What Is the FRCEM SBA Exam Blueprint and Why Does It Matter in the ED?


The FRCEM SBA is the final theory exam for UK Emergency Medicine trainees. It’s a 180-question Single Best Answer (SBA) paper, delivered as two 2-hour papers of 90 questions each, with a one-hour break in between. (RCEM)


Since August 2021, the FRCEM SBA has been fully mapped to the RCEM 2021 Emergency Medicine Curriculum, using Specialty Learning Outcomes (SLOs) as the backbone of assessment.


The exam blueprint is RCEM’s published breakdown of how many questions are drawn from each SLO and syllabus area. In other words, it’s the official “where the marks are” document. If you want to revise efficiently, you need to know:


  • Which SLOs carry the most questions
  • How adult, paeds, trauma, resus, procedures and “non-clinical” topics are sampled
  • Where stats, QI, leadership and management are hiding in the paper


For FRCEM SBA candidates, this blueprint is effectively your exam map. Understanding it lets you prioritise revision, allocate time sensibly, and avoid over-studying low-yield niches while neglecting big-ticket areas.


How the Blueprint Shapes the FRCEM SBA Exam


The FRCEM SBA exam is:


  • A theory exam: 180 SBAs
  • Two papers, 90 questions each, 2 hours per paper, 1-hour break in between
  • Delivered via Pearson VUE test centres twice a year
  • Blueprinted to the 2021 EM Curriculum – every question is linked to an SLO and syllabus category


Typical question angles the blueprint drives:


  • Diagnosis / recognition (classic vignettes, “most likely diagnosis”)
  • Initial investigation (best single test, or next investigation)
  • First-line ED management (including drugs, doses, and sequencing)
  • Complications and red flags (who needs resus, theatre, ICU, or senior review now)
  • Guideline-based “next best step” aligned with RCEM / NICE / specialty guidance


Common formats:


  • Text-only clinical vignettes (most of the paper)
  • Imaging and ECGs embedded in the stem (especially for SLO1, 3, 4, 5)
  • Procedural / skills questions (e.g., NIV set-up, sedation, LP)
  • Evidence-based medicine and statistics (SLO10)
  • QI / patient safety / governance / leadership scenarios (SLO7, 8, 10, 11, 12)


A typical “blueprint-style” scenario:


A 68-year-old man with COPD and AF presents with breathlessness and chest tightness. You’re given full observations, a 12-lead ECG, and a CXR. The question asks for the single best next investigation or the most appropriate immediate management, often with more than one plausible answer.


Core Concepts You Must Know About the FRCEM SBA Blueprint


SLOs: The Framework Behind the Exam


The RCEM 2021 curriculum is structured around Specialty Learning Outcomes (SLOs) – high-level activities that describe the work of an independent EM clinician. There are 12 EM SLOs plus 2 additional ACCS SLOs, giving 14 SLOs overall for Emergency Medicine.(RCEM)


The FRCEM SBA blueprint samples mainly from these SLOs:


  • SLO1: Complex stable adult patients
  • SLO3: Resuscitation of sick adults (excluding major trauma)
  • SLO4: Injured patients / trauma
  • SLO5: Paediatric emergencies
  • SLO6: Procedural skills
  • SLO7: Complex/challenging workplace situations (safeguarding, medicolegal)
  • SLO8 & SLO12: Leadership, management, governance
  • SLO10 & SLO11: Research, stats, data, quality improvement and patient safety


For exam purposes, you can think of the blueprint as four big “clinical” chunks plus a smaller but important “non-clinical” chunk:


  1. Adult ED medicine (SLO1, 3, 4)
  2. Paediatric ED medicine (SLO5)
  3. Procedures / practical skills (SLO6)
  4. Leadership, governance, research, QI (SLO7, 8, 10, 11, 12)


FRCEM SBA Exam Format at a Glance


From RCEM’s exam regulations and information pack:


  • Number of questions: 180
  • Format: Single Best Answer (SBA) MCQs
  • Papers: Two papers of 90 questions
  • Time: 2 hours per paper (total 4 hours + 1-hour break)
  • Attempts: Up to 4 attempts per FRCEM component as standard(RCEM)
  • Standard setting: Modified Angoff method, with SEM added to the cut score (so the pass mark varies by diet)(bromleyemergency.com)


You must also pass the FRCEM OSCE, and there is a 7-year “currency” window between SBA and OSCE passes in each direction.


Question Weighting by SLO: Where the Marks Are


The official blueprint in the RCEM FRCEM Regulations & Information Pack gives the following breakdown:


SLO / Group Theme Questions Approx. % of paper
| SLO1  | Complex stable adult patients  | 35  | ~19%
| SLO3  | Adult resuscitation (non-major trauma)  | 40  | ~22%
| SLO4  | Injured patients / major trauma  | 35  | ~19%
| SLO5  | Paediatric emergencies  | 30  | ~17%
| SLO6  | Procedural skills  | 13  | ~7%
| SLO7  | Complex/challenging situations (safeguarding etc.)  | 10  | ~6%
| SLO8 + SLO12  | Leadership, management, governance  | 7  | ~4%
| SLO10 + SLO11  | Research, stats, QI & patient safety  | 10  | ~6%
| Total  |   | 180  | 100%


Key implications:


  • SLO1, 3, 4, 5 ≈ 78% of the paper. Adult medicine, resus, trauma and paeds are your bread and butter.
  • Procedures (SLO6) are surprisingly chunky – ~7% is a lot of marks to lose if you neglect sedation, NIV, LP and thoracotomy indications.
  • Leadership / management / QI / research together account for ~20+ questions – that’s an entire short-answer paper in old-money.


How Systems Map to SLOs


Within each SLO, the blueprint lists body systems and topic areas. For example, under SLO1 (complex stable patient) you’ll see:


  • Allergy, cardiology, respiratory, gastro/hepatology, neurology, nephrology
  • Endocrinology, infectious diseases, haematology, oncology, rheumatology
  • Dermatology, ENT, ophthalmology, sexual health, urology, vascular
  • Pain & sedation, palliative & end-of-life care, pharmacology & poisoning
  • Elderly care/frailty, mental health, surgical emergencies, maxfax, MSK (non-traumatic)


SLO3 (resus) focuses on:


  • Adult resuscitation (medical + some trauma physiology)
  • Palliative decisions in the resus context
  • Recognition of futility and when to stop


SLO4 (injured patients) includes:


  • Major trauma, multi-system trauma, head injury
  • Analgesia and sedation in trauma
  • Trauma imaging and damage-control surgery thresholds


SLO5 (paediatrics) samples:


  • Paediatric resus, BRUE, SUDI/SUDIC protocols
  • Paediatric respiratory, GI, infectious disease, neurology, MSK, surgical emergencies
  • Safeguarding and psychosocial emergencies


The blueprint therefore ensures that all the familiar ED systems appear, but framed within SLOs that match how you actually work in the department.


What Happened to Critical Appraisal & QIP?


Under the old (pre-2021) curriculum, candidates sat separate FRCEM Critical Appraisal and FRCEM QIP exams. These have now been withdrawn as formal exams. The associated skills and knowledge are:(RCEMCurriculum)


  • Assessed via SLO10 (research & data management) and SLO11 (QI & patient safety)
  • Sampled in the FRCEM SBA and FRCEM OSCE, as well as in-training assessments


Practically, this means:


  • You must be comfortable with study design, diagnostic tests, trial interpretation and basic statistics.
  • You must understand QI models, PDSA cycles, measurement for improvement, and patient safety tools.


You don’t get a separate exam for these – they’re baked into your SBA and OSCE.


Common FRCEM SBA Traps Related to the Blueprint


Question writers love exploiting the gap between what candidates actually revise and what the blueprint says. Classic traps:


  • Ignoring SLO1/3/4 weighting


  • Trap: Spending disproportionate time on niche tox or rare environmental emergencies.
  • Fix: 4 out of 5 questions come from bread-and-butter adult EM, resus and trauma – they should dominate your revision plan.


  • Underestimating SLO10/11 (stats & QI)


  • Trap: Assuming “stats will be just a handful of easy questions” and leaving them to the end.
  • Fix: ~10 questions on research methods and QI is a lot of marks. Learn the basics of RCTs, diagnostic tests, confidence intervals, PDSA, run charts and SPC.


  • Neglecting “non-clinical” SLO7/8/12


  • Trap: Skipping leadership, management, safeguarding, complaints, and governance because “it’s not medicine”.
  • Fix: These are real marks and relatively learnable from policy documents and RCEM guidance.


  • Not recognising overlap


  • Trap: Thinking palliative care only appears under SLO1, or safeguarding only in SLO5.
  • Fix: The blueprint shows cross-cutting themes (palliative care appears in SLO1 and SLO3; safeguarding in SLO5 and SLO7).


  • Misjudging difficulty vs weight


  • Trap: Spending huge amounts of time on very low-yield, high-difficulty topics because they’re “interesting” (e.g., exotic tox, rare vasculitides).
  • Fix: Nail the common, high-weight topics first; then use spare time to polish the rarer stuff.


High-Yield Clinical Patterns for Blueprint-Driven Questions


Even though this post is about the structure of the exam, the blueprint translates directly into clinical pattern recognition. Think in terms of SLO-style vignettes.


Classic Presentation (SLO1 / SLO3 / SLO4 / SLO5)


  • SLO1 – Complex stable adult:
    • 55-year-old with chest pain, stable vitals, ECG + troponin results.
    • You’re asked about risk stratification, next investigation, or disposition.


  • SLO3 – Sick adult / resus:
    • 72-year-old with septic shock: hypotensive, tachycardic, hyper- or hypothermic, raised lactate.
    • The question focuses on initial resuscitation, vasopressor choice, or when to call ICU / theatre.


  • SLO4 – Injured patient:
    • High-speed RTC with multi-system trauma, low GCS, and hypotension.
    • Often about airway priorities, thoracostomy indications, permissive hypotension, damage control.


  • SLO5 – Paediatrics:
    • 18-month-old with fever, tachypnoea, poor feeding, subtle signs of respiratory distress.
    • Questions often test identification of red flags, safe discharge criteria, or when to escalate.


Atypical Presentation


  • Frailty and elderly care:
    • Fall, delirium, minimal pain but serious injury (extradural, cervical fracture, pubic ramus).
    • Blueprint drives questions on hidden pathology and safe discharge.


  • Immunocompromise and oncology:
    • Afebrile neutropenia, subtle sepsis signs, non-specific abdominal pain.
    • Often linked to SLO1, SLO3, and SLO5 (for paediatric oncology).


  • Atypical ACS / aortic dissection / PE:
    • Back pain, abdominal pain, syncope, or isolated hypotension.
    • Testing your ability to spot dangerous mimics beyond the textbook chest pain.


Dangerous Mimics You’ll See Across the Blueprint


  • ACS vs pericarditis vs benign early repolarisation (ECG pattern traps)
  • Aortic dissection vs PE vs tension pneumothorax in the shocked patient
  • Sepsis vs anaphylaxis vs adrenal crisis
  • Non-accidental injury vs accidental trauma in children
  • Stroke vs hypoglycaemia vs post-ictal paresis


These are the clinical expressions of SLO-based exam construction – the blueprint just tells you how often you’ll see each flavour.


How to Revise the Blueprint Efficiently for the FRCEM SBA


Use Question Banks First, Then the Blueprint & Curriculum

  1. Do a large block of SBAs in one SLO (e.g., SLO3 resus or SLO4 trauma).
  2. Review explanations carefully – especially why wrong answers were wrong.
  3. Then open the FRCEM SBA blueprint and 2021 curriculum and map each question back to its SLO, key capabilities and descriptors.


This “questions → blueprint → curriculum” loop makes the document feel alive, not just a PDF you skim once.


Build Mini-Notes or Flashcards from Blueprint-Driven Mistakes


Every time you miss a question:


  • Note which SLO and system it belonged to (e.g., “SLO4 – trauma imaging – pelvic fracture”).
  • Write down: 
    • What the question tested (e.g. “indication for pre-peritoneal packing vs laparotomy”).
    • Why your answer was wrong (e.g. “I over-valued CT in unstable trauma”).
    • The one-liner rule or guideline (“Unstable pelvic # with haemodynamic compromise → pelvic binder + early invasive haemorrhage control, not CT first.”)

Over time, you’ll build an SLO-tagged, blueprint-aware crib sheet.


Mix Text-Based and Image-Based Questions


Because the blueprint is so resus-, trauma-, and paeds-heavy, image questions are inevitable:


  • ECGs for arrhythmias, ACS, PE, brugada, long QT
  • CXR for pneumothorax, pulmonary oedema, consolidation, misplaced lines
  • CT heads for trauma and stroke, CT abdomen for AAA, perforation, obstruction
  • Paediatric X-rays (intussusception, NEC, epiglottitis signs), rash images


Deliberately include image-based SBAs in your revision so you’re not blindsided on the day.


How StudyMedical Covers the FRCEM SBA Blueprint in Its Question Bank


StudyMedical’s FRCEM SBA bank is built explicitly around the RCEM 2021 curriculum and the official FRCEM SBA blueprint rather than a random list of topics.


There are hundreds of questions spanning:


  • SLO1–SLO5 clinical content: adult medicine, resus, trauma, and paediatrics across all major systems
  • SLO6 procedural skills: sedation, NIV, pericardiocentesis, escharotomy, lumbar puncture
  • SLO7, 8, 10, 11, 12 “non-clinical” areas: safeguarding, complaints, leadership, governance, QI and statistics


Key features that fit the blueprint:


  • System-based filters (cardiology, trauma, paediatrics, tox, etc.) that mirror the blueprint’s syllabus categories.
  • Image-based SBAs (ECGs, X-rays, CT, US, rashes) reflecting blueprint-heavy SLOs like SLO1, 3, 4, 5.
  • Multiple modes: 
    • New questions only
    • Previously incorrect questions
    • Flagged questions for targeted review
    • Exam-style timed papers with no explanations until the end
  • Detailed explanations referencing RCEM, NICE, and specialty society guidelines so you can tie question learning back to official practice.


“Start practising blueprint-aligned FRCEM SBA questions with StudyMedical today and build revision sessions that match the real exam.”


FAQs About the FRCEM SBA Blueprint


1. How strictly does the FRCEM SBA follow the published blueprint?


Very strictly. RCEM’s regulations state that the exam is blueprinted against the 2021 EM curriculum, and the information pack gives an explicit question breakdown by SLO. The exact questions change each diet, but the relative weighting of SLOs is stable.


2. Which areas make up most of the paper?


The “big four” are:

  • SLO1 – complex stable adult (~19%)
  • SLO3 – resus (~22%)
  • SLO4 – injured patient (~19%)
  • SLO5 – paediatrics (~17%)


Together they account for roughly three-quarters of the paper.


3. Do I really need to know stats, QI, and leadership for the FRCEM SBA?


Yes. SLO7, 8, 10, 11, 12 together account for about 24–27 questions when you add safeguarding, governance, QI and research methods. These are often relatively “clean” marks if you’ve read the right guidance.


4. How many questions will be about procedures and skills?


Procedural skills (SLO6) account for 13 questions – around 7% of the paper. Expect sedation (adult & paeds), NIV, LP, thoracotomy indications, and occasionally more niche ED procedures.


5. Is paediatrics just a small part of the blueprint?


Not at all. SLO5 (paediatrics) gets 30 questions (~17%) and paediatric topics also bleed into resus and safeguarding SLOs. Paeds is a significant chunk and absolutely worth a dedicated revision block.


6. Where can I find the official FRCEM SBA blueprint and regulations?


On the RCEM website you’ll find:

  • The FRCEM exams overview and regulations pages(RCEM)
  • The FRCEM Final Regulations & Information Pack PDF, which contains the full blueprint table by SLO and question count.


Always check the latest version before each diet.


Key Takeaways: The FRCEM SBA Blueprint in 5 Bullet Points


  1. Know the structure: 180 SBAs, two 2-hour papers, mapped to the RCEM 2021 curriculum.
  2. Follow the weights: SLO1, 3, 4, 5 (adult medicine, resus, trauma, paeds) make up most of the paper – prioritise them.
  3. Don’t ignore non-clinical content: Leadership, governance, safeguarding, stats and QI collectively form a significant mark-chunk.
  4. Use the blueprint to drive your revision plan: Build SLO-targeted question blocks and map your weak areas back to specific SLOs.
  5. Practise exam-style SBAs: A good question bank that mirrors the blueprint is the fastest way to learn how RCEM actually examines the curriculum.


Ready to Test Yourself Against the FRCEM SBA Blueprint?


The FRCEM SBA is not just a random collection of questions – it’s a carefully blueprinted sample of the RCEM 2021 Emergency Medicine Curriculum.


If you:

  • Understand which SLOs carry the marks, and
  • Practise blueprint-aligned SBAs that feel like the real exam, you’ll turn the blueprint from an intimidating PDF into a strategic advantage.


👉 Create a “Blueprint-based” revision session in the StudyMedical FRCEM SBA bank today – start with SLO3 (resus) or SLO4 (trauma), then systematically work through the rest of the SLOs until you’ve covered the entire blueprint.