Maximum number of MRCEM Primary attempts
TL;DR — The Royal College of Emergency Medicine (RCEM) allows a maximum of six attempts at the MRCEM Primary as standard. After six failed attempts, you may apply in writing for one additional (discretionary) attempt, decided case-by-case by the Chief Examiner. That is the absolute ceiling: seven sittings in total, and only if your application for the extra go is approved. If you exhaust attempts you are not permitted to restart the MRCEM journey, which has obvious consequences for ARCP outcomes and continued training in a UK Emergency Medicine programme.
Authoritative sources
- RCEM — MRCEM Primary exam
- RCEM — Exam regulations
- GMC — Emergency Medicine curriculum approval
- RCEM — Exam calendar and fees
Facts last verified against the MRCEM Exam Regulations 2025 V1 (September 2024 issue) published by RCEM.
What is the official maximum number of MRCEM Primary attempts?
Section 4 of the MRCEM Exam Regulations is unambiguous: candidates are allowed a maximum of six attempts at each MRCEM exam component, including the MRCEM Primary. After six fails, you can submit a single application for one additional attempt — a seventh and final sitting. The Chief Examiner reviews each request on its merits and the decision is final. There is no further route after that.
Two things often catch candidates out:
- Past equivalents count. Any attempts at recognised previous exams sat after 1 August 2016 — for example the FRCEM Primary in its 2016–2021 form — are added to your MRCEM Primary tally. The clock did not reset when the exam was renamed.
- The 7-year window starts the day you pass. Once you clear MRCEM Primary, you have seven years to complete the remaining MRCEM components (SBA and OSCE). The attempt cap and the time cap operate independently — you can hit either one first.
How attempts are counted: when the clock starts, ticks, and resets
The headline rules are simple but the edge cases matter. The table below summarises how each event affects your attempt count.
| Event | Counts as an attempt? | Notes |
|---|---|---|
| You sit MRCEM Primary and fail | Yes | One of your six standard attempts is used. |
| You sit MRCEM Primary and pass | Yes (but you are done) | The 7-year window to complete SBA and OSCE begins. |
| You withdraw >5 working days before the exam (approved) | No | Application transferred to the next diet under the Cancellation Policy. |
| You no-show or withdraw within 5 working days | No | Fee forfeited, but the sitting does not count toward your six attempts. |
| You sat the FRCEM Primary between 1 Aug 2016 and 31 Jul 2021 | Yes | Recognised as MRCEM Primary equivalent — every attempt counts. |
| You sat MCEM Part A between 1 Aug 2012 and 31 Jul 2016 | No | Pre-2016 attempts do not count toward the current cap. |
| Your first online attempt between 1 Jul 2020 and 31 Aug 2021 | No (COVID derogation) | One-time exemption, applied once only to that first online sitting. |
| Approved additional attempt under reasonable adjustments | Adds attempts | New or previously undeclared diagnosis route — see below. |
| Discretionary 7th attempt after 6 fails | Yes (final attempt) | Must apply on the online form; Chief Examiner decides. |
There is no rolling reset. The count does not lapse after a quiet year, and it does not reset if you transfer training programmes. The number sits against you, indefinitely, until you pass or run out.
What happens after six failed attempts?
You have one route left: an application for a discretionary 7th attempt. It is not automatic and it is not a formality. The regulations spell out the process:
- Submit via the online application form. Requests sent directly to the Chief Examiner by email or letter are not considered. The form is on the RCEM website during the relevant application window.
- Explain how you will succeed this time. You must set out, in writing, what has changed since your previous attempts — different preparation, different question bank strategy, formal coaching, a new diagnosis with reasonable adjustments, treated health issues, addressed life circumstances. Vague reassurance does not move the needle.
- The Chief Examiner reviews case-by-case. The decision is final. There is no appeal of the outcome itself, though procedural appeals are possible under the standard Appeal Regulations.
- If approved, this is your last sitting. Fail it and you have exhausted your MRCEM Primary attempts; you cannot restart.
Candidates who have a new or previously undeclared diagnosis of a condition requiring reasonable adjustments, and who failed earlier attempts without those adjustments in place, have a separate route. Under Section 4(vii), they can apply for additional attempts on the basis that earlier sittings were not on a level playing field. Supporting documentation is required and each request goes to the Chief Examiner and Head of Exams. This is the only mechanism by which the attempt count can effectively be extended beyond the standard six-plus-one.
What does exhausting attempts mean for training?
If you are in a UK Emergency Medicine training programme, your exam progress is shared with your local NHS England (formerly HEE) office, Head of School and Training Programme Director. ARCP outcomes — particularly Outcome 3 (inadequate progress, additional training time required) and Outcome 4 (release from the programme) — frequently turn on whether MRCEM is being passed in time. Practical implications of running out of attempts include:
- You cannot progress to ST4. MRCEM in full (Primary, SBA and OSCE) is the gateway to UK Higher Specialty Training in Emergency Medicine. No MRCEM Primary, no MRCEM, no ST4.
- Continued training in EM in the UK becomes untenable. Without a route to MRCEM, the curriculum cannot be completed. ARCP panels are not in a position to award further extensions beyond what the regulations allow.
- You will be reported to your TPD and educational supervisor. RCEM shares results data routinely with deaneries, so deferred or hidden conversations are not realistic.
- Cross-college or career-change planning becomes urgent. Doctors in this position commonly look at General Practice training, Acute Medicine via MRCP, sub-specialty pivots, or a return to non-training NHS posts while reconsidering.
None of this is intended to alarm — it is intended to be honest. The cap exists; the consequences are real; and the right time to think about them is well before sitting number five, not after sitting number six.
How should I approach the exam if I am close to the limit?
If you are sitting attempt four, five or six, the strategy shifts. The marginal benefit of another pass through the same notes is small. The bigger gains usually come from:
- An honest diagnostic. Look at your last feedback letter. Are you failing breadth (gaps in whole sections of the Basic Sciences Curriculum) or depth (consistently picking the second-best option)? The remedy is different.
- A new question bank. Most candidates who fail repeatedly have memorised the explanations of one bank rather than learning the underlying physiology or pharmacology. Switch banks and you switch the patterns.
- Timed full-length mocks under exam conditions. 180 questions in three hours is a stamina exercise as much as a knowledge one. Most candidates underestimate the cognitive fatigue of the third hour.
- A look at the human factors. Sleep, working pattern, on-call burden, undeclared health issues, undiagnosed neurodiversity. The reasonable adjustments route exists for a reason — it is not a workaround, it is a recognition that some candidates have been competing on an uneven field.
- Honest conversations early. Your educational supervisor, TPD and (if applicable) Occupational Health should know where you are. A formal Action Plan with study leave allocated is more useful than another silent attempt.
Frequently asked questions
Is the maximum really six attempts at MRCEM Primary?
Yes. RCEM’s MRCEM Exam Regulations 2025 V1, Section 4(i), state that candidates are allowed a maximum of six attempts at each MRCEM exam component as standard. After that, one further discretionary attempt may be granted on application.
Do attempts at the old FRCEM Primary count toward my MRCEM Primary cap?
Yes, if they were sat between 1 August 2016 and 31 July 2021. The FRCEM Primary is the accepted equivalent of the current MRCEM Primary for that window, and every attempt in that period is added to your tally.
What about MCEM Part A — does that count?
No. MCEM Part A is recognised as equivalent only for the period 1 August 2012 to 31 July 2016. Attempts under MCEM Part A do not count toward the current MRCEM Primary attempt cap.
Does a no-show or last-minute withdrawal use up an attempt?
No. If you do not attend an exam, or you withdraw within five working days of the exam, you forfeit the fee, but that sitting does not count toward your maximum number of attempts. The same applies to approved transfers under the Cancellation Policy.
If I pass MRCEM Primary, how long do I have to complete the rest of the MRCEM?
Seven years from the date you pass the MRCEM Primary. Within that window you must pass both the MRCEM SBA and MRCEM OSCE to be awarded Membership.
How do I apply for a discretionary seventh attempt?
Through the online application form on the RCEM website during the relevant application window. You must explain how you will ensure the additional attempt is successful. Direct emails to the Chief Examiner are not accepted. Each request is decided case-by-case and the Chief Examiner’s decision is final.
What if I have a new diagnosis that affected my earlier attempts?
Section 4(vii) of the regulations covers this. If you have a new or previously undeclared diagnosis of a condition requiring reasonable adjustments, and you failed previous attempts without those adjustments in place, you can apply for additional attempts. Supporting documentation must be submitted, and the Chief Examiner and Head of Exams decide on a case-by-case basis.
Can I restart the MRCEM if I exhaust all my attempts?
No. Section 4(v) is explicit: candidates who have exhausted all exam attempts are not permitted to restart their exam journey.
Did the COVID-19 derogation change anything for me?
Possibly. Between 1 July 2020 and 31 August 2021, a candidate’s first attempt at an online exam format did not count toward the maximum number of attempts for that specific exam. The derogation was applied once only, to the first online attempt in that window. If you sat MRCEM Primary online for the first time during that period, check your RCEM account to confirm whether the derogation was applied to your record.
Will my deanery or TPD be told about my failed attempts?
Yes. If you are in a UK Emergency Medicine training programme, RCEM routinely shares your results data — including failed attempts — with the local NHS England office, Head of School and Training Programme Director, and with the GMC for quality assurance purposes.
Can I appeal a failed MRCEM Primary result?
Appeals are limited to cases where performance was affected by a procedural irregularity and/or exceptional circumstances on the day, under the published Appeal Regulations. RCEM does not offer remarks or score revaluations — the results production process includes full quality assurance steps and a sign-off by the Chief Examiner.
Where can I see the full regulations?
The MRCEM Exam Regulations 2025 V1 are published on the RCEM website under Exam Regulations & Policies. The attempts rules sit in Section 4, “Number of Attempts and Exam Currency.”
Next step
If you are mapping out a realistic study plan to clear MRCEM Primary before running into the attempt cap, our exam-focused question banks, timed mocks and structured revision pathways are built around the current RCEM Basic Sciences Curriculum. Start at emfinalexams.com to see the MRCEM Primary materials in detail.
Facts last verified against the MRCEM Exam Regulations 2025 V1 (September 2024 issue) published by the Royal College of Emergency Medicine.
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