Every year we teach radiologists from outside the UK who come to the FRCR long after their local training has finished. Many are already consultants. A good number are balancing preparation with a full service job and a young family. And I'm sure many think ‘’I wish I had done this while I was still training’’.

I understand that feeling. Once training ends, life usually gets fuller, not lighter. Work expands, responsibilities grow, and studying has to fight for a place that used to come more naturally. This article is my attempt to write down why that instinct may be right.

The argument is not that every overseas trainee should sit the FRCR. Nor is it that the FRCR matters more than the local qualification. It does not. The local qualification comes first. But for trainees already working towards an MD or a similar national exam, I think there may be a sensible way to use the same years of revision twice.

That is what I mean by the title. Not that every part of the FRCR is finished inside the same 3 years, but that most of the intellectual heavy lifting can happen during the same 3 years you are already using to become a radiologist and to prepare for your local exams. In many cases, the final 2B may then follow shortly afterwards.

The timeline we would suggest

1. Sit the First FRCR, anatomy and physics, after the first year of radiology training.

2. Sit the 2A soon after the final MD examinations, around 3 years after starting radiology.

3. Sit the 2B 6 to 12 months after that.

On that plan, most of the study sits within the same 3 years as the local training pathway, even if the last step, the 2B, often falls a little later.

What the regulations allow

The regulations do not get in the way of this plan. To enter the First FRCR, a doctor needs to hold a formal clinical radiology training post, and there is no minimum period of training required. To enter the 2A and then the 2B, a doctor needs to have passed the preceding stage and to have completed the College's minimum training thresholds by the month of the exam. A trainee following the timeline above clears those thresholds comfortably.

The exam calendar matters too. The First FRCR is normally held 3 times a year, in March, June and September. The 2A is normally held 2 times a year, in April and November. The 2B is offered multiple times a year. For the First FRCR, candidates training in the UK, Singapore or Hong Kong, and candidates already contributing to the NHS in radiology, are given a priority 1 application window. Other candidates apply in a priority 2 window for the remaining places. In practice, a trainee aiming for the 2A soon after their MD finals may need to book before the final results are known.

Anatomy and physics after year 1

The RCR's own guidance for UK trainees says the First FRCR should be completed during the first year of training, because the knowledge it tests is essential to clinical radiology practice. I think overseas trainees should at least consider aiming for it soon after the first year, once they have seen enough imaging for the anatomy to have somewhere to attach itself.

I have written before about my own physics, which I more or less got through rather than properly understood. The price of that comes later. You recognise an artefact on an MRI list, or you sense that something about an image is not right, but you are learning it backwards, from years of reporting, rather than from first principles. A trainee who learns physics properly early carries it into every scan they report for the rest of training.

Anatomy works in much the same way. The cross-sectional anatomy the First FRCR expects is the anatomy a junior trainee is using every week anyway. The exam and the job reinforce each other.

The 2A soon after the MD finals

This is where the argument really sits.

In the months before the final MD examinations, a trainee revises the whole of radiology, system by system, more thoroughly than at almost any other point in their career. The 2A examines all aspects of clinical radiology, together with the basic sciences of physics, anatomy and techniques, in 2 papers of 120 single best answer questions each. The overlap with a final MD syllabus is large, though not complete.

That overlap matters. Sitting the 2A within a few months of the MD finals means that one stretch of serious revision is being used twice. In my view, that is the heart of the opportunity. Leaving the 2A for another 2 or 3 years usually means rebuilding a great deal of knowledge that was once fresh.

The educational research supports the principle, even if it does not prove this exact timetable. A meta-analysis by Cepeda and colleagues, covering 317 experiments in 184 articles, found that learning spread across separate sessions is retained better than the same learning massed together, and that the best gap between sessions grows as the period you need to remember for grows. Most of those experiments used verbal recall tasks rather than postgraduate medical examinations, so that finding should be applied carefully. Closer to our world, Larsen, Butler and Roediger ran a randomised trial with paediatric and emergency medicine residents. Six months later, the residents scored 39% on the topic they had been repeatedly tested on, against 26% on the topic they had repeatedly re-read.

So I would not claim that MD finals, then 2A, then 2B at these intervals is the one scientifically proven sequence. I would say something narrower and more honest: it is consistent with what we know about spaced practice and repeated retrieval, and it uses revision that is happening anyway instead of letting it decay and then rebuilding it later.

The 2B 6 to 12 months later

The 2B is where many overseas candidates find the FRCR hardest, and the RCR's published figures show a gap between UK and global candidates. In October 2023, UK candidates passed at 74% and global candidates at 54%. An analysis of 2,238 attempts at the 2B by Hawtin and colleagues, summarised in a 2018 review in Clinical Radiology, found that candidates who had trained in the UK were significantly more likely to pass at the first, second and third attempts.

There are probably several reasons for that. Familiarity with UK reporting expectations is one. Familiarity with NHS pathways and management language is another. Comfort with the style of the oral examination is another. None of that means an overseas candidate cannot do very well. Many do. It does mean the 2B is asking for something beyond raw knowledge.

That is why the 6 to 12 months after the 2A matter. The 2B examines rapid reporting, reporting and oral performance under pressure. By that point, the candidate is no longer trying to learn the whole curriculum from scratch. The job becomes narrower and more practical: to report against the clock, to present a case clearly, and to sound like someone who can be trusted in an exam room. Those are skills, and skills need repeated practice over months.

What it gives you

The first advantage is optionality.

The FRCR is on the GMC's list of acceptable postgraduate qualifications for the route to full registration with a licence to practise. It is not the only requirement, and it does not by itself place someone on the Specialist Register. But it does mean that a doctor who has completed the FRCR has kept the UK open as a future possibility without needing PLAB.

The benefit is not only about the UK. Booth and colleagues, in their review of the evidence on the FRCR, describe it as important for career progression in many countries internationally.

There is also a simpler advantage, which is time. A trainee who builds the FRCR into training is using study years that already exist. The radiologists we teach who come to it later often do so successfully, but the cost is usually higher because the exam has to fit around a fuller working life. I do not say that critically. Many people have no realistic way to do it earlier. I say it because, where the earlier option is genuinely available, it is often kinder.

The costs, and why the local qualification still comes first

There are real costs to this plan.

The first is financial. Exam fees, travel and preparation are substantial, especially for an overseas trainee. For some people that alone will decide the question, and that is perfectly reasonable.

The second is cognitive. The overlap between the MD and the FRCR is large, but the syllabuses are not identical. The 2A is set against the UK Specialty Training Curriculum for Clinical Radiology, and some topics will be weighted differently from a local exam.

The third is practical. There is also a limit on attempts. No candidate is automatically permitted more than 6 attempts at any FRCR examination or module, and every previous attempt counts. These are not exams to enter casually.

And then there is the main point. The local qualification comes first. It is the qualification a trainee needs in their own country, and the FRCR should never be allowed to damage that. If the First FRCR starts crowding out core first-year learning, wait. If the final MD year needs everything a trainee has, then the 2A can follow later. The value of this plan lies in using overlap where it genuinely exists, not in trying to do 2 full-time things badly at the same time.

A question worth putting to departments

The deeper question here is whether training programmes outside the UK should think more deliberately about this.

If a department already knows that some of its trainees are likely to sit the FRCR eventually, I think it may be kinder and more educationally sensible to help them do it while the relevant knowledge is alive, rather than after training when life has become more crowded and the revision has gone cold.

That will not suit every trainee, every country or every programme. But I suspect it will suit more people than we currently assume.

We would like to hear from trainees, trainers and heads of department outside the UK who have tried something like this, or considered it and decided against it. If there are training systems where this timeline works particularly well, I would be interested to know why. And if there are systems where it plainly does not, I would rather know that too.

Sources

1. The Royal College of Radiologists. Exam regulations and policies [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/exams-training/rcr-exams/exam-regulations-policies/

2. The Royal College of Radiologists. FRCR Part 1 (Radiology) - CR1 - guidance notes for candidates [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/exams-training/rcr-exams/clinical-radiology-exams/frcr-part-1-radiology-cr1/frcr-part-1-radiology-cr1-guidance-notes-for-candidates/

3. The Royal College of Radiologists. FRCR Part 1 (Radiology) - CR1 [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/clinical-radiology/exams/frcr-part-1-radiology-cr1

4. The Royal College of Radiologists. FRCR Part 2A (Radiology) - CR2A [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/exams-training/rcr-exams/clinical-radiology-exams/frcr-part-2a-radiology-cr2a/

5. The Royal College of Radiologists. FRCR Part 2A (Radiology) - CR2A - guidance notes for candidates [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/exams-training/rcr-exams/clinical-radiology-exams/frcr-part-2a-radiology-cr2a/frcr-part-2a-radiology-cr2a-guidance-notes-for-candidates/

6. The Royal College of Radiologists. FRCR Part 2B (Radiology) - CR2B [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/exams-training/rcr-exams/clinical-radiology-exams/frcr-part-2b-radiology-cr2b/

7. The Royal College of Radiologists. FRCR Part 2B (Radiology) - guidance notes for candidates [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/exams-training/rcr-exams/clinical-radiology-exams/frcr-part-2b-radiology-cr2b/frcr-part-2b-radiology-guidance-notes-for-candidates/

8. The Royal College of Radiologists. Examiners’ reports (radiology) [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/exams-training/rcr-exams/clinical-radiology-exams/examiners-reports-radiology/

9. General Medical Council. Acceptable postgraduate qualifications [Internet]. London: General Medical Council; [cited 2026 Oct 2]. Available from: https://www.gmc-uk.org/registration-and-licensing/join-our-registers/before-you-apply-guide-for-doctors/acceptable-postgraduate-qualifications

10. General Medical Council. Full registration for international medical graduates with a postgraduate qualification [Internet]. London: General Medical Council; [cited 2026 Oct 2]. Available from: https://www.gmc-uk.org/registration-and-licensing/join-our-registers/registration-applications/application-guides/full-registration-for-international-medical-graduates-with-a-postgraduate-qualification

11. The Royal College of Radiologists. GMC registration [Internet]. London: The Royal College of Radiologists; [cited 2026 Oct 2]. Available from: https://www.rcr.ac.uk/our-specialties/clinical-radiology/discover-clinical-radiology/thinking-about-a-career-in-clinical-radiology/gmc-registration-radiology/

12. Booth TC, Martins RDM, McKnight L, Courtney K, Malliwal RS. The Fellowship of the Royal College of Radiologists (FRCR) examination: a review of the evidence. Clin Radiol. 2019;74(1):18-23. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6506684/

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14. Larsen DP, Butler AC, Roediger HL 3rd. Repeated testing improves long-term retention relative to repeated study: a randomised controlled trial. Med Educ. 2009;43(12):1174-81. Available from: https://pubmed.ncbi.nlm.nih.gov/19930508/