This article refers to the examinations formerly known as Membership of the Faculty of Accident and Emergency Medicine and Fellowship of the Faculty of Accident and Emergency Medicine. After the change in name of the Faculty of Accident and Emergency Medicine to College of Emergency Medicine, these examinations are now named Membership of the College of Emergency Medicine (MCEM) and Faculty of the College of Emergency Medicine (FCEM), respectively.

PURPOSE OF THE EXAMINATIONS

Part of the role of the National Health Service is in training the next generation of staff. This training facilitates young and inexperienced doctors in gaining knowledge and developing specific skills while delivering care under the supervision of senior doctors. Such in-service training at a higher training level gives the doctor specialty-specific skills, which he or she will in turn pass on to junior doctors. Thus, the specialty perpetuates its own expertise and identity. Training has to occur while continuing to provide care to patients and, in emergency medicine, in an often difficult and stressful environment. Workplace-based assessment of a trainee actually “doing” what we want them to be able to do is important, and there is increasing attention to developing suitable methods in all specialties. However, the practicalities of such assessments and the work required to train the assessors and standardise techniques means that formal summative assessment outside the workplace remains a core part of assessment in medical education.

While recognising that the speed of progression of the trainee doctor from novice to expert is variable, the way in which career paths and the workforce are organised means that certain levels of autonomy are expected at particular levels in training (senior house officer, registrar). Doctors who are working at a level of autonomy higher than their capability present a considerable risk to patient safety. In emergency medicine, there are two …