A step towards the new FRCA examination - the CASE pilot

As members will know, we are in the process of developing both the Primary and Final FRCA exams, in line with the recommendations of internal and independent reviews, published in 2023. New exam formats will be introduced in 2027, subject to approval from the GMC. We are implementing these changes with care and will give all candidates at least 12 months’ notice of changes to help them prepare.    

For the Primary exam, the most notable changes are focused on the face-to-face exam. These include the removal of the SOE to ensure that knowledge-only components are assessed in the written exam and greater emphasis is placed on the assessment of clinical performance skills in the face-to-face part of the exam.  

Piloting the Clinical and Anaesthetic Sciences Exam (CASE) 

The new Primary FRCA exam will continue to form part of the programme of assessments for Stage 1 anaesthetic training and will comprise two components, a written exam consisting of Single Best Answer questions and an oral, clinical performance exam. The clinical performance exam will be based on a circuit of stations that incorporate the best features of the current OSCE and SOE and assesses skills such as clinical reasoning, critical thinking, clinical management and professional practice together with the clinical application of basic sciences. It will be known as CASE, the Clinical and Anaesthetic Sciences Exam, a name chosen to reflect its purpose.  

While the current SOE and OSCE exams remain valid and reliable assessments, the changes will improve how we test candidates’ clinical application of their knowledge and understanding of basic sciences. Over the last two years, examiners and the exams team have been developing the purpose, structure and content of CASE. A fundamental aim is to develop stations that represent authentic clinical encounters and allow candidates to demonstrate their clinical skills in a way that better reflects their performance in the workplace. The stations will have some similarity to a supervised learning event in the workplace, albeit one with a defined standard against which the candidate is assessed. To do this effectively, we think some of the stations should be longer than the five minutes currently set for the OSCE. We developed a pilot exam to evaluate 10-minute stations.   

The purpose of the pilot was to evaluate the effectiveness of the proposed format, the authenticity of the stations and how well they assess clinical performance skills and the application of basic sciences for Stage 1 anaesthesia. We also assessed the application of borderline regression methodology to standard set the exam.  

We developed a total of eighteen 10-minute stations which cover the clinical arenas in which anaesthetists work, using role players and simulation manikins to create authenticity. In some stations, the candidates demonstrated their skills observed by the examiner and in others, the examiner discussed clinical questions with the candidate as they might do in their role as consultant. The basic sciences were embedded within clinical situations.   

A huge thank you to our volunteer candidates 

The day was positively received by both the volunteer candidates and the examiners, for whom it was also a new way of delivering this type of assessment. Both groups appreciated the improved clinical authenticity of the stations. We are reviewing the feedback data on the pilot exam in detail to help refine and develop the exam and steer the final format of CASE ready for candidates in the autumn of 2027. 

We would like to express our immense gratitude to anaesthetists in training who volunteered to participate in the pilot. We would not be able to develop the exam without their contribution. There will be additional pilots as we further refine the new exam so plenty of opportunity for members to participate in the development process.    

Read about the volunteer candidate experience of the CASE pilot in this companion blog from Dr Elliot Yates.