CTR – Choosing a topic for the FCEM

Want to be a consultant? Well if you do you need to pass the FCEM (Fellowship of the College of Emergency Medicine) and that means that you are going to have to write a CTR (Clinical Topic Review).

So what’s the point of the CTR exactly? Well, the original reasons a probably lost in time, but it seems to me that the purpose is for candidates to demonstrate that they can produce an academic piece of work before becoming a consultant. I think this is reasonable as if the speciality is to develop (and we are still pretty young you know) we need consultants that can shape a question, research a question, synthesise the evidence and come to a workable conclusion.

That’s what consultants (should) do – so it’s fair to be examined on it in my opinion. At this point I should declare that I am an examiner and therefore potentially brainwashed and biased. The views here are entirely my own and do not necessarily reflect the college view. In fact in places it might contradict it! No matter, it’s my view alone and you are welcome to take it or leave it.

So, the exam says that you must write a 3500 word essay on a subject of your choice. So what are you going to talk about? Obviously this is entirely up to you, but you may wish to consider the following points, and bear in mind that choosing a topic for a CTR is a bit like choosing a name for a child, you need to get it right or it will burden the child/CTR with all sorts of problems. So, let’s have a think and compare choosing a name for a child and a topic for the CTR. First we need a child…..

1. Be wary of choosing something weird. Naming your child Fifi Trixibelle will certainly be interesting, but unless you are very rich they will be bullied at school so don’t do it. Similarly choosing something incredibly rare, or not relevant to emergency medicine is going to make it difficult to answer questions related to ‘how would you impliment this knowledge in practice’. If you work in Scarborough, don’t do a CTR on the management of Tarantula bites.

2. Do you want your child to have a common name? Well perhaps, John is a nice name, but there are a hell of a lot of them around. They will not stand out that much and it’s going to be very easy to compare and contrast them with all the other Johns out there. So you don’t want weird, and you don’t want common when naming your child. Similarly, if you write a CTR on Ketamine (there have been more than 2 and less a million in recent years) it will not stand out and it will be easy to compare. I’ve seen Ketamine considered at all ages and pretty much via every route possible except rectal (though that may have been covered in the body packing one – I cannot remember). Anyway, it’s fab to do something topical, but following the trendy crowd may not be the best plan.

3. When naming your child you will be asked why you chose that name. There is usually a reason that goes beyond that of ‘because we liked it’, you want to be able to say something about the name and why it came to you. There should be a real story behind it that you can share with family and friends. Names really should mean something and it’s great when they originate from a real story. Similarly with CTRs they are much easier to write and engage with if they originate from something tangible and memorable. If your topic does not arise from your real clinical practice you are unlikely to be passionate and interested in it, and if you aren’t it will be painful and tedious to write. Choose a topic that was born from a genuinely interesting personal experience. If you do it will be so much easier to read about, research and write.

4. It might be an idea to test your prospective baby’s name with family and friends. You will get different opinions but look out for the following responses regardless of whether you are discussing a name or a CTR topic.

  1. That’s lovely (good response)
  2. Oh, my cousin, SpR, brother, colleague,  uncle, aunt (?) have the same name (hmm, a bit common then)
  3. Good to hear a very traditional name (boring)
  4. Really? (not a good response)
  5. Is it a boy or a girl? (a really bad response)

5. A name creates an impression and some of this is based on how much is associated with it. For a baby it is probably unwise to call them Hitler as there is a lot of bad press associated with this. You want good literature to be associated with the name so something like ‘Emma’ reminds me of Jane Austen so there will be something to talk about which is good. There will be high quality literature associated with the name, but not too much (let’s not do Kylie), and not too little (so not L-a then).

6. Lastly, choose something that you are happy with. Try the shouting test. Would you be happy to holler the name across the playground? Would you be happy to introduce your CTR at the viva with pride and confidence. You should so give it a try with family/colleagues.

7. Make it sound like a person’s name. Sure you can call your baby Banana, but it’s a bit stupid. It’s not wrong, and if you want your child to be asked ‘is that really a proper, appropriate name’ for the duration of their education (until they get to an age where they can change it), then sure go right ahead. Similarly, remember that CTR stands for Clinical Topic Review, and although the college says that you can do it on a management subject…why would you? You’ll just make it difficult for yourself and make it trickier for the examiners to give you marks. You wouldn’t want to give your child a hard time because of their name, so don’t do the same to your CTR.

So there we are, choosing a CTR topic is almost as hard as choosing a baby’s name and sadly those of us with Y chromosones cannot delegate the CTR task in perhaps the same way that we did when choosing a child’s name. It’s worth taking some time over this, chatting with colleagues and running a few ideas around your consultants and friends, take your time and get it right, you could waste a lot of time by setting off on the wrong foot.



Simon Carley


PS. Did you get L-a?? I suspect you thought this was Lea, we certainly did, but no the child’s mother informed us that  it’s Ledasha. Honest!

PPS. That’s a picture of Emma our youngest daughter in this post. We think it stands up to the criteria above.

PPS. Other rules for babies that don’t apply to CTRs. No ex-girl/boyfriend names. No ex-pet names (although Rover would be a great boy’s name IMHO).

Cite this article as: Simon Carley, "CTR – Choosing a topic for the FCEM," in St.Emlyn's, September 9, 2012, https://www.stemlynsblog.org/exams/ctr-choosing-a-topic-for-the-fcem/.

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