Both are probably as fair and reliable as an exam can be. My concern is that 
anyone can have a bad day/ bad examiner / bad patient and we all know of 
people who deserved to pass but didn't, and the impact on ones family life 
and self esteem can be huge. Some form of ongoing assessment - more 
objective and testing than RITA - would in my opinion be fairer than the 
all-or-nothing/heaven-hell approach.

I think there are strengths and weaknesses in both systems. FFAEM much 
stronger on management and EBM. I felt with my FFAEM training I could've 
hammered any management viva questions in the FACEM, whereas some of my 
colleagues were worried about these. I gave a talk on EBM to some of the 
advanced trainees at my hospital, and the concepts of literature searching, 
sources of secondary evidence, critical appraisal and so on seemed extremely 
alien. Said advanced trainees would often quote several-year old textbooks 
as absolute truth - oblivious to what has been subsequently refuted or 
improved in the literature. It seems to me that reading papers is very much 
viewed as an activity performed by qualified specialists, not trainees. 
Another 'weakness' I perceived is in teaching ability. Most UK EP trainees 
gain excellent skills on life support instructor courses. I've not met an 
Australasian trainee who's had the privilege of this experience. That last 
point of course has nothing to do with the exam.

The strength of the Aussie system is its clinical side. It is there to train 
specialists in emergency medicine - a critical care specialty. The 
assessment in the Fellowship exam consists of a tough written exam then a 
clinical exam. The written exam has a hard MCQ, short answer questions (mini 
essays based on scenarios which test your ability to think laterally) and 
'visual aid questions' - consisting of data/x-ray/ecg interpretation. A 
satisfactory mark in this leads to an invitation to sit the clinical - a 
traditional MRCP-style long case (but with discussion revolving around ED 
issues), 4 short cases, and then the fun bit: 6 x 10 minute rapid-fire viva 
questions on written scenarios testing any emergency scenario you can 
imagine, from neuroleptic malignant syndrome to thyrotoxic storm to major 
incidents to setting up a ventilator to obstetric emergencies. If you don't 
know your stuff, you don't get the fellowship.

One major difference is that all my bosses in Australia were keen for us to 
pass, and went out of their way to pass on tips, wisdom, knowledge and 
experience. They were all shop floor doctors with excellent knowledge and 
skills and had kept up to date. I pretty much taught myself for the clinical 
side of the FFAEM (had good management training though - my boss knew his 
strengths) and I'm sure I wasn't the only one.

Bear in mind my FFAEM was October 1999. The clinical part may well be 
tougher now, but it was embarassingly easy then.

Speaking to the examiners after, it's clear they view the UK system with 
considerable bemusement. Why don't we want to make sure our specialists can 
function at that level? Who are we frightened of upsetting? Are we afraid of 
exposing the RITA system as a failure to ensure minimum standards, or is it 
because we still haven't agreed on what our specialists should be capable 
of? Are we concerned the trainers aren't competent to produce sufficiently 
trained candidates? If so, that's a self-fulfilling prophecy.

I gather a contingent of FFAEM examiners will witness the next sitting of 
the FACEM. I think that will be good.

In summary, there are strengths and weaknesses in both exams. I personally 
feel a better doctor for having done both. I will practice in Britain.

I'd be interested in hearing others' views, especially if they've trained in 
both systems.

Cliff

(Congratulations on Isabelle - sounds like you've got your priorities right. 
HEMS has missed out.)

>Sorry, that was meant to go to Cliff only. But public congrats on the FACEM 
>anyway. Having done both can you tell us the differences and which you 
>believe to be better/fairer/more reliable?
>
>Simon
>


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