Dr James Shorthouse MBBS BSc (Hons) FRCA Final FRCA Resource Editor
The Final FRCA Examination is considered to be the gateway to the rest of your career as it defines the moment when you become a senior trainee in anaesthesia. You will also become a Fellow of the Royal College of Anaesthetists, for some the first postgraduate qualification, entitling you to use the letters FRCA after your name. This massive step in your career is not an easy one; you have to convince the examiners that you are worthy to become one of their consultant colleagues, for this is what they are looking for, especially in the Structured Oral Examination. As with the Primary exam, the reason that many candidates fail, some at the first hurdle of the written paper, is a lack of preparation (both mental and academic) and understanding of what is required to be successful. I enjoyed participating in the Final FRCA so much that I decided to do it twice (rumour has it that some enjoy it even more than me!). You may say then why should someone who failed the exam be qualified to give advice on how to pass it. Fair point, but I believe that it has given me even further insight into the workings of the exam, what is required of the candidate, and how to maximise one’s chances of being successful first time off. It also allows me to highlight some of the pitfalls of my revision and mistakes that I made – I certainly learnt from them the second time round!
When I first started revising for the Final exam, I often heard the comment: “It’s much easier than the Primary because you’ve done the Science already and the Clinical is what you do everyday”. Unless you are taking the Final straight off the back of the Primary (v.brave!), then months (even years) may have elapsed since you were last in ‘Exam Mode’. This makes the above statement a very dangerous comment to take on board and potentially fatal if that is the mentality one adopts. In reality, you need to go back to the beginning and re-revise your Basic Sciences, for this is the section of the exam where many candidates (me included) fall down, especially in the SOE section. One also needs to start thinking about Clinical Revision because some candidates will need to revise Clinical Specialties such as Cardiothoracic Anaesthesia or Neuroanaesthesia never having experienced these branches of anaesthetics in their careers. As I mentioned in my Primary Guide, the changing structure of the Final Exam should not translate to a shortened revision period. The syllabus is huge, encompassing both the Basic Sciences (with clinical orientation) and not just Clinical Anaesthesia with its many sub-specialties, but rapidly-expanding branches such as Critical Care Medicine and Pain. I believe that to cover these areas adequately, a period of six months of hard book-work following the syllabus is required. Before starting the hard graft, a period of mental planning is required. Honest explanations to your partner/family that yet another six months of your life (or a year in my case – that did not go down well!) will not be devoted to them but rather to books and studying are inevitable. The hardest part of revision is getting started. There seems to be a greater feeling of lethargy in wanting to commence revision for the Final exam; whether it is because generally the candidate is older, or there are different commitments to juggle with revision, I don’t know, but I certainly found it much more difficult to get stuck in and knuckle down. One again needs to plan study leave to cover courses and the exam dates well in advance. Financial preparation is also necessary – as we all know, books, courses, and exam fees are not cheap!
It is obviously fundamental that you know when the exam is, when the application has to be in by (point of no return!), and most importantly for the RCOA, how to pay your hard-earned money. It is also vital that you keep abreast of changes to examinations using the RCOA examinations homepageExam calendar & fees Application form
Candidates revise in different ways. Some like to practice questions/MCQs early on and fill their knowledge in around this structure. Others use a topic-based approach. I cannot emphasise strongly enough the need to use the RCOA Final FRCA syllabus as a road-map for your revision. By dividing exam revision up into topics, perhaps starting with unfamiliar or less confident topics, one can make some headway up the mountain! The obligatory, extremely-detailed, colourful timetable can be an excellent way to procrastinate and delay the inevitable.
I find it very hard to recommend particular courses as I have only been on a few myself. It is worth speaking to past candidates/trainees who have been on the courses recently as they will give you the most up-to-date information of how useful that particular course was. I attended a well-known eponymously-named course in the North-West of England which I found fantastic, as it really gave me a kick up the backside to obtain the standard required for the written section of the exam. It was also an excellent opportunity to undertake strictly timed SAQ papers – a must when building up the stamina required to attempt the whole paper. A list of available courses for various aspects of the Final FRCA exam can be found here.
a) The Final FRCA written section
A stand-alone examination which must be passed before progressing on to attempt the SOE section. A pass in this section is valid for two years measured to the published starting date of the exam applied for. The pass mark for the written section is obtained from adding the percentage pass marks of the combined MCQ and SAQ papers – each paper carries equal weighting.
It is divided into two sub-sections:
i) Multiple Choice Question (MCQ) paper
There are currently 90 MCQ questions, each with five stems, to be answered in a True/False style, over 3 hours. Negative marking has been removed from this section so there is no advantage to omitting stems i.e. all stems/questions should be attempted. The sub-division of the MCQ section is as follows: Medicine & Surgery (20 questions), Anaesthesia & Pain Management, including applied Basic Sciences (40 questions), Clinical Measurement (10 questions), & ICU (10 questions).
ii) Short Answer Question (SAQ) paper
Please see separate SAQ guide here
***September 2010 Changes***
The number of MCQs will be reduced from 90 to 60, and 30 Single Best Answer (SBA) questions will be introduced to the paper. Further details can be found here and sample SBA questions may be found here
b) The Structured Oral Examination (SOE)
This is a stand-alone section of the Final FRCA exam, requiring a pass in the written section prior to attempts. Candidates have a maximum of six attempts at the SOE section.
It is divided into two sub-sections consisting of:
Clinical Anaesthesia
Candidates are given 10 minutes to look at a clinical scenario, including history, examination, investigations, & scans. There is then a 20 minute long-case viva comprising three questions based on the clinical material. This is followed by 20 minutes on three short-case clinical anaesthesia questions unrelated to the previous clinical material.
Clinical Science
This section consists of four questions on the application of basic science to clinical anaesthesia, intensive care medicine, and pain management. It lasts for 30 minutes with each section given equal timing & marks weighting.
Two examiners mark each part of the SOE. Both examiners independently mark every question. There are 10 questions altogether, 2 marks are given for a pass, 1 mark for a borderline performance and 0 marks for a fail, giving a maximum total score of 40 marks (pass mark being 32).
The recommended textbooks for the Final FRCA can be found here An absolute must: FRCA Final Examination. As with the Primary version, this has examples of questions from all sections of the exam. The MCQ section is particularly useful as it is taken from the actual college bank and some do appear in the exam. Opinion is divided as to whether to use a large textbook or not e.g. Aitkenhead, Pinnock, Hutton etc. This is a personal opinion and one which can be decided by previous experience for Primary and browsing before trying. One book particularly recommended by many consultants is Stoelting's Anesthesia and Co-Existing Disease. Candidates will need to purchase/borrow some specialist textbooks - many can be ordered from AnaesthesiaUK (Cambridge books, Elsevier books , Hodder Arnold ). Here is a list I found useful: General Companion to Clinical Anaesthesia Exams (FRCA Study Guides) (Charlie Corke)Clinical Notes for the FRCA (FRCA Study Guides) (Charles Deakin) MCQ Final FRCA: Multiple Choice Questions (FRCA Study Guides) (Michael D. Brunner) QBase Anaesthesia: MCQs for the Final FRCA v. 5 (Edward Hammond)MCQs for the Final FRCA (Khaled Elfituri) MCQ's in Anaesthesia (FRCA Study Guides) (A. Ganado) QBase Anaesthesia: MCQs for the Anaesthesia Final FRCA v. 2 (QBase) (Mark Blunt) FRCA: MCQs for the Final FRCA: Saunders Self Assessment Series: MCQs for the Final FRCA (FRCA Study Guides) (Karen Henderson) Practice MCQ's for the Final FRCA (FRCA Study Guides) (Jon Hardman) SAQ Anaesthesia & Critical Care (Chris Dodds & Neil Soni) Short Answer Questions and MCQs in Anaesthesia and Intensive Care (Peter Murphy)Short Answer Questions in Anaesthesia (Simon Bricker)Final F.R.C.A.: Short Answer Questions (J. Nickells)SOE The Anaesthesia Science Viva Book (Simon Bricker)The Clinical Anaesthesia Viva Book (Simon J. Mills)
Primary textbooks to use for the Final FRCA:
- The A-Z of Anaesthesia (Smith, Yentis)- Basic Physics and Measurement in Anaesthesia (Kenny, Davis) - Essentials of Anaesthetic Equipment (Al-Shaikh, Stacey) - Pharmacology for Anaesthesia and Intensive Care (Peck, Hill, Williams): - Respiratory Physiology: The Essentials (West) - Oxford Handbook of Anaesthesia: the second edition is well-updated topically and contains some interesting extra sections which will aid in exam revision. - Drugs in Anaesthesia and Intensive Care (Sasada, Smith): again great for viva practive - The Anaesthesia Viva 1(Urquhart, Blunt, Pinnock, & Dixon): Physiology 7 Pharmacology. Common SOE questions with model answers. Great for last minute SOE revision. - The Anaesthesia Viva 2(Blunt, Urquhart, Pinnock, & Chong): Physics, Clinical Measurement, Safety, & Clinical Anaesthesia, as above - The Structured Oral Examination in Anaesthesia (Balasubramanian, Mendonca, & Pinnock): I found this so useful again even for the Final exam – 10 full SOEs divided by topic with model answers. As stressed before, this list of textbooks is not exhaustive, merely the ones I used. Some of my fellow candidates used additional textbooks such as Anatomy for Anaesthetists (Ellis, Feldman, & Harrop-Griffiths) and various specialist physiology texts.
The World Wide Web is a great source of advice and revision material for this exam. If you are reading this you hopefully will concur. I will try and list some of the resources I used whilst revising for the Final FRCA: AnaesthesiaUK Specifically for topical issues and guidelines. Passingthefinal Although now not updated, this was a diary of my journey through revising for the Final exam. Examintelligence Another Final FRCA revision website written by a successful candidate. Includes a wide range of medical and non-medical topics. Instantanatomy A great anatomy resource Ecglibrary A great ECG resource! AnaesthesiaCases A relatively new evolving site from Australia concentrating on topical issues and anaesthesia education. Update in Anaesthesia CEACCP articles NICE NPSA AAGBI DAS NCEPOD Surviving Sepsis NYSORA Lipid Rescue Radiology Pain Society
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