MRCEM Primary: Important Syllabus Update for April 2027

The Royal College of Emergency Medicine (RCEM) published a revised Basic Sciences Syllabus on 28 October 2026, following the October MRCEM Primary examination.

The new syllabus replaces the previous version introduced in 2010 and will apply to all MRCEM Primary examinations from 21 April 2027 onwards.

We have reviewed the revised syllabus against our existing MRCEM Primary revision resources. This announcement explains the main changes, additional topics candidates should consider during their preparation, and the updates we are working on.

The revised syllabus retains the same six core disciplines: Anatomy, Physiology, Pharmacology, Microbiology, Pathology and Evidence-Based Medicine.

Much of the underlying basic sciences knowledge remains unchanged. However, the syllabus has undergone several important revisions:

• New and expanded topics: Additional subject areas, drugs, organisms and knowledge requirements have been introduced.

• Changes to the scope of knowledge: Some previously specified exclusions or limitations have been removed, potentially broadening the knowledge expected.

• Reorganisation of content: Existing topics have been restructured, regrouped or presented under different headings.

• Changes to the level of detail: Some previously detailed requirements have been replaced with broader descriptions, making the precise depth of knowledge required less explicit.

These changes do not mean that the entire syllabus is new. Much of the existing material remains relevant, although candidates preparing for April 2027 and subsequent sittings should familiarise themselves with the updated requirements.

View the official RCEM Basic Sciences Syllabus

The revised syllabus introduces a number of additional topics and knowledge requirements, particularly within Pharmacology and Microbiology.

As our existing revision resources were developed around the previous syllabus, some of these areas may not yet be covered in full.

We recommend that candidates pay particular attention to the following topics and use supplementary learning resources where necessary.

General pharmacology and prescribing

A new section introduces broader prescribing principles, including:

• Pharmacokinetics and pharmacodynamics.

• Prescribing in children, older patients, pregnancy and breastfeeding, and patients with renal or hepatic impairment.

• Prescribing considerations relating to driving and palliative care.

• Medication safety, including important safety information, adverse drug reactions and reporting systems.

Poisoning and antidotes

A dedicated section now covers poisoning, toxidromes and specific antidote treatments.

Named treatments include activated charcoal, N-acetylcysteine, naloxone, flumazenil, sodium bicarbonate, lipid emulsion, digoxin-specific antibody fragments (Digifab), glucagon, insulin, methylene blue, fomepizole, ethanol, oxygen and desferrioxamine.

Additional therapeutic areas and drug classes

The revised syllabus introduces or expands requirements relating to:

• Hormonal treatments, including contraception and hormone replacement therapy.

• Endocrine emergencies, including adrenal insufficiency, pituitary disorders and thyroid crises.

• Pharmacological management of gastrointestinal bleeding, including terlipressin and octreotide.

• Alcohol dependence and withdrawal.

• Newer therapeutic agents, including GLP-1 receptor agonists.

• Electrolyte replacement, including potassium, sodium, magnesium and calcium.

• Additional emergency medications and drug classes, including noradrenaline, angiotensin receptor blockers, levetiracetam and disease-modifying antirheumatic drugs (DMARDs).

Antimicrobial prescribing and resistance

The revised syllabus places greater emphasis on antimicrobial stewardship, appropriate antimicrobial selection, empirical versus targeted treatment, mechanisms of resistance, and resistant organisms including MRSA, ESBL-producing bacteria and carbapenem-resistant organisms. It also explicitly includes antimicrobial prophylaxis, including HIV post-exposure prophylaxis.

Additional infectious organisms

The revised syllabus explicitly names a number of organisms that were not individually specified in the previous version.

These include:

• Bacteria: Listeria, Mycoplasma, Shigella, enterohaemorrhagic E. coli (EHEC), Proteus, Pasteurella, Vibrio vulnificus, Rickettsia, Haemophilus influenzae type b (Hib) and Treponema pallidum (syphilis).

• Viruses: SARS-CoV-2, Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19 and Zika virus.

• Other organisms: Toxoplasma.

The revised syllabus also reorganises organism-specific knowledge around clinical syndromes, rather than individual organisms.

This list highlights notable additions and expansions rather than every change to the revised syllabus. Some topics may already be covered within our existing resources, while others require additional or updated content. Candidates should refer to the official RCEM syllabus as the definitive guide to examination requirements.

Our review has established that much of our existing MRCEM Primary question bank and revision material remains relevant to the revised syllabus and continues to provide a valuable foundation for examination preparation.

However, we have also identified additional syllabus requirements for which our existing coverage needs to be expanded or updated.

We are working to bring our resources into alignment with the revised syllabus, including developing new questions and explanations, reviewing existing content against updated knowledge requirements, and making revisions where necessary.

We recommend that candidates continue to use MRCEM Success for their core revision, while supplementing their preparation with additional learning resources for topics that may not yet be covered in full.

Although we recognise the importance of these updates, particularly for candidates preparing for April 2027, we cannot currently guarantee that all additional content will be available before this examination.

We will keep this announcement updated as our content development progresses and clearly confirm when we are confident that our resources provide comprehensive coverage of the revised syllabus.

The MRCEM Success Team