FRCR Examination: The Ultimate Guide for Overseas Radiologists

When it comes to clinical radiologists, the UK healthcare system is facing a serious demand-supply issue: service demand consistently exceeds workforce capacity.

As per the Royal College of Radiologists’ (RCR) latest assessment from 2022:

• The demand for diagnostic activity is rising by 5% every year. The increase in the annual radiology workforce? Just 3%.
• There is a 29% shortfall of clinical radiologists in the UK. That number is expected to go up to 40% by 2027 if about 3400 radiologists aren’t added to the workforce by then.
• Only 24% of clinical directors say they have a large enough team of radiologists to deliver safe and effective patient care. For context, this number was 36% in 2020 and 30% in 2021.
• 52% of vacancies have been open for over a year across the UK.

These capacity constraints mean that the UK is spending hundreds of millions of pounds outsourcing radiology work to private companies. Alternatively, hospitals are insourcing radiology work, which is stretching doctors too thin and causing burnout.

The bottom line: The UK needs clinical radiologists; there is a lack of internal talent to fill up vacant positions, and they are looking at recruiting more IMGs to fill the gap. If you’re an overseas radiologist looking to practise in the UK, there’s no better time than now to go for it.

Your route to a clinical radiologist job in the UK? Clearing the FRCR (Radiology) exams.

What are the FRCR Radiology exams?

The Fellowship of the Royal College of Radiologists (or FRCR) exams is a route to getting registered with the UK’s General Medical Council (GMC) and becoming eligible to practise as a radiologist in the UK.

The exam is split into three parts: FRCR Part 1, FRCR Part 2A, and FRCR Part 2B. Each part comprises 2-3 further components that assess your radiology knowledge and know-how in different ways. Each part of the FRCR exam series is scored differently as well.

If you’re new to this, you’re probably confused by the many moving parts of this exam series. We’ve created this detailed FRCR examination guide to help you figure it all out.

We’ll go over areas like exam eligibility, structure, scoring system, and commonly-tested skills. We’ll also walk you through when, where, and how you can appear for any of the FRCR exams.

Should you take FRCR or PLAB?

If you’re looking to get registered with the GMC as a radiologist, there are two routes you can take: FRCR or PLAB (Professional and Linguistic Assessment Board).

* Sources: The Royal College of Radiologists Website and General Medical Council UK website 

Between the two, we recommend you appear for the FRCR exam. Here’s why:

• Course outcome: When you clear all FRCR exams, you get an internationally recognised diploma. When you clear PLAB, you’re only gaining eligibility to register with the GMC.
• Career outcome: With FRCR, you join the UK healthcare system in an ST3+ radiology position, i.e., a senior trainee position. With PLAB, you start at junior radiology positions.

And what about difficulty? The FRCR exam is generally considered more difficult than PLAB. But FRCR also gives you a significant jump in your career as a healthcare professional in the UK, which PLAB doesn’t. The payoff is worth it.

Who’s eligible to take the FRCR exam?

Here are the eligibility criteria for attempting each exam in the FRCR (Radiology) series.

FRCR Part 1 (Radiology) eligibility:

• You must be in a formal clinical radiology training post in which you are actively receiving clinical radiology training (or have held such a post in the past).
• No minimum period of clinical experience or clinical radiology training is required.

FRCR Part 2A (Radiology) eligibility:

• You must have passed the FRCR Part 1 exam.
• You must have completed 24 months of clinical radiology training.

FRCR Part 2B (Radiology) eligibility:

• You must have passed the FRCR Part 2A exam.
• You must have completed 34 months of clinical radiology training.

What is the FRCR exam structure?

Here’s a quick overview of the structure for Parts 1, 2A, and 2B of the FRCR examination.

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Source: Royal College of Radiologists

Now, let’s break it down.

FRCR Part 1 exam structure:

There are two modules in the FRCR Part 1 exam: Physics and Anatomy. You need to pass both modules in order to clear FRCR Part 1.

Exams for both modules are held on separate days and can be attempted in any order. 

If you choose, you can attempt either module in a separate sitting (i.e., exam month). Usually, candidates prefer to attempt both modules on consecutive days.

Physics module:

• Testing duration: The Physics module lasts a total of 120 minutes.
• Number of questions: There are a total of 40 true or false questions, with 5 statements associated with each question. You have to mark each of these 5 statements as true or false. So, effectively, you’re solving a total of 200 questions.
• Mode of response: Computer-based selection.
• Scoring system: You get +1 for a correct answer and 0 for an incorrect answer. There is no negative marking.
• Maximum possible score: The highest score you can achieve is 200.

Note: There is no restriction on the number of true or false items in a question. It is possible for all five items to be true or for all to be false.

Anatomy module:

• Testing duration: The Anatomy module lasts a total of 90 minutes.
• Number of questions: There are a total of 100 image-based questions, i.e., 1 question associated with each image.
• Mode of response: Computer-based typed responses.
• Scoring system: You get +2 for a completely accurate response, +1 for a lower accuracy response, and 0 for an incorrect response. There is no negative marking.
• Maximum possible score: The highest score you can achieve is 200.

Note: Answers in the Anatomy module are matched by a computer. Any answers that do not exactly match those within the platform will be reviewed by examiners and awarded an appropriate mark.

FRCR Part 2A exam structure:

There are two papers in the FRCR Part 2A exam, each attempted on the same day. Both papers have to be taken in the same sitting and cannot be attempted on separate days.

• Testing duration: Each paper lasts a total of 3 hours, with the combined exam duration amounting to 6 hours. You can take a break in between papers as well.
• Number of questions: Each paper has a total of 120 questions, with the combined total across the two papers amounting to 240 questions.
• Mode of response: Single-best answer (SBA) via pen and paper
• Scoring system: You get +1 for a correct answer and 0 for an incorrect answer. There is no negative marking.

Note: The pass mark for FRCR Part 2A varies from one sitting to another. This is because scoring is done via statistical models based on how difficult a paper is.

FRCR Part 2B exam structure:

FRCR Part 2B (commonly known as FRCR Part B)  consists of three components: rapid reporting, reporting, and viva.

Rapid reporting component:

• Testing duration: 35 minutes.
• Number of questions: 30 image-based questions. The questions are a split between normal and abnormal cases. The images are primarily plain radiographs.
• Mode of response: Computer-based typed responses.

Reporting component

• Testing duration: 75 minutes.
• Number of questions: 6 long cases, the answers for which have to be provided as a typed report in a standard format comprising ‘Observations,’ ‘Interpretation,’ ‘Main diagnosis,’ ‘Differential diagnosis,’ and ‘Further investigations/management’ sections.
• Mode of response: Computer-based typed responses.

Viva component

• Testing duration: 60 minutes, broken down into two 30-minute sessions. Each session will be taken by a pair of examiners.
• Number of questions: No specified number of questions.
• Mode of response: Oral responses based on a wide range of provided material (including images) 

Breaking down the FRCR 2B scoring system:

The FRCR 2B scoring system is a tad bit complex, with separate scoring systems for each of the components: two orals, a reporting session, and a rapid reporting session. 

Let’s break it down per component.

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Overall scoring system:

• Each component of the FRCR 2B exam is marked out of a total score of 8. 
• For each component, the pass mark is 6 marks. 
• There is also an overall pass mark of 24 marks.

Crucially, you need to achieve a score of 6 or above in a minimum of two out of the four components to pass the FRCR 2B exam.

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Source: Royal College of Radiologists

In other words, if you receive less than 6 marks in three or more components, you fail and have to reattempt all modules again, even if you’ve achieved a total of 24+ marks.

With us so far? Now, let’s get into each component.

Rapid reporting scoring system

You’ll be assessed on your ability to correctly classify and identify normal and abnormal appearances across 30 case studies. Here’s how your responses will be marked. 

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Your final score will then be scaled to a specific range. More on this below.

Reporting scoring system:

You’ll be assessed on your ability to make observations, interpret information, present a diagnosis, present a differential diagnosis, and elaborate on any steps needed for further investigation or management. This assessment will be based on 6 separate cases.

Source: Royal College of Radiologists

Your final score will then be scaled to a specific range. More on this below.

Viva scoring system:

You’ll be evaluated on how well you assess and diagnose cases you’re likely to encounter at your job. The assessment will be conducted by two pairs of examiners on cases from major radiology subspecialities. Here’s how you will be marked.

Source: Royal College of Radiologists

Final score scaling:

In order to arrive at a final score that accounts for all three components of the FRCR Part 2B exam, the scores obtained in the Reporting and Rapid Reporting components will be scaled to a range between 4 to 8 marks. These scores will then be added to your Viva score to arrive at the final score.

Source: Royal College of Radiologists

Skills tested on the FRCR exam:

Each FRCR (Radiology) exam tests you on your radiology knowledge and skills gained from your experience as a resident. Let’s go over what this looks like for each exam.

FRCR Part 1 areas tested:

FRCR Part 1 tests your knowledge of physical principles of diagnostic medical imaging, as well as your ability to perform and interpret radiological studies.

Physics module

• You’re assessed on your knowledge of physical, cellular, and molecular principles of radiological imaging.
• Radiology processes tested include radiography, fluoroscopy, angiography, computed tomography (CT), ultrasound imaging, radionuclide imaging, and magnetic resonance imaging (MRI).

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Source: The Royal College of Radiologists

Anatomy module

• You’re required to assess radiological images and type in the most precise anatomical description.
• Each image will have one or more arrows that indicate a single structure with a single associated question that needs to be answered.

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Source: The Royal College of Radiologists

FRCR Part 2A areas tested:

The following subspecialities are tested on the FRCR 2A exam.

• Cardiothoracic and Vascular
• Musculoskeletal and Trauma
• Gastro-intestinal
• Genito-urinary, Adrenal, Obstetrics & Gynaecology and Breast
• Paediatric
• Central Nervous and Head & Neck

Both papers will have a mixture of questions from each of these subspecialities.

FRCR Part 2B areas tested:

The FRCR Part 2B exam is a largely case-based assessment of your radiology knowledge and skills with the intent of testing your performance in situations you’ll regularly encounter while practising.

Rapid reporting component:

• The rapid reporting session comprises 30 cases. You’re required to identify those cases that show normal appearances and those that show an abnormality.
• The images are all radiographs, with no other forms of imaging tested.
• The balance of normals within the images is about 45-50%, with trauma cases as the majority but some chest and abdominal radiographs are included.
• Where an abnormality is present, you need to briefly identify it or give a diagnosis.
• Each abnormal case shows one significant diagnosable abnormality.

Reporting component:

• The reporting session comprises 6 cases. You’re required to evaluate each case and type a detailed assessment report.
• 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.
• The cases vary in complexity and difficulty; some require more time for analysis and reporting than others.

Viva component:

• This component mirrors the day-to-day clinical discussions and MDT meetings.
• You will be shown a wide range of materials of varying complexity. This material can include images and text cases from major clinical radiology subspecialties.
• Based on your assessment of the material, you’ll be asked a series of questions by the examiners.

What happens if you fail any of the three exams?

In the FRCR exam series, you get per exam and per module reattempts. Let’s break this down.

• In FRCR Part 1, if you pass in one module but fail in another, you can reattempt the one you failed in. You do not have to reattempt the module you’ve passed in. Here, you get a total of 6 reattempts per module.
  
  
• In FRCR Part 2A, you are assessed for your performance in both papers. There isn’t an individual passing mark for each paper. If you fail, you have to reattempt both papers. Here, you get a total of 6 reattempts for the entire exam.
  
  
• In FRCR Part 2B, failing is equivalent to either not getting 24 marks or above or not getting 6 marks or above in at least two of the four components. If you fail the overall examination, you have to reattempt all components. Here, you get a total of 6 reattempts for the entire exam.
  
  
• If you’ve passed one exam in the FRCR series but failed the next one, you only have to reattempt the exam you’ve failed. E.g., if you passed FRCR 2A but failed FRCR 2B, you only have to reattempt FRCR 2B.

Here’s a graphical representation of how this works.

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Also, bear in mind that:

• If you’ve applied for but don’t sit for an exam, it is not counted as an attempt
• If you’ve exhausted all attempts for any of the exams, you’ll need to undertake at least twelve months of additional educational experience before being permitted to retake the exam.
• Before any attempt beyond your sixth attempt, you also have to submit a signed statement from your educational supervisor confirming that additional training and support have been provided, which has materially improved your chances of clearing the exam or exam module.

When and where can you take the FRCR exam?

Each exam in the FRCR (Radiology) series happens at least twice in a calendar year. The exams are usually split into two parts over two consecutive days. 

Currently, Indian candidates can appear for each of the FRCR exams in Hyderabad only.

FRCR Part 1 exam dates:

The FRCR Part 1 exam is conducted thrice a year, in March, June, and September. Currently, Indian applicants can appear for FRCR Part 1 in Hyderabad only.

Source: The Royal College of Radiologists

FRCR Part 2A exam dates:

The FRCR Part 2A exam is conducted twice a year, in April and November. Currently, Indian applicants can appear for FRCR Part 2A in Hyderabad only.

Source: The Royal College of Radiologists

FRCR Part 2B exam dates:

The FRCR Part 2A exam is conducted thrice a year, in March, June, and September/October. Currently, Indian applicants can appear for FRCR Part 2A in Hyderabad only.

Source: The Royal College of Radiologists

How much does the FRCR exam cost?

The FRCR exams will cost you a total of £2,754 as a non-member of the Royal College of Radiologists. If you’re a member, the cost comes down to £2,078.

‍Note: An RCR membership gets you access to exam material, RCR’s Learning Hub, a network of radiologists, mentors, and many other resources. This is a paid membership and will cost you over and above your FRCR booking fee.

Learn about RCR’s rescheduling and refund policy here.

How do you apply to take the FRCR exam?

To register for any exam in the FRCR Radiology series, follow these steps:

1. Register an account with the RCR, if you haven’t created one before.
2. Once registered, you will receive an email with a unique RCR number. 
3. Enter your RCR number as the username on the RCR exam hub portal.
4. You can now access your MyRCR dashboard.
5. On your dashboard, you’ll be asked to choose an exam pathway. Your option will be Clinical Radiology, Dental Radiology, and Clinical Oncology. Choose Clinical Radiology.
6. You can now schedule the exam you want to appear for. You can also cancel and reschedule your exam bookings through the MyRCR dashboard.
7. Once the exam is booked, you will be taken to a payment gateway. You’ll need to pay separately for each exam booked. 
8. You’re all set!

You’ve passed. What’s next?

Let’s break down each scenario.

If you’ve passed FRCR Part 1

You’re now eligible to register for FRCR Part 2A. Before applying for FRCR Part 2A, you need to have completed at least 24 months of clinical radiology training.

If you’ve passed FRCR Part 2A

You’re now eligible to register for FRCR Part 2B. Before applying for FRCR Part 2B, you need to have completed at least 34 months of clinical radiology training.

If you’ve passed FRCR Part 2B

Congratulations! You’ve hopped a tremendous hurdle. As the next step, you need to register yourself with the GMC. Once your application is approved, you’re eligible to practise as a radiologist in the UK!

Get a top radiology position in the UK with help from TERN:

After successfully passing the FRCR exams, obtaining your diploma, and registering with the GMC, the next logical step is to secure a suitable role. This is where we come in to assist.

TERN is a comprehensive platform for recruitment, skill development, and migration designed to support healthcare professionals like you in advancing your career.

• Personalised job matches: We assist you in finding opportunities that align with your qualifications and resume. From searching for roles to accepting offers, the process is streamlined through the TERN platform.
  
  
• Reputable employers: We connect you with reputable employers, including the NHS, ensuring a good fit. All recruiters on TERN undergo a thorough vetting process, ensuring a reliable and surprise-free experience.
  
  
• Relocation support: We provide assistance with the visa process, travel, accommodation, and local services in the UK, helping you transition smoothly.

Contact us to discover how we can support you in securing and transitioning into the top healthcare positions in the UK.