A Complete Guide to FRCPath Haematology for IMGs

FRCPath is the Fellowship of the Royal College of Pathologists, which is a qualification awarded by the Royal College of Pathologists. For IMGs, it grants access to GMC registration, allowing you to practice medicine in the UK. Not only that, but the FRCPath is a highly regarded qualification that acts as a route to specialist registration in 23 different specialties, including genetics, clinical biochemistry, dermatopathology, and toxicology. The one we'll focus on in this article is haematology. 

The FRCPath qualifications set a high standard for all pathologists working in the UK, which ensures that all pathologists can provide a high level of clinical care while working at a senior level. With those high clinical standards, if you hold FRCPath as an IMG, you could secure a Locum Consultant role as your first NHS post, rather than working up from a Specialty Doctor level. 

As an IMG wanting to work as a haematologist in the UK, this is the ideal route, as the completion of FRCPath Haematology showcases the skills and experience you have attained over the years. 

FRCPath: Haematology

FRCPath haematology is for those who have already specialised in haematology and want to get a UK qualification demonstrating their knowledge and abilities. So, as an international medical graduate, you will have studied and trained in haematology overseas for a number of years (at least 3, although more is recommended) before taking these exams. 

Given that the Royal College exams are also taken by UK medical trainees, the content is unsurprisingly focussed on the UK haematology training curriculum – this covers the full spectrum of the science of blood and blood-related diseases, such as anaemia, bone marrow failure, and myeloid disorders. As an already challenging set of examinations, this means that IMGs will need to prepare with particular attention to areas where local training programs diverge from UK standards and content. Because of the alignment with the UK haematology training curriculum, holders are held in high regard when it comes to interviewing for NHS jobs as they are seen as clinically comparable to UK trained doctors, as well as being considered closer to Specialist Registration via the CESR/Portfolio Pathway routes.

FRCPath Haematology: Cost and Eligibility

As with anything of value, there is an associated cost, so every candidate is required to pay a fee to take the exams. These fees pay for examination training, staff costs, running costs, and other general expenses. On top of the fee, you must meet the eligibility criteria to sit the exams. 

Part 1

Cost: £707

Eligibility: Two years of training. 

Part 2

Cost: £1,487

Eligibility: Three years of training. 

There must also be a 12-month gap between taking FRCPath Haematology parts one and two. 

Keep in mind that these fees rise each year, so they might be a little higher by the time you apply.

It is also important to keep in mind that you will only get four attempts to pass per exam. In Spring 2022 the pass rate for Part 1 was 65.9% and the pass rate for Part 2 was 58.8%. You should start your revision about six months before the exam and spend a few hours a day studying, more when you are not working, though the amount you need to study will depend on your experience and knowledge. Remember, you will need to give yourself breaks so allocate yourself adequate time to prepare and only start the qualification when you feel you are ready. 

How to Apply for FRCPath Examinations

Fortunately, it's easy for IMGs to apply for the FRCPath Haematology examinations, as you can do it all online from anywhere in the world! You apply on the Royal College of Pathologists website, where you fill in the application form for either FRCPath Haematology part one or part two. Once accepted, you will receive details about the time and place of the examinations. 

It's crucial to apply on time. Late applications are never accepted, and these exams are in high demand. As a result, we recommend applying as early as possible within the application window to avoid disappointment. 

Before applying, the Royal College of Pathologists asks that you read through all the Examinations Regulations and Guidelines. The exams are costly, and you want to pass the first time. Reading through these carefully will help you avoid mistakes that could cost you a passing mark. 

FRCPath Haematology: Part 1 

Part 1 of the FRCPath Haematology exams consists of two papers: paper one and paper two. Passing both papers is essential for an overall pass – you cannot make up points in paper two if you didn't accrue enough marks in paper one. 

The goal of both papers is to demonstrate your knowledge and competence in the field of haematology. 

Paper One

Paper one is a written examination that asks you to write essays as your answers. The paper tests your knowledge of haematology as well as your written communication skills. 

You get three hours in total to answer four essay questions. The topics include haematological oncology, general haematology, blood transfusion, and haemostasis & thrombosis. The goal? To present your essay answers in a clear, structured manner that demonstrates your ability to use your knowledge in typical clinical settings. 

To pass paper one of FRCPath Haematology, the answers must be lengthy, detailed, and clear. Keep all the information organised, ensuring it's easy for the examiners to absorb and understand your answers. 

Past Paper Example Questions: 

1. Question 1 – Transfusion

A 54-year-old male with Hb SS with recurrent crisis and history of acute chest syndrome several years and pulmonary hypertension, has been admitted following a mechanical fall. X-ray findings confirm fracture right neck of femur. He needs urgent orthopaedic surgery but is reluctant to agree to have blood transfusion as he is concerned about the safety of blood and his wife is a Jehovah’s Witness. He is blood group B RhD negative. His Hb S was 84% when last checked 4 months ago and Hb at admission was 90 g/L.

a) Discuss how you will manage his concerns and what you need to do to optimise

him for surgery. Discuss potential complications in this patient including those related to treatment. (20 marks)
 b) Describe the specification of blood components, volume required for exchange

transfusion and targets for treatment. (5 marks)

1. Question 4 - General Haematology

A 35-year-old man referred urgently with Hb 210g/L. The patient had been attending a

gym and had an episode of lightheadedness.

1. What is your advice to the GP and management plan? (10 marks) 

4 weeks later he is in Haematology clinic with a negative Jak2 result.

b) What further investigations? Discuss ongoing management (15 marks)

Paper Two

Paper two is a multiple-choice questions exam. You get three hours to answer a total of 125 MCQs, of which there are 50 best-of-five questions and 75 extended matching questions. 

These questions cover a range of haematology topics. Questions might be related to subjects like obstetric haematology, platelet disorders, plasma cell dyscrasias, lymphomas, and laboratory management.

A lot of the questions provide clinical situations in which the candidate must answer accordingly, using your judgement of clinical cases. It is about more than memorising haematological facts; it's about using that knowledge in the best possible way. 

Past Paper Example Questions: 

1. Question 2

A 39 year old Caucasian man is referred with a serum ferritin of 1945 ng/ml and is found to be heterozygous for HFE C282Y and H63D. Liver function tests are normal. He is commenced on a venesection programme. 

Optimal venesection is best assessed by which of the following?

• Normalisation of magnetic resonance of liver
• Normalisation of percentage transferring saturation
• Normalisation of serum ferritin
• Normalisation of serum ferritin and percentage transferring saturation
• Normalisation of serum ferritin and serum iron

1. Question 3

A 24 year old woman has a 2 litre primary post partum haemorrhage. Coagulation studies show a normal platelet count, PT 13 secs (control 12 secs), APTT ratio 2.9 and fibrinogen 3.5 g/l. 

Which test will distinguish between acquired haemophilia A and lupus anticoagulant (antiphospholipid antibody)?

• Bleeding time
• DRVVT with platelet neutralisation procedure
• Factor VIII assay
• Platelet function tests
• Von Willebrand factor activity

FRCPath Haematology: Part 2

FRCPath Haematology part two must be taken in the UK. These exams – which include four written exams and one oral exam – take place over the course of three days. 

Written Exam: Short Answer Questions

The first written exam comprises up to twelve short answer questions; you get 90 minutes to answer them. You'll come across various questions related to haematology, including microscope slides and cytometry plots. You only need to give a few short words or phrases to answer. 

Written Exam: Long Cases

The long case examination lasts twenty minutes and includes three long questions, so you have around 30 minutes to answer each question. These questions ask you to examine and interpret clinical investigations, using your long answers to make a report and diagnosis. 

Past Paper Example Questions: 

1. Morphology Short Answer Question

You are provided with a Quality Assurance Report from a NEQAS exercise on a

laboratory’s automated cell counter. 

Briefly interpret the results. What action is required?

1. Morphology Long Case

A 51 year old farmer develops a flu-like illness and a routine FBC shows a Hb of 12.0 g/dl, a WBC of 14.0 x 109/l and a lymphocyte count of 6.5 x 109/l. Six weeks later, the flu-like symptoms have improved but the FBC is unchanged. 

1. You are provided with a blood film (1A). Report the film.

The patient remains well for 7 years and is then referred with night sweats and splenomegaly. 

b) You are provided with a bone marrow aspirate (1C) and a trephine biopsy (1D). Report the aspirate and the trephine. Recommend 2 further investigations. Provide an initial management plan. 

The patient is now refractory to initial therapy. 

c) You are provided with a blood film (1D), an immunophenotype report (1E) and a karyotype (1F). 

d) Report the blood film. Report the immunophenotype and karyotype. What 2 further investigations do you require? Outline the therapeutic measures you recommend.

Written Exam: Transfusion 

For the transfusion exam, you answer ten questions in two hours. For each question, you'll examine a case history and lab results. In your answer, you must give your interpretation, whether that's a diagnosis, treatment, or the need for further investigations (which you should detail). 

Past Paper Example Questions:

1. Question 1

A 18 week pregnant woman has had her booking blood tests and stated that she is a Jehovah's Witness. Her booking bloods show the following: 

Hb 102g/L, MCV 67fl, MCH 21, WCC 9.2x10^9/L, Plt 170x10^9/L

a) Outline briefly further investigations you may request for this lady. 

b) Come up with a management plan given the results above, and a peri-delivery plan. 

2) Question 2

Give recommendations for the blood products you would require for a patient with the following history (choose the single best option): 

1. Hodgkin's disease patient with diagnosed HIV undergoing chemotherapy (red cells) 
2. Pregnant woman at 30 weeks' gestation with a history of sickle cell disease having exchange transfusions prior to delivery (red cells) 
3. Pregnant woman with a planned intrauterine transfusion, previous history of being CMV negative (red cells)
4. Multiply transfused thalassaemia patient with anti-Jkb antibodies (red cells) 
5. Allogeneic stem cell transplant patient prior to engraftment (donor A RhD+, recipient O RhD-) - (FFP and platelets)
6. Neonatal transfusion in a septic baby who has not previously had an intrauterine transfusion (red cells) 
7. Autologous stem cell transplant patient (mini-BEAM) with lymphoma with previous R-bendamustine and ESHAP therapy (red cells) 
8. Myeloablative allogeneic stem cell transplant patient for leukaemia five days prior to the start of conditioning. Donor group A RhD+, recipient B RhD+. (red cells) 

Written Exam: Coagulation

The coagulation exam asks you to answer eight questions within two hours. Like the transfusion exam, you'll be given a case history and laboratory results. You'll then need to interpret this in your answer to come to a conclusion. 

1. Question 1 

A patient who is on rivaroxaban for atrial fibrillation (CHA2DS2-VASc score 5) is undergoing a cholecystectomy in a few weeks time and you have been contacted by the anaesthetist for assistance in offering a bridging plan. This 60 year old lady weighs 85kg and her renal function is normal. Outline a bridging plan for the anaesthetist in the perioperative period and include advice to the patient about what to do when she is discharged from hospital. (10) 

1. Question 2

A 78 year old patient comes in overnight to the Emergency Department with a diagnosed small intracranial haemorrhage with no mass effect and is on apixaban 2.5mg BD for atrial fibrillation. He has a mild left hemiparesis. His last dose of apixaban was 17 hours ago and you are waiting for the patient’s renal function to come back. In the meantime, you have the coagulation results available (patient’s full blood count is normal). You are contacted at 3am to provide advice on further management.

PT 14s (NR 10-13s)

APTT 35s (NR 25-35s)

Fibrinogen 2g/L (NR 1.5-4g/L)

Outline your management plan for this patient, explaining your reasoning (8). 

The Oral Exam 

The last examination of FRCPath Haematology Part 2 is an oral exam. For each part of this exam, you'll give your answers verbally to two examiners, covering the following topics: 

• Coagulation
• Transfusion
• General and Laboratory Haematology
• Haematology Oncology 

The oral exam is designed to help you demonstrate your clinical knowledge, judgment, and verbal communication skills. 

Past Paper Example Questions: 

Field: Haematological disorders in pregnancy

Topic: Thrombocytopenia in pregnancy.

Introductory Question

What are the causes of a platelet count of 100 in a pregnant woman at 37 weeks?

• This question sets the topic on which questions will be asked
• It should be simple or factual: well below the level of competency
• It is important that the candidate answers this successfully to settle him/her for the competence question to follow

Default Question 1

Is gestational thrombocytopaenia a frequent cause of platelets of 100 in pregnancy?

• used if the candidate does not understand or cannot answer the first core question
• should be an even simpler question which may be a ‘closed question’ requiring a yes or no answer

The candidate must answer this phase successfully to achieve a pass mark.

Near-Competence Question

What is the significance of a platelet count of 40 in a pregnant woman at 37 weeks?

• not used if time is short, the examiner may move directly to the Competence Question
• brings the candidate close to competence
• more complex; just below competence
• a problem solving question

Default Question 2

What level of thrombocytopenia would you regard as significant in a woman at 37 weeks gestation and what are the possible consequences?

• for the nervous candidate to lead him/her towards the final question
• If used, the candidate must answer this second phase successfully to pass.

Competence Question

A GP informs you that he has a patient at 37 weeks with a platelet count of 40 who is scheduled for home delivery, what further investigation and management do you recommend?

• candidates must safely manage this problem to be ‘competent’ 

Preparing for the FRCPath Haematology Exams

To pass all parts of FRCPath Haematology, you must put plenty of time and effort into revision. The exams are not easy – they are designed to test your ability to work as a Haematologist at a senior level. Naturally, they cover a wide range of haematology topics, following the haematology curriculum. Your preparation methods must cover all aspects of haematology, particularly in the areas you might not feel so confident in. 

Here are our tips for preparing for the FRCPath Haematology examinations: 

Give Yourself Plenty of Time

Of course, you need two years of training to complete part one and three years of training for part two. When it comes to actual revision and preparation, though, you should allow yourself at least three months per exam (we recommend starting 6 months before). Devise a study plan, ensuring you fit enough hours of revision each week. Pacing yourself when revising will ensure you absorb all the necessary clinical knowledge you need for a pass - rather than trying to "cram" study in alongside your full-time job just weeks ahead of your attempt!

Read Widely

As mentioned, the FRCPath Haematology exams cover a wide breadth of haematology topics. You can't just focus on one area of the specialism and expect to pass. To increase your chances of getting through the exams, reading a vast array of pieces is essential. Here are some books we recommend to get started in your studies: 

• Haematology by Gary Moore
• Practical Haematology by Dacie and Lewis
• Oxford Handbook of Clinical Haematology 
• Essential Haematology by Victor Hoffbrand, Paul Moss, John Pettit 

Practice the Oral Exam 

Standing before two examiners and delivering your spoken answers may seem daunting, and it can be tricky for many IMGs. No matter how much clinical knowledge of haematology you may have, you still need to demonstrate that clearly and succinctly in verbal English. 

To increase your confidence, communication skills, and clinical knowledge, start practising the oral examination with a colleague or mentor (who can speak English), asking them for pointers so that you can improve. The more you practice, the more you hone the necessary skills to impress the examiner. This exam is as much about your confidence in your skills, your ability to communicate and your demeanour in a clinical context as it is about the actual clinical content of your answers – this is the part where they can see how well you will be interacting with patients, which is just as important as the medical knowledge. 

Do Past Papers

Familiarising yourself with the examinations' structure will help you come exam day. Fortunately, the Royal College of Pathologists has a range of past papers on their website for you to practice. Do as many as you can!

To prepare for the FRCPath Haematology exams, plenty of online resources are available to you, so use them. The more you practice and revise, the more chance you have of passing the examinations. 

Passing FRCPath Haematology: On the Day 

After doing all your prep for FRCPath Haematology parts one and two, you don't want to let yourself down on the day. 

A few things you can do to increase your chances of passing the exams include: 

Arrive Early

Before the exam date, you will be given a time to arrive (either online or at the examination centre). Be sure to arrive early each time. For the part two examinations in the UK, we recommend planning your route beforehand, especially if you're taking public transportation[TC1] . 

Pace Yourself

You only have a limited amount of time for each examination, so it's important to pace yourself. You don't want to have only ten minutes left with half of the questions yet to be answered! Time management is critical here, so make sure you bring a watch with you. 

For example, for FRCPath: Haematology part one, paper one, you get three hours for four questions, so it makes sense to allow yourself forty minutes per essay question, with twenty minutes spare for reading the questions and checking answers at the end. 

Trust What You Know

Many candidates feel uneasy about the exams despite possessing all the necessary skills and experience to pass. This lack of confidence may affect your ability to answer questions clearly and in a timely manner. So, on the day, try to instil confidence in yourself by trusting what you know and try to relax. Perhaps have a look into relaxation techniques which might help you, such as breathing techniques to calm nerves.  

Getting Your Results 

You will receive your results via airmail (or first-class post if you reside in the UK). All candidate results will also be published on the RCPath website next to candidate numbers. These will appear at midday on results day[TC2]  – you will be told the date of this in advance. Your certificate will come several months later. Results will be sent via post on the same day as they are electronically posted online.

Please note: The Royal College of Pathology asks all candidates not to phone in with queries about their results. Generally, they do not offer an electric copy, but you can request one if it has been a few weeks since the results day and you have not yet received a copy of your results. 

What Happens if You Fail? 

It happens! Many candidates discover on results day that they have not passed FRCPath: Haematology. It can be highly disappointing, especially if you feel you have the right amount of training, experience, and clinical knowledge. However, failing is not the end of the world – as mentioned, you get four attempts per examination, so you can always try again. 

If you have already attempted the exam four times, another option is to get your Educational Supervisor to complete the Additional Attempt forms. Once sent, the Mitigating Circumstances Panel and Director of Examinations will consider it before submitting it to the college council. Of course, this is not the ideal route to taking the FRCPath examinations, but it is an option if you have failed four times and wish to try again (after further training and preparation).

We always recommend spending some time preparing before you apply again. You only get a handful of attempts, so you want to increase the chances of a passing mark. In particular, read through your examination performance report carefully. The Royal College of Pathologists provides each candidate with an assessment of their knowledge based on their examination. The information in the report can guide your further studies, so you can spend more time working on your weaker areas, thus increasing your chances of passing the next time.

What Happens Once You Pass?

If you pass part one, you can go on to applying for and completing part two (remembering that there must be a 12-month gap between the two). 

Congratulations if you pass both part one and part two of FRCPath Haematology! It's an enormous achievement, so congratulate yourself – they are not easy exams. After passing them, you'll be awarded the Fellowship status of The Royal College of Pathologists. With this, you gain access to GMC registration and a route toward getting on the specialist register to work as a haematologist at Consultant level. 

Relocating to the UK

Being awarded fellowship status at The Royal College of Pathologists is an excellent route into the UK. Of course, there are a couple of other things to do/keep in mind before embarking on relocation. 

Getting GMC Registered

Before being able to practice medicine in the UK, you must be GMC-registered. This is a requirement for all doctors in the UK – not just IMGs. As well as your FRCPath Haematology qualification, you will also need the following documents and evidence: 

- Photographic ID

Usually, this will be your passport, which you will need anyway to enter and live in the UK. 

- Primary Medical Qualification

Your primary medical qualification is your medical degree. The GMC has a list of PMQs they accept, so it's worth checking yours is on there before applying. 

- Evidence of English Language Capabilities

You must prove your English skills, which usually means passing either OET or IELTS. The exception is if you achieved your PMQ in an English-speaking country. 

- Evidence of Internship/Experience 

If you have completed an internship, you must submit evidence of this. Alternatively, you can submit proof of the last two years of medical experience if you have not completed an internship. 

- Certificate of Good Standing 

For every medical regulatory authority you've been licensed with within the last five years, you will need a certificate of good standing. These are valid for three months after they have been signed. 

- Declaration of Fitness to Practice

The GMC application will include ten questions related to your health and overall fitness – you must answer these truthfully. 

Much like your application for FRCPath, you can submit your GMC application online. Make sure you meet all requirements before sending in the application, and translate any documents that aren't in English. 

At the time of this post being published, the GMC registration application costs £433, but this may vary over time. 

Moving to the UK 

Moving to the UK can be a major culture shock for many IMGs. On top of a new working environment – which may have different policies and procedures to the one you know – you will also be living in an entirely new country. 

Before moving to the UK, research the UK's culture, focusing on the city/town you'll be living in. The UK has a lot to offer people from all over the world; many cities are multicultural, and you will find a range of excellent schools, places of worship, natural beauty, friendly communities, and much more. 

The NHS Trust you'll be working for may provide a relocation package to help you with the move. The team here at BDI Resourcing can also offer excellent relocation information, advice, and packages, so get in touch with the team if you need assistance or have any questions. 

Getting on the Specialist Register

Passing both FRCPath parts one and two provides access to the specialist register. The Royal College of Pathologists will send you information about how to apply for the specialist register upon completion. For IMGs, this is often the CESR/Portfolio Pathway route, which is for any GMC-registered doctor who has completed their training outside of the UK and EU. This is a separate process which will be time-consuming and can be complicated depending on your individual experience. Read our blog here for guidance on how to go down this route. 

Once on the specialist register, you can apply to permanent Consultant-level haematologist roles. These positions provide a competitive salary and high levels of responsibility. Your time will generally be split between direct patient care and the lab, and you'll often work alongside other doctors in a multi-disciplinary effort. It's a fantastic role that truly helps people. 

FRCPath: Frequently Asked Questions 

FAQ 1: Will I Have to Pay for Taking an FRCPath Exam a Second Time?

Yes – if you fail one of the exams and need to retake it, you will have to pay full price again. Remember that you only get a total of four attempts per exam. 

FAQ 2: How Do I Know I'm Accepted to Sit the FRCPath Exams?

You will receive an email confirmation of your place. The email should include all details about the date and location of the exam. 

FAQ 3: I'm Not Happy with My Result – What Can I Do?

Generally, the result you get for an FRCPath Haematology exam is final. However, if you have any complaints about the exam, use the Examinations Complaints Procedure. For requests to appeal the results, you must use the Candidate Appeals Procedure. 

FAQ 4: Does Passing FRCPath Get Me on the Specialist Register?

Not automatically, no. However, passing FRCPath Haematology does prove you have the skills to work at a senior level as a haematologist. As an IMG, your best way of getting on the specialist register as a haematologist is to use FRCPath for the CESR/Portfolio Pathway route. 

FAQ 5: Can I Request Special Accommodations for Sitting the Exams?

Yes – if you need any adjustments to your FRCPath examinations (such as extra time), you must submit a reasonable adjustments request form. You must do this while applying for the exam; you can't ask for adjustments once your place is confirmed. 

In Summary 

FRCPath Haematology is a highly regarded qualification awarded by the Royal College of Pathologists, completing it demonstrates your breadth and depth of understanding of haematology, as well as your communication abilities. With it, you prove that you can work as a haematologist at the Consultant level in the UK. However, keep in mind that these exams are challenging – to pass, you'll need to put a lot of time into revision, ensuring you have covered everything in the haematology curriculum. By passing, though, you are giving yourself the best chance of securing a role in the NHS and ensuring you are a safe clinician!

If you're interested in working in the NHS as a Haematologist then get in touch - BDI Resourcing have placed hundreds of Haematology doctors with only 5-star reviews.