This article is adapted from a post in Dr Koshy Jacob's "Building Revise Radiology in Public" series on LinkedIn.

For most of our history, if you had asked me who Revise Radiology was for, I would have said FRCR candidates. It was an accurate answer and, I have come to think, a limiting one, because it defined the people we serve by an examination they are temporarily sitting rather than by the thing they are permanently doing.

We have changed how we describe it. The person we exist to serve is the Learning Radiologist, and that phrase is doing more work than it might appear to.

The trouble with defining people by an exam

An examination is a moment. Being a radiologist who is still learning is a condition that lasts an entire career, and if you organise everything you build around the moment, you end up serving people only during the eighteen months when they are most frightened and least able to think clearly about their own development.

It also excludes a great many people who ought not to be excluded. The registrar two years out from any sitting, who simply wants to see more cases and get better. The radiologist with no exam ahead of them at all, working in a system where the FRCR is not the currency, who nonetheless wants to sharpen their reporting. The consultant a decade past their fellowship, moving into a subspecialty they were never formally trained in, who is a beginner again and knows it. Dr Ramy Mansour made this point rather beautifully in his piece on radiology as a language: graduation marks not the end of learning but it's true beginning, and after decades of practice experienced radiologists discover that they are still students.

If that is true, and I believe it is, then the exam-shaped definition of our audience was always too small. Everyone in the paragraph above is a Learning Radiologist. Only some of them are candidates.

What follows from this about money

The harder implication of the reframe is about price, and it is where I want to be most explicit, because there is a piece of received wisdom in education that I think is simply wrong.

The wisdom holds that a higher price signals seriousness. Charge more and you attract committed learners, filter out the casual, and the learner values what they paid for. I understand the appeal of this argument. I no longer believe it. What a price actually filters for is not commitment. It is money. A radiologist in a country where the currency has moved against the pound, or one supporting a family on a trainee's salary, is not less committed than a radiologist in a well-paid consultant post. Charging them both the same amount and calling the result a filter for seriousness is a comfortable story we tell to avoid a more difficult conversation.

So our position is that payment should reflect what someone can afford, not what they are willing to sacrifice to prove they are worthy of learning. That is why Core is priced low, for everyone, everywhere, rather than being positioned as a premium product for the committed few. We do charge something rather than nothing, and I want to be honest about why: a nominal fee changes how a resource is used, and material that costs nothing tends to be collected rather than worked through. But the fee is meant to be small enough to be beside the point for almost anybody, which is a very different intention from pricing for signal.

The three tiers we described a few posts ago still stand, and I will not repeat that reasoning here. What has changed is the principle underneath them: your budget should determine which of the three you can reach, and it should never determine whether you get to keep learning at all.

What we are actually trying to do

There is a version of this business that optimises for pass rates, because pass rates are the number that sells. I have written recently about why I distrust that measure, and about what a first-time pass conceals as well as what it demonstrates. The reframe follows the same logic to its conclusion.

Our purpose is not to move as many people as possible through a gate. It is to make sure that a radiologist who wants to get better has somewhere to do that, at a price they can actually pay, with material good enough that their time is not wasted and structured well enough that they can trust it. If that produces good exam results, and it does, then good. But the exam was never the point, and building a company around it was always going to distort what we made.

Radiology is a profession people spend forty years getting better at. Almost everything available to support that is aimed at the first five. We would like to be useful for the rest of it too.

What this changes, and what it does not

Practically speaking, less than you might expect. The same faculty, the same case material, the same courses, the same insistence that every diagnosis in the curriculum should appear at least once so that nobody walks into an examination hall seeing something for the first time.

What changes is who we picture when we make decisions. Not a candidate with a date in eleven weeks, though we will keep serving them with everything we have. A radiologist, somewhere, at some stage, who wants to be better at this tomorrow than they are today, and who should not have to be wealthy or examinable to get help with that.

That is who we are for. It took us rather a long time to say it plainly.

Originally shared by Dr Koshy Jacob on LinkedIn. Follow the series there