FRCR Part 2B (Radiology) - guidance notes for candidates

The Final FRCR (Part B) exam comprises three components: a short case reporting component, a long case reporting component and an oral component. All components are delivered using the exam platform risr/Assess on individual workstations.

2a Short Reporting content 

The short case reporting component includes a short answer question type. Candidates will be presented with a case which will include a brief clinical history and plain radiograph. Candidates will be asked to write a short report and include their next recommended management step for the patient. The short case component comprises 25 cases and runs for 120 minutes. The images are plain radiographs only. Reports should be short, simple statements of your observations, diagnosis and recommendation. 

Each case is displayed on a single screen, with some cases showing a montage of different views, or a single view only. 

The coverage of chest, musculoskeletal and abdominal X-rays will fall approximately within the ranges indicated below:

• CXR: 50-60% of the set
• MSK: 40-50% of the set
• AXR: up to 4% (1 question) of the set

The coverage of adult and paediatric cases will be split as indicated below:

• Adult cases: approximately 75%
• Paediatric cases: approximately 25%

There are no fixed criteria for coverage of specific pathology, but content will be appropriately balanced and representative. The cases may vary in complexity and difficulty – this will be accounted for in standard setting

2b Long Case Reporting content 

The long case reporting component comprises six cases, each of which requires a typed report, and it runs for 75 minutes. Each case may comprise multiple modalities including CT, ultrasound, radionuclide and MR scans. Cross-sectional imaging may comprise more than one sequence, which can be scrolled through.

Brief case histories and other relevant clinical data for each case will be displayed, and responses should be presented in a standard format as follows: 

• Observations: This section is for recording observations from all the imaging studies available, including relevant positive and negative findings. 
• Interpretation: This section is for stating interpretations of the observed findings; for example, describing whether the mass or process observed is benign, malignant or infective rather than neoplastic, giving reasons. 
• Main or Principal Diagnosis: This single diagnosis should be based on the interpretations provided above. If a single diagnosis is not possible, then the most likely diagnosis should be stated.. 
• Any Differential Diagnoses: For some cases there will be no differential diagnoses; in others a few may merit inclusion. These should be limited in number and brief, and the report should indicate why these were less likely than the main or principal diagnosis above. 
• Any Relevant Further Investigations or Management: This section is for indicating any further appropriate investigations or clinical management. For example, if a patient with a sub-dural collection is diagnosed then urgent referral is needed if there is evidence of brain compression. Similarly, if an abscess or tumour is diagnosed, indicate if drainage or biopsy is appropriate. 

The cases vary in complexity and difficulty – this will be accounted for in standard setting. Some cases require more time for analysis and reporting than others. Candidates should ensure sufficient time is allocated to report each case adequately. It is not essential to record an answer in every section, candidates will not be penalised for entering their responses in the wrong section, or for entering their responses entirely in one section. There are no fixed criteria for coverage of specific pathology, but content will be appropriately balanced and representative.

2c Equipment and software 

The reporting components are delivered using the exam platform risr/Assess, which allows candidates to view images and type their responses. The platform provides a simple image viewing window and the ability to move through cases. 

A demonstration site and instructional videos are available online and candidates and trainers are encouraged to familiarise themselves with the platform in advance of the exam. 

During the exam, keystrokes and screen activity are monitored and recorded centrally.  The exam will time out after the allocated time allowance. No further responses can be added after the time is up. In the unlikely event of computer hardware or software failure during the exam, candidates should alert an invigilator by raising their hand – spare workstations are available if necessary. 

3a Content 

The oral component lasts for a maximum of 60 minutes in total, during which time the candidate spends 30 minutes with each of two pairs of examiners (and so will be assessed by four radiologists in total). Candidates will be assessed on six cases per oral session, 12 cases in total. The oral component allows for four independent judgments of candidate performance. 

A wide range of material of varying complexity will be shown. A higher level of performance will be expected in the interpretation of common and routine exams than will be the case with more complex investigations. Case sets are compiled to ensure that they are appropriate and balanced across the major clinical radiology sub-specialties. Candidates are assessed across five clinical skill domains with the opportunity to demonstrate their radiology knowledge, observation, clinical reasoning, clinical safety and management, and communication skills.  A logical and informed approach to image interpretation, as well as a clear ability to debate the merits, relevance and role of techniques that might assist in further investigation of diagnostic problems, will be expected. Examiners will ask standard supplementary questions to further assess a candidate’s understanding of the problem. 

In reaching a conclusion, candidates should place their diagnoses in order of probability. In some cases, it will be possible to make the correct diagnosis as soon as the signs are elicited. 

In others, further views or investigations will be helpful and it is important that candidates clearly state their reasons for wanting these.

Candidates should listen carefully to any information provided and ask for clarification if anything the examiner says is unclear. The amount of discussion that takes place on each case may vary but all candidates will encounter the same number of cases. Examiners may move candidates on to the next case to ensure all cases are shown within the allotted time. 

3b Equipment and software 

The oral component will be delivered to candidates in venues, via the exam platform Risr/assess (as is used for the reporting components). 

Images are presented digitally on monitors and a practise case will be shown first so that candidates can try scrolling. The examiners will move through a set a pre-selected cases and share associated images with candidates.  The exam platform functionality allows candidates to move to ‘broadcast’ mode when accessing an image which include functionality to manipulate images. This is broadcast live to the examiners. Functionality includes ability to  zoom, window, pan, scroll, and reset images, and candidates can use the mouse pointer to indicate areas being discussed. 

An instructional video is available online as well as a video of a simulated oral encounter between examiners and candidate. Candidates and trainers are encouraged to familiarise themselves with the platform functionalities in advance of the exam. 

Candidates are required to bring their candidate timetable to the exam, together with a form of photographic identification. Candidates that are not registered with the General Medical Council must bring their passport. Details on identification documents must match those supplied at application. 

The oral examiners identify candidates using their candidate number only. The examiners may introduce themselves by name; however, candidates should not give their name, or any other personal details, in reply. 

During the exam, information about patients will become available. Candidates are reminded that patients' confidentiality must be respected at all times. Exam cases must not be discussed with anyone other than the examiners. 

Patient and hospital identification names and numbers have been removed from the material used in the exam. The examiners advise candidates of any relevant personal details about the oral images under consideration, so candidates need not spend time looking for these on the cases shown.

6a Short case reporting and long case reporting

All responses are double marked by examiners. For both reporting components, each case is scored out of a maximum of five marks. Scores are recorded within the exam platform.

6b Orals 

Candidates are marked across four domains for each oral case and across one domain (the communication domain) across each of their 30-minute oral sessions. Ratings given for each are converted to a numeric value. All scores are double marked and scores are recorded within the exam platform. 

6c Overall 

Each of the exam’s three components are independently double marked, and each has an established pass mark generated through appropriate standard setting methodology.  A CR2B pass is given if a candidate has met or exceeded the passing standard for each of the three components or if they have met the passing standard for two of the three components and met additional criteria. Please refer to the scoring system webpage for more information on how results are determined. 

All candidates will receive the same standardised feedback following their CR2B attempt. This will be included in the results letter issued to candidates. Feedback will include a breakdown of scores for each of the three components. As candidates will be provided with all available details of their performance across each component, no further information will be provided. 

• Queries arising from this webpage should be addressed to the RCR’s Exams Office, either by email to [email protected] or by telephone on 020 7406 5905.  
• Queries at the time of the exam should be raised with the invigilators or College staff present.  
• Comments, feedback or complaints following the exam should be directed to the Exams Office, either by email to [email protected] or by telephone on 020 7406 5905.