About the MRCEM Primary exam
The MRCEM Primary is the first exam towards Membership of the Royal College of Emergency Medicine. It tests the basic sciences that emergency medicine is built on. Everything on this page comes from RCEM's own documents, linked below each section.
Last updated after the 27 October 2026 MRCEM Primary sitting.
Format
- One paper of 180 single-best-answer questions in 3 hours, taken on a computer.
- It is mapped to RCEM's Emergency Medicine curriculum, with detail in the RCEM Basic Sciences Curriculum.
- It is the first of the MRCEM exams. After it come the MRCEM SBA (Intermediate) and the MRCEM OSCE.
- The exam is in English. RCEM advises that IELTS level 7 is the expected standard for its exams.
The official MRCEM Primary blueprint
RCEM sets out how many of the 180 questions come from each subject. The links go to our free questions for each area.
| Subject | Questions | Share | What it covers |
|---|---|---|---|
| Anatomy | 60 | 33% | Upper limb, lower limb, thorax, abdomen, head and neck, central nervous system, cranial nerve lesions. Practise: Upper Limb, Lower Limb, Thorax, Abdomen, Head & Neck, Central Nervous System, Cranial Nerve Lesions |
| Physiology | 60 | 33% | Basic cellular, respiratory, cardiovascular, gastrointestinal, renal and endocrine physiology. Practise: Cell, Respiratory, Cardiac, Gastrointestinal, Renal, Endocrine, Blood Physiology & Pathology |
| Pharmacology | 24 | 13% | Cardiovascular, respiratory and central nervous systems, infections, endocrine, fluids and electrolytes, musculoskeletal, immunological products and vaccines, anaesthesia. Practise: Cardiology Pharmacology, Respiratory pharmacology, CNS Pharmacology, Anaesthesia pharmacology, High Yield Pharmacology |
| Microbiology | 17 | 9% | Principles of microbiology, pathogen groups. Practise: Microbiology |
| Evidence-based medicine | 10 | 6% | Statistics, study methodology, principles of critical appraisal. Practise: Evidence Based Medicine |
| Pathology | 9 | 5% | Inflammatory and immune responses, infection, wound healing, haematology. Practise: Pathology, Blood Physiology & Pathology |
| Total | 180 | 100% | 3 hours |
Source: RCEM MRCEM Primary Regulations and Information Pack. RCEM can revise the blueprint, so check before you sit.
What matters most
- Anatomy and physiology: 120 of 180 marks (67%). This is where the exam is won. Make sure you know every region and every system.
- Pharmacology: 24 marks (13%). The next biggest block, spread over many systems. Know drug mechanisms, side effects and interactions. Start with high-yield pharmacology and anaesthesia pharmacology.
- Microbiology: 17 marks (9%). Organisms, how they cause disease, and which drugs treat them. Microbiology questions.
- Evidence-based medicine: 10 marks (6%). Small, but the same ideas come back every time: statistics, study design and critical appraisal. Easy marks if you practise. Evidence-based medicine questions.
- Pathology: 9 marks (5%). Inflammation, immunity, infection, wound healing and haematology. Pathology questions.
MRCEM Primary pass mark and pass rate
There is no fixed pass mark. RCEM sets the pass mark for each sitting with the Angoff method. A panel of emergency medicine consultants judges, for every question, what share of just-passing candidates would get it right. The total of those judgements is the pass mark for the Primary. Because each paper has different questions, the pass mark changes a little each sitting.
In RCEM's own worked example, the Angoff total was 107.1 out of 180, which is about 60%. If a question is withdrawn after the exam, it is removed from both your score and the pass mark.
Pass rate: in 2024, 2,770 of 4,824 candidates passed the Primary (57.4%). In 2023 it was 58.0%.
What to aim for: since the pass mark sits around 60%, aim to score well above that in your mock exams before you sit, so a hard paper does not catch you out. This is our advice, not an RCEM rule.
Sources: RCEM, Setting the Pass Mark: the Angoff Method Explained; RCEM Exam Pass Rate Report 2024.
Who can sit it, and how many times
- Eligibility: a primary medical qualification accepted by the General Medical Council (GMC) for registration. Doctors registered outside the GMC upload their current registration when they apply.
- Attempts: a maximum of six. Attempts at the old FRCEM Primary after August 2016 count towards them.
- Currency: a pass stays current. If RCEM ever replaces it, holders get at least 24 months' notice.
- UK Foundation doctors may sit it from Foundation Year 1.
- Results come out about five weeks after the exam, in your RCEM account. They are not given by phone or email.
Source: RCEM MRCEM Primary Regulations and Information Pack. Rules can change, so check the current pack and the RCEM exam calendar for dates and fees before you apply.
Questions people ask
What is the MRCEM Primary?
The MRCEM Primary is the first of the three MRCEM exams set by the Royal College of Emergency Medicine (RCEM): Primary, then the SBA (Intermediate), then the OSCE. It tests the basic sciences that emergency medicine is built on.
What is the format of the MRCEM Primary?
One paper of 180 single-best-answer questions in 3 hours. Each question has five options and one best answer.
Which subjects does the MRCEM Primary cover?
RCEM's official blueprint has 180 questions: anatomy 60, physiology 60, pharmacology 24, microbiology 17, evidence-based medicine 10 and pathology 9. Anatomy and physiology together are 120 of the 180 marks, two-thirds of the paper.
What is the pass mark for the MRCEM Primary?
There is no fixed pass mark. RCEM sets it for each sitting with the Angoff method: consultants judge how a just-passing candidate would do on every question, and the total of those judgements is the pass mark. In RCEM's own worked example the Angoff total was 107.1 out of 180, about 60%. It changes a little each sitting.
What is the MRCEM Primary pass rate?
RCEM's 2024 pass rate report shows 2,770 of 4,824 candidates passed the Primary in 2024 (57.4%), and 58.0% passed in 2023.
When are the MRCEM Primary exam dates and fees?
RCEM publishes dates, fees and eligibility for each sitting on its exam calendar page. They change every year, so check rcem.ac.uk before you apply.
Practise for it: 50 MRCEM Primary questions free
Every question has a full highlighted explanation. No card needed.