How is the Primary FRCA exam format changing in 2027?
The Royal College of Anaesthetists (RCoA) is replacing the current Primary FRCA exam format from July 2027. These changes will affect your exam route, your revision approach and your timeline – regardless of whether you're already preparing for the Primary FRCA, or plan to sit it in the next few years.
Here's what we know about the changes to the FRCA exam so far, and what they mean for you.
What are the changes to the FRCA Exam?
The RCoA announced in 2023 that both the Primary FRCA exam format and Final FRCA exams would be restructured. The changes follow an independent review of exam processes and four years of development by the College.
For the Primary FRCA exam, two things are changing. The written MCQ exam becomes an Applied Knowledge Test (AKT), and the OSCE and SOE (which are separate exams) merge into a single new clinical exam called CASE (Clinical and Anaesthetic Sciences Exam).
The curriculum itself isn't changing. Neither is the pass standard. The RCoA has been clear on this: the scope of what's being tested across the Primary FRCA stays the same. All that’s changing is how it's tested.
What is the new Primary FRCA structure?
From July 2027, the Primary FRCA will have two components instead of three.
The Applied Knowledge Test (AKT)
The current written MCQ becomes the Primary AKT. It will still use Single Best Answer (SBA) questions – this is the same format the MCQ has used since MTF questions were removed in September 2023. The RCoA has not indicated any change to the question count, exam length or online delivery method. You'll still need to pass the written exam before progressing to the clinical component.
This is more of a naming change than a format change. The Primary FRCA isn't changing its question style or structure for the written paper. If you're already revising SBA questions for the Primary MCQ, that preparation carries directly into the new AKT.
The Clinical and Anaesthetic Sciences Exam (CASE)
This is the bigger change. CASE replaces both the OSCE and the SOE with a single circuit of stations. The format was updated after the April 2026 pilot and now consists of 13 stations, each lasting 9 minutes.
The stations use role players and simulation manikins to create realistic clinical scenarios. In some, you'll demonstrate practical skills while an examiner observes. In others, the examiner will discuss clinical questions with you. This will be closer to a workplace conversation with a consultant than a traditional viva.
Basic science knowledge hasn't been dropped. Instead, the sciences are embedded within clinical situations. So rather than answering a standalone pharmacology viva question, you might apply that pharmacology knowledge as part of managing a simulated patient scenario.
The RCoA developed CASE to assess clinical reasoning, critical thinking, clinical management and professional practice, and this is now within the context of authentic anaesthetic encounters. Pilot feedback from volunteer candidates and examiners was positive, with both groups noting the improved clinical realism of the stations.
How does the new CASE format compare to the current OSCE and SOE?
The current setup separates practical skills (OSCE) from knowledge-based oral questioning (SOE). Under the new structure, those two strands merge.
Right now, the OSCE runs up to 16 stations of 5 minutes each, testing clinical and communication skills across a circuit. The SOE is a structured 60-minute viva with two examiners, covering pharmacology, physiology, clinical topics and physics. You sit both on the same day, and you need to pass each one separately.
CASE consolidates this into 13 stations of 9 minutes each. The longer station time gives you more space to work through a scenario all within a single encounter. This could include taking a history, demonstrating a skill, applying science to a clinical decision, and discussing your reasoning. It's a noticeable shift from the current model, where a 5-minute OSCE station often means performing one discrete task under time pressure.
The RCoA has said the new FRCA structure places greater emphasis on clinical performance skills and less on testing knowledge in isolation. Pure knowledge recall moves to the written AKT, while CASE focuses on how you apply that knowledge to real clinical situations.
What happens to the Primary FRCA SOE?
The Primary FRCA SOE format is being retired as a standalone component. Its content, the oral assessment of basic science knowledge and clinical reasoning, is absorbed into two places. First in the AKT (for pure knowledge testing) and then CASE (for applied clinical science within station scenarios).
This was one of the main recommendations from the 2023 review. The review panel found that knowledge-only assessment was better suited to a written format, freeing up the face-to-face exam to concentrate on clinical performance and applied decision-making.
If you're currently revising for the SOE, that work isn't wasted. You'll still need the same depth of understanding in physiology, pharmacology and physics. You'll just be applying it differently in the CASE stations rather than answering viva-style questions in isolation.
When do the new Primary FRCA exam formats start?
The RCoA has set out three phases for introducing the new Primary FRCA exam formats.
Up to June 2027: The current Primary FRCA format (MCQ, OSCE, SOE) continues to run as normal.
July 2027 to June 2028 (transition year): All first-time candidates sit the new format. Legacy OSCE and SOE exams will still be available, but only for candidates who already hold a valid partial pass – for example, if you've passed the SOE but not the OSCE.
From July 2028: The legacy format is fully retired. All candidates sit the AKT and CASE, with no exceptions.
If you're planning your exam timeline, the transition year offers some flexibility. But from July 2028 onwards, the new format is the only route.
What if I already have a partial pass?
If you've passed the OSCE but not the SOE (or vice versa) before July 2027, you'll be able to complete the remaining legacy component during the 2027–2028 transition year. You can also choose to sit the new CASE format instead. The RCoA treats legacy and new formats as equivalent, and you won't be disadvantaged by switching.
If you don't complete the missing component by June 2028, you'll move onto CASE. Your partial pass won't carry forward as a partial exemption from CASE. You'll sit the full new clinical exam.
For candidates who can't sit during the transition year due to health, parental leave or other personal reasons, the RCoA has confirmed you'll transition to the new format when you return.
Will my attempt count reset under the new format?
Yes. The RCoA has confirmed that attempts at the new CASE exam are counted separately from legacy OSCE and SOE attempts. If you failed the OSCE or SOE on your fifth attempt in the 2026–2027 academic year, your first sitting of CASE will count as attempt one.
The maximum of six attempts per component stays in place. And if you've already exhausted all six attempts on a legacy component, you remain ineligible for further sittings.
Is the Primary FRCA curriculum changing in 2027?
No. The RCoA has confirmed that the curriculum and syllabus stay the same. The changes are to how you're assessed, not what you're assessed on. All Primary FRCA content will still be mapped to Stage 1 of the anaesthetic training curriculum, and the exam will continue to cover pharmacology, physiology, physics, clinical measurement and equipment.
Will the new CASE exam be harder than the current OSCE and SOE?
The RCoA has stated that the pass standard is not changing. CASE is designed to be a more clinically authentic assessment, not a more difficult one. The longer 9-minute stations give you more time to demonstrate your reasoning than the current 5-minute OSCE format allows. This may actually reduce the time pressure that many candidates find most stressful about the OSCE circuit.
Do you need to wait for 2027 to start preparing?
No, and there's a good case for starting early. The knowledge base for the Primary FRCA isn't changing, so SBA revision and applied science study remain relevant whether you sit the current format or the new one. Practising how you apply basic science to clinical scenarios will benefit you under either exam structure. If anything, candidates who build that habit now will be better placed when CASE arrives.
Where can you find sample materials for CASE?
The RCoA is publishing sample content through its resource hub and running webinars with members of the examining team ahead of the July 2027 launch. Registrations for the June webinar series are currently open on the College's website. Pastest will update our Primary FRCA resources as new exam details are confirmed.
How should you prepare for the new Primary FRCA?
The written component stays SBA-focused, so the core of your MCQ revision doesn't change. Practising under exam conditions with a question bank that reflects the current SBA format is still the most effective way to prepare for the AKT.
For CASE, the emphasis shifts towards applied clinical reasoning. That means practising how you'd explain your thinking to a consultant, working through simulated scenarios, and getting comfortable applying basic science within a clinical context. You’re no longer just recalling it in isolation.
For a full breakdown of the current exam structure, eligibility and revision tips, see our Complete Guide to the Primary FRCA Exam.
Kick-start your Primary FRCA revision with Pastest
Pastest's Primary FRCA question bank covers the SBA component with over 1,000 exam-style questions written by clinicians and updated to reflect the most recent exam themes. You can practise under timed conditions, track your performance by topic, and focus your revision where it counts.
The Primary FRCA Exam Essentials Course pairs well with the QBank. It features 60+ on-demand video lessons (5–10 minutes each) covering physiology, pharmacology, physics and equipment. It currently includes SBA and viva-style questions built into each module. That combination of structured video learning and active question practice is especially relevant as the exam moves towards applied science within clinical stations.
Pastest's question bank and video course together prepare you for both sides of the new exam structure: the AKT and the applied science you'll need in CASE. Our questions are written by practising clinicians and reviewed against current guidelines, so you're revising with materials that reflect what the RCoA tests.
Get started today, or contact us to find out more!