ERPM (ACT 16 Exams)

Examination for Registration to Practice Medicine in Sri Lanka (ERPM)

• Compulsory Examination for Registration to Practice Medicine in Sri Lanka (ERPM) / ACT 16 Exams.
• The purpose of the ERPM examination is to assess:
  • Whether a candidate can approach medical practice with the appropriate intellectual skills of enquiry, clinical reasoning, critical thinking and decision making
  • Possessing sufficient knowledge of the basic and clinical sciences, and an understanding of the underlying principles of the scientific method and the ability to create a differential diagnosis and rationalize a treatment plan for common clinical situations prevalent in Sri Lanka.

Objectives of ERPM

• To assess

1. 1. The core knowledge in clinical subjects with particular reference to problems prevalent in Sri Lanka.
   2. The skills and competencies required to bear the responsibilities as a preregistration house officer (intern medical officer).

• Eligibility

1. 1. Should be a citizen of Sri Lanka
   2. Should possess an MBBS degree or equivalent qualification obtained from a foreign medical school recognized by the SL (degree recognition certificate)

Composition of the ERPM

There are four parts: Parts A, B, C and D

• ERPM Part A  : The theory component containing True/False type (T / F) multiple choice questions (MCQ) and Single Best Answer (SBA) questions in the subjects of Medicine with Psychiatry, Paediatrics with Psychiatry, Surgery and Obstetrics & Gynaecology.
• ERPM Part B : An interactive assessment in clinical/practical problems in the subjects Medicine, Paediatrics, Surgery and Obstetrics &Gynaecology.
• ERPM Part C : An oral examination on Emergency Medicine in the subjects of Medicine, Paediatrics, Surgery and Obstetrics &Gynaecology.
• ERPM Part D : The theory component containing True/False type multiple choice questions in the theoretical and practical aspects of Community Medicine and Forensic Medicine.
  • The detailed curriculum for each of these subjects and sample questions are available on the website of the SLMC at www.mc.lk and www.srilankamedicalcouncil.org
  • The examination will be conducted in English. Interaction with examiners will be in English. Interaction with patients however may be in Sinhala or Tamil or English. Interpreters or translators will not be provided. However if any candidate has difficulties in communicating with the patients due to language barriers the examiners may make suitable arrangements to facilitate history taking etc.
  • The ERPM (Part A and Part D) will be conducted in paper format as at present or in the future after due notice in electronic or other format.

Transition from old to new format ERPM

• The candidates who have sat the ERPM under the previous formats of the examination may complete the ERPM as follows:

1. 1. Written papers in clinical subjects: Those who have passed individual papers in Medicine, Paediatrics, Surgery and Obstetrics and Gynaecology under the previous format ERPM can fit into the Track pattern as stated above.
   2. Community Medicine and Forensic Medicine: The written papers will be conducted as stated in the section referring to Part D. The concession given to those who have passed the former combined paper or written papers in any previous formats of ERPM by way of two options has ceased to operate after the ERPM Part D conducted in October/November 2015 and only the modified new format ERPM will be conducted from 1^st January 2016.

ERPM Part A

• Theory examination in medicine with psychiatry, paediatrics with psychiatry, surgery and obstetrics & Gynaecology
• The theory examination consists of both True/False type Multiple Choice Questions (MCQ) and Single Best Answer (SBA) type questions.
• Core knowledge will be assessed through T/F MCQs. The candidate’s ability to solve basic clinical problems and interpret data including laboratory results in a given clinical setting will be assessed through SBA questions.
• The theory examination has 2 tracks. Each track has 2 papers:
  • Track 1 : Medical Track
    • Paper 1 (Medicine including 4 questions in adult psychiatry)
    • Paper 2 (Paediatrics including 4 questions in child psychiatry)
  • Track 2 : Surgical Track
    • Paper 3 (Surgery)
    • Paper 4 (Obstetrics and Gynaecology)
• Details of papers, questions and pass marks:

• Candidates are required to sit (as per notice announced on 14th February 2017):

1. 1. All the subjects of ERPM (Part A) at the first attempt.
   2. Together in subsequent attempts all the subjects NOT passed or the subjects previously failed in each of ERPM (Part A).

• The requirements to pass Part A are tabulated below.
• Completing these requirements will qualify a candidate to sit Part B and Part C. 
• Options in sitting ERPM and requirements to pass part a

Eligibility to sit ERPM Part B AND Part C

1.  A candidate who has passed in the subjects of Medical and Surgical Tracks of ERPM (Part A) is permitted to sit both tracks of Part B and Part C if a minimum mark of 112.5 of 250 marks (45%) is obtained in each paper of each track.
2. A candidate who has passed Part A of only one track is permitted to sit Part B and Part C of the relevant Track only when a minimum mark of 112.5 of 250 marks (45%) is obtained in each paper of the Track.
3. A candidate who has passed a single paper in Part A of Track 1 or Track 2 is permitted to sit the two relevant stations in Part B and sit the corresponding Track of Part C only after passing the remaining paper of the relevant track in Part A by obtaining a minimum mark of 112.5 of 250 marks (45%).

• Note:
  • With effect from 1^st March 2017 only the above regulations will operate in conducting the ERPM Part A.
  • Those who have previously passed individual papers in Medicine, Paediatrics, Surgery and Obstetrics and Gynaecology under the previous format of the ERPM can fit into the Track pattern as stated above.

ERPM Part B (Clinical examination)

• The clinical component comprises of 4 Subjects, and each Subject has 2 stations.
• Medicine and Paediatrics will be in the Medical Track while Surgery and Obstetrics & Gynaecology will be in the Surgical Track.

• The evaluation will be based on marks awarded for:
  • Demonstration of skills listed against each station.
  • These include history-taking, problem identification, physical examination identification of abnormal signs, differential diagnosis, patient management and communication skills.
• The examiner will award marks on the basis that the pass mark (minimum expected standard) for each station is 50%.
• Each station will have 2 examiners who will award marks independently.
• The total mark awarded by each examiner for all skills evaluated at the station will be the total mark (out of 100) for the station.
  • The final mark obtained by the candidate for each station (out of 100) will be the average of the total mark awarded by each examiner for the station.
  • Example:  Station 1
    • Examiner 1: 60 / 100
    • Examiner 2: 50 / 100
    • Final mark:   55 / 100

Requirements to pass Part B (Clinical Examination)

• Candidates should pass all subjects (Medicine, Paediatrics, Surgery and Obstetrics & Gynaecology) to complete ERPM Part B.
• In order to pass each Subject a candidate must obtain:
  • A minimum final mark of 45 / 100 (45%) for each station AN
  • A minimum of 100 marks out of 200 (50%) for the two Stations of the subject.
  • A candidate who has a minimum of 100 out of 200 marks from the two stations of a subject but has scored less than 45% for one or more stations will be required to sit the whole Subject (both stations) of Part B to qualify at a repeat attempt.
• Candidates are required to sit (as per notice announced on 14th February 2017):
  • All the subjects of ERPM (Part B) at the first attempt since qualifying from the Medical and Surgical Tracks of ERPM (Part A).
  • In subsequent attempts all the subjects which were NOT passed or the subjects previously failed in ERPM (Part B), except those where the candidate is not qualified to sit by NOT passing the relevant subjects in ERPM (Part A).
  • The relevant subjects(s) which a candidate has failed in the current attempt, only in a subsequent attempt
  • Both stations of the subject(s) in a subsequent attempt if a candidate fails a subject(s) due to a score of less than 45% for a station(s) in the current attempt although the score for the subject(s) has been more than 50%, as he/she shall be considered as failing that subject(s).
• Note: With effect from 1^st March 2017 only the above regulations will operate in conducting the ERPM Part B.
• Those who have previously passed individual subjects in Medicine, Paediatrics, Surgery and Obstetrics and Gynaecology under the previous format of the ERPM can fit into the Track pattern as stated above.

ERPM Part C: Oral examinations

• This part is composed of two tracks (Refer Item 5 for eligibility to sit the ERPM Part C).
  • Track 1 : Oral examinations in emergencies in Medicine and Paediatrics will be conducted by a panel consisting of an Examiner in Medicine and an Examiner in Paediatrics, for 20 minutes.
    • Each examiner shall mark the performance of the candidate independently out of 100 marks.
    • The final mark obtained for the Medical Track of Part C (out of 100 marks) will be determined from the average of the marks awarded by the two examiners.
  • Track 2 : Oral examinations in emergencies in Surgery and Obstetrics & Gynaecology will be conducted by a panel consisting of an Examiner in Surgery and an Examiner in Obstetrics & Gynaecology, for 20 minutes.
    • Each examiner shall mark the performance of the candidate independently out of 100 mark.
    • The final mark obtained for the Surgical Track of Part C (out of 100 marks) will be determined from the average of the marks awarded by the two examiners.
• Requirements to pass Part C :
  • A candidate has to obtain 50 out of 100 marks (50%) at the Part C oral examinations in Emergencies in Medicine and Paediatrics.
  • A candidate has to obtain 50 out of 100 marks (50%) at the Part C oral examinations in Emergencies in Surgery and Obstetrics & Gynaecology.
• Note: 
  • With effect from 1st March 2017 only the above regulations will operate in conducting the ERPM Part C.
  • Those who have previously passed individual Medical Track (Emergency Medicine and Paediatrics) and Surgical Track (Emergency Surgery and Obstetrics and Gynaecology) under the previous format of the ERPM can fit into the Track pattern as stated above.

ERPM Part D. Community medicine and forensic medicine

• Part D will continue to consist of two written papers with Multiple Choice Questions of the True/False type.
  • Paper 5 – Community Medicine comprising 30 T/F MCQs
  • Paper 6 – Forensic Medicine comprising 30 T/F MCQs
  • Duration: 90 minutes for each of Paper 5 and Paper 6.
  • Each question will have 5 responses.
  • A correct answer will score +1 and a wrong answer -1.
  • Negative marks will not be carried over.
  • Each paper will be marked out of a total of 150 marks and results presented as a percentage.

• Requirements to pass Part D :
  • In order to pass Part D, a candidate must obtain a minimum of 67.5 out of 150 (45%) in each of the Papers 5 (Community Medicine) and 6 (Forensic Medicine).
  • Those who have failed to obtain the mark of 67.5 of 150 (45%) for each paper in Part D would be required to re-sit the failed paper(s) in Part D in order to obtain the mark of 67.5 of 150 (45%) for each paper to complete ERPM Part D.
  • Note:
    • Candidates are required to sit (as per notice announced on 14th February 2017):
    • Both subjects of ERPM Part D at the first attempt.
    • Together in subsequent attempts both the subjects NOT passed or the subjects previously failed in each of ERPM Part D.

ERPM examination rules

• This Examination is limited to those who are eligible to sit, under Act No.16 of 1965 and Section 29(I)(b)(ii)(cc) of the Medical Ordinance, having fulfilled the requirement criteria.
• The format of the ERPM examination from 2014 and modified from 1^st March 2017 is presented in this document.
• The date to complete all Parts of ERPM (A, B, C and D) is five (5) years from the date of first registration. Those who complete would be eligible to obtain Provisional Registration with the SLMC to proceed to training as an Intern. (ref. conditions applicable to candidates registering for the ERPM before 1st March in the document stating “Arrangements for the ERPM from 1^st March 2017” which is displayed in the SLMC website).
• Every candidate who registers for an examination shall be deemed to have sat the examination unless he/she withdraws from the examination with proven valid reasons submitted to the Education Committee for approval of such withdrawal within the specified period (closing date for applications) or submits a valid medical certificate (MC) covering the period of absence before the end of the examination.
  • The medical certificate shall be from a medical practitioner registered with the SLMC. Such MC will require the acceptance of the Education Committee of the SLMC. The candidate may have to appear before a Medical Board appointed by the SLMC if the necessity arises.
  • Changing of the date, time, venue or centre of the examination by the candidate is not permitted and such requests shall not be entertained.
• Candidates shall be present at the examination hall at least 30 minutes before the commencement of each paper or clinical/viva voce examination, but shall not enter the hall until requested to do so by the supervisor.
• A candidate should have the Passport, National Identity Card or Driving License (to prove his/her identity)as well as the SLMC Registration Card and the Admission Card with the Index Number when entering the examination hall and on every occasion on he / she sits the examination.
  • Note :  Any damage or defacement or modification of Passport, National Identity Card, Driving License, Admission Card (including photograph) and the SLMC Registration Card will result in the candidate being disallowed to sit the examination and the incident subsequently subjected to an enquiry and due punishment given if found to be guilty.
• On admission to the hall, a candidate should occupy the allotted seat/place and should not change it except on the specific instructions of the supervisor.
• It is the sole responsibility of the candidate to sign the attendance sheet at the examination hall on each occasion before leaving the examination venue. Failure to do so would be considered as not having sat the examination.
• No candidate shall be admitted to the examination hall for any reason whatsoever after 30 minutes from the commencement of the examination. A candidate will not be allowed to leave the hall until 30 minutes has lapsed from commencement of the examination or during the last 5 minutes of the paper.
• Candidates shall bring their own pens, ink, erasers, pencils or any other equipment and stationery which the candidates have been instructed to bring for the written papers. A stethoscope, knee hammer, torch, pins, cotton wool and any other necessary equipment should be brought for the clinical examination. The candidate should wear a white overcoat for the clinical examination.
• Examination stationery, i.e writing paper, answer papers etc. would be supplied as and when necessary. No sheet of paper or answer book supplied to a candidate may be torn, crumpled, folded or otherwise mutilated. No other paper shall be used for answering by the candidate. Any materials supplied including question papers, whether used or unused, should be handed over to invigilators and should not be removed from the examination hall.
• Every candidate shall enter his/her Index number on the answer sheets and the question papers. A candidate who writes on his/her answer sheet an Index Number other than his/her own is liable to be considered as having attempted to cheat. A script that bears no Index Number or one that is not legible will be rejected. No candidate shall write his/her name or any other identifying mark on the answer script.
• Candidates are under the authority of the supervisor/coordinator/examiners and shall assist them by carrying out instructions as well as those of the invigilators and other supporting staff, during the examination and immediately before and after it. Candidates shall stop work promptly when ordered to do so by the supervisor/examiner/ invigilator.
• Every candidate shall hand over the answer scripts personally to the invigilator or remain in his/her seat until it is collected. On no account shall a candidate hand over the answer script to an attendant, a minor employee or any other candidate
• No candidate shall have on his/her person or on any document listed above, any notes, signs or formulae. Except for stationery such as pencils, pens erasers, identity documents, Index number cards and Admission cards, no other paper or envelopes should be kept with the candidate. No candidate shall have on his/her person, with him/her or anywhere near him/her any material such as books, notes parcels, handbags or any electronic communication equipment such as cellular phones, note pads etc. If a candidate has brought any of the above they shall not be permitted into the examination venue.
• A candidate should not communicate in any form with another candidate or any other person other than an invigilator or a supervisor during the examination.
• No candidate should copy or attempt to copy from any book, paper notes or similar material or from the scripts of or by communication with another candidate. A candidate shall not help another candidate or obtain help from another person. No candidate should conduct himself/herself negligently so as to provide an opportunity to assist any other candidate.
• Every candidate shall conduct himself/herself in the examination hall and precincts so as not to cause disturbance or inconvenience to the supervisors/examiners or other staff and to other candidates. A candidate is liable to be evicted from the examination hall for disorderly conduct.
• Absolute silence shall be maintained in the examination hall and its precincts. A candidate is not permitted for any reason whatsoever to communicate or have any dealings with any person other than the supervisor/examiner/invigilator. The attention of the supervisor/examiner/ invigilator could be drawn by raising a hand.
• During the course of answering a paper, viva voce examination or examining a patient, no candidate shall be permitted to leave the examination hall even temporarily. In the case of an emergency, the supervisor/examiner/invigilator will grant permission to do so but the candidate will be under surveillance.
• No person shall impersonate a candidate, nor shall any candidate allow himself/herself to be impersonated by another person.
• No candidate shall obtain or attempt to obtain by any means prior knowledge of questions/clinical cases/examination material or names of examiners. All examination centres are out-of-bounds for a specified period before and during the examination.
• Serious notice will be taken of any dishonest assistance given to a candidate, by any person aiding, abetting or copying at the examination.
• If circumstances arise, which in the opinion of the supervisor/examiner/invigilator requires cancellation or postponement of the examination; he shall stop the examination, collect the scripts already written and then report the matter as soon as possible to the Sri Lanka Medical Council (SLMC).
• The supervisor/examiner is empowered to require any candidate to make a statement in writing on any matter which may have arisen during the course of the examination, and such statement shall be signed by the candidate.
• The results of the examination announced by the SLMC will be final and no complaints or representations will be entertained regarding the results, except re-scrutiny of the papers of ERPM Parts A and D, which is officially permitted.
• Complaint(s) regarding the conduct of the ERPM examination should be sent in double envelopes to the Registrar by registered post before the release of the results.
  • The outer envelope should be addressed to the Registrar SLMC, 31 Norris Canal Road, Colombo 10. The inner envelope should contain the sealed letter of complaint stating “ERPM Complaint” and dated.
  • The complaint would be kept securely and acted upon in due course by an Appeals Board. Such complaint(s) shall be in writing and state precisely the grounds for such appeal(s). Anonymous complaints will not be entertained.

ERPM Results

• Requirements to pass the erpm and qualify for provisional registration
• To pass the ERPM and qualify to obtain provisional registration with the SLMC, a graduate with qualifications from a medical school overseas must meet the following criteria:

1. 1. Successfully complete Part A of ERPM by obtaining a minimum of 112.5 of 250 marks (i.e. 45%) in each of the Papers 1 (Medicine including Psychiatry), 2 (Paediatrics including Psychiatry), 3 (Surgery) and 4 (Obstetrics and Gynaecology).
   2. Successfully complete Part B of ERPM by obtaining a minimum final mark of 45 out of 100 (45%) for each station AND a minimum total of 100 marks out of 200 (50%) for the two stations in each Subject (Medicine, Paediatrics, Surgery and Obstetrics & Gynaecology).
   3. 3. Successfully complete Part C by obtaining 50 out of 100 marks (50%) at the oral examinations in Emergencies in each of the Medical and Surgical Tracks.
   4. 4. Successfully complete Part D by obtaining a minimum of 67.5 of 150 marks (45%) in each of Paper 5 (Community Medicine) and Paper 6 (Forensic Medicine).

• Note: As per decision of the Council on 20^th July 2018 the ERPM registration of all candidates will be terminated as specified above. Rejoining or continuation in the ERPM programme is then NOT permitted.

Order of merit for employment by the ministry of health

• Calculation for ranking by order of merit at ERPM will be performed taking into account the following details of each candidate who has passed in all Parts of the ERPM (A, B, C, and D).
• Candidates will be grouped according to the total number of attempts obtained by the addition of attempts at each of the ERPM Parts A, B, C and D.
• A grand total mark (out of 1200) is calculated by adding the highest mark scored for each component.

1. 1. Part A out of 400
   2. Part B out of 400
   3. Part C out of 200
   4. Part D out of 200

• The grand total mark obtained for all Parts of the ERPM is then used to determine the rank order within each group.
• The list of rank order according to merit is then forwarded to the Ministry of Health for appointment as Intern Medical Officers.

Compulsory training for candidates who fail parts A OR B

• There will be a compulsory clinical training course for candidates who cannot pass Part A or B of the ERPM in three attempts, before they are allowed to sit the ERPM Part A or Part B again.
  • After completion of the clinical training course, the respective Specialist who provided the training should certify attendance and satisfactory performance for the candidate to be eligible to sit the examination again.
• The compulsory clinical training course will be for one month in each clinical subject as appropriate: Medicine, Surgery, Paediatrics and Obstetrics & Gynaecology.
  • After the announcement of results of Part B, the SLMC will forward a list of names of the candidates who require training to the DDG.MS of the Department of Health.
  • The DDG.MS will identify the hospitals where training can be provided and assign these, as far as possible, according to the candidate’s preference.
  • The DDG MS will assign candidates to named Specialists in the identified hospitals, indicating the period of training.
  • The SLMC will issue a booklet to each candidate who has to undergo training.
  • This booklet must be initialed by the Specialist who provides the training to indicate satisfactory attendance and performance during training.

Also Read:

1. Guidelines to prepare for ERPM (ACT 16 Exams)
2. How to prepare for ERPM (ACT 16 Exams)?

Also Watch:

• Community medicine theory 1 MCQ discussion from the youtube channel “ERPM Sri Lanka”

• ERPM Pediatric emergency viva from the Youtube channel “Dr V & A Health tips”

Also read:

1. ERPM @ SLMC Website