Tips from Dr. Hameed Rafiee, Norwich Course Examiner

One of the biggest challenges candidates face during the FRCR 2B exam is knowing how to start and finish a case smoothly. According to Dr Hameed Rafiee, having a structured approach can make all the difference, both for your performance and for reassuring the examiner that you’re a competent and safe radiologist. Here’s how you can master the art of case presentation:

1. Start Strong: Set the Scene

It’s crucial to have a reliable way to start every case. Whether it’s a memorized phrase or a set of opening remarks, this buys you time to take a closer look at the film while you speak on autopilot. For instance, when assessing a chest X-ray, you might say:

"This is a frontal PA chest radiograph of an adult male patient. The film is well-centred, good inspiration, good penetration, etc."

This familiar opening not only gets you talking, but it also gives you a crucial 10 to 15 seconds to observe the case without pressure.

2. Finish with Confidence: Signal You're Done

Knowing how to wrap up a case is just as important as starting it. Ending abruptly or trailing off can make things awkward, and the examiner might be unsure if you’re finished. The best way to signal the end is by discussing management. Once you start talking about management, it’s clear that you’re concluding. Examiners typically recognize this as a sign that you’ve covered all essential aspects of the case.

3. Structure Matters: Approach Every Case in Steps

Having a structured approach is key. Dr Rafiee recommends following this sequence for every case:

- Start by describing the findings

- Offer an interpretation

- Provide a differential diagnosis and a principal diagnosis

- Discuss what you’d do next, focusing on patient management

This method not only gives you a clear framework but also signals to the examiner that you’re competent and organized.

4. Maximize Your Chances: Get Through More Cases

The more cases you can get through, the better your chances of passing. If you handle eight cases but struggle with one, it’s much better than facing only four and doing poorly in one. Manage your time efficiently by spending less time on cases where you’re struggling. If needed, be honest with the examiner and say you’d seek advice or consult a colleague. This is a sign of self-awareness and professionalism.

5. Present Differentials that Matter

When giving your differential diagnosis, focus on what’s most relevant and likely. If you know a certain condition is improbable, explain why. For example, if you see an anterior mediastinal mass that doesn’t extend above the clavicles, you might mention that while thyroid is in the differential, it’s less likely due to the mass's location. This shows the examiner you’ve considered it but ruled it out for valid reasons.

6. The Examiner Wants to Know You're Safe

At the end of the day, examiners are looking for radiologists they can trust to make safe decisions. If you can give them that sense of confidence with your structured approach, clear differentials, and sound management plans, you’re more likely to pass.

Final Thoughts

Dr Rafiee’s insights highlight the importance of preparation, structure, and clarity. By learning how to start, structure, and finish your cases with confidence, you can not only impress the examiners but also make the process smoother for yourself. Always aim to demonstrate that you are a competent, safe, and knowledgeable radiologist.

With these tips in mind, you’re better equipped to tackle your FRCR 2B exam and make the most of every case that comes your way!