per year: 2 (May and October).
• Maximum attempts: 4.
• Results released: ~5 weeks post-exam.
• Arrive: 30 minutes before the scheduled start; late = forfeit.

How should the paper structure shape your revision?

Three things drop out of the format and blueprint:

1. Train at 80 seconds a question, not 60. Build your timed practice sets in 90-question blocks of 2 hours so you rehearse the exact paper duration. Single 90-question runs are more useful than scattered 20-question blocks because they teach you stamina, calibrate your flagging discipline, and surface the late-paper concentration dip you will face on the day.
2. Do not over-weight rare topics. 78% of the paper is adult acute care, resus, trauma and paeds. If your weakest area is research methodology (10 questions) you can lose all 10 and still pass comfortably if the rest is solid. If your weakest area is paediatric resus (sampled in both SLO3 and SLO5) it will hurt you in both papers. Audit your last three timed papers by SLO before deciding where to spend the next two weeks.
3. Use the one-hour break as part of your race plan. Decide before exam day what you will eat (something light, predictable, non-fizzy), where you will go (out of the test centre if you can, for daylight), and that you will not open any notes. The break is there to protect your performance on paper 2 — treat it as a rest, not a study session.

What next?

If you are mapping out a structured FRCEM SBA revision plan against this blueprint and want timed 90-question mock papers built to the exact 2-hour format, start at emfinalexams.com.

Facts last verified 30 May 2026 against RCEM’s published FRCEM Exams page, Exam Regulations & Policies, Exam Calendar & Fees, the FRCEM Regulations & Information Pack (Nov 2023), and RCEM’s Theory Exams FAQs covering the January 2026 Surpass transition.

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