FCEM(SA) Part 2: The Complete Guide

FCEM(SA) Part 2 is the exit examination of the College of Emergency Medicine of the Colleges of Medicine of South Africa (CMSA). It tests the theory and practice of emergency medicine across every age group and every type of presentation, from the pre-hospital scene to resuscitation, toxicology and mass-casualty care. This guide focuses on the written component, which decides whether you are invited to the Performance examination, and explains its structure, who can sit it, and how to prepare.

What is the FCEM(SA) Part 2?

Part 2 is designed to confirm that you can function as a specialist emergency physician in pre-hospital, in-hospital and academic settings. It is a two-stage examination. First come two digital written papers covering the principles and practice of emergency medicine. Candidates who reach the standard are then invited to the Performance examination, an online structured oral assessment. Basic science can and does appear in Part 2, so the Part 1 material does not disappear once you have passed it.

FCEM(SA) Part 2 format and structure

The College's regulations and its Part 2 candidate information leaflet describe the written component as follows:

• Two digital papers of 3 hours each, sat in separate sittings.
• Paper 1: 100 single best answer MCQs in a "best of five" format, without a stimulus.
• Paper 2: 100 stimulus-based single best answer MCQs, built around ECGs, radiographs, CT, ultrasound, clinical photographs, laboratory and blood gas data, and other data relevant to emergency practice.
• There are no short answer questions, and no negative marking.
• To be invited to the Performance examination you must achieve an average above the standard-set cut score across both papers, and score above the 40% subminimum on each paper.
• The Performance examination is an online, video-based structured oral examination, including case-based assessments, critical appraisal and structured oral stations, and may draw on your portfolio.

If you pass the written component but fail the Performance examination, you may repeat the Performance component once, at the next set of examinations, without rewriting the papers. Confirm the current format on the CMSA website when you apply.

Who can sit FCEM(SA) Part 2?

The regulations set several requirements. You must have passed Part 1 within the previous six years, have been qualified to practise for at least four years post-internship, and have completed at least three years of the prescribed training, with 36 months completed by the date of the first paper. You must also submit a CMSA-approved Critical Performance Portfolio, which includes Level I certification in emergency ultrasonography and a completed research assignment, supported by your academic head. An incomplete portfolio results in the application being declined, so build it throughout training rather than at the end. Confirm the current criteria with the CMSA before you register.

FCEM(SA) Part 2 syllabus: where to focus

The candidate information leaflet publishes approximate weightings for the written papers, which is the best guide to how to divide your time. Cardiovascular, respiratory, trauma and toxicology with environmental emergencies each carry roughly 10 to 15% of the marks. Neurology, musculoskeletal, infectious disease, paediatrics, geriatrics and critical care each carry roughly 5 to 10%. The remaining areas, including psychiatry, obstetrics and gynaecology, ENT, ophthalmology, endocrinology, dermatology, pre-hospital care, ethics and research, carry roughly 1 to 5% each. The College also targets an acuity mix of about 40% critical, 40% emergent and 20% lower-acuity presentations.

• Resuscitation: airway, arrhythmias, shock states, acid-base and electrolyte disturbances, and the ethics of resuscitation and termination.
• Cardiovascular and respiratory emergencies: acute coronary syndromes, pulmonary embolism, aortic catastrophes, asthma, COPD, pneumonia and TB.
• Trauma and toxicology, including envenomation and environmental injury, which are core to South African emergency practice.
• Image and data interpretation: ECGs, plain films, CT, point-of-care ultrasound and blood gases, which make up the whole of Paper 2.
• Paediatric and geriatric emergencies, and the pre-hospital and disaster medicine sections of the syllabus.

A realistic FCEM(SA) Part 2 study plan

Most registrars prepare over several months alongside shift work, which makes short, frequent sessions more realistic than long ones.

• Phase one, cover the heavy hitters. Start with cardiovascular, respiratory, trauma and toxicology, since together they account for a large share of the marks. Pair each topic with questions straight away.
• Phase two, train your eye. Build a daily habit of interpreting ECGs, radiographs, ultrasound clips and blood gases. Paper 2 is entirely stimulus-based, and interpretation speed only comes from volume.
• Phase three, simulate and widen. Sit timed 100-question blocks for both paper types, then use your results to work through the lower-weighted specialties, where a few hours of focused revision often secures easy marks. Start practising critical appraisal for the Performance examination before the written results arrive.

Exam technique that earns marks

One hundred questions in three hours gives you under two minutes each. In Paper 1, read the lead-in first and look for the acuity cues in the stem, because many questions ask for the most appropriate immediate action rather than the final diagnosis. In Paper 2, interpret the image or data systematically before reading the options, so that the distractors do not steer your eye. With no negative marking, answer every question. Remember the 40% subminimum on each paper: a strong Paper 1 cannot rescue a collapsed Paper 2, so prepare both formats seriously.

The best way to revise for FCEM(SA) Part 2

The written component is entirely single best answer, so a large volume of good questions is the most efficient preparation. Look for a bank that mirrors the CMSA style, includes stimulus-based questions with real ECGs and images, explains every option, and tracks your performance across the blueprint so that you can see whether you are on course for both papers.

Passmed's FCEM(SA) Part 2 question bank is written by qualified doctors, mapped to the CMSA emergency medicine blueprint, and pairs detailed explanations with performance tracking across every specialty area. Explore the FCEM(SA) Part 2 question bank →

Frequently asked questions

How many questions are in the FCEM(SA) Part 2 written papers?

Each of the two papers has 100 single best answer questions in a best-of-five format, with 3 hours per paper. Paper 2 is entirely stimulus-based.

Is there a subminimum?

Yes. You need an average above the standard-set cut score across both papers and at least 40% on each paper to be invited to the Performance examination.

What is in the Critical Performance Portfolio?

The regulations require a CMSA-approved portfolio that includes Level I certification in emergency ultrasonography and a completed research assignment, supported by your academic head.

Do I rewrite the papers if I fail the Performance examination?

No, provided you resit the Performance component at the next set of examinations. This carry-over applies once only.

Exam format details were checked against the Colleges of Medicine of South Africa (accessed October 2026). Regulations, dates and fees change, always confirm the current details on the CMSA website before you sit.