Most candidates who sit the FRCR 2B and don't pass the first time aren't missing clinical knowledge. They prepared the wrong way or walked into the viva without understanding what the examiner actually needs to see.

This article covers three things: how the exam is structured, a preparation method that works, and the specific behaviours that separate pass candidates from fail candidates on the day.

Understanding the Exam

The FRCR 2B has three components.

Short case reporting: 25 plain films, 120 minutes, scored 0 to 5 per case by two independent examiners. A five is achievable. What earns it is a clear, logical report; detection of all major findings; a correct or reasonable differential; and a management plan. That last part, the management plan, is where many candidates quietly lose marks.

Long case reporting: 6 complex multimodal cases, 75 minutes. Think of these as the complex cases you will face in everyday consultant practice. Describe systematically, reason carefully, and always close the case.

The oral viva: 2 stations, 2 examiners per station, 6 cases per station, 12 cases in total. The pass mark sits at approximately 60%. The viva is the hardest component and the one most candidates underinvest in.

How to Prepare

Practice over reading

You have been reading textbooks for over a decade. This exam tests your ability to reason, present, and manage under pressure. Those skills are built through repetition, not reading. Use a reference text alongside your practice. Never instead of it.

Study partners: the magic number is three

Solo preparation does not work. You cannot identify your own blind spots, and no one is examining you under realistic conditions. Three is the right number: one candidate presents, two examine, then you rotate. Sitting in the examiner's seat is as valuable as sitting in the candidate's seat. More than three and the group becomes difficult to organise and the feedback thins out.

The case categorisation framework

Build this mental habit during preparation and apply it automatically on the day.

Category 1: You see the case and know immediately. Have your spiel ready before you open your mouth. For a Ewing sarcoma in a child: MRI of the whole limb, chest CT per departmental protocol, refer to orthopaedic surgery. This is where you score 5. Losing marks on a Category 1 case is avoidable.

Category 2: You recognise the case but have a gap, often in management. Describe clearly, verbalise the uncertainty, and always close the case.

Category 3: You don't know what you're looking at. There is a method for this. Do not assume your preparation has failed.

The goal of preparation is to move cases from Categories 3 and 2 into Category 1.

Prioritise the viva

Allocate roughly 70% of your preparation time to the oral component. The viva is where composure matters most, and the skills it builds transfer directly to your short and long case performance.

On the Day

Working through cases

For Category 1: present cleanly and confidently. This is where you bank marks and save time.

For Category 2: describe what you know, verbalise what you don't. "The constellation of findings points to a syndrome; the name eludes me right now." Examiners understand exam conditions. What matters is the quality of your reasoning. Always close the case.

For Category 3: start describing. State the modality, then describe the findings systematically. Then apply this sieve: Infection (TB in particular; also, parasites and fungus), Inflammation (autoimmune, vasculitis), Injury, Idiopathic (including iatrogenic such as drug reactions), and Neoplasia (lymphomas and leukaemia's in particular). By the time you finish your description, you will often have arrived at a diagnosis or a reasonable differential. If not, state your possibilities and close the case: MDT referral, histological evaluation, or specialist input.

One case done, forget it. Compartmentalise. Move on when your allocated time is reached. A single difficult case does not decide your result. A cascade of distraction does.

What the Examiner is Actually Thinking

One question runs through the examiner's mind for every case: is this a safe radiologist?

Not encyclopaedic knowledge. Not perfection. A safe clinician who can describe, reason, and refer appropriately from day one as a consultant. Examiners are briefed to pass candidates. Your job is to give them the reason to.

The first 30 seconds matter. Before you speak, take a brief pause. Look at the case, categorise it, compose your opening line. Two or three seconds of organised silence signals control, not uncertainty. Then: straight posture, hands visible, eyes to the screen. Repeat the clinical history before describing findings. "This is an HRCT of a 40-year-old with chronic cough." That settles your nerves and frames your response.

Ignore the poker face. Examiners are not permitted to encourage or discourage you through expression. Neutrality is protocol, not disapproval.

Pay close attention to prompts. If an examiner asks, "is there anything else, you would like to comment on?" drop what you were doing and re-examine the case. They can lead you. They cannot mislead you.

Difficult questions are often a good sign. Standard questions go to every candidate. Advanced or specific questions tend to go to high-scoring ones.

Confidence is not the absence of doubt. It is a safe, structured plan, presented clearly.

This article draws on content from a faculty-led Revise Radiology webinar on the FRCR 2B examination. The preparation framework and examiner perspective were presented by Dr Syed Shahzad Hussain.