There is no central ACEM selection interview. Trainees are employed by hospitals and networks, so the interview is run by the emergency department that will employ you, under state merit selection rules, mapped to the selection criteria and the ACEM curriculum domains. The panel is usually two or three FACEMs and a nurse manager, about thirty minutes, with the same questions to every candidate. Because the curriculum domains are shared, the questions are similar across departments. This guide covers the ones that come up almost everywhere.
Motivation and suitability
- Why emergency medicine, and why this department?
- What makes you suited to a career in emergency medicine, and what will you find hardest?
- What do you know about the ACEM training programme, its examinations and what it will require of you?
- Emergency medicine has high rates of burnout. How will you sustain a long career in it?
- What would you bring to the department's teaching, quality or research work?
The burnout question is not rhetorical. FACEMs ask it because they have watched colleagues leave, and they want a real strategy: shift patterns and recovery, life outside the department, what you would do if you noticed the signs, and what the department can do. Candidates who say they thrive on the pace read as not having thought about it.
The resus scenarios
The clinical scenario is the heart of the interview and it is pitched at the registrar running resus:
- The hypotensive, tachycardic, drowsy patient with no history, then free fluid on ultrasound.
- The motorcyclist after a high speed crash: lead the primary survey, then absent breath sounds on the left.
- The three year old with fever, a non blanching rash and a prolonged capillary refill.
- ST elevation two hours from a cath lab.
- The tiring asthmatic saturating 88 on high flow oxygen.
- The intoxicated, combative patient with a head injury brought in by police.
- Heavy bleeding at thirty weeks of pregnancy.
- The snake bite in a regional department.
- The patient who needs retrieval and the retrieval team is two hours away.
Answer as the team leader: the primary survey, the immediate interventions, who does what, the decision, the escalation and the retrieval conversation, and the communication with the patient or family. In a regional department say what you would do during the wait.
Department flow and ethics
- The waiting room is full, ambulances are ramped, and a frail patient in the corridor is deteriorating. How do you prioritise and escalate?
- A patient who has taken an overdose wants to leave.
- A fifteen year old asks for emergency contraception without her parents knowing.
- A colleague discharged a patient you think should have been admitted, and they return much worse.
- An Aboriginal patient wants to leave before their work up is complete.
- Police ask for information about a patient.
The flow scenario is a leadership question: how you triage the department, who you escalate to, how you protect the corridor patient, and what you do about the ambulances. The others test capacity, confidentiality, safeguarding, cultural safety and professionalism. Work through patient safety, information, escalation and support, and give the next step when the first fails.
Teamwork, errors and cultural safety
A multidisciplinary teamwork example, a conflict, an error you made and what changed, and what cultural safety means for an Aboriginal patient who is frightened of the hospital. STAR form, your own actions clear.
Preparing
List the ten resus scenarios and talk each through as the team leader, with the retrieval conversation where it applies. Write a one minute answer for each motivation question, including an honest one on burnout. Then practise the flow and ethics scenarios with someone who asks "and if they still want to leave?". Find out whether your department runs a panel or stations, because some do, and practise in that format.