Why revising for the FRCA is harder than ever

"Anyone else finding they're revising stuff and it's just not sticking? Exams never used to be this hard."

You're not alone, and hopefully this post helps.

A promise and a challenge

Before we start I want to promise you there is no AI slop here.

Every word you're about to read has been written by a human who has personally sat and passed these examinations and experienced these difficulties.

I also used every one of these techniques myself and noticed a significant improvement in my retention as a result, so I wanted to pass them on in case they help.

The challenge is to read the whole post without getting distracted.

The three steps to a correct answer

There are three fundamental steps to getting an FRCA question right, whether that's for the written exam or a viva.

Encode the information into your working memory
File it away into your long term memory
Retrieve it and hand it to the examiner

That's it.

This process hasn't changed since exams were first invented, and the FRCA exam syllabus is very similar to fifteen years ago, but what has changed recently is how difficult it is to do these three things.

(I fully appreciate this is not exactly how the impossibly intricate mechanics of human memory actually work, but it is a useful cognitive framework to work with.)

Here we go through the three steps, explain why they're so challenging, and hopefully provide some solutions that will win you some more marks on exam day.

Step 1 - Encoding

Every time I sat down to revise for the Final FRCA written exam, within five minutes my attention would drift off.

I would feel this incredible urge to pick up my phone and 'just check' to see if anyone had messaged, emailed or if any new notifications had popped up.

Even when my notifications were turned off, my phone was in another room and all I had in front of me was a book and a pencil - my mind would still wander.

This was because I had conditioned my brain to expect interruption.

While not perfectly regular, on average my phone was beeping or vibrating every few minutes throughout the day, and even if my willpower was strong enough not to immediately attend to it, what I was actually doing was training my brain to anticipate something interesting coming along every few minutes.

I couldn't even read a book without losing my train of thought halfway down every page.

"It was never this hard at school, or at uni."

But then again I didn't have a supercomputer with immediate access to everything in my pocket then either.

It has never been harder to study

We're made to think that we have it easy these days, what with our access to unparalleled quantities of up-to-date information, science-backed spaced repetition flashcard apps that optimise our retention and AI-powered personal exam tutors.

It's total rubbish.

We never needed more access to increasing quantities of information.

What we're missing is focus and attention.

It's nigh-on impossible to maintain a coherent stream of thought in this day and age, through no fault of our own, because it is a skill that has been deliberately hammered out of us by tech companies who figured they could harvest attention for advertising revenue.

Our senior colleagues sat in a quiet library with one or two textbooks and no distractions, no instant messaging, no FOMO
Meanwhile we're force-fed a diet of brightly-coloured, dopamine-rich instant gratification that has absolutely fried our working memory and attention span

Everything is urgent, messaging is instant and nobody wants to be left behind.

It's one of the reasons that we don't run adverts here, because they're so distracting, and they ruin the immersive and enjoyable experience that reading should be. We want to maintain a clean, calm interface to allow you to focus on the information in front of you, so that it actually sinks in.

💡

Put your phone in greyscale.

Every app icon on your phone has been specifically designed to be as enticing as possible, to get you to tap it without even thinking
The screen automatically enhances the brightness of the colours of images and videos to make them nicer to look at so you get a bigger hit of dopamine and serotonin when you use it

Putting your phone screen into greyscale renders it immediately less inviting to use, and makes it much easier to put down.

With time, the interruptions start to dwindle and the attention span returns.

There's too much information

There has never been a lack of information when it comes to FRCA exam resources.

Whether it's textbooks, podcasts, question banks or guidelines, the information has always been readily available to learn.

In fact we have the opposite problem now.

There is far too much information for any human to reasonably consume and process, and this has a number of deleterious effects:

It generates anxiety over how much you actually have to know
It encourages 'resource hoarding' rather than 'studying'
You end up jumping between multiple resources rather than just sticking with one

The bottleneck for the student in the learning process has always been the reading and understanding of the information. Pouring more information into the top isn't going to speed things along, it's just going to overwhelm them.

Think about an alternative scenario; one you might remember from GCSE or A-levels.

If there were literally one book that covered everything you needed, and the information couldn't be found anywhere else, how much easier would revision be?

You knew exactly how much you needed to know
You knew how far through the material you were
You didn't worry whether you were using the best possible resource for the exam
You just sat and studied the book

I personally used to stress about ensuring I had enough resources or the most recent guidelines or the most up to date information when learning for the FRCA exams, and would end up downloading endless pretty PDFs, slides and resources, only to stick them in my drive folder and never look at them again.

There is far too much information available, and not nearly enough time.

💡

Pick a resource you like, and stick with it.

Step 2 - Filing

This is the mental equivalent of taking all of the notes you've written over the course of the year and sorting them into easily accessible folders rather than leaving them in a pile on the table.

You don't build muscle in the gym, you build it while resting and sleeping after going to the gym.

Similarly, once you finish studying, your brain churns dutifully through the information dumped into the working memory, sifting and sorting it into your long term memory depending on:

What other information it naturally links to
How many times you've seen it before
How important it seems to be

And this sorting process takes a little while.

Five minutes of silence

This was the single most influential change I made to my revision.

Does the following sound familiar?

I've crawled to the end of my assigned 'block' of revision, be that twenty minutes, fifteen pages, nine questions or whatever I've decided to use as my motivator that day.

I finish the final sentence, breathe a sigh of relief that it's over for another day, and pick up my phone, allowing myself some prime doomscrolling as a reward for my brilliant hard work.

💡

This actively undid the work I just put in.

You need to let the cognitive glue dry on what you've just studied.

By immediately picking up your phone and dousing your attention with short-form video and bright colours, you're essentially telling your brain to immediately drop what it was just doing, and start focusing on this new, high-paced, high-intensity information that you're supplying - because that's more important.

That's why it's so difficult to remember what happened in the videos you just scrolled through a few minutes ago, because those memories got dumped as soon as the next video flipped up on the screen.

You will increase your retention of information enormously by simply waiting for a few minutes before supplying your brain with new information after you finish a study session.

Close the book or laptop
Sit quietly for a few minutes
Make a cup of coffee
Go for a walk in silence

Just don't pick up the phone.

Fix your sleep

You know this already, I knew this already, but did I listen?

Hell no.

I crammed until the early hours of the morning, thinking that more information, more time spent studying, more SBAs ticked off would bring me greater success on exam day.

I knew the science, I knew the importance of sleep for learning, but somehow it just felt more 'justifiable' to give up sleep in order to study more, than to actually allow my brain to rest and recuperate.

In hindsight I wish I'd had the confidence to just close the book and go to bed.

This is easier said than done, especially with night shifts and kids, but if there's ever the choice between another hour of questions at 11pm, or an earlier night, the sleep wins hands down.

This is especially true in the week or two before the exam, where the statistical probability of you selecting a topic to study that actually comes up is tiny, but the benefit of some extra shut-eye is enormous.

Spaced repetition

This has become the buzzphrase of flashcard apps and exam gurus everywhere, and it's true - you get better recall by revisiting information after gradually increasing time intervals.

This presumably isn't news to you, however I just wanted to switch the concept around into some reassurance:

If you're finding you're studying a topic, and then a week later it feels as if you never studied it at all, then have faith - this is just spaced repetition doing its thing.

You have encoded and filed the information, it wasn't wasted time, you just need to cement it in place and then work on recalling it.

Which brings us nicely onto...

Step 3 - Retrieval

Train your recall

It's all well and good having studied and remembered enormous quantities of information, but it's a complete waste of time if you can't then retrieve that information on exam day.

A library without a librarian - stacks of beautifully organised information that you can't access when you need it.

You have to train recall.

This is arguably the most crucial part of your revision, and also the most neglected, because it doesn't feel like useful revision.

The temptation is always to sit down and learn something new, rather than recalling stuff you've already studied, because then you're expanding your knowledge base and acquiring new knowledge.

This is absolutely true at the very beginning of your revision
But after a few weeks you need to start actively training recall too

Every time you attempt to retrieve a piece of information from the depths of your memory, you tell your brain 'this is really important to know' and so your brain remembers it better next time around.

Even if you get the answer wrong, the sheer act of retrieving it from your psychological database helps build those synapses that allow you to access it more easily next time.

💡

For the written exams, it's practising MCQs, and for the CASE/FCPE, it's practising talking.

It starts with seeing the information for the first time
Then it's recognition of a fact or idea you've seen before
Then it's cued recall, where you remember the answer if the question prompts you
Then it's free recall, where you retrieve the information without prompting

The frustrating bit is when you're stuck between recognition and cued recall, because you know you've studied this concept before, but it clearly hasn't stuck yet and so you keep getting the question wrong.

But that's the point - it's not failure - this is just the process. This is how you train recall.

After three or four attempts you should find it becomes reliably cued recall which is what you need for the MCQ papers, and eventually free recall which is what you need for the viva.

Train for the game you're playing

You wouldn't swim endless lengths of a pool in order to train for a 400m track sprint, and neither should you train for a three-hour written exam by answering a few SBAs here and there on the bus while listening to music.

The FRCA requires deep, uninterrupted focus.

On exam day you're going to have to sit down in a quiet room with no distractions, and focus on a single task for several hours in one stretch.

When was the last time you did this?

Certainly not at work.

Our job is riddled with distraction and interruption from both humans and machines:

Airway pressure has gone up
Fluid is finished
"Table down please"
"Have you signed for the morphine?"
TRAUMA CALL TO RESUS 5
Blood pressure didn't cycle
Airway pressure has normalised
"Head down right side up please"
Inspired CO2 concentration is 0.8%
'Hi guys is anyone able to offer Dr Jones a break in Theatre 7'
"The last patient in recovery is being sick, what else can they have?"
Oh look another ectopic beat

And this is just four minutes on a Tuesday morning.

That's literally the opposite of what the exam is asking of us.

💡

You have to specifically practise sitting quietly for a prolonged period of time.

Even if you're not actually learning new information, or don't feel like it's 'going in', the simple act of training yourself to sit still without distraction for over an hour at a time is enormously beneficial to your performance come exam day.

Specific retrieval exercises

Here are a few techniques to actively boost retrieval training.

Immediately before revising a topic, write down everything you can about it

This shows you where the gaps are, and primes your brain that this information is important and worth remembering.

Then when you start reading the material, you will automatically give more of your attention to the bits that need more work.

Immediately after studying a concept, explain it out loud in the mirror

This tells you whether you actually understood and retained the information, and shows you which bits need filling in, before you move onto another separate topic.

If you understand it sufficiently to explain it coherently, you'll remember it much more easily.

You'll also find yourself naturally rephrasing and re-ordering the information to make it easier to understand and explain, which in turn will increase your recall in future.

Film yourself explaining

Not only does this force you to actually state the information out loud, but it allows you to watch yourself back again and see how you're conveying the information from the examiner's perspective, and whether it makes sense.

Explain every option

When you answer an MCQ, explain out loud why each other option is wrong.

Do this both before you submit the answer, and then again after revealing the correct choice.

This boosted my MCQ performance more than anything else.

Summary

Here's everything I did that massively improved my revision and exam performance:

Removed distractions
Practised focusing on one thing for a prolonged period of time
Put my phone in greyscale
Turned off notifications for messages and email
Uninstalled social media apps
Got a cheap watch so I didn't need to get my phone out to check the time
Enforced five quiet minutes after revision sessions
Increased my sleep
Reduced the number of resources I was using
Actively practised recall as part of every revision session

Good luck!

Tell us your story

Hopefully there are some useful bits that you can take away and incorporate into your own revision plan that will help boost your exam performance.

If you have any of your own tips and tricks to share, or questions and feedback, fire away in the comments below or email anaestheasier@gmail.com.

We're always delighted to hear from you.

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