As a foundation doctor or core anaesthetic trainee who wants to progress to ST4 anaesthetics, one of the biggest hurdles you will face is the FRCA Primary exams – a 3-part exam series consisting of:
- FRCA Primary MCQ – a theory-based multiple-choice paper
- FRCA OSCE – a practical test of your clinical skills
- FRCA SOE – structured interviews
These exams have a reputation for making anaesthetic trainees tremble in their Crocs but worry not; in this article, we’ll go through the first of the three exams – the written FRCA Primary MCQ.
About the FRCA Primary MCQ Exam
The MCQ/SBA exam is the first part of the Fellowship of the Royal College of Anaesthetists (FRCA) primary examination process, without which you cannot take the subsequent two exams.
The primary MCQ is a multiple-choice exam that covers the core knowledge of anaesthesia, pain medicine, and intensive care. It typically occurs thrice a year, usually in February, September, and November.
This is a more theoretical exam compared to the OSCE and SOE exams and will ask you to answer 90 single best answer questions over 3 hours. You will be tested on the following parts of the core anaesthetic training curriculum:
- Pharmacology
- Physiology
- Biochemistry
- Anatomy
- Physics
- Clinical measurement
- Statistics
- Data interpretation
Passing the FRCA primary written SBA exam is a requirement for progressing to the OSCE and SOE parts of the primary FRCA examination process. The primary MCQ covers the foundational elements of the FRCA qualification, assessing your knowledge of the theory and clinical knowledge in the core areas of anaesthesia, pain medicine, and intensive care.
The Format of FRCA Primary MCQ Exam
The Primary FRCA (Fellowship of the Royal College of Anaesthetists) exam comprehensively evaluates the entire syllabus for aspiring anaesthetists.
The exam consists of 90 multiple-choice questions (MCQs) which give you a scenario and asks you to choose the most correct answer out of 5 options.
Note – From September 2023, Multiple True False (MTF) questions will no longer be on the exam, with all 90 taking the single best answer format.
While the OSCE and SOE exams are returning to face-to-face delivery in 2023, the MCQ exam will remain online, using your computer or laptop.
IT Requirements for the Online Exam
- Laptop or Computer running Windows 7 or Mac OS 10.10, or newer.
- Intel Core i3 CPU (or equivalent), or better.
- 4GB+ RAM
- A webcam which can be used to scan the room
- Working microphone and speakers
- A 13”+ screen with at least 1024 x 768 resolution.
- Multiple screens are not allowed.
- Stable internet connection with at least 2 Mbps speed
If you’re unsure whether your computer will work, check out the demo of the TestReach exam software prior to the exam.
It is important to note that MCQ questions may come from any of the curriculum codes tested in the exam and candidates are advised to refer to the "CCT in Anaesthetics, Annex B, Core Level Training" document for a detailed understanding of what is tested in the Primary FRCA exam. This document provides a blueprint of the exam, mapping it against the core level units of training, and gives candidates a better understanding of what to expect and how to prepare for the exam.
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How to Apply for the Exam
Here is the process for applying for the written FRCA primary exam in a step-by-step format:
- Meet the eligibility criteria – see below.
- Visit the Royal College of Anaesthetists (RCoA) website and create an account.
- Access the application form for the FRCA primary exam and fill in the required personal information, such as your name, contact details, and information about your training and qualifications.
- Upload a copy of your GMC registration certificate (or equivalent) and a passport-style photograph.
- Submit the completed application form along with the application fee, (previously £370.00 but yet to be announced), to the RCoA. The application fee is non-refundable and must be paid by the closing date, which can be found on the RCoA website.
- Receive confirmation of your exam date, IT instructions, along with information about the study materials and resources available to help you prepare for the exam.
Eligibility Criteria
To be eligible for this exam, you must:
- Be registered with the GMC or an equivalent national medical council.
- Not have failed the exam 6 times.
- Plus, one of the following:
Be registered with the Royal College of Anaesthesia (RCoA) as a trainee in one of the following training programmes:
- Foundation Programme
- Core Anaesthetics
- Acute Care Common Stem (ACCS)
- Intensive Care Medicine
OR
Be registered as a trainee with the College of Anaesthetists, Ireland.
OR
Be registered with the RCoA in a recognised non-affiliate membership category and currently working as an anaesthetist.
OR
Be registered with the RCoA in a recognised non-affiliate membership category and you have previously left anaesthetic training in the UK or Ireland less than 5 years ago.
OR
Have successfully applied for a Temporary Examination Eligibility (TEE) with the RCoA within 3 months of the date of the exam.
Source: Section 5: Eligibility for the Primary FRCA MCQ Examination - RCoA
For individuals who have a physical or mental disability, a specific learning difficulty, or an ongoing medical condition, reasonable adjustments can be requested during the application process by checking the appropriate boxes. It is advised to book the exam as early as possible to ensure sufficient time to put the necessary accommodations in place.
With regards to withdrawals, if a candidate decides to withdraw their application, the refund status depends on how close they are to the exam:
- Before the application closing date – a full refund
- After the application closing date but >7 working days from the exam – refund minus an admin fee
- <7 working days from the exam - no refund unless exceptional circumstances
Trainees who are taking the exam as part of their training program can claim tax relief on both their exam fees and membership fees. You can find more information on how to claim your tax rebate on the Medics Money website.
FRCA Primary MCQ Exam Dates
The FRCA primary SBA exam is typically held twice a year, usually in April and October for the written part and in June and December for the Clinical part. The exact dates for the exam are determined by the Royal College of Anaesthetists (RCoA), the organisation responsible for administering the exam.
It's important to note that the exact dates for the primary FRCA MCQ exam may change from year to year, and may also vary depending on location. The best way to find out the exact dates for the exam is to visit the RCoA website and check their exam calendar or contact the RCoA directly.
The fee for the exam is increasing. In 2023 it was £385. However, for 2024, it has increased to £400.
For the 2023-2024 period, these are the dates for the Primary MCQ Examinations:
| Exam Date | Application Open Date | Application Close Date |
|---|---|---|
| 16th February 2024 | 20th November 2023 | 20th December 2023 |
| 3rd September 2024 | 28th May 2024 | 8th July 2024 |
| 18th November 2024 | 5th August 2024 | 26th September 2024 |
FRCA Primary MCQ Pass Mark
The FRCA Primary SBA exam was previously marked with less weighting on the Multiple True False section. However, as the MTF section is being withdrawn from September, the exam is unlikely to be weighted and the overall score of 390 marks is likely to change.
Regardless, the overall pass mark will still be calculated using a Modified Angoff Method and will not be available ahead of time.
FRCA Pass Mark Calculation Process
In the Modified Angoff Method, the passing score for the exam is calculated using expert opinion on how many questions a "borderline" candidate (expected to just scrape a pass) should answer correctly, taking biases into account.
This is combined with adjustments for questions with errors, as well as a standard error of measurement, to give the official exam pass mark. The process is as follows:
- Subject Matter Experts (SMEs) go through each question, giving the likelihood that a borderline candidate will get the answer right.
- SMEs go through several rounds of being given additional information, such as real-life performance data and how their answers compare to other experts.
- In each round, they are permitted to change or keep their answers (this is where the modified version differs from the standard Angoff Method).
- Questions with errors or ambiguities are removed from candidate scores and the marking criteria.
- The calculated average borderline pass mask is then reduced by one Standard Error of Measurement to give the official pass mark for the exam.
The pass rate for the Primary MCQ has been around 60% over the past few years, though this varies year to year (range 45.31 – 73.36 in the past 3 years of released data).
It is also important to note that passing the primary FRCA exams is only one of the requirements to become a consultant anaesthetist in the UK, trainees must also pass the FRCA final exams and must meet all the other requirements of the RCoA, including completing a certain number of years of training and passing an assessment of their clinical practice.
FRCA Primary Exam Prizes
There are two prizes available for those on their first attempt at sitting the primary FRCA exams:
Nuffield Prize
This is given to those achieving the highest levels of distinction in a Primary FRCA exam.
Chair’s Commendation Letter
This is given to any candidate who missed out on the Nuffield prize who performs at a level of distinction (top 5% of candidates) in a Primary FRCA exam.
FRCA Primary MCQ Exam Results Date
The exact results date for primary exams the results varies depending on the timing of the exam and the location, and are subject to change. You will be able to find out the exact release date on the RCoA website nearer the time, but expect results to take approximately 3-4 weeks to release.
The results of the exam will be emailed to the address associated with your RCoA account.
Frequently Asked Questions
Here are some other frequently asked questions about the FRCA primary exam and their answers. If you have any questions left unanswered in this article, please feel free to get in touch with us.
What is the format of the FRCA primary exam?
The FRCA primary is divided into three exams: a multiple-choice written (MCQ) exam, a practical (OSCE) exam, and a structured oral viva (SOE) exam. MCQ examination consists of multiple-choice questions and is typically held three times a year, in February, September, and November.
The clinical examinations (OSCE and SOE) are taken together, consisting of 16 OSCE stations followed by a structured interview with questions taken with two examiners. These are typically held three times per year, in May, November, and January.
How long is the FRCA primary exam?
The primary FRCA MCQ exam is usually 3 hours long, though you may be eligible for a reasonable adjustment if you have a disability, learning difficulty, or ongoing medical condition.
How do I prepare for the FRCA primary exam?
The RCoA provides a variety of resources to help candidates prepare for the exam, including sample questions, past papers, and study guides. It is also recommended that candidates attend FRCA primary exam courses, study groups, and use other relevant resources such as books and articles.
How many times can I take the FRCA primary MCQ exam?
You may sit the primary FRCA SBA/MCQ exam a maximum of 6 times without requiring an exemption. If you have failed the exam 6 times, you will need to provide evidence of extenuating circumstances in an appeals process. Candidates must wait at least 6 months between attempts and must reapply and pay the exam fee for each attempt.
What happens if I fail the FRCA primary exam?
If a candidate fails the written FRCA primary exam, they will be given feedback on their performance and be advised on the steps they need to take to prepare for their next attempt. You may fail a maximum of 6 times.
How does the FRCA primary exam affect my training?
Passing the FRCA primary exam is a requirement for progressing to the next level of anaesthesia training in the UK. Candidates who pass the exam will be able to move on to the FRCA final exams.
How long is the Primary FRCA valid for?
Each component of the FRCA Primary is valid for three years – meaning that if you have not obtained a pass in all three of the examinations within three years of your first passing date, you may be required to re-take one or more of the expired exams.
