How many questions are in MRCEM Primary

TL;DR: MRCEM Primary contains 180 single best answer (SBA) questions delivered as one paper over 3 hours, giving you exactly 60 seconds per question. Anatomy and physiology together make up 120 of the 180 marks (60 each), so weight your revision accordingly. There is no negative marking, and the pass mark is set per diet by the Angoff method (historically around 103-110/180).

How many questions are in MRCEM Primary?

MRCEM Primary contains 180 single best answer questions. The Royal College of Emergency Medicine (RCEM) delivers them as one continuous, machine-marked paper at a Surpass Assessment test centre. Every question carries one mark, there is no negative marking, and a correct answer scores 1 while a blank or wrong answer scores 0.

The 180-question count has been stable since the current MRCEM structure replaced the FRCEM Primary in August 2021. If you are revising from older question banks or notes, anything labelled FRCEM Primary (August 2016 to July 2021) or MRCEM Part A (post-August 2012) is testing the same blueprint and the same 180 questions — only the name on the certificate changed.

How long is the MRCEM Primary paper, and how much time per question?

You get 3 hours for the 180 questions, which works out to exactly 60 seconds per question — one minute, no spare time built in. That is the benchmark to drill against from day one of revision. If your timed-bank average is 75-90 seconds per SBA, you are not ready for the exam clock yet, even if your accuracy looks healthy.

The paper runs in one sitting with no scheduled break. You can flag questions for review and come back to them, but only inside the 3-hour window. Most candidates report finishing with 10-20 minutes spare for review when their pre-exam mocks were averaging 50-55 seconds per question — anything slower than that and you will be triaging the last 20 questions in a panic.

What is the MRCEM Primary blueprint — how are the 180 questions split?

The 180 questions are split across six subject domains, and the weighting is published by RCEM in the MRCEM Primary Regulations & Information Pack. Anatomy and physiology dominate, together covering two-thirds of the paper. See our detailed breakdown of anatomy vs physiology weighting in MRCEM Primary for revision strategy.

In plain text: anatomy 60, physiology 60, pharmacology 24, microbiology 17, EBM 10, pathology 9. The figure is identical in the RCEM Basic Sciences Curriculum and the current Regulations Pack — treat it as the single source of truth.

One reading of this table: if you nail anatomy and physiology, you have already exposed yourself to 120 of 180 marks. Most candidates who fail Primary fail because they under-weighted these two domains, not because pharmacology or microbiology blindsided them. Pharmacology, microbiology, pathology and EBM combined are only 60 marks — exactly the same as anatomy alone.

What does the anatomy section of MRCEM Primary cover?

Anatomy in MRCEM Primary covers seven regional and system blocks across 60 questions: upper limb, lower limb, thorax, abdomen, head and neck, central nervous system, and cranial nerve lesions. The emphasis is clinically applied anatomy — surface markings, nerve supplies, the consequences of a specific injury — rather than obscure embryological detail.

Typical question stems describe a stab wound, a fracture, or a nerve palsy and ask which structure is affected or which deficit follows. Bromley Emergency Courses and other established providers consistently flag the brachial plexus, the foot and ankle, cranial nerve lesions, and surface anatomy of the chest and abdomen as the highest-yield revision areas inside the 60 anatomy marks.

What does the physiology section of MRCEM Primary cover?

Physiology in MRCEM Primary covers six system blocks across 60 questions: basic cellular physiology, respiratory, cardiovascular, gastrointestinal, renal, and endocrine. Expect questions on the cardiac cycle, ventilation-perfusion matching, acid-base, renal tubular handling, hormonal axes, and cellular transport.

Physiology rewards conceptual understanding over rote facts. If you can sketch a pressure-volume loop, explain why a hypoxic patient on a non-rebreather might still desaturate, or talk through the renin-angiotensin-aldosterone cascade without notes, you are revising at the right depth. Candidates who memorise numbers without mechanism tend to score worst here.

How many pharmacology, microbiology, pathology and EBM questions are there?

The remaining 60 marks split as 24 pharmacology, 17 microbiology, 10 evidence-based medicine, and 9 pathology. These four domains together equal the anatomy weighting, but each individually is small enough that diminishing returns kick in fast.

• Pharmacology (24 questions): Drug classes covering gastrointestinal, cardiovascular, respiratory, CNS, infection, endocrine, fluids and electrolytes, musculoskeletal, immunological products and vaccines, and anaesthesia. Mechanism of action, common interactions, and ED-relevant side effects come up most.
• Microbiology (17 questions): Principles of microbiology plus the main pathogen groups — bacteria, viruses, fungi, parasites. Focus on common ED presentations (sepsis, meningitis, cellulitis) and the bugs that cause them.
• Evidence-based medicine (10 questions): Statistics, study methodology, principles of critical appraisal. Sensitivity, specificity, NNT, likelihood ratios, study design — high return for small revision time because the content scope is narrow.
• Pathology (9 questions): Inflammatory responses, immune responses, infection, wound healing, haematology. The smallest section — do not over-invest beyond the curriculum bullet points.

How is the MRCEM Primary pass mark set?

The MRCEM Primary pass mark is set per diet using the Angoff method, not by a fixed percentage. A panel of subject matter experts rates each of the 180 questions for difficulty, the ratings are aggregated, and the resulting cut score becomes that diet’s pass mark. Because every diet has a different question mix, the pass mark moves between sittings.

Published data from MedCourse and other providers puts the historical pass mark between 103 and 110 out of 180 — roughly 57-61%. RCEM does not publish a single fixed pass mark, and you will not know your exact target before the exam. The practical implication: aim for 70%+ on timed mock papers to give yourself a comfortable buffer against the worst-case Angoff cut.

For the MRCEM SBA and FRCEM SBA, the Angoff cut score has 1 standard error of measurement (SEM) added to create the final pass mark. The MRCEM Primary uses straight Angoff without the SEM adjustment per the current RCEM exam guidance — but always confirm the live methodology on the RCEM site before sitting.

How many attempts do I get at MRCEM Primary?

You get a maximum of six attempts at MRCEM Primary. Any FRCEM Primary attempts you sat between August 2016 and July 2021 count toward that six, because RCEM treats the two exams as equivalent. MRCEM Part A passes from before August 2012 are time-expired and do not count as an exemption.

Exceptional additional attempts are decided case-by-case at the Dean’s discretion. Candidates with a late diagnosis of a neurodiverse condition (dyslexia, ADHD, ASD) who sat earlier attempts without reasonable adjustments can apply to have those attempts expunged — again at the Dean’s discretion.

A pass remains current indefinitely once you have it, but if you sat MRCEM Primary outside an Emergency Medicine training programme, the pass only counts toward CCT if you enter or re-enter EM training within seven years of passing.

When and where can I sit MRCEM Primary in 2026?

MRCEM Primary runs twice in 2026: 22 April 2026 and 27 October 2026, both at Surpass Assessment test centres worldwide. Application windows open at 10am UK time and close at 4pm UK time seven days later — applications opened 11 December 2025 (closed 18 December) for the April sitting, and open 15 July 2026 (close 22 July) for the October sitting.

Results are released approximately 6-8 weeks after the exam date via your RCEM account — no email, no phone confirmation. The April 2026 diet results dropped on 4 June 2026; the October 2026 diet results are scheduled for 1 December 2026.

How much does MRCEM Primary cost in 2026?

MRCEM Primary fees for 2026 are £429 for UK RCEM members, £485 for international members, £525 for UK non-members, and £609 for international non-members. Membership fees must be paid at least 24 hours before the application window opens to receive the member discount.

For most IMG candidates, the maths usually favours becoming a member before the first attempt — the membership fee plus the discounted exam fee comes out close to or below the non-member exam fee on its own, and you also unlock RCEMLearning (the only exam preparation material formally endorsed by the College).

How many practice SBAs per day should I drill?

Most candidates who pass MRCEM Primary first time complete 2,500 to 4,500 practice SBAs across their full revision period. Over a 12-week run-in that is roughly 30-50 SBAs per day, six days a week, plus longer mock papers on the seventh day. Over a 24-week run-in it halves to 15-25 SBAs per day.

What matters more than the daily count is the pattern: every question reviewed properly (read the explanation, identify the gap, note the principle), and at least one full 180-question, 3-hour timed mock per week in the final month. The timed mock is non-negotiable — it is the only way to calibrate your actual pace against the 60-seconds-per-question target and identify whether anatomy or physiology is silently slowing you down.

Which MRCEM Primary question bank should I use?

The three question banks most consistently mentioned by UK and IMG candidates are Pastest, RCEMLearning, and BMJ OnExamination. RCEMLearning is the only resource formally endorsed by the College, but Pastest is by far the most-used commercially for sheer question volume. Most candidates who pass use two banks in combination — typically one large commercial bank plus RCEMLearning for College-style stems.

The trap with question banks is mistaking them for a syllabus. The MRCEM Primary blueprint is defined by the RCEM Basic Sciences Curriculum (June 2010), not by the bank you happened to buy. Open the curriculum PDF on day one of revision, tick off each domain as you cover it, and use the question bank to test recall rather than to define what you study.

What do candidates actually find hardest in MRCEM Primary?

Candidate feedback on r/doctorsUK and Facebook groups consistently flags anatomy as the highest-effort domain and pathology + EBM as the highest-anxiety domain. Anatomy is hardest because the volume is large and the questions are clinically applied, so passive textbook reading does not work — you need to drill region by region with question repetition.

Pathology and EBM cause anxiety not because the content is hard, but because the small question counts (9 and 10 respectively) make candidates feel under-invested. The fix is to accept the weighting: cap pathology revision at 1-2 weeks of focused work and EBM at 3-5 days. Beyond that you are stealing time from anatomy, which is where marks are actually won and lost.

The single most common piece of advice from candidates who passed first time: start anatomy first, start it early, and never stop drilling it until the day before the exam.

Frequently asked questions about MRCEM Primary

Is MRCEM Primary 180 questions in one paper or split into sections?

One paper, one continuous 3-hour sitting, 180 questions. Unlike MRCEM SBA (which is 180 questions split into two 2-hour papers with a 1-hour break), MRCEM Primary has no scheduled break in the middle.

Is there negative marking on MRCEM Primary?

No. A correct answer scores 1 mark, an incorrect or blank answer scores 0. You should answer every question — leaving blanks is mathematically worse than guessing.

What is the pass mark for MRCEM Primary out of 180?

There is no fixed pass mark. The cut score is set per diet using the Angoff method and has historically fallen between 103 and 110 out of 180 (roughly 57-61%). Aim for 70%+ on mocks to absorb the variance.

How long is each MRCEM Primary question?

You have exactly 60 seconds per question on average — 180 questions in 3 hours (180 minutes). Drill against that benchmark on every timed practice session.

What is the difference between MRCEM Primary, FRCEM Primary, and MRCEM Part A?

They are the same exam under different names. MRCEM Part A ran pre-2016 (passes after August 2012 are equivalent to current MRCEM Primary). FRCEM Primary ran August 2016 to July 2021 and is fully equivalent. MRCEM Primary is the current name from August 2021 onward. The 180-question structure has been stable across all three.

How many anatomy questions are in MRCEM Primary?

60 anatomy questions — exactly one-third of the paper. Sub-domains are upper limb, lower limb, thorax, abdomen, head and neck, central nervous system, and cranial nerve lesions.

How many physiology questions are in MRCEM Primary?

60 physiology questions — the other third of the paper. Sub-domains are basic cellular, respiratory, cardiovascular, gastrointestinal, renal, and endocrine physiology.

How many attempts do I get at MRCEM Primary?

Six attempts maximum. FRCEM Primary attempts from August 2016 to July 2021 count toward the total.

How soon will my MRCEM Primary results come out?

Results are released to your RCEM account approximately 6-8 weeks after the exam date. The April 2026 diet results were released on 4 June 2026; October 2026 results are scheduled for 1 December 2026. RCEM will not confirm results by email or phone.

Can I sit MRCEM Primary as a Foundation Year doctor?

Yes — UK Foundation Programme doctors can sit MRCEM Primary during FY1 onward. The only catch is that if you pass before entering a GMC-approved Emergency Medicine training programme, the pass only counts toward CCT if you enter EM training within seven years of passing.

Does MRCS or MRCSI exempt me from MRCEM Primary?

Only if you are on the Defined Route of Entry into Emergency Medicine (DRE-EM) programme and obtained MRCS or MRCSI after 1 January 2012. You then submit the FRCEM Primary Exemption form to RCEM at least six weeks before applying for MRCEM SBA.

How much does MRCEM Primary cost in 2026?

£429 (UK member), £485 (international member), £525 (UK non-member), £609 (international non-member). Pay your RCEM membership at least 24 hours before the application window opens to lock in the discount.

Facts last verified 30 May 2026 — confirm exam logistics on the RCEM site.

Next step

You now have the question count, the time budget, and the blueprint weighting you need to scope the next 12-24 weeks of revision. The next decision is structure — building a week-by-week revision plan that puts anatomy and physiology in the right proportion and leaves space for weekly timed mocks. Browse our MRCEM Primary revision resources and structured question banks at emfinalexams.com.

Ready to build your plan? EMF Premium gives you all 40,000 questions and 20 mocks for £59 — one payment, six months' access.