ACEM Primary Exam Prep: One Question at a Time

So, you're gearing up to sit the Primary exam. Welcome! You're about to embark on what will probably be a tough 3-6 months, but take comfort in knowing that we've all been there. We've all questioned our life choices, wondered if we'd ever remember another anatomy fact, and felt completely overwhelmed at times. The good news? We all survived.

There'll be days where you feel like you've forgotten everything you've ever learnt. That's completely normal. The Primary has a funny way of making everyone feel underprepared, even when they're making good progress.

One thing I learnt pretty quickly is that there's no perfect way to study. Everyone goes through a bit of trial and error, trying different methods, feeling overwhelmed, changing strategy, and figuring out what actually works for them.

Start with questions

For me, the biggest game changer was working through questions first, then reviewing the content based on the gaps I'd identified. You can absolutely sit down and try to memorise Robbins and Cotran or disappear into Katzung for weeks, but there's a huge amount of content and not all of it is exam-relevant. Whenever you're reading, ask yourself: "Could this reasonably be written into an MCQ?" If the answer is no, it's probably not worth spending hours on.

Look for the pattern behind the question

One thing that really helped me was trying to identify what the question was actually testing, rather than just memorising the answer. Once you've done a question, ask yourself how the examiners could write the same style of question about a different topic.

If you've just answered a question about one cranial nerve, can you apply the same approach to the others: their innervation, actions, or course? If you've learnt the receptor affinity of one beta blocker, could they ask the same question about another drug in the class? If you've revised the course of the radial nerve, could you describe the course of the ulnar or median nerve?

The Primary loves testing similar concepts in different ways, so if you can recognise the pattern behind the question rather than just the specific fact, you'll get much more value out of every question you do.

If I could give one piece of advice, it'd be this: do questions. Read the explanations. Make your own Anki cards or flashcards from the concepts you got wrong. Then do more questions. Rinse and repeat.

Prioritise the high-yield topics

Focus on the high-yield topics first: upper and lower limb anatomy, cardiorespiratory, renal, and gastrointestinal physiology. Get really comfortable with these, then gradually interleave the lower-yield topics as you go.

Having a study group can also make a huge difference. Even if it's just one or two people, having someone to keep you accountable, and occasionally convince you to stop procrastinating, can really help.

Practise the exam itself

As the exam gets closer, start practising the exam itself. Sit down and do 180 questions in three hours. It doesn't even have to be a perfect mock exam; just get used to concentrating for that long. It's a mentally exhausting day, and being prepared for that is almost as important as knowing the content.

Look after yourself

Finally, and this is probably the most important advice, look after yourself. Take breaks when you need them. Keep seeing your friends and family. Make time for hobbies and things that make you happy outside of work and study. Looking after your mental health isn't wasting study time; it helps you study better and makes burnout much less likely.

Managing shift work alongside Primary study is genuinely hard, so give yourself a bit of grace. I certainly wasn't smashing out physiology questions on night shift, and that's okay.

Good luck. You've got this. One question at a time.