This is the final boss. You may have vanquished many monsters and small bosses but this is the mega monster which will test you so you better bring your A-game to this battle. I gave just more than 2 months of my life to the preparation for this exam and here in this article, I will distill all the lessons I learnt, mistakes I made and the secrets I discovered which made the difference for me.
Before I immerse myself completely into this, I want to remind you that I also have a complete guide to the FRCR if you want a wider perspective on all parts of this exam and if you want a personalised account of my own journey, this is where you can find out.
Remember, this exam is a monster and it deserves your respect. The exam is designed to probe your weaknesses in every way and the viva examiners are experts in digging out these chinks in your armour. So you need to give it enough time and really know your enemy inside out. Now, let’s get to it.
Disclaimer: As always, I would like to point out that there are several links here which direct you to some products. The opinions are my own and I only endorse products and services that I personally like or have used myself. When you purchase through links on my site, I may earn an affiliate commission. Sometimes you may get a discount but you never have to pay more.
What is the exam all about?
The Final FRCR Examination is a three pronged radiology assessment, each with its own flair and panache. First up, we have rapid reporting, where you’ll have to swiftly decipher images. Then comes Longs reporting, where you have take apart 6 cases and prepare full reports. And finally, we have the oral examination, the part which scared me the most personally, where you’ll need the verbal finesse of a smooth-talking radio host to charm your way through. Oh, and since covid (or at least past few years), the entire process is digital – even the viva where the examiner is looking at your through a webcam as you try to talk your way through the cases. One of the biggest difference between this exam and the rest of it’s kin is that it has a fixed passing score. There is now annual or seasonal variation in the pass marks – theoretically every candidate can pass (or fail) in this exam.
Rapid reporting
This section tries to mimic what it’s like stepping into the chaotic world of an ER, where X-rays are flying left and right. Your mission, should you choose to accept it (spoiler alert: you have no choice), is to play a game of “normal or not?” with each image that pops up on your screen. This section deals ONLY with radiographs so don’t worry about CTs or MRIs here.
What is this section testing for?
It’s trying to see if you can confidently identify abnormalities when present and exclude them when they are not. It is a very close approximation of what real world radiology feels like and I personally really liked preparing for this.
How should you prepare for this?
Step 1: Get a hang of the type of cases in the exam. Approximately half of the images you’ll encounter are your everyday, garden-variety normal ones, while the other half are mostly trauma cases with a sprinkling of some chest and abdominal radiographs, just like you’d see on a typical day in the ER. Importantly, each abnormal case shows one significant diagnosable abnormality.
Step 2: Understand normal anatomical appearance including the effect of age and anatomical variants.
Step 3: Make a list of pathologies that you can expect in a particular study by using checklists. You can access some sample checklists here but one of the best pieces of advice I received from Dr. Sandeep Singh Awal was this –
“Make your own personalised checklist based on the mistakes your are making in your practice sets.”
Step 4: Practice, practice, practice. I recommend doing 20 sets in a week/3 sets a day on average.
Step 5: Identify what types of mistakes are you making. If you are missing findings, You are an Undercaller. Solution? Look up examples of that pathology online and train yourself to get better at recognising them. If you are marking normal studies as abnormal, you are an Overcaller. Solution? Train your mind to not second guess yourself. A really great piece of advice I received from Dr. Imran Lasker:
“If you are 100% confident about a pathology mark it abnormal but if there is even a 1% doubt, mark it as normal. Ask yourself this – Am I willing to bet my most prized possession on this? Only if you are, mark it abnormal. Or else it’s normal.”
Reporting (Longs)
What is this section testing for?
The reporting component recognises that radiologists largely communicate their findings in the form of written reports. This element tests the ability of the candidate to make a number of observations, distinguish the relevance of these findings, deduce a list of differential diagnoses, suggest the most likely diagnosis and discuss further management including further imaging where appropriate.
How are they doing it?
This part of the examination mirrors a mixed list of cross-sectional and fluoroscopic imaging and a short structured reporting sheet is provided. Each case can include any type of radiological imaging and often involves more than one e.g. plain film, CT and isotope study. This written element of the examination aims to test the candidate’s ability to assess and interpret a variety of clinical cases across all modalities safely, and to accurately communicate their findings, conclusions and recommendations.
Important things to remember about this aspect of the exam:
- It is widely considered the easiest component because it is most similar to what you do regularly as a trainee
- It is also the most commonly ignored section during preparation!
- Make sure you practice typing out atleast a few of these sets within the time limit (70 minutes) to make sure you are aware of what the exam conditions will feel like
- The examiners are not particularly bothered if you mention your inference in under the heading of your findings or one of your differentials in the provisional box – as long as you type clearly and correctly, you will be marked for everything you mention.
Oral examination
What is this section testing for?
The oral component further assesses the candidate’s powers of observation and interpretation, but in addition allows assessment of the candidate’s ability to discuss wide-ranging aspects of patient care as influenced by the radiological findings. This mirrors the day-to-day clinical discussions and MDT meetings, which form an integral part of a radiologist’s workload.
What do they want to see?
Candidates are expected to be able to integrate their observations with emerging clinical information to help refine their differential diagnosis. They are testing your ability to communicate effectively, their analytical and decision making skills, and use searching questions to explore your depth of knowledge and ensure that your practice supports patient safety. The format of the oral examination allows for flexibility and for complexity to be built into the examiners questioning and you’ll be surprised how similar to a “discussion” this viva feels like.
A few important factoids that I think need special emphasis:
- The examiners never trick you – they will never ask or say something that will take you farther from a diagnosis.
- We tend to worry about the time a lot. We fear the pregnant silence in the middle of a viva when we are stuck and the examiner peers at us unhelpfully but that is not a very common scenario. The examiners are aware that things can go wrong and a single case is not a true reflection of our abilities and they do try to take you through more cases to give you more chances to prove yourselves.
- Demonstrating a rational and safe approach is more important than getting to the diagnosis. The system wants you to be safe and avoid making serious mistakes but encourages you to ask for help when you are not confident about something – infact if you show that you are sensible and will ask for help and discuss with your colleagues, you may even score higher than if you just get to the diagnosis without adequately showing you you got there.
Timing and Fees: These exams happen three times a year – March, June and September/October. There are several important dates when bookings open and close. Take a look at this image from the RCR website. Plan well in advance so that life doesn’t get in the way.
How to start: Making a plan
First step: Are you ready?
Of course, if you are a trainee in UK (or similar system) then you are expected to attempt the exam core clinical radiology training (ST3 – ST4).
A general thumb rule for IMGS that can guide you towards an answer is your own performance in your clinical duties in your department. The timing can be different for everyone but if you have rotated through all modalities/subspecialties at least once and are on the on-call rota, you can take this exam. Mid third-year is a great time to take this exam as you have enough time to get ready for this and passing this equips you with some of the ammo you need to pass your board exams in your own country like the MD/DNB exams in India.
Membership: If you haven’t already become a member before your first FRCR exams, do think about taking the RCR membership for two reasons.
- As you can see above, the booking dates open a few weeks before for members.
- The fees are lower for members – of course, you should balance it against the membership fees itself but usually, you end up saving on fees.
How much time does it take?
This is a deeply personal question because it depends on the baseline skill and knowledge of a candidate as well as how many hours they are devoting to studying each week. To keep things simple however, without going too deep into a philosophical discourse, in my opinion 10-12 weeks of prep time should put you in a good position if you are devoting roughly 30 hours per week. Of course, it take take you longer or shorter depending on your level of genius (or lack thereof).
Marking system and Passing scores
Part of making a strategy is to have adequate knowledge about the scoring system and the passing marks. I have taken screenshots from the RCR website.
Rapids
Summary: 30 questions each worth 2 marks – full marks of 60 which translates to 8. The passmark is 54 which translates to 6 out of 8.
Longs
Summary: 6 Long cases each worth 8 marks for a total of 48 marks which translates to 8 marks overall. The pass mark is 6 which can be anything between 34.5 and 37.
Orals
Summary: If you reach the primary diagnosis yourself without making major mistakes – you get a 6. If you need help getting there you get between 5 and 6.
Passing Flowchart
Summary:
The pass mark in each component is 6 out of 8, making the overall pass mark 24 out of 32. This is fixed. Unlike the other exams, this does not change with question severity or performance of other candidates.
In addition to achieving a score of 24 in total, candidates must obtain a mark of 6 or above in a minimum of two of the four components
Books:
You do not need a textbook. Do NOT overthink this.
What you need are question books and most such books are created equal. Having said that, if you are in the shop for one of my recommendations, I will recommend my favourite books that I personally used.
Oral books
Final FRCR Part B Viva: 100 Cases and Revision Notes (Link: United Kingdom, India)
- My favourite viva book
- 100 high yiled viva cases with top notch explanations
- Concise revision notes accompanying the model asnwers
FRCR 2B Viva: A case-Based Approach (Link: United Kingdom, India)
- This book is great for developing a script on how to speak when dealing with different types of cases
- Explanations are quite good
Final FRCR 2B Viva: A Survival Guide (Link: United Kingdom, India)
- Excellent collection of High yield cases with a focus on how to approach different types
- The explanations and discussions help you prepare for the inevitable discussion during a viva
Chapman & Nakielny’s Aids to Radiological Differential Diagnosis: Expert Consult (Link: United Kingdom, India)
- Comprehensive lists of differential diagnoses for quick reference when preparing for viva cases
- The top differentials in each list are the ones the examiners are going o expect you to discuss
- Important discriminating features at a glance helps to remember these
Longs books
I personally did not use a book for long cases because I had a Revise Radiology Subscription (more about that below) but if you want to use a book, I read this book partly and found it to be quite good.
Final FRCR 2B Long Cases: A Survival Guide (Link: United Kingdom, India)
- 60 illustrated long cases and answers arranged in 10 sets of 6 cases each
Rapids books
Accident and Emergency Radiology: A Survival Guide (Link: United Kingdom, India)
- This is the best book to prepare for the rapids.
- Very comprehensive, focuses on important testable areas
- Easy to revise before the exam
Paediatric Radiology Rapid Reporting (Link: United Kingdom, India)
- This is an additional book for those who require practice with peds images
- Excellent collection of cases with detailed explanations
Online resources – Revise Radiology Subscription
I heavily depended on Revise Radiology for my preparation. I personally favoured the FRCR 2B combined subscription which covers both the viva and the written component because I realised pretty early on during my preparation that I needed all the help I can get and I personally was not looking forward to taking different subscriptions from different services. I have a full review of Revise Radiology here but I will share some of the highlights here.
- They have several offerings – online subscriptions and courses (both online and offline) for all steps of the FRCR
- I used the FRCR 2B combined subscription which gave me access to 80 Curated Rapid Reporting sets, 30 Long case Packets, 100 viva spotters packets (3000 spotters total), On-demand videos of 200+ hours of FRCR teaching webinars, 4 x Study Group sessions online per week, 6-12 hours of viva format teaching per month.
- The study groups are my favourite feature. I didn’t have a friend or colleague taking the exam with me but the study groups ensured that I had a whole bunch of people in a similar situation with whom I regularly had very productive discussions. I went from having a very rudimentary idea of what was expected of me in the vivas to becoming very confident in presenting my cases.
- I also found most of the Rapid Reporting and Long Case packets to be very high quality, especially the 180 long cases with fantastic “8-mark” model answers also help you to level-up
Disclosure: I should disclose that I teach a course on Written Component of FRCR in association with Revise Radiology which you can find out more about on my social media. In addition, I do get to offer you an affiliate link which you can use for a discount and I will get a commission if you buy something on my recommendation.
Social media
There are several resources on social media that can be useful. Some of them are useful to regular revision while others can be that proverbial poke that reminds you to get back to your revision when you are lazily scrolling through your Instagram feed.
- Instagram: I have to shameless plug my own account because I post regular content in the form of rapids (in association with Revise Radiology) and other exam format viva and long cases. There are similar accounts posting high quality content regularly like @Radiologyvibes, @theradiologistpage
- Telegram: There is an excellent group run by Radiology Vibes.
Conclusion
There you go – my not to secret tips for how to pass the Final FRCR exam. Remember to get a lot of VIVA practice with colleagues/friends, practice a lot of rapids to identify areas of weaknesses and you’ll be good to go!