This is a continuation of the previous blog on FRCR preparation. In this, preparing for FRCR part 2A will be discussed.

FRCR part 2A examination

The FRCR part 2A examination tests the candidates’ knowledge of clinical radiology across all organ systems. The examination has undergone a change in format from December 2017 (when I appeared for it) and it is now a single day, two paper exam with both papers having questions from all organ systems.

Applying for FRCR part 2A

The FRCR part 2A being a written examination requiring pencil and paper, there is no limit on the number of candidates who can appear for the examination. As such there is no ballot or waiting list. The exam is now held twice a year in June and December. Venues for the examination are London, Birmingham, Manchester, Belfast, Bristol, Edinburgh, Singapore and Hong Kong.

Further information regarding the FRCR part 2A examination  can be found here.^[8]

The FRCR part 2A papers

After undergoing a change in format, the FRCR part 2A exam now consists of two papers of 120 questions each on a single day. Each paper is of 3 hours length. This gives the candidate 90 seconds for attempting each question. The questions are in the form of SBAs or single best answer questions, i.e. only one option out of the five given is correct and that option has to be marked.

As for FRCR part 1, it helps for the FRCR part 2A as well to go through the paper solving the easier questions first followed by attempting the difficult questions which take a longer time to think. I had finished solving the easier questions in each of my papers in 2 hours, then spent the next half hour in each paper solving the difficult questions and the last half hour for rechecking the paper.1 mark is given for a correct answer and 0 marks are awarded for a wrong answer. There is no negative marking. Candidates are permitted to carry a water bottle with them into the examination hall.

One advantage I found of this new format as compared to the old format was that being strong in one organ system can now compensate for weakness in another organ system. For example if a radiologist in strong in musculoskeletal but weak in cardiothoracic, the marks scored by answering MSK questions will compensate for a loss of marks in CVS. This advantage was not available to the earlier radiologists who gave FRCR 2A before December 2017 as they had to pass all 6 organ system based modules separately.

I would recommend giving FRCR 2A immediately after you pass your MD / DNB / DMRD as you have recently read all the basic textbooks and your knowledge is fresh, and this gives you a good chance of passing. You can also attempt it in the 3^rd year of your residency in December if you are confident enough that you have read all organ systems thoroughly.

Preparing for the FRCR part 2A examination

Never underestimate the level of difficulty of the FRCR 2A examination. It is always better to over-prepare than under-prepare. The questions may seem straightforward but some of them are actually very tricky, and test your basic concepts. Questions are commonly asked on dilemmas which radiologists will find in their day to day clinical life.

The questions are asked in the form of a case with a long clinical as well as radiological description, and the query asked in the end is usually “what is the most likely diagnosis” or “which of these is least likely”, or “what is the next step in management”. Candidates are thus expected to have a good clinical knowledge of common diseases from each organ system along with knowledge of imaging, as well as a basic idea of the management of common diseases and how our reports influence patient management.

Preparing for the FRCR part 2A and actually giving the exam was a joy, as it cleared a lot of my concepts and I feel it made me a better radiologist. And it was an exam which for the first time in my life I actually liked giving, as the questions were very nicely framed clinical scenarios which do occur in day to day life, and an in depth understanding of not just radiology but of the “bigger clinical picture” of where radiology stands in the medical world was required.

Grainger and Allison 6^th edition is one of my favourite textbooks and I found it really helpful for FRCR Part 2A. So if you have read Grainger it will be a big plus. Some people prefer reading the shorter version of Grainger i.e. Essentials and that would also be sufficient. Dahnert can be used as a reference text for some questions but is not useful enough for FRCR 2A to be read cover to cover. I did not read Brant and Helms’ book. Residents do read Osborn for Neuro, Webb for Thoracic and Greenspan for Musculoskeletal so if you have read these in residency it would help to revise them once before the exam.

I did not use paid online resources like R-ITI so again I would not recommend using them as its quite possible to pass without them.

Some people do manage to pass FRCR 2A without reading Grainger or other textbooks and sticking to only the online journal articles like IJRI, Radiographics, AJR etc which is also a good strategy. A mix of Grainger and online journal articles as required is what I would recommend to get the best results.

As for FRCR part 1, the key to clearing FRCR 2A is MCQ practice, practice and more practice!!Solving MCQs gives you an idea of the level of questions asked in the final exam, and the topics on which questions are asked in the exam also match with those given in the MCQ books; even if the questions themselves of course do not exactly match. So it helps to be thorough with the topics on which questions are asked in the MCQ books. Most of the MCQ books for FRCR 2A are old and published in 2010 or earlier, so they do not cover many of the questions on newer topics which are asked.

There are many MCQ books for FRCR 2A as well, some of which I will name below-

1. Richard Lindsay’s SBAs for the Final FRCR 2A
2. Robin Proctor’s Final FRCR Part A Modules
3. Stuart Currie’s SBAs for the FRCR 2A
4. Chaitanya Gupta’s 300 SBAs
5. Tristan Barrett’s FRCR 2A
6. Asim Ahmed Afaq’s Succeeding in the new FRCR 2A exam

Bear in mind that all of these books were published 7-8 years back so go through the new guidelines for common diseases online. Among these I would recommend Lindsay, Proctor and Currie as these have good accuracy of answers and match the level of the final examination in question style and difficulty.

Try to solve at least 3 to 4 MCQ books before the examination. I would generally not take notes for an exam, but I did do so for the FRCR part 2A where I combined points from the MCQ books and various journal articles and it helped me for the final week and final day revision. If you have cleared your radiology final exams, 2.5 to 3 months of revision are usually sufficient to clear FRCR 2A.

Quite a few questions are asked on the latest UK and NICE practice guidelines; you will get an idea of these from the MCQ books. For example, questions are asked in the format “as per NICE guidelines what is the next step in management for this patient”. However the guidelines might have changed since the publication of the MCQ book so it always helps to go online and read the new guidelines yourself, and write them in your notes for further revision.

Read all organ systems well, especially your weak points. For passing you need to get at least 65% questions from each organ system correct which is a challenge considering the level of questions asked.

Having good clinical exposure helps. There were some questions which were related to cases which I had seen in our department only a week before the exam and I could answer these questions as I had read about those cases.

Passing and statistical analysis of a previous FRCR part 2A examination

Going back to Dr. Patterson’s statistical report, the data regarding the FRCR 2A 2014 Spring examination can be obtained.

The average cut off percentage of marks for passing FRCR 2A varied between 61% to 64%. The recent new format FRCR 2A conducted in December 2017 also had a similar passing cut-off percentage. The mean score varied widely according to the modules, from 58% for cardiovascular to 66% for gastrointestinal with the other modules in between. The failure rate also showed a large variation across the modules, with 65% failing in cardiovascular to only 35% failing in gastrointestinal. However this data is from the old format of examination, and the RCR is yet to publish a statistical analysis of the new two paper single day examination.As a finale, the website of the UK’s Society of Radiologists in Training also provides resources and a list of recommended books for FRCR-

http://thesrt.co.uk/book-category/first-frcr-recommended-booklist/

http://thesrt.co.uk/book-category/frcr-2a/

A useful guide for FRCR candidates on how to prepare, books to read, etc written by the Junior Radiologists’ Forum can be found here.^[6]

To read more about how to prepare for FRCR part 1, click here or copy paste this link on your url: https://caferoentgen.wordpress.com/2018/03/12/the-why-and-how-of-frcr-part-i/

Disclaimer – Disclosing questions from any part of the FRCR examination is forbidden by the Royal College of Radiologists under strict penalty. No attempt to divulge questions has been made in the above blog post, with the intention being to impart general guidance and tips to candidates for appearing for the exam.

– Ameya Kawthalkar, MD,

Senior resident, Tata Memorial Hospital, Mumbai

PS: You can check our other blogs on training abroad in our section ‘Beyond the Shores’.