Anaesthetists in Training Webinar - Examinations

The Royal College of Anaesthetists is pleased to present a series of three webinars for Anaesthetists in Training.

Webinar 2 - Examinations

Chair: Dr Gary Rodgers, Elected Trainee Member, RCoA Scottish Board

Panel Members:

  • Dr Chris Carey, Chair, RCoA Education, Training and Examinations Board

  • Dr Mark Forrest, Chair, RCoA Examinations Committee
  • Fiona Daniels, RCoA Head of Examinations

Webinar recorded 22 July, 2021


Below is a list of questions submitted by members before and during the webinar. The College is pleased to provide answers to all questions submitted by members to this webinar.

If members have any further questions, please refer to the College website or email

I have completed CT2 and am currently a trust grade doctor who has multiple intermediate competencies signed. Can I use these competencies to demonstrate CT3 equivalence now?

You are advised to refer to the CT3/Stage 1 ‘top up’ training document for details of the content of Stage 1 ‘top up’ training. If your experience meets these requirements, then yes you can use it towards CT3 equivalence.

A lot of applicants had their portfolio scores marked down. At present even one or two points can make the difference between a job and not however we are only allowed to appeal with a five-point difference. Will the College consider lowering this threshold? Or having two people verify scores prior to publishing given the very large variability in scores awarded?

Recruitment is run by HEE and it is not within the College’s gift to change how it is managed.  However, the Recruitment Advisory Group (RAG) has liaised with HEE’s Anaesthesia National Recruitment Office (ANRO) and the Medical and Dental Recruitment Selection (MDRS) to review the process for second marking of portfolio scores.

Following our request it has been agreed that any applicant will be able to request a review of their portfolio scores where there is disagreement on marks awarded following assessor feedback in any of the domains. There is no minimum divergence score required and applicants will not need to follow a complaints process to request certain domains to be re-scored. However, no new documents will be able to be presented as evidence at this stage. The ability to request re-scoring of portfolio domains following assessor feedback will commence for the recruitment round starting in September 2021.

Why has the portfolio been so heavily weighted in ST recruitment in the past few rounds? Given most of the outgoing CT2s have completed most of their training during COVID-19 it is undeniable that portfolio opportunities have been harder to seek out especially on COVID-19 Rotas. Wouldn’t the re-introduction of a clinical station (even over Zoom like the viva) help to balance this?

In face-to-face interviews the portfolio station accounted for 50 per cent of the overall interview score. In virtual interviews the weighting is 38 per cent. More interview stations would be preferable in providing a more balanced weighting.  The Recruitment Advisory Group (RAG) is proposing that two, or three stations with six independent assessors are used for 2022 recruitment. This is currently a proposal and will be dependent on MDRS approval following testing of software platforms which are able to run multiple stations virtually.  

For clarity, this is the RAG proposal for the 2022 recruitment. Those preparing for round three applications in the 2021 recruitment timetable, which is for posts starting in February 2022, will have the same interview station format as in previous rounds this   year.

Will it remain the case that you will only need Primary FRCA MCQ prior to application for February 2022 ST3 intake. Please could you clarify that you can apply for ST3 anaesthetics without the complete primary? Why is the full primary FRCA still not mandatory for ST3 applications February 2022?

The February 2022 intake for recruitment sits within the round and process that was  agreed for 2021 national recruitment. Therefore, the principles and ST3 Person Specification that were agreed with MDRS at the end of 2020 continue for this round.

 In addition, the curriculum derogation agreed with the GMC remains in place until September 2021, which encompasses the autumn recruitment round.

The full Primary FRCA will be a requirement for ST4 applications in the next recruitment round, which we are planning for a February 2023 start.

I failed the primary FRCA SOE this year, and so have been awarded an outcome 3 at ARCP. I have heard that others in different deaneries are being awarded an outcome 10.1 in the same situation. What is the College doing to ensure consistency across the country?

The College has produced ARCP Outcome guidance which deaneries are encouraged to use to support panels in managing the assessment and progress of anaesthetists in training. We cannot comment on individual outcomes awarded without having all of the facts but if you have concerns you should speak to your Head of School and Regional Advisor.

I left training having completed my intermediate training except failing to pass FRCA in 2016. I have worked in anaesthesia and critical care as a SAS since. I have now completed my FRCA and plan on returning to training in February 2022. I have all my competencies completed for intermediate training and completed ST3, ST4 and ST4E. I assume I complete the ST3 application process, and include documentation to reflect my non-conventional pathway?

Yes, when you are appointed you should discuss your situation with your Training Programme Director to consider where you can fit into the training programme.

Is there any possibility of recruiting ST4 for August 2022 start if appropriate CT3 equivalence is achieved 2021-2022, if not, why not and why is there a hiatus in applying for ST4?

At the moment we are not planning to recruit to ST4 in August 2022. The reason for this is that all ST4 posts will be filled from this year’s ST3 intake. If schools are able to secure funding for additional posts, then this situation may change but as things stand at the moment all posts will be filled.

Will the new curriculum have an effect on what the exams will cover? Will the E-LFH be updated to cover any changes in curriculum and have a clear content for those planning to sit the exams? When will this guidance (relating to exam syllabus) be issued and expected to be reflected in the exam contents?

The examinations will cover the same content and have not changed as a result of the introduction of the 2021 curriculum. The FRCA examinations syllabus will be published in due course.

What parts of the FRCA exams does an international medical graduate need to pass to apply for a specialist training post in Anaesthesia?

An international medical graduate is required to pass the same parts of the FRCA as a UK graduate. The Primary MCQ is a requirement of the February 2022 ST3 intake for recruitment.

The full Primary FRCA will be a requirement for ST4 applications in the next recruitment round, which we are planning for a February 2023 start.

For those sitting the FRCA primary MCQ this September 2021, will we be notified of the results of this in time for submission of applications for the last ST3 recruitment round in February 2022? I have previously contacted ANRO and the RCoA regarding this, but nobody has been able to give a definitive answer (as obviously this will have a great impact on when we will therefore be able to apply for ST jobs - whether this is ST3 in February 2022, or August 2023).

The results of the FRCA primary MCQ taking place on 7 September will be released by email on Monday 27 September 2021. The last ever recruitment round for ST3 opened on 27 July and closed on 17 August.

Will ST3s be able to sit the final FRCA in their ST3 year despite now being part of “stage 1”?

Trainees will be able to sit the FRCA Final in their ST3 year despite the curriculum change, however, trainees should note that if it is necessary to once again prioritise places for the Final SOE, ST3 trainees will be in a lower priority group to those at ST4 and ST5. Eligibility to sit the FRCA Final is based on having already passed the Primary. The College makes the following recommendations on when to sit FRCA examinations:  

  • Candidates should not sit the Primary FRCA MCQ paper until they have passed the Initial Assessment of Competency
  • Candidates should not sit the Primary FRCA OSCE and SOE until they have completed at least 1 year of Stage 1.
  • Candidates should not sit the Final FRCA Examination until they have completed Stage 1 of training.

A statement regarding a revision to the Prioritisation of Applications policy was released on 16 August

How is the College going to continue allowing attendance for exams for trainees stuck abroad? Will there be eligibility for those trainees abroad to continue to complete their exams remotely via the online format?

FRCA examinations (written and clinical) will remain online until April 2022. This decision was made due to the continued level of uncertainty caused by the pandemic and the need to give trainees ultimate certainty and protect training and career progression. However, it may be necessary to prioritise places on clinical exams (primary OSCE SOE and final SOE) and those in lower priority groups may not be able to obtain an exam place.

From your experience, what's the average pass mark for the primary FRCA MCQ. (I understand it's being arrived at using the Angoff's formula) Just want to have an idea of what it has been in the last few exams.

The pass mark in the FRCA MCQ examinations is derived from a modified Angoff process. A set of trained Angoff judges review each question and determine the likelihood of a previously defined minimally competent candidate answering correctly. The scores are then summed and averaged and the final figure forms the pass mark. However, this is not the end of the process. Once an examination has been sat, the group of examiners responsible for that exam come together to review the performance of the paper. In this process, the examiners are looking at how well each question has performed, as well as reviewing any feedback on the questions submitted by candidates. The questions are reviewed by looking at: the proportion of candidates answering correctly, the proportion of candidates selecting each distractor and correct answer in a multiple-choice question, and whether the question is discriminating between high and low performing candidates.

Questions may be voided during the review of the questions and where they are, the Angoff for that question will be removed and the pass mark recalculated. Since the number of items removed from the exam during the post-exam analysis varies from paper to paper and the Angoff scores also vary from paper to paper, the pass mark will be different for each exam.

An advantage to this method is that the pass mark is determined on the content on the examination rather than the performance of the cohort, and this enables us to maintain a standard and deliver a fair examination to candidates. It is therefore not helpful to focus on the pass mark but rather on good preparation for the exam with a clear revision plan.

As an international medical graduate, after getting fully registered with GMC, is it possible to take part in the exam if I am not working at the moment because of pregnancy in this pandemic situation? (I had three years’ working experiences in clinical anaesthesia abroad).

Applicants who fully meet the eligibility criteria available on our website will be permitted to sit the examination. Applicants should be currently registered with the College in a recognised membership category (not Affiliate grade) and if not currently working as an anaesthetist, be a former UK or Irish anaesthetic trainee who left anaesthetic training no more than five years before date of the sitting applied for. Applicants who are not currently working as anaesthetists in the UK and are not eligible for Temporary Examination Eligibility (TEE) are not eligible to sit the examination.

Previously, anyone who sat the exam online was allowed the first attempt not to be counted (if they failed). Is this still ongoing or removed? In reference particularly to the primary. Will the first online attempt be exempted from the total number of attempts allowed for FRCA Primary?

This policy was only valid for one year and expired on 31 July 2021. The policy was a recommendation from the General Medical Council after there was a need for Colleges to change swiftly to an online format to ensure exam delivery could continue during the pandemic. One year on, we feel the platforms and processes for the online delivery are fully embedded and therefore there is no requirement to continue this policy.

If I sit the FRCA Primary MCQ as a TEE (temporary examination eligibility) and then move to the UK, what type of membership will I need and will I be able to take the remaining steps of the FRCA as I won’t be working in anaesthesia when I move to the UK?

To sit the FRCA Primary OSCE SOE, candidates must be practicing anaesthesia. Temporary Examination Eligibility (TEE) requires applicants to be practicing anaesthetists with permanent residence outside the UK. TEE candidates who move to the UK during the year-long validity of the TEE, will no longer be eligible to sit the FRCA.

With regards to online exam sittings: if there were severe connectivity issues or technical difficulties, how will this be managed with respect to not missing the whole exam sitting? Would this count towards one of the six attempts?

In general terms, the responsibility lies with the candidate to have the appropriate hardware and sufficient connectivity, however, using an example of an unexpected power cut (without prior notification from the power supplier), such events would be classed as an exceptional circumstance that is beyond the control of the candidate. These are dealt with on a case-by-case basis.

The action taken would depend on, for example, when the power supply/connection issue occurred during the test, how long the power/connection remained unavailable, if temporary, whether the exam could be rescheduled for later on the same day. There may also be the option to change hardware, change location during a reschedule or use hotspot.

We do not run the same exam again on a subsequent day due to exam security concerns and we are unable to run an additional exam paper between diets.  If rescheduling or test completion on the same day is not possible, and it is clear that it is an exceptional circumstance that is unexpected and beyond the candidate’s control, we would request that the candidate send evidence of the event e.g. from the power supplier/WIFI provider. If approved, we would then discuss with the candidate the best option for them, for example, a refund of the exam fee or a free sitting in the next exam diet. The exam would likely be classified as a void and therefore would not count as an attempt.