Sitting the FRCR 2A catches many candidates off-guard. Not because the knowledge required is beyond registrar level, but because the format rewards a specific approach that most candidates do not train for deliberately. This article sets out that approach: how the exam works, how to prepare, and what to do on the day.

Understanding the Exam

The FRCR 2A is two papers, each containing 120 single best answer questions, 240 in total. The exam runs twice a year, in November and April, and is delivered via Speedwell software. You have three hours per paper. The target is 60 seconds per question. That may feel tight; it is not. Sixty seconds is a long time when you know the material.

Marking is straightforward: plus, one for a correct answer, zero for an incorrect or unanswered one. There is no negative marking, which means you should never leave a question blank. The pass mark fluctuates between approximately 55% and 66%, adjusted per sitting. Up to 35% of questions in any paper are new and untested, so after the exam, questions are reviewed. Those where more than 95% of candidates answered correctly are flagged as too easy. Those where fewer than 17% got it right are considered ambiguous or too difficult. Both are removed before the final score is calculated.

Aim for 80% correct. That margin keeps you comfortably above the threshold even after adjustments.

All modules are now mixed within each paper. A genitourinary question may be immediately followed by one on paediatric radiology. Preparation has to cover the full curriculum. The exam tests safe registrar-level practice. Every detail in a stem is there for a reason, to narrow the differential or confirm the diagnosis. The college does not set trick questions.

Around 30% of questions are management-type, covering clinical decision-making pathways rather than just diagnosis or imaging. This proportion reached over 50% in the April 2025 sitting, which prompted significant candidate feedback and has since been reduced. It remains a meaningful part of the paper and needs to be covered.

How to Prepare

Practice questions are the engine. A reference website such as Radiopaedia or StatPX is useful to look things up, but working through one linearly will not prepare you for this exam. Questions teach you how stems are written, how options are phrased, and what the examiner considers safe registrar practice. You may know a topic well and still answer a question on it incorrectly the first time you see it from an examiner's angle. Make those mistakes now.

At the start of your preparation, do not go straight to the option that looks right. Work through all five and understand why each is correct or incorrect. This builds the reflex to reach the right answer with certainty. Candidates who skip this step end up second-guessing in the exam room because they never trained their instinct deliberately.

After every block of questions, log every miss and every guess. Ask where the confusion was and what part of the concept you had not fully grasped. Do not move forward until you have covered that topic.

Track your progress using three confidence categories. Category A means you know immediately with certainty. Category B means you can reach it with effort. Category C means you have no clear idea. As your sitting approaches, the large majority should be in A, very few in B, and almost none in C. Address Category B questions immediately because the gap usually converts quickly. Category C gaps go on your reading list before the next session.

Do not neglect the quiet topics: contrast reactions, drug interactions before scans such as metformin and aspirin guidelines, what advice to give before a PET scan, nuclear medicine, paediatric pathways, and physics techniques. Each comes up infrequently, but together they represent 15 to 20 questions. Guidelines are free marks. If you know them, there is no ambiguity. Review them in the final days before the exam while they are fresh.

A Realistic Timeline

For a seven-month preparation cycle, the structure works in three phases. Phase one builds momentum at one packet of questions a day, identifying weak areas and establishing the habit. Phase two ramps up volume; by month three or four you should have worked through the majority of the curriculum. Phase three, the final two to three weeks, is consolidation only: tying loose ends, reviewing guidelines, and getting Category C questions as close to zero as possible.

The target is 20 packets of 120 questions each, 2,400 questions in total. Reaching that number with genuine review of every miss is what separates candidates who pass first time from those who feel prepared but are not.

On the Day

Adjust your sleep in the week before. A six-hour exam at half cognitive capacity is not recoverable. If you have ADHD, a reading disability, or any condition that affects exam performance, seek the accommodations you are entitled to. Avoid building a caffeine dependency during your revision period. State-dependent recall is real: if your preparation has been done under a specific level of stimulation, your recall in different conditions will be less reliable. Hydrate well on the day, but sensibly.

Sixty seconds per question is enough. If you reach it without a committed answer, flag the question and move on. Dwelling costs, you straightforward marks further along the paper, and a later question sometimes contains a detail that resolves the one you flagged. Every question is independent. If one goes badly, compartmentalise and move on. It is one mark.

Five to ten questions per paper will have unusually long stems. For these, read the final line of the question first, then the options, then the stem. You already know what you are looking for, so your brain filters out the irrelevant detail. Sixty seconds is still adequate with this approach.

For questions where you cannot reach a confident answer, eliminate the implausible first. Then look for a contradicting pair. Examiners often include an option and its direct opposite, such as "the artery runs medial to the cuboid" alongside "the artery runs lateral to the cuboid." If two options are exact opposites, one is typically correct, which eliminates three and leaves a 50/50 choice. For policy or management questions, always choose the safest clinical option. If an answer uses "may," as in "this may cause...," that framing is often correct since it cannot be definitively refuted. If none of the above narrows it down, C and D are statistically correct more often in five-choice exams. Whatever you land on, do not leave it blank.

Adapted from the Beyond Syllabus: FRCR 2A Webinar, presented by Dr Syed Shahzad Hussain (Consultant Radiologist; Fellowships in MSK, Euro and PET, NUH Singapore; Global Lead Revise Radiology)

The FRCR 2A Online Autumn Course at Revise Radiology is built around exactly this preparation model - faculty-led, question-driven, with structured coverage of every module.

Enrol now and start preparing seriously. Enrol in the FRCR 2A Online Autumn Course