The MRCEM SBA has one of the lowest pass rates of any RCEM exam. In 2024, fewer than a third of candidates got through. The candidates who do pass tend to share a handful of habits, and every one of them can be learned. Nine of those habits are below, from what to revise and how to weight it, through to how to read an SBA stem and how to hold your timing together across four hours.
First, a quick reminder of what you're sitting. The MRCEM Intermediate SBA is the second written exam on the route to RCEM membership, between the Primary and the OSCE. It runs as two papers of 90 single best answer questions, two hours per paper, with a one-hour break in between. That is 180 questions and four hours of exam time. Every question is mapped to the Specialty Learning Outcomes (SLOs) for Years 1–3 of the 2021 Emergency Medicine Curriculum. For the full breakdown of format, eligibility, and fees, see our complete guide to the MRCEM Intermediate SBA exam.
Read on for our top tips on how to pass the MRCEM Intermediate.
1. Anchor your revision to the SLO blueprint
The exam isn't testing a textbook. It's testing the curriculum. Every SBA question is written against the Year 1–3 SLOs of the 2021 RCEM curriculum, and the SBA covers SLO1 and SLOs 3–7. That makes the blueprint your revision map.
Before you open a single question bank, read the SLO descriptors and key capabilities for each outcome the SBA assesses. Build your study notes against those headings rather than against chapter titles from a reference book. When your revision follows the same structure the examiners use to write the paper, you stop wasting time on material that won't appear and you spot the gaps that will.
2. Give SLO1 the weight it carries
Not every SLO carries the same number of questions. SLO1 (the care of acutely unwell and complex patients across the full range of emergency presentations) is the largest single block on the paper. It spans cardiology, respiratory, neurology, gastroenterology, endocrinology, toxicology, and more.
Spread your effort to match. It's tempting to spend equal time on every outcome, but that leaves the biggest scoring area under-prepared. Map roughly how many questions each SLO contributes, then weight your revision hours accordingly. The specialties inside SLO1 are where a first-time pass is won or lost.
3. Revise for clinical reasoning
The Primary rewards recall of applied basic science. The SBA is a different exam. It asks you to take what you know and make a decision in an emergency scenario. That breaks down to the most likely diagnosis, the next best investigation, and the safest immediate management.
Memorising answers won't carry you here. You can know every fact on a topic and still pick the wrong option if you can't reason through a clinical stem under pressure. So, practise deciding, not reciting. Work through cases, talk yourself through why one option beats the others, and treat every practice question as a small clinical judgement rather than a fact to remember.
4. Sharpen your single best answer technique
Single best answer questions are built to be tricky. Several options will look reasonable. Sometimes more than one is technically correct. But only one is the best answer to the exact question asked.
A reliable method helps. Read the stem carefully and work out precisely what it wants. The diagnosis, the first step, the most appropriate drug, the likeliest cause. Watch the qualifiers. "Most likely", "initial", "next". They change the right answer entirely. Rule out the options you can, then choose the best fit from what's left. Getting slick at this is a skill, and it comes from volume.
5. Practise under timed, exam-day conditions
Ninety questions in 120 minutes gives you about 80 seconds per question. That's comfortable if you've rehearsed it and brutal if you haven't. Timing is where even well-prepared candidates can struggle.
Do full timed blocks, not just casual question practice. Sit 90 questions in one go, against the clock, and get used to the rhythm of moving on when a question is eating your time. Build a habit of flagging anything you're unsure of and coming back to it, rather than stalling. Practised often enough, good pacing stops being something you think about and becomes automatic.
6. Learn from every question
The number you get at the end of a practice session tells you almost nothing on its own. The learning is in the review. Read the explanation for every question (both those you got wrong and those you got right) because a lucky guess is a gap you missed in your earlier revision.
Track your performance by topic so your weak areas are impossible to ignore, then go back and close them. Working through thousands of questions without reviewing the explanations rarely translates into a pass. Our MRCEM Intermediate preparation guide goes deeper on how to structure this review loop over a full revision block.
7. Answer everything, and understand the MRCEM SBA pass mark
There is no negative marking. A wrong answer costs you nothing more than a blank one, so never leave a question unanswered. Guess if you have to but then flag it to revisit if time allows.
It also helps to understand how the MRCEM SBA pass mark works. RCEM doesn't set a fixed percentage like "you need 65% to pass". The pass mark is set for each sitting using the modified Angoff method, with one standard error of measurement added, so the exact number changes depending on how difficult that paper's questions were. Chase understanding and accuracy, not a magic number. There's more detail on marking in our complete guide to the MRCEM Intermediate SBA exam.
8. Get comfortable with the on-screen exam format
The SBA is a computer-based exam, delivered by RCEM through Surpass Assessments at test centres in the UK and overseas. The interface is straightforward, but exam day is not the moment to meet it for the first time.
Get used to reading long clinical stems on a screen, using the flag function, and moving between questions without losing your place. If your revision questions are presented in a similar on-screen format, so much the better. That will ensure you arrive already fluent in the mechanics and can spend your attention on the medicine instead of the software.
9. Set a realistic timeline and know your resit position
Most candidates give themselves several months of structured revision alongside clinical work. Less time is possible if you're already working in emergency medicine with strong foundations, but it's tight, and the low pass rate is a reminder not to underestimate the exam.
Plan backwards from your sitting date and protect your revision time. It's also worth knowing where you stand if things don't go your way. Candidates are allowed up to six attempts at the MRCEM Intermediate SBA. If you do need to resit, use the score breakdown from your result to target the SLOs that let you down, rather than starting from scratch.
Ready to start revising? Explore the Pastest MRCEM Intermediate SBA QBank and practise exam-style single best answer questions under timed conditions, with explanations for every answer.
Frequently asked questions
What is the MRCEM SBA pass mark?
There's no fixed pass mark. RCEM sets the pass mark for each sitting using the modified Angoff method, plus one standard error of measurement, so the exact score you need changes from one exam to the next depending on how difficult the paper is. You won't be told the figure in advance.
How many questions are on the MRCEM Intermediate SBA?
The exam has 180 single best answer questions, split across two papers of 90 questions each. You get two hours per paper and a one-hour break in between. That’s four hours of exam time in total.
Is there negative marking on the MRCEM SBA?
No. A correct answer scores one mark and an incorrect answer scores zero, with no marks deducted for wrong answers. Because of this, you should answer every question, even if you're guessing.
How hard is it to pass the MRCEM Intermediate SBA?
It's one of the harder RCEM exams by pass rate. The difficulty comes from its breadth and its focus on clinical decision-making rather than recall. Structured revision mapped to the SLOs, plus plenty of reviewed question practice, is what separates a first-time pass from a resit.