Everything you need to know for the new 2027 FRCA exams
We're getting new FRCA exams.
Why, you ask?
Because apparently life isn't stressful enough and now you need to learn a completely new game to play in order to progress through your already demanding professional career.
Not really.
The FRCA examinations have long been criticised for requiring candidates to learn voluminous quantities of irrelevant esoteric information, which is then to be regurgitated as part of an elaborate performative dance to please the examiners, rather than an accurate assessment of one's actual day-to-day practice.
The new exams aim to change this.
- The curriculum is the same as before
- It's still a really difficult exam
- It's still going to take a hell of a lot of work
- Hopefully it's going to feel a bit more realistic
Trainees have been crying out for years, lamenting how archaic, nitpicky and generally unrepresentative of the actual job of being an anaesthetist the FRCA examinations are, and so it seems that the RCoA are making steps in the right direction to mitigate this.
And from what we can see having read through the RCoA resources, the feedback and watching the sample videos, it seems that - at least on first impression - it's a significantly better set up.
You're getting tested on important, useful information that you actually need to know in a clinically relevant setting that could feasibly come up on a Tuesday morning as the CEPOD anaesthetist.
The feedback from their pilot study guinea pigs is also positive, with pretty much everyone agreeing it's more true to real life and specifically that it rewards those who are actually good at their job, rather than those who can smash out exams under pressure.
What's actually new?
From July 2027 onwards:
- The Primary MCQ is becoming the Primary AKT
- The OSCE and SOE are becoming the CASE
- The Final written (CRQ and SBA) is becoming the Final AKT
- The Final SOE is becoming the FCPE
Don't worry, we'll explain, starting with the AKTs, where relatively little has actually changed from the previous format.
Primary AKT
This stands for Applied Knowledge Test.
- Two papers
- 80 SBAs each
- 2 hours 20 minutes each
- Online
- Sat on different days
- Performance on both papers is combined to determine pass or fail
The RCoA have confirmed that the curriculum has not changed.
PAPER A
- 40 questions on pharmacology
- 40 questions on physiology
PAPER B
- 30 questions on physics
- 35 questions on clinical measurement and data interpretation
- 10 questions on anatomy
- 5 questions on statistics
Use this information to prioritise your revision!
The RCoA states:
"The revised AKT places greater emphasis on:
- clinically relevant questioning
- application of knowledge
- integration of basic sciences into clinical practice
Candidates are expected not only to recall information, but to demonstrate how knowledge informs safe and effective clinical decision-making."
They specifically mention that you need to be able to apply basic science to clinical practice, interpret clinical data and investigations, and integrate physiology and pharmacology into perioperative decision-making.
So don't just expect to be asked what Bowman's principle is, you'll need to be able to apply this knowledge to inform a clinical decision.
(Bowman's principle = less potent drug is faster onset, because you have to give a much bigger dose, and therefore you generate a bigger concentration gradient. This is partly why we use rocuronium rather than vecuronium for RSI.)
Final AKT
This replaces the CRQ and SBA papers and the first sitting will be in January 2028.
- One paper
- 100 SBAs
- 3 hours
- Online
No more CRQs. Much less basic science. Still an enormous syllabus.
- 50 questions on general anaesthesia
- 10 questions on perioperative medicine
- 10 questions on regional anaesthesia
- 30 questions on 'other domains' of the curriculum