The Pastest Complete Guide to the Primary FRCA Exam

In our complete guide to the Primary FRCA Exam you'll find everything you need to know about the different components and how to ace them.

What is the Primary FRCA Examination?

The Primary FRCA Examination is the first part of the Fellowship of the Royal College of Anaesthetists (FRCA) examination. It is a postgraduate examination in anaesthesia that assesses a candidate's competency across a range of disciplines. 

The Primary FRCA is made up of three parts:

• Multiple Choice Question (MCQ): A computer-based exam that tests a candidate's knowledge of pharmacology, physiology, biochemistry, anatomy, physics, clinical measurement, statistics and equipment and safety.

• Objective Structured Clinical Examination (OSCE): A practical exam that assesses a candidate's clinical skills, such as patient assessment, airway management and decision-making.

• Structured Oral Examination (SOE): A viva voce exam that assesses a candidate's communication skills, knowledge of anaesthetic techniques and ability to apply theoretical knowledge to clinical practice.

Candidates must pass all three components to pass the Primary FRCA. Once you have passed, it is valid for seven years as part of your eligibility for the Final FRCA Exam.

How long does the Primary FRCA take?

How long the Primary FRCA takes depends on when you pass each component and how many attempts you need to pass. 

The three FRCA Exams are spread across the calendar year. The MCQ runs three times a year (February, September and November), and the OSCE and SOE are held together three times a year (May, November and February). You need to pass the MCQ before you can sit the OSCE and SOE, so the earliest you could complete all three components is at the very next OSCE/SOE sitting after passing the MCQ. That would be roughly two to four months later, depending on where in the calendar your sitting falls.

Most candidates take longer, though. Once you've passed the MCQ, you have three years to pass the OSCE and SOE before the MCQ expires and you'd need to resit it. The full Primary FRCA pass is then valid for seven years toward eligibility for the Final FRCA.

Who is eligible for the Primary FRCA Exam?

According to the Royal College of Anaesthetists (RCoA), to be eligible to take the Primary FRCA Examination, you need to meet the following criteria:

• Be registered with the GMC or an equivalent National Medical Council

• Be registered with the Royal College of Anaesthetists (RCoA) as a trainee in one of the following training programmes:

• Foundation Programme

• Anaesthetics

• Acute Care Common Stem (ACCS)

• Intensive Care Medicine

• Be attempting the exam for the sixth time or less; a maximum of six attempts is allowed.

Or, in place of the final point above, you can also:

• Be registered as a trainee with the College of Anaesthetists, Ireland

• Be registered with the RCoA in a recognised non-affiliate membership category and currently working as an Anaesthetist

• Be registered with the RCoA in a recognised non-affiliate membership category and you have previously left anaesthetic training in the UK or Ireland less than five years ago.

Eligibility for the Primary FRCA OSCE and SOE

To sit the OSCE and SOE, you must have passed the Primary FRCA MCQ within three years of the published starting date of the sitting you're applying for. Beyond the three-year window, the MCQ pass expires and you would need to resit it before entering the OSCE or SOE.

You will also need to hold the Initial Assessment of Competency in Anaesthetics (IAC), or an accepted equivalent:

• The College of Anaesthetists in Ireland equivalent of the IAC

• A satisfactory NHS appraisal at ARCP standard, for doctors practising anaesthesia in a non-UK training post

• A written report from a college tutor, for candidates sponsored under the RCoA MTI scheme

• An overseas anaesthetic competency certificate comparable to the UK IAC, accompanied by a letter of authentication from a senior anaesthetic consultant or notary.

As with the MCQ, a maximum of six attempts is allowed for each of the OSCE and SOE separately.

The RCoA strongly recommends that candidates do not sit the OSCE and SOE until they are at least halfway through their Core Level/Stage 1 training programme in anaesthetics. Foundation trainees are eligible for the MCQ only and cannot enter the OSCE or SOE.

The FRCA Primary MCQ Exam

The Multiple-Choice Question (MCQ) exam is the first part of the exam you will take in the FRCA process; without this one, you cannot take the subsequent two exams. This more theoretical multiple-choice exam covers the core parts of the anaesthetic training curriculum, featuring 90 single best answer (SBA) questions over three hours. These are the topics you'll be tested on:

• Pharmacology – Drug actions, interactions and adverse effects.

• Physiology – Cardiovascular, respiratory, renal and neurological systems.

• Biochemistry – Metabolic processes, acid-base balance and electrolyte disturbances.

• Anatomy – Relevant anatomical structures and their functions.

• Physics – Principles of gas laws, fluid dynamics and medical equipment.

• Clinical measurement – Techniques and interpretation of physiological parameters.

• Statistics and data interpretation – Understanding and analysing data.

There will be 30 questions in pharmacology, 30 in physiology (including biochemistry and anatomy) and 30 in physics, clinical measurement, statistical methods and data interpretation.

How to apply for the Primary FRCA MCQ Exam

1. Make sure you meet the eligibility criteria.

2. Head to the Royal College of Anaesthetists website and create an account, if you haven't already got one.

3. Select the application form for the FRCA primary exam and fill in all the necessary personal information, including name, contact information, details of your training and qualifications.

4. Upload a passport-style photograph of yourself and a copy of your GMC registration certificate, or equivalent.

5. Submit the completed application and pay the application fee (currently £410). This fee is non-refundable and must be paid by your exam's closing date.

How the Primary MCQ is marked

One mark will be awarded for each correct answer, with a maximum of 90 marks on the exam. Negative marking will not be used.

What is the Primary FRCA MCQ pass mark?

The pass mark for the Primary FRCA MCQ is not fixed. It's set by the examiners before each sitting using a modified Angoff method, which means it can vary between sittings. The RCoA does not publish a standard pass mark in advance. Results are released by email on the date confirmed in the exam calendar below.

Exam dates and fees for the Primary FRCA MCQ

Primary FRCA dates for current and upcoming sittings are listed below.

Make sure to check the RCoA website nearer the time, as application deadlines, examination dates, and result release dates are occasionally subject to change. FRCA primary results for the MCQ can be accessed via the My RCoA portal by 5pm on the specified date and results cannot be given over the phone.

The FRCA OSCE Exam

The FRCA Primary OSCE (Objective Structured Clinical Examination) is the practical component of the FRCA Exam, designed to assess a candidate's clinical skills and ability to apply theoretical knowledge to real-world scenarios. 

The format of this exam comprises up to 16 live exam stations in a circuit, each one simulating a different clinical scenario, and typically lasts for two to three hours. You will be observed by an examiner and scored on your performance.

During the OSCE part of the FRCA, you may be assessed on the following stations and scenarios:

• History taking and examination: focused anaesthetic history, airway assessment and targeted cardiovascular/respiratory examination.

• Airway management: airway assessment and planning, basic and advanced airway techniques and failed airway drills.

• Drug handling and administration: dose calculation, safe preparation and labelling and management of adverse drug events.

• Equipment and monitoring: anaesthetic machine checks, breathing systems and ventilators and interpretation of monitors.

• Resuscitation and emergencies: ALS algorithms, anaesthetic emergencies (anaphylaxis, MH, LAST) and crisis management.

• Communication and professionalism: consent and capacity, explaining risk and procedures, patient safety and escalation.

You will be assessed and graded on the following by the examiners:

• Knowledge: accuracy, relevance and recall under pressure.

• Practical skill: safe technique, and systematics and asepsis.

• Application and judgement: prioritisation, decision-making and safety focus.

• Communication: clarity, structure and professional manner.

• Organisation: logical flow, time management and signposting.

Structure of the FRCA OSCE

Since it is more of a practical exam, the OSCE part of the FRCA exam is structured differently. There will be around 16 stations that you will work your way through, each one lasting about five minutes. Outside of each station, guidance will be displayed, and you have one minute to read before entering. Once inside, an examiner may ask questions, and you may be asked to demonstrate a technical skill, show how to use a piece of equipment or interact with a patient (an actor). After five minutes, a bell will sound and you will move to the next station.

It's important to remember that this describes a typical OSCE exam and adjustments can be made if a candidate has additional needs.

There are rest stations throughout the circuit where you will be seated and asked to wear ear defenders. Floor leads will be stationed throughout and will inform you when you need to move to the next circuit. You are allowed to take a water bottle with you during the exam, but no paper, electronic devices or other resources.

How the FRCA OSCE is marked

Each station is marked out of 20. The pass mark for each station is determined by the examiners prior to the exam beginning using a modified Angoff referencing. The Angoff score for each of the live stations are summed to obtain the pass mark for the whole examination.

The FRCA Primary SOE Exam

The FRCA Primary SOE (Structured Oral Examination) is the third and final component of the FRCA primary Examination, designed to assess a candidate's communication skills, knowledge of anaesthetic techniques and ability to apply theoretical knowledge to clinical practice.

This last examination takes the form of a series of structured interviews with examiners, in two 30-minute segments of six questions each on different topics.

To take the SOE, you will need to have passed the Primary FRCA MCQ in the last three years.

During the SOE part of the FRCA, you may be assessed on the following:

• Physiology: Cardiovascular, respiratory, CNS, renal, hepatic, endocrine and applied physiology in anaesthesia and critical care.

• Pharmacology: Pharmacokinetics and pharmacodynamics, anaesthetic drugs, adjuncts and emergency drugs.

• Physics, measurement and equipment: Gas laws, electricity, fluid dynamics, anaesthetic machines, breathing systems, monitors and safety features.

• Anatomy: Airway, neuraxial and regional anaesthesia anatomy.

• Clinical anaesthesia: Pre-operative assessment and optimisation, intra-operative management and monitoring and post-operative care and pain management.

• Critical care and emergencies: Shock, hypoxia, acid–base and electrolyte disorders, airway crises, anaphylaxis and MH and ALS principles.

• Pain medicine: Acute pain, multimodal analgesia and core chronic pain principles.

• Ethics, law and professionalism: Consent, capacity, DNACPR and end-of-life care, patient safety and human factors.

This is what you'll be assessed and graded on by the examiners:

• Knowledge: Accuracy and breadth

• Application: Linking theory to clinical practice.

• Clinical reasoning and judgement: Prioritisation, safety and decision-making

• Communication: Clear, structured, concise answers.

• Professionalism and safety: Recognition of risk and escalation.

• Organisation: Logical flow and time management.

Structure of the Primary SOE

The Primary SOE is made up of two subsections:

• 30 minutes of three questions in pharmacology, and three questions in physiology and biochemistry

• Followed by 30 minutes of three questions on clinical topics (including a critical incident) and three questions in physics, clinical measurement and equipment and safety.

How the Primary SOE is marked

Two examiners mark each part of the SOE. Both examiners independently mark every question. There are 12 questions, 2 marks are given for a pass, 1 mark for a borderline performance and 0 marks for a fail, giving a maximum total score of 48 marks.

Exam dates and fees for the Primary FRCA OSCE and SOE

The OSCE and SOE exams are sat together, and take place on the same day.  

As with the MCQ exam, keep checking the RCoA site or portal to make sure you have the most up-to-date exam and results dates. 

Taking your exam at the college

The OSCE and SOE require you to attend in person rather than take the exam on a computer. This will take place at the Royal College of Anaesthetists. Please arrive at least 30 minutes before the first call time on your Admission Notice; late admissions are not allowed, and the earliest you will be admitted to the College is 7:30 am.

Upon being admitted, report to the reception desk and present your Admission Notice and ID, where you will receive clear instructions on when and where to report for each component. You must sign in and out at reception when leaving and/or returning throughout the day.

How Pastest can help you pass the Primary FRCA Exam

We hope this guide has told you everything you need to know about the different components of the Primary FRCA Exam. With the right resources and tools at your disposal and plenty of time to prepare, we are sure you'll be able to pass and take the next step on your path to becoming a qualified anaesthetist.

If you’re preparing for the Primary FRCA, Pastest’s online revision tools are designed to support and challenge you in your exam preparation.

 

Our Primary FRCA Qbank contains more than 1,000 questions in the SBA (Single Best Answer) format, all reflecting the most recent exam themes and with explanations for each answer option. Our online revision platform tracks your scores and provides real-time insights into your study progress, helping you to focus your revision where it matters most.

We also offer a Primary FRCA Exam Essentials course - the perfect companion to the Primary FRCA Qbank. Designed to make FRCA revision manageable for busy trainees, this on-demand course features 60+ videos complete with integrated SBAs and Viva questions covering all the essential topics.

Get started today or contact us for more information. 

 

Frequently asked questions about the Primary FRCA

How is the Primary FRCA formatted?

The FRCA Primary is divided into three exams:

• A multiple-choice written (MCQ) exam which consists of multiple-choice questions and is usually held three times a year – February, September and November

• A practical (OSCE) exam

• A structured oral viva (SOE) exam

The latter two exams are taken together and consist of 16 OSCE stations with questions provided by two examiners. These exams are usually held three times a year – May, November and February.

How many times can you take the Primary FRCA Exam?

The MCQ, OSCE, and SOE each have a maximum of six attempts. For the MCQ, you must also wait a minimum of six months between attempts and will need to reapply and pay the exam fee each time. If you reach the limit on any component, you will need to submit evidence to an appeals process showing extenuating circumstances. Note that the OSCE and SOE attempt limits are counted separately—failing one does not count as a failed attempt at the other.

What is the dress code for the exam?

For the Primary FRCA Exam, you should dress the same as any other day-to-day clinical practice or contact with patients. Your form of dress should not constrain your ability to demonstrate recognised skills, including effective communication with simulated patients or examiners. You will not be required to wear clinical or theatre clothing at any time.

How long is the FRCA Primary valid for?

There are two different timelines to be aware of. Once you have passed the MCQ, you have three years to pass the OSCE and SOE. If you don't complete both within that window, your MCQ pass expires and you will need to resit it. Once you have passed all three components, the full Primary FRCA pass is valid for seven years toward eligibility for the Final FRCA Examination.

What happens if I fail a component of the Primary FRCA?

You can resit any component you fail, up to a maximum of six attempts per component. For the MCQ, you must wait at least six months before resitting. If you fail the MCQ six times and cannot complete it, you will also be unable to progress to the OSCE and SOE. If you pass the MCQ but subsequently fail the OSCE or SOE six times, the same appeals process applies. 

Bear in mind that if your MCQ pass expires during this process—more than three years have passed since you sat it—you will need to resit the MCQ before you can re-enter the OSCE or SOE.

What are the Primary FRCA exam dates?

The MCQ runs three times a year, in February, September, and November. The OSCE and SOE are held together three times a year, in May, November, and February. Full dates, booking deadlines, and results release dates for 2025–2027 are in the exam calendars above.