The System of Examination in Emergency Medicine – Do We Need to Change?

Winston Churchill famously said, "To improve is to change; to be perfect is to change often." In Emergency Medicine-a speciality defined by urgency, uncertainty, and decisive action-this sentiment is particularly relevant.As educators and clinicians, we must ask an uncomfortable but necessary question: Does our present system of examination truly assess the competencies required of an emergency physician?Examinations influence how students learn.ey shape priorities, determine the depth of engagement, and ultimately define the kind of clinicians we produce.Yet, there is an important distinction between examination and evaluation.An examination measures performance at a single point in time.Evaluation is broader and longitudinal-it captures growth, professional behaviour, procedural competence, communication skills, and clinical judgment over time.In a fast-paced, high-stakes speciality like Emergency Medicine, this distinction matters profoundly.Essay-type questions have historically formed the backbone of postgraduate theory examinations.ey are relatively easy to construct and allow candidates to demonstrate recall, reasoning, and organisation of knowledge.However, their limitations are well recognised.Marking can be subjective, coverage of the syllabus is often limited, and performance may reflect writing ability more than clinical competence.A single long essay on acute coronary syndrome may test theoretical understanding, but it does not determine whether a candidate can recognise a subtle STEMI on an ECG or initiate timely reperfusion in real practice.Objective-type questions offer improved reliability and standardisation.ey are easier to score and reduce examiner bias.Yet, they tend to assess recognition rather than synthesis.ey rarely evaluate communication skills, professionalism, or the ability to manage dynamic, evolving clinical situations.Short answer and problem-solving formats attempt to bridge this gap but remain constrained by time and limited sampling.Given the vast scope of Emergency Medicine-from trauma and toxicology to obstetrics, paediatrics, disaster medicine, and critical care-traditional written examinations struggle to comprehensively assess the cognitive domain within the allotted time.e competency framework outlined by the National Medical Commission reflects the true breadth of Emergency Medicine practice.It includes prehospital care, resuscitation, procedural sedation, trauma management, organ-system emergencies, point-of-care ultrasound, medicolegal responsibilities, toxicology, and environmental injuries.Importantly, it also emphasises psychomotor skills-multiple defined procedural competencies-as well as affective attributes such as communication, leadership, teamwork, ethical reasoning, and professionalism.Can these domains be adequately measured through four written theory papers and a conventional