Disclaimer: The thoughts, comments and figures provided are personal and are in no way endorsed by the Royal College of Radiologists (RCR). This article is aimed at a general audience but does include information that I hope will be interesting to radiologists and other doctors of all grades.
Having just passed the FRCR exam, I thought I would reflect on the numbers behind the most important and challenging exam a radiologist will ever undertake. This topic is big and so I have split it into several posts. This first post is a general introduction to becoming a radiologist and the structure of the exam for non-radiologists. A follow up post will provide a more specific break down of my reporting figures as a guide to the amount of work required to pass the exam.
For the uninitiated, the FRCR exam is an entrance requirement for admission to the Royal College of Radiologists as a Fellow. In short, it’s a collection of 3 parts and 9 separate examinations that a doctor must pass in order to practise as a consultant radiologist in the UK. It is very highly regarded internationally as evidence of competence in radiology and permits work as a consultant-equivalent in several other first world countries such as Australia.
What is a radiologist?
This is actually quite a difficult question to answer. Simplistically, a radiologist is a medical doctor trained in the use of medical imaging to diagnose and treat disease. Whilst there are many subspecialties within radiology, all radiologists are trained to interpret the full spectrum of medical imaging including plain films (simple “X-rays”), ultrasound, CT and MRI. All radiologists are also trained in the use of minimally invasive diagnostic and therapeutic techniques such as CT-guided biopsy and ultrasound-guided drainage of collections.
Pathway to consultant radiologist
The typical pathway is as follows:
- Medical school (5 - 6 years)
- Generic Foundation training (2 years)
- Variable amount of speciality training (optional but approx. 50% of radiologists have spent 2-5 years doing general surgical or medical jobs). I spent 18 months working in A&E in Australia followed by 18 months of core surgical training in the UK
- Clinical radiology training program (5 years)
As you can see, the absolute shortest time from leaving school to becoming a consultant radiologist is 12 years. I am due to complete my clinical radiology training in July 2014 having started medical school in 1999. A total of 15 years of full time training.
The FRCR exam
As I alluded to earlier (for all intents and purposes), you cannot become a consultant radiologist without passing the FRCR exam. This is done during a doctor’s clinical radiology 5 year training program. It is split into 3 parts: Part 1, Part 2A and Part 2B. You must sit (and pass) all parts in order. You cannot sit Part 2B (herein known as “the 2B”) until you have been in a clinical radiology training program for a minimum of 3 years irrespective of whether you have passed Parts 1 and 2A before this time.
FRCR Part 1 (formally known as the First examination for the Fellowship) consists of two modules (exams) (physics and anatomy) which can be sat independent of one another or at the same time. The physics exam is a two hour MCQ (multiple choice question) format. It covers radiation physics, radiation protection and image generation amongst other things. The anatomy exam format has recently changed. It is sat at a computer workstation and the candidate is given 90 minutes to look at 100 medical images. On each image, the candidate will need to name an arrowed structure.
The majority of UK trainees will sit both modules at the same time in the Spring sitting (March) in their first year or training having started the preceding August. Trainees generally can not progress to year 2 of their radiological training if they have not passed Part 1.
I passed both modules in Spring 2011 at the first attempt.
The 2A exam (formally known as the Final examination for the Fellowship Part A) consists of six modules which can be sat together or individually. Each module is two hours long and comprises 75 SBAs (single best answers). The individual modules are:
- Cardiothoracic & vascular
- Musculoskeletal & trauma
- Genito-urinary, adrenal, obstetrics & gynaecology and breast
- Neuroradiology and head & neck
Before any of the 2A modules can be sat, Part 1 must have been passed. Most candidates start sitting the 2As in the autumn (September) sitting of their second year of training. The majority of trainees sit two modules at a time and about 90% will pass after three sittings (as sittings are twice yearly, this will take 18 months to complete).
I sat two modules at each of the following sittings: Autumn 2011, Spring 2012, Autumn 2012 and passed all at the first attempt.
The 2B exam (formally known as the Final examination for the Fellowship Part B) is, hands down, the hardest exam I have ever sat and my greatest academic achievement to date.
There are four components to the 2B exam: rapid reporting, long cases and two vivas. All are taken at the same sitting. The exam is an all-or-nothing affair. Each component is scored 4-8 and 6 is deemed a passing score (don’t ask me why). You must pass at least two of the components (i.e. score a 6 in them). You need to score 24 points to pass overall.
This is sat at a Mac workstation and lasts 60 minutes. You have to look through six different cases (each containing between 1-4 different studies, i.e. chest X-rays, CT scans, etc), write down your observations, interpretations, diagnoses and management. Time management is crucial here and is frequently cited as the cause for failure by unsuccessful candidates.
Immediately after the long cases you sit the rapids. This is a 35 minute examination again sat at a Mac workstation. You are shown 30 radiographs (e.g. chest X-rays, wrist X-rays, etc) and have to decide if the image is normal or abnormal. If it’s abnormal, you have to state the abnormality. To get a pass (i.e. 6 out of 8) it is thought you need to score at least 27 correct answers.
Formally known as the oral component, this is the part of the 2B that most people dread and spend most of their time preparing for. It involves spending 30 minutes in a room with two examiners (consultant radiologists) who will present images to you and expect you to comment on them, make a diagnosis and formulate a management plan. They are free to ask questions seemingly on any topic within radiology. Each examiner has 15 minutes with you whilst the other observes and marks you. The examiners then swap over. After this torment, you move next door to another room and repeat the process with two new examiners for a total of 60 minutes of oral examination.
The scores from the four components are added up and a pass of at least 24 is a pass (with the above proviso of having to pass at least two components). You generally have to wait about a week for the results.
I passed at my first attempt in October 2013.
So there you have it. A brief summary of the academic hurdles that need to be cleared to become a consultant radiologist. The next post will take a detailed look at my reporting figures up to the point of sitting the 2B and the preparation work that went into passing it.