Congratulations everyone on clearing the FRCR 2A! Part 2B is the last hurdle of the long and arduous journey before the inscription of golden words- FRCR to your name. After our earlier blogs on how to prepare for FRCR part 1 and part 2A, we will talk about tips and tricks to clear part 2B here.
The prerequisite for the final step is completion of 34 months of formal radiology training. The best time to take the exam is when you feel most prepared. The knowledge expected during the exam is that of a junior consultant/registrar in General Radiology and not that of a Professor of Neuroradiology or a senior MSK radiologist.
1. Examination centers and dates: FRCR 2B is conducted in the UK (Spring and Autumn), Singapore (Spring and even Autumn recently) and Hong Kong (Autumn). The application process is slightly different for all and is enlisted further. At this point, it is important to clear a renowned myth that the difficulty level varies from center to center. It is not true and the performance is directly proportional to the efforts you put in.
2. How to apply:
A) UK examination: There is a rolling list for the UK examination slot. Fill the form available on the https://www.rcr.ac.uk/clinical-radiology/examinations/final-frcr-part-b-examination-0 (In the ‘Apply Now’ sub-section). For the overseas applicants, a letter drafted by the head of institution is required, a prototype is given below.
The form and the letter have to be EMAILED to the college on firstname.lastname@example.org. It is important to go through the application process in detail on the link provided above as the rules keep changing from time to time. In case, you refuse the slot, your number on the waiting list would advance serially and they might offer you again in next session. Fees have to be paid only on accepting the slot.
B) Singapore examination: Getting lucky for the Singapore slot is a race against time. There is a long online application form which has to be filled up and paid for (20 SGD) within minutes. One needs to be ready with all the documents on the computer ready to be uploaded. Follow this link http://medicine.nus.edu.sg//dgms/diagnostic-radiology.htm for the announcements. Tips to get lucky is a fast internet connection, a working international debit/credit card and most importantly fill up only the mandatory columns ;-). Yes, getting a slot at Singapore seems easier, but then all good things come at a price. This one hits hard on your pocket as an additional fee of 3790 SGD (at the time of writing this blog) has to be paid for the Master of medicine degree awarded by the NUS.
C) Hong Kong examination: The success of getting a slot at Hong Kong depends merely on your internet speed, as it is again on first come first serve basis. The application has to be emailed to email@example.com and should reach them bang on the opening time. This is usually updated on the following link https://www.hkcr.org/education.php/ec/action,ec_cr every year and around last week of May. An additional examination fee of HK$27,320 (at the time of writing this blog) is to be paid, ONLY if you are successful in getting the slot.
3. Examination Structure: A reporting session (aka long cases), a rapid reporting session and an oral examination (held within 1-5 days of the reporting set). Each component is scored out of 8. The pass mark in each component is 6, with a total of 24 and passing in 2 out of 4 components is mandatory. https://www.rcr.ac.uk/sites/default/files/cr2b_scoring_system.pdf gives the detailed scoring system of each component.
A. Reporting session (Long cases):
- This is your 1st tryst with the exam on the D day. 6 cases with a brief history and usually a mix of multiple modalities are provided.
- They have to be reported under the headings of Observation, Interpretation, Principle diagnosis, Differential diagnosis and further management. It is important to remember, that the reports have to be TYPED.
- Under the heading of observation, all positive findings and PERTINENT negative findings are to be reported in a point wise manner.
- Interpretation is the most confusing section. It is expected of the candidate to assign the disease process into broad categories of ischemia, infection, inflammation, traumatic, neoplasm, aggressive/non aggressive, slow/rapidly growing etc as applicable.
- A single appropriate most likely diagnosis has to be mentioned under the principle diagnosis column. Apart from it, significant other positive findings can be mentioned. For eg: in a case of ovarian carcinoma with pulmonary embolism, it is important to mention both of these in the principle diagnosis.
- Differential diagnosis: Only relevant differentials need to be written and the entire list of Chapman should not be enlisted. Mentioning why the differential is not in the principle diagnosis would fetch brownie points.
- Further management: Urgently informing the referring doctor about any life-threatening finding on the scan is a must. Multidisciplinary discussions and other RELEVANT radiological/pathological tests for confirmation should be mentioned.
- Tips: Finish all 6 cases, and no column should be left blank. Excessive detail is not necessary in the reports. No need to mention the relationship with adjacent structures in detail unless vascular infiltration/thrombosis. One cannot easily flunk in long cases, unless you leave one of the 6 cases completely blank. The other most important tip is most of these cases will have at least 2 findings, for eg- an intestinal obstruction with arterial thrombus, a colon malignancy with pulmonary embolism in lower sections. TIME is the most crucial factor. Practice typing of your day to day reports.
B. Rapid reporting:
- This is conducted immediately after the long cases. Make sure you do not carry forward your sentiments of the long cases into the rapid reporting session. Your best bet to cover up for the long cases is a good rapid reporting session.
- 30 routine day to day and emergency radiographs to be assigned as normal or abnormal and mention the abnormality. Most abnormalities would be fractures, pneumothoraces, pneumoperitoneum, lung and hilar masses etc.
- The twist in the tale is that there are NORMAL radiographs mixed with the abnormal ones and one needs to get at least 27 of the 30 right to clear the section(that’s a whopping 90%). Sounds tough right!!
- Tip: PRACTICE, PRACTICE AND PRACTICE. Looking at all possible types of fractures of the appendicular skeleton is worthwhile, especially the rarer ones like Pisiform fracture/stress fracture of calcaneum etc. Usually, there would be 14-18 abnormal radiographs, of which 8-9 would be glaring abnormalities. OVERCALL is your biggest enemy and therefore if you have sure shot 15 abnormal radiographs, you can mark the doubtful ones as normal. Usually one will get at least 2-3 spare minutes at the end, which should be utilized to go through the abnormal ones for silly mistakes like mislabeling the 2nd as 3rd metacarpal/side of hand etc. Tracing every cortex and looking at the review areas is also a must. One needs to be accustomed with pediatric fractures/neonatal emergencies/non accidental injuries, bowel obstruction findings and pneumoperitoneum in a supine patient as well as slipped epiphyses etc.
- CHECKLIST with your specific review areas for different prototype radiographs is a must.
- One more tip for those doing predominantly cross sectional imaging is to look at all the topograms/scout films, make your provisional diagnosis on it and then read the CT scan to confirm your findings. This would be helpful even for viva sessions.
- Before practicing rapid reporting, it is essential to go through – ‘Accident and Emergency – A survival guide’ by Nigel Raby, Laurence Berman et al.
C. Viva session:
- 4 viva sessions of 15 minutes each, divided in 2 rooms.
- Any case can show up. Mock viva practice of day to day cases with your friend/colleague/boss/spouse (even if non medico) is the magic mantra.
- Each room has two monitors and one mouse shared between. One viewing monitor is for the candidate and the other one for the examiner. It is important that the candidate doesn’t repeatedly scroll through the case. They would supply the history in most cases and it is always of paramount importance, so pay heed to it.
- Go through radiopedia FRCR viva case packets and practice them with your study partner.
- The examiners would never misguide the candidate. They are not allowed to get cases of their subspeciality and the examiner sitting behind is the one marking your ongoing viva session. So be clear and voice your thoughts. DO NOT MUMBLE. If at all, one is completely unaware about the case, you can frame it as I do not find any overt abnormality and in my routine practice would discuss it with my clinician/radiology colleague for the same. Don’t use this in every case, they would send you back home for detailed discussion 😉
A. When would you get lucky as per the rolling list: There are approximately 284 positions at every UK session. UK candidates are given the 1st preference and the remaining seats are offered to the international graduates. Usually one can expect a rolling number up to 350-400 to expect a call in the upcoming session, especially in the spring examination.
B. How much time is sufficient for the preparation: 2-3 months, of which at least 20 days should be non-working excluding the week of exam.
C. A month before the exam: By now, one should figure out the books to read, online rapid reporting sets to solve and daily work schedule. An ideal day should include 3-4 (not more or less) rapid reporting sets, 1 long set and/or viva session as time permits. It is essential to note down the errors committed in rapid reporting set, look at other examples of the missed/overcalled fractures on the internet and add them to your review areas.
D. A week before the exam: The last week is crucial. It is highly preferable to reach the exam city/country at least 3-4 days in advance. My advice would be to set your body clock as per your exam schedule irrespective of the time zone you are in. For example, If your long case and rapids are from 3 to 4.30 pm GMT, one should spend the last week practicing the long case and rapid reporting between 3 to 4.30 pm GMT( which would be 7.30 to 9 pm IST). Don’t burn out yourself and keep solving 2 to 3 sets of rapids, 1-2 long case sets per day. Reflect on the common mistakes made in the last month and look at those specific radiographs from the internet. For example, skull radiographs are often tricky as we don’t do them in routine practice. So look at plenty of them online and read a few articles to get the concepts cleared.
E. On the day of the exam: Stay calm; easier said than done. Revise your checklists. Be confident and keep saying to yourself, I can and I will crack the exam (helps boost your self-confidence). Try your best to leave behind the experience of long cases and get in the groove for rapids. Refrain from discussing the long cases and rapids, however tempting it might be, as it would affect your viva preparation. Remember, getting a diagnosis wrong in the long cases won’t affect your marks drastically and it is very difficult to flunk in that unless you leave an entire long case blank.
F. The days before your viva session: In the few days between the rapid/long case day and viva session, try and present random cases from online resources/institute PACs server to your colleagues and friends who are giving the exam. Presenting cases of one’s weak areas would be helpful. Dress suitably for the viva and be calm and confident (atleast act like you are). But don’t sound over confident or argue with the examiners.
A. Do not take the exam lightly or be over confident. It needs dedicated preparation and adequate time.
B. Do not opt for the slot if you can foresee busy months before the scheduled exam. A negative result at the exam would delay your next attempt by almost 2 years.
C. Do not waste your invaluable preparatory time in planning post exam exotic vacations 😉
D. Do not mention that the radiograph is of poor exposure etc as the cases would be dear to the examiners.
6. PREPARATORY MATERIAL:
A. Rapid reporting:
1. Accident and Emergency Radiology- Nigel Raby- MUST READ
2. Get through- Rapid Reporting of Plain Radiographs- Nisha Sharma.
3. APPROACH TO RR- http://www.frcrtutorials.com/rapid-reporting (MUST READ).
4. ONLINE RAPID REPORTING SETS-
- http://www.frcrtutorials.com/rapid-reporting- Free 40 sets. ( Rapids are a tad difficult than exam) – MUST SOLVE.
- http://www.frcrscholar.com/ – Paid (Rapids are almost of the same quality- avg score should be more than 25). MUST SOLVE.
- https://frcracademy.co.uk/ – Paid (Rapids are almost of the same quality- avg score should be more than 25). MUST SOLVE.
- https://www.medmantra.com/elearning/frcr/frcr-2b-rapid-reporting – Paid.
B. LONG CASES AND VIVA SESSION:
- Rapid Review of Radiology- Shahid Hussain- MUST READ.
- Final FRCR 2b Long Cases – A Survival Guide- Jessie Aw And John Curtis.
- Long Cases for Final FRCR 2b- Rebecca Hanlon, John Curtis Et Al.
- A Complete Guide to the Final FRCR 2b- Master Pass Edited By – Deepak Subedi
- Final FRCR 2b Viva- A Survival Guide- Tsong Tan, Jessie Aw And John Curtis.
- Top 3 Differentials In Radiology –William O’brien
- Final FRCR Part B Viva: 100 Cases- Richard White And Robin Proctor.
- http://www.frcrtutorials.com/longcases Online free sets of long cases.
There are plenty of courses in India, Dubai, Singapore, London etc. It helps get the hang of the exam. These are expensive, however worth every penny. Most of the courses get booked well in advance, so it is important to keep an eye on these. Google FRCR 2B courses to get a detailed list of these. I am hereby providing links to few of them. Being on the respective course mail list is also a good way to get a reminder of the dates.
COURSES IN INDIA:
- http://teleradiology.columbiaasia.com/education/- BANGALORE COLUMBIA ASIA FRCR COURSE.
All the best!!
‘HE HELPS THOSE WHO HELP THEMSELVES’- Bhagvad Gita.
– Chinmay Mehta, DNB, FRCR, MMed
PS: You can check our other blogs on training abroad in our section ‘Beyond the Shores’.