Preparing for the FRCR 2B

So you’ve passed the Part 1 and Part 2A exams and now you are ready for the 2b. Congratulations!

For those of you coming into radiology from foundation training this may well be a different style of exam from what you are used to. However there is lots of advice and help available and in this document and I will try to help Severn trainees navigate this process. Most of the content of this document is personal opinion, may not be wholly accurate and will undoubtedly become less relevant over time, but this does reflect my genuine experience and I hope you find it useful.

Working towards the final 2b exam started as soon as you started the training scheme. The part 1 and 2a written examination based around the core radiology principles, together with your day-to-day clinical work is the basic background to the 2b exam. However a focused period of preparation for the components of the 2b examination is sensible.

The timeline for most trainees starts soon after completing 2a, though some choose to delay for 6 months or possibly more. A 4 month period of dedicated work toward 2b with a 2 month organisational and familiarisation process is probably generous, as it can be difficult to keep fresh and enthusiastic for longer. Considering which if any specific course you wish to attend should be a priority as some of these do fill up very quickly, even before the previous 2a/2b results are published.

Details of the FRCR 2b exams including: dates, fees, regulations and some advice, is available on the FRCR website. The FRCR 2b exam breaks down into 3 separate section and it makes some sense to think about preparing for each part separately, though ultimately you do have to pass all 3 in the same sitting.

By reading this document at the start of your 2b campaign or even in advance you will hopefully gain some insight, however some of the points I make may only be relevant once you have started the process in earnest and I urge you to reread this document a month or two before the exam.

Books:

Critical Books for 2B:

Chapman and Nalkielny : Guide to Radiological Diagnosis.

Useful:

Aunt Minnes guide to radiological diagnosis.

Case series: Neuro, GI and Paeds are particularly strong.

Eisenberg’s – which is basically Chap and Nack with pictures.

Aw + Curtis - FRCR 2b Long cases

Dahnert:

Rapid review of Radiology – Shahid Hussain, alternative to Chap and Nack

The VIVA:

This part of the exam probably generates the most anxiety and in my case was the part I spent the longest preparing for.

The key to preparing for this exam is seeing a lot of plain film. People say it is atypical presentations of common pathology (eg biliary gas on CXR) or common presentation of rare pathology (eg LAM on HRCT). Most trainees will be relatively comfortable with cross sectional imaging, but relative to the examiner (at a similiar stage of training) will have much less plain film experience, chest x-rays really are the bread and butter here. Also every individual candidate will have a different set of strengths and weaknesses at the start of their preparation, and it is probably more important to try and fill in the gaps, and excel only occasionally rather than leave large holes in your knowledge. As an example most trainees seem to find barium and contrast studies a particular weakness.

A good way to increase experience is to visit one of the regional film libraries. They each have strengths and weaknesses. The answer is normally written on the film packet with a limited differentia. Taking Chap and Nak for reference is really useful.

• Bath has a very extensive and well categorised library , if a little aged, which is very useful for eg 25 different cases of Crohn’s disease, but has limited cross sectional. The categorisation into GI, chest, MSK etc is useful if you want to fill in a particular weakness. But for viva practice it can be deceptive (eg in the MSK section every CXR is probably a rib lesion)

• Weston has a smaller film library, however it is organised into viva style style packets with different systems in each packet. The emphasis is clearly on plain film. I strongly recommend making several visits, if possible in small group, and using this as an opportunity for viva presentation.

• BRI again has a smaller film library , which is almost completely disorganised. There are some great cases, though equally there are some slightly obscure techniques. This is probably best left till last/ when you feel you need an extra challenge.

In addition within the region there are many opportunities for viva practice and teaching. These require you to be well organised and in my experience one individual needs to act as overall coordinator, with ideally people arranging the teaching at their base hospital. The consultants available to do this do vary from year to year, due to other commitments. However most years generate a list of interested individuals and are happy to pass the information on. Contacting the relevant educational supervisor is an alternative. Email seems a sensible way to organise this and giving people as much warning as possible is key (especially over the summer holidays). In my experience compiling the list and then sending out preliminary emails about 4 to 5 months in advance of the exam is probably about right. Ideally the majority of sessions should be in the 2 to 3 months prior to the exams, which give a 2 to 3 month lead time.

Some departments in the region arrange mock exams days, which I suggest are particularly useful to do earlier rather than later, to give a flavour of the exam. Previously Yeovil, Gloucester, Cheltenham, and Swindon have all been keen.

On the Day:

On the day this will involve an hour in the basement of the college split between 2 pairs of examiners, where you will be shown predominantly plain film radiographs and expected not to talk rubbish. Clearly confidence and professionalism as well as sensible radiology are what they are looking for, though the nuance can vary from year to year. Examinees are given a scenario, such as: ‘its Monday morning, I’m a consultant at work lets look at some films together’, ‘I’m a clinician come down form the wards to ask you about some cases’, ‘I’m the medical SpR and I want to ask you about some films’.

Mostly plain film. Some times with follow up cross sectional imaging. Limited amount of US and nuclear medicine. Tend to cover a variety of the FRCR modules, eg neuro and head and neck, chest, GI. With occasional follow up questions, though not in every case, I presumed these meant I was doing very well or very badly. 1 set of examiners were very keen for a final diagnosis, I was asked to give an answer as a ‘dictated report’, in another case I was asked talk about the degree of confidence.

The transition to digital cases, will probably have only limited impact on the content, but may well affect the delivery, especially if there are teething problems.

Rapids:

30 films, 35 minutes. Lots of possibility to discuss statistical distributions (eg maximum 18, minimum 12 abnormals) but this is not really the point, also I think the college are wise to this and I know someone who passed and called 22 abnormals, so be cautious. My personal tactic: spot the definite abnormal. Call the rest normal. I tried not to re-review to much as this made me overcall. Overall this part of the exam there is potential to improve your marks significantly with a little exam technique. Not to be underestimated, anecdotally this is the section that most people fail.

Long Cases:

6 cases, 60 minutes. Closed marking system, 4 to 8. Time keeping is critical. Relates to clinical work most readily. Expect a variety of techniques and systems to be covered. Main advice is to look at a lot of cases and there are several books that do this. Also there is a teaching file of these cases in Southmead. The answer booklet includes sections for

• Description,

• Interpretation

• Main Diagnosis

• Limited differential

• Action plan

The key is to write concise legible answers (using bullet points) to enable the examiner to see what you’ve put down and get the points you deserve. Also enables additional points to be retrospectively included, if the bullets are suitably spaced. My general approach fell into 3 categories:

1/Simple case – eg trauma or diffusely metastatic disease. Lots of thing to observe with limited interpretation and differential – start writing ASAP.

2/Special case – eg MEN 1a. I knew the answer – technique here is to attempt to maximise opportunity for marks. Likely to be a typical case with typical findings.

3/Special case – I didn’t know the answer. Again aim is to maximise opportunity for marks. Don’t waste time better spent on another case. Stay general, good observation, general differential, action plan that involves eg MDT or surgical input .

Courses:

Rapid Reporting:

Red Dot – Northwick Park – get used to the equipment that is used in the exam, has been running for a while and really does cover a lot of ground. They run a series of days, but I felt that the first day gives the biggest gains.

Viva/Mock Exam

Swindon – attempts to recreate the feel of the exam, also cheaper than most, well worth it. Gets oversubscribed so book early.

Aintree- one of the best regarded courses, particularly the 4 days, in conjunction with DB course. Gets oversubscribed so book early.

Bristol – local course, so clearly to be supported. Strong in rapid packets, weakness is that local consultants are involved, so potential to reproduce local teaching, though every effort is made to avoid this. Has been a little while since I attended this course, so feel free to provide an update.

Plymouth – Good overall course

Birmingham – Strong course. Some local examiners (from cheltenham). Very strong on the long cases, with good structured feedback and advise as to how to increase your effectiveness.

Coventry – good overall course. Runs in the fortnight before the exams. Includes some dedicated tutorials (NM, Breast, Cardiac).

Many other courses are available. Particularly Edinburgh and some of the London courses are talked about, though I have no personal experience.

Educational - clearly there are a lot of courses out there, but the ones below are aimed at preparation for the FRCR

Basildon FRCR course, runs as a set of lectures every weekend, which recovers the 2A syllabus with emphasis on preparation for 2B. Runs in a big lecture theatre, with clear potential for extra candidate. I believe hospital accommodation is available. This is an awesome course, though clearly the effort in getting to Basildon makes it difficult. I attended as part of my preparation for resit, and found it very usefull.

Bones and Joints Course – Stanmore – Good revision course which covers a lot of ground.

Advances CXR course - Northwick park

Final Comment:

Ultimately the FRCR 2B exam attempts to mirror the work of a radiologist in the NHS, so if you can relax and try to enjoy it. If you have any constructive comments or opinions about this document I would be glad to hear them.

 

 

Resources and Hints & Tips 

 

General Recommended Online Resources : 

 

Radiopaedia

  • Online Radiology encyclopaedia including...
  • Articles covering pathologies and their radiological findings with imaging examples
  • Online lecture series - some require a paid subscription
  • Cases and case playlists

 

Radiology Cafe 

 

R-ITI 

  • Comprehensive bank of online modules developed by HEE and RCR 
  • Based on the Curriculum

 

Radiology Assistant

  • High quality articles on the core aspects of Radiology

 

Ultrasoundopaedia

 

 

Recommended Resources for FRCR Part 1:

 

PHYSICS

- Farr’s Physics for Medical Imaging (Book)

- Radiology Cafe (Online)

- Radiology Cafe’s 'FRCR Physics Notes' - based on the R-ITI Physics Modules. Free on Radiology Cafe or available to purchase as an e-Book.

 

ANATOMY

- Imaging atlas of Human Anatomy by Weir & Abraham (Book)

- IMAIOS (Online interactive radiology anatomy atlas; subscription usually bought as an ST1 group)

- Radiology Cafe (Mock Anatomy exam)

 

 

 

RECOMMENDED TO SIGN UP TO:

 

 

DISCOUNTS:

 

NUS Card - apply using RCR as your institution

 

50% Discount on RCR annual membership fees if earning £40,000 or below i.e. ST1 & ST2 

  • Email membership@rcr.ac.uk annually to apply. 
  • Submit applications before 1st June each year or applications submitted after this point will be subject to a pro-rata discount, applied from when your application is received.

 

 

FREE FOR REGISTRARS:

 

CLINICAL KEY

  • Access textbooks online and download chapters for free
  • Requires an Athens login that can be organised through hospital libraries

 

RSNA (Royal Society of North America)

  • Journals:
    • Radiographics (Education)
    • Radiology (Research)
  • Annual conference held in Chicago which is free for Registrars to attend

 

ESR (European Society of Radiology)

 

AUNT MINNIE