CTR – How to put it together for FCEM.

Estimated reading time: 4 minutes

There’s a big bundle of CTRs (Clinical Topic Review) in my pigeon hole this morning, all freshly printed and pristine ready for marking at the next FCEM exam. I’ve not opened them yet, but since the topic is on my mind it’s time for the second installment on getting your CTR ready for the FCEM.


Ok folks, so I am going to presume that you have decided on a topic for your CTR. You will have considered this with as much care as you would if choosing your first born child’s name. You cherish it, love it, want to spend more time with it and will no doubt be boring everyone else with the story of why it is as it is. Fantastic. If you’re not enthusiastic at this stage then you are stuffed. So, let’s think about how you are actually going to go about getting your CTR together, basically how do we move from idea through to submission.


The first thing is to admit to yourself and others that this is something that you cannot do alone. You are going to need help and support and you will need to bounce ideas off people as you progress. That’s not to say that writing a CTR is a team effort (there are rules about that sort of thing) but rather you will almost certainly get so close to the subject that sometimes you will not be able to write coherently for someone who does not share your passion for the topic. Remember that an examiner is going to have to make sense of your topic, and although all examiners are brilliant (obviously), it never hurts to make it easy for them to give you marks.


We’ve already mentioned the issue of time. There will not be enough time – ever. You need to start early and certainly be giving your CTR topics a lot of though at least a year before the exam…really?? That long?? Well yes, if you look at the flow diagram below you will see that there are a number of loops in here that could really catch you out. In particular the final loop from ‘any good?’ all the way back to ideas is a killer. I’ve had several trainees come to me with a week to go to submission for ‘a quick look at my CTR’, and I’ve had to tell them that I think it’s going to fail (I’m 100% sensitive and specific on this test thus far). They have effectively wasted their time up to that point, plus a load of cash on an exam entrance fee that they have no chance of passing.

So what can we suggest? If you bob back to the flow diagram just try and assign a time period to each of the steps to do it WELL. How long do you think it will realistically take you to get through all the stages, remembering that you should be talking about and discussing your ideas and concerns as you go along with colleagues and your trainer? I reckon about 3-4 months is a minimum time for someone who has not done this sort of work before, may be more if it’s the very first time……and the worst case scenario is that you might have to do this twice if the final test fails. So, believe me that you should start at least a year ahead? It’s true. You want this done in good time so that you can concentrate on other aspects of the exam.




Before you go please don’t forget to…





Cite this article as: Simon Carley, "CTR – How to put it together for FCEM.," in St.Emlyn's, September 19, 2012, https://www.stemlynsblog.org/ctr-how-to-put-it-together-for-fcem/.

5 thoughts on “CTR – How to put it together for FCEM.”

  1. Great pearls, Simon. In my experience, possibly the biggest mistake people make is to underestimate how long it takes to do a CTR. I think all trainees should have a 3-part question in place within the first 6 months of ST4. I’d recommend running a couple of Best BETs to get a feel for it, then maybe select your favourite as a CTR topic.

    The original work has been really badly done by many people for years. Times are changing now – and simple online surveys that are poorly designed and have unclear objectives are just not going to cut it.

    My advice… Get senior input early, particularly from your educational supervisor, but also consider asking other people with academic expertise. Plan early – definitely no later than ST4. You just can’t get a reasonable piece of original work done without good planning.


  2. Cant we just get shut of the CTR. I find it stifles doctors from following areas of interest because of the workload and time in conjunction to the pressures of the job. The only thing the CTR has done for me is made me miserable, not follow other areas of interest and put me of research for life.

    1. Hi Peter, the problem is that ‘we’ can’t as neither of us are in a position of power in that regard. It’s really up to the college and in particular the Dean (now Kevin Reynard from Leeds).

      I do feel your pain though, I’ve seen many trainees tackle the CTR without really knowing what they are trying to achieve. In fact the main reason I became an examiner was when a few of us sat down some years ago and moaned about why good candidates were not passing the exam. We felt that one of us had to become an examiner in order to learn the system….it was me with the short straw! Having said that I’ve learned loads from getting into the exams system and the aim of these posts in the blog is to try and share what I have learned with the people who matter – i.e. the trainees.

      The more I can do to make the system transparent the better people can prepare, though I hope you appreciate that these are unofficial pieces of advice based on my opinion – they are not the official college view.

      So, I genuinely hope that you get something out of the process, even if it’s just getting it finished 😉

      Good luck and best wishes,


  3. Simon,
    Unusually I disagree with you – I have no power either!

    I agree on everything else. The CTR is more than an academic exercise. It is project management, with all that entails, as well. Planning and working to deadlines is important. The FCEM review will report soon. This will, coupled Will Townend’s Assessment group and discussions surrounding new and alternative routes to CCT, result in changes to training, assessment and examinations. I think the CTR will remain an option, but it maybe that a quality improvement project undertaken in the workplace is the preferred route to demonstrate academic, problem solving and project management skills. The Australians have a similar option approach to their research element of FACEM whereby they can do a taught course in research methodology or similar (I think).

    In terms of preparation I agree entirely. Formulating a question on a topic that enthuses you is key. Ensuring that question is answerable is equally important. I recommend a quick search to see what evidence is there- aiming for 6-10 good quality papers. If necessary refine question to reduce number of papers. If only one RCT then however good your idea is you will find it difficult to accrue all the marks for critical appraisal and synthesis of evidence.

    When writing the CTR I agree with Simon- make it difficult for examiners not to give you marks! Signpost the sections of your CTR using the headings in the mark document.

    Plagiarism is an important and increasing issue 9perhaps just because we are better at identifying it). Make sure you know what plagiarism is and protect yourself from any accusation in this regard.

    Lastly whilst gaining advice is important- remember it is your CTR, and too many different sources of advice may render your CTR incoherent. Seek targeted advice early for specific issues, at a midpoint for review of a good completed draft (when there is still time to press the abort button if necessary) and presubmission for proof reading. Whilst spelling and grammar maybe a ‘halo’ issue- it will influence the examiner.

    1. Kevin, it’s fantastic to hear from you and to get your contributions. Your points are well made and certainly add to the blog post.

      I’m really looking forward to hearing from Will and yourself about potential changes and would of course be happy to help publicise them here.


      PS Hope you like the St.Emlyn’s blog 🙂

Thanks so much for following. Viva la #FOAMed

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