Overview of FRCR
The Fellowship of the Royal College of Radiologists (FRCR) is postgraduate exam qualification awarded by The Royal College of Radiologists, a professional body responsible for the speciality of clinical oncology and clinical radiology throughout the UK.
The FRCR Exam is the main way in which UK radiology trainees demonstrate objectively that they have the necessary skills and knowledge to work as an independent radiologist in the UK. The postgraduate qualification is also GMC approved – thus evidencing that you have the necessary knowledge, skills and experience to apply for full registration with a licence to practise.
What components are there to the FRCR
First FRCR Examination
Anatomy and Physics
Final FRCR Examination
Please note that each exam must be passed sequentially in order to progress to the next stage.
First FRCR Examination
The First FRCR examination comprises of two modules: Anatomy and Physics.
Anatomy is examined by an image viewing session delivered on individual workstations and Physics by a multiple-choice written question (MCQ) paper.
Both modules will be held during a two-day examination period three times each year (September, March, June); and both modules will be held on separate days. For further details on dates click here.
The cost of this exam is £253 for a member and £298 for a non-member – this price is for each module. So will be double the price if you book both Anatomy and Physics.
What will I be tested on?
The First FRCR Examination will assess your knowledge of those physical, cellular and molecular principles that underpin the generation of radiological studies.
The purpose of this examination is to assess whether those undertaking speciality training in clinical radiology have an appropriate knowledge of the scientific principles that underpin all radiological imaging, including radiology, fluoroscopy, angiography, computed tomography (CT), ultrasound imaging, radionuclide imaging and magnetic resonance imaging (MRI).
The syllabus for this examination is described in the curriculum. The exam ensures that successful candidates understand the underlying principles that underpin the generation of images, such that they can:
Select the most appropriate imaging technique for a clinical scenario from the intrinsic properties of the method of image generation.
Understand the risk, safety and quality consideration that are inherent in image generation to allow an informed choice of the appropriate modality and any alteration in technique.
The anatomy module covers radiological anatomy across all body systems and imaging modalities. The exam will consist of a computer-based image viewing session of one-hundred images. Most of the questions will be “What structure does the arrow point to?” or “What normal anatomical variant is demonstrated?”
The exam will last for ninety minutes and each examination paper aims to cover the curriculum and individual modalities give roughly equal weight as follows:
1/3 plain radiographs
1/3 contrast studies
Similarly, different body parts are given roughly equal weight as follows:
¼ head, neck and spine
¼ chest and cardiovascular
¼ abdomen and pelvis
There will also be Paediatric images and normal variants, but foetal imaging and neonatal cranial ultrasound will not be in the exam.
The anatomy exam takes place at the Royal College of Radiology in London. Overseas candidates can elect to sit the exam in Hong Kong or Singapore. Depending on the number of applications that the College receives, candidates are assigned to an examination session over a period of one to three days immediately following the physics exam.
The physics exam can be taken at a number of centres: typically, Birmingham, London, Manchester, Dublin, Hong Kong and Singapore. When making your exam application you will be asked to provide your first and second choice test centre.
This exam will last for two-hours and is a multiple choice written question paper. You will have 120 minutes to answer 40 questions. Each question will present you with a topic, for example, Doppler ultrasound, and then follow with five statements that must be marked either true or false. The pass mark will vary for each exam sitting, however, typically it is usually somewhere in the region of 70-75%.
This module covers UK ionising radiation legislation, patient safety and the physical principles that underpin diagnostic medical imaging.
It has been reported that the physics paper can be very tricky if you did not learn physics at school or university. However, we advise you to keep reading and learning until you have a good understanding of the key concepts it will become easier from there. Remember to use varied revision resources from books, e-learning sessions to revising the topics with colleagues.
Final FRCR Examination
The Final FRCR Part A exam is a single-best answer paper and you will be tested on all aspects of clinical radiology and the basic sciences of physics, anatomy and techniques, against the Speciality Training Curriculum for Clinical Radiology.
The examination will be held in June and December each year and examination dates can be found here and the exam fee is £340 for a member and £400 for a non-member.
Candidates must have passed the First FRCR examination, comprising of the Anatomy and Physics modules. Furthermore, to take FRCR Final Part A you must have acquired 24 months in a formal clinical radiology training post by the month which you take your exam.
This exam consists of two papers which will be sat on the same day with a break in between. Each paper will contain 120 single-best-answer questions (240 questions in total) and each paper lasts three-hours. Please note that both papers make up one exam and there is no concept of passing one paper.
You will be examined on all aspects of clinical radiology and this exam must be passed before you can attempt the FRCR Final Part B Exam.
The Exam will cover the following topics:
Cardiothoracic and Vascular
Musculoskeletal and Trauma
Genito-urinary, Adrenal, Obstetrics & Gynaecology and Breast
Central Nervous and Head & Neck
Both papers will be entirely mixed and contain questions from all subspecialties. Helpfully, the results of the exam are broken into subspecialty so on receipt of your feedback you will know what your strengths and weaknesses are. The pass rate for the exam will be based on the overall percentage.
The Final FRCR Part B assessment will examine you on all aspects of clinical radiology against the Speciality Training Curriculum for Clinical Radiology.
The Part B Exam will consist of a rapid reporting session (also known as rapids), reporting session (also known as long cases), and an oral examination (viva). All components are examined via an image viewing session and held during a single examination period twice a year. Click here to access how each component is marked and how the overall results are determined.
The examination is held in April and October of each year and the exam fee is £474 for a member and £558 for a non-member. Please click here for further details on dates.
Candidates who have passed the Final FRCR Part A examination, are permitted to enter the Part B examination once 34 months of clinical radiology training have been completed.
Rapid Reporting (Rapids)
In this part of your exam, you will receive thirty plain radiographs and you will have to classify each graph in thirty-five minutes. This element of the exam will truly test you because you are not given much time to answer the questions. Passing this element will require you to practise a vast amount and develop a systematic approach to radiograph interpretation. The idea is that the exam will reflect a normal day-to-day A&E or GP reporting session. The cases will be a mixture of facial, abdominal, chest, spine and limb radiographs. It has been reported that typically half of the cases are normal and half the cases are abnormal, however, this ratio will vary.
There is one mark per image, and so a maximum of thirty marks is available.
Reporting Session (Long Cases)
In this part of the exam, you will be presented with six cases and have sixty-minutes to answer them. Each case may comprise of one or more imaging modalities, such as an ultrasound image, a CT scan and a plain radiograph. You will be given a brief history and relevant clinical data to help and guide you (as you would in day-to-day practise) and you must report on all six cases.
To answer you will need to type your report in the spaces provided on the screen and they are divided into the following sections to aid you to communicate your report clearly.
Observations: Record observations from all the imaging studies available, including relevant positive and negative findings.
Interpretation: State interpretations of the observed findings; e.g. whether the mass or process is benign, malignant or infective, giving your reasons.
Principal diagnosis: The single diagnosis based on the interpretations above. If a single diagnosis is not possible, give the most likely differential diagnosis here.
Differential diagnosis: For some questions, this will be left blank, however, if a single diagnosis is not possible then differentials other than the most likely differential diagnosis should be included here. These should be few and brief and you must indicate why these are less likely than the main or principal diagnosis above.
Further management: Include any further investigations or future management here.
Oral Examination (Viva)
This element of the exam consists of two thirty-minute oral examinations, so the total exam time will be one hour. There will be two examiners who will each examine you. For the first fifteen minutes examiner A will ask you questions regarding radiographs, and then after those fifteen minutes are up examiner B will ask you questions while examiner A marks, and so on. You will, therefore, be assessed by four independent judgements on your performance. The total marks for the viva component are sixteen marks.
The radiographs typically fall into four groups:
Often people do not have a problem diagnosis this radiograph e.g. peri-lunate dislocation.
Tie it Together
Multiple findings on one or more modality. You will need to put all the findings together to come up with a diagnosis.
The abnormality is subtle and may be difficult to spot. One example is an ‘edge of the radiograph’ finding such as a calcified hydatid cyst in the liver on a chest radiograph.
The abnormality is obvious but the location may be atypical.
Tips and Tricks to Passing your FRCR Exams
Practice papers – Doing practice papers prior to your real exam will be a great way to learn the exam topics whilst improving your exam technique. There are many good courses, books and online resources which offer free mock FRCR Exam papers.
Be mindful with the spelling of similar sounding structures – The FRCR Exam is not a spelling test and the examiners often look over minor spelling mistakes, however, it is important to get right similar sounding names. One example includes ilium/ileum. Take care or you could miss out on a mark.
Write an answer to every question – There is no negative marking so if you are not sure of an answer we advise you to make your best guess. When you are struggling with a question, write something and move on because if you have enough time at the end you can come back to it.
Timing is fundamental – As with all the exams, but most specifically the FRCR Final Examinations Part B, it is essential you manage it. It is easy to write a correct and successful report after looking at the radiographs, however, it is very difficult to do so when you have to spend an average of ten minutes on each case. You will not have time to check your answers so we advise for you to be very strict with time management, and recommend that you spend no more than 7-8 minutes on each case to allow time for the more difficult cases that require a longer analysis.
Avoid Acronyms and Abbreviations – Reports reveal that many clinical errors have arisen from the use of acronyms and just because an abbreviation is common in your current hospital does not mean it is used in other hospitals or other international healthcare systems.
Rcr.ac.uk. (2018). First FRCR Examination | The Royal College of Radiologists. [online] Available at: https://www.rcr.ac.uk/clinical-radiology/examinations/first-frcr-examination-0 [Accessed 21 May 2018].
Rcr.ac.uk. (2018). Final FRCR Part B Examination | The Royal College of Radiologists. [online] Available at: https://www.rcr.ac.uk/clinical-radiology/examinations/final-frcr-part-b-examination-0 [Accessed 21 May 2018]
Clare, C. (2018) Exams. [online] Radiology Café. Available at: https://www.radiologycafe.com/radiology-trainees/exams [Accessed 21 May 2018].
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