Blog Summary
The Final FRCR (Part 2B) is the last big gateway to independent radiology practice. The exam is delivered across three components—Short Case Reporting (the modern “rapid reporting”), Long Case Reporting, and the Oral/viva—each testing your ability to observe accurately, reason clearly, and recommend safe next steps. This guide breaks down the current structure, timings, typical case mix, scoring logic (including the borderline/SEm policy), and offers an eight-week preparation plan, exam-day tactics, and common pitfalls so you can perform with clarity and confidence.
- Introduction
- The exam at a glance
- “Rapid reporting” reimagined: mastering Short Case Reporting
- Long Case Reporting: win with structure
- The Oral: think aloud—safely and succinctly
- Scoring and the borderline policy (what it means for you)
- Strategic takeaway
- An eight-week, high-yield prep plan
- Common pitfalls—and how to fix them
- Exam-day checklist
- Conclusion
- FAQs
Introduction
Few milestones in a radiology course carry as much weight as fellowship in radiology part 2B. It compresses what matters on a real clinical list speed, safety, and succinct communication into a single sitting. Success comes from three things: (1) knowing exactly what’s assessed, (2) practicing in the format you’ll face, and (3) presenting answers that are structured, decisive, and safe. If you build those habits early, the exam stops feeling like a mystery and starts feeling like a high-stakes but predictable workday.
The exam at a glance
- Three components in one sitting: Short Case Reporting, Long Case Reporting, and the Oral (two stations).
- Short Case Reporting: 25 plain radiograph cases in 120 minutes. You submit brief written reports with a clear diagnostic impression and a sensible next step. Typical mix is chest and MSK dominant, with a small slice of abdomen, and roughly a quarter paediatric.
- Long Case Reporting: 6 multimodality cases in 75 minutes (commonly CT and MRI, with occasional US/NM). You’re scored on structured written responses: observations → interpretation → principal diagnosis → reasoned differentials → recommended investigations/management.
- Oral (viva): Two stations, each 30 minutes, with two examiners per station and multiple cases per station. Domains include knowledge, observation, clinical reasoning, clinical safety/management, and communication.
“Rapid reporting” reimagined: mastering Short Case Reporting
Short Case Reporting rewards speed with structure. Think like you’re clearing a busy plain-film list for the on-call team.
How to approach each film (a 5-line micro-template):
- Study details: “PA CXR” / “AP pelvis—right hip focus” / “Lateral ankle—left.”
- Observations: Objective positives and key negatives (“small right apical lucency without vascular markings; no mediastinal shift”).
- Interpretation/diagnosis: One clear line (“Small right pneumothorax”).
- Complications/pitfalls: “No visible subcutaneous emphysema. No rib fracture identified.”
- Safe recommendation: “Treat per pneumothorax pathway; urgent clinical correlation; interval film if stable.”
What to drill
- CXR: Subtle pneumothorax, basal pneumonia, edema patterns, lines/tubes, mediastinal contours, hidden rib fractures, small pleural effusions.
- MSK: Distal radius fractures (Colles/Smith), scaphoid/triquetral signs, shoulder dislocation types, ankle mortise widening, Lisfranc hints, pediatric growth plate variants versus pathology, periprosthetic lucencies.
- Pediatrics: SUFE lines, elbow ossification centers (CRITOE), normal variants, ingestion/foreign body patterns.
- Abdomen: Dilated bowel gas patterns, “football sign,” sentinel loops, calcifications, device positioning.
Time discipline
25 films in 120 minutes means roughly 4.5 minutes per film. If you’re stuck at 3 minutes with no diagnosis, park it and return later. One stubborn film must not sink your set.
Long Case Reporting: win with structure
The marking scheme favors candidates who separate what they see from what it means and then what to do next. For each of the 6 cases (75 minutes total):
- Observations: Purely descriptive, modality-appropriate, and ordered (e.g., “Multiloculated rim-enhancing 5-cm collection tracking along the right iliacus with surrounding fat stranding”).
- Interpretation: Synthesize into a coherent explanation (“Appearance is most consistent with an iliopsoas abscess”).
- Principal diagnosis: Put a stake in the ground.
- Reasoned differentials: List only plausible alternatives with one reason each (“Necrotic nodal conglomerate—less likely given diffusion pattern”).
- Management: A safe, exam-worthy next step (e.g., “Urgent surgical/ID referral; image-guided drainage and cultures; look for source, including bowel/vertebral infection”).
Style pointers
- Write in bullet-like sentences.
- Avoid hedging words in every line. Be decisive where it’s safe to be decisive.
- Name complications and safety issues explicitly (e.g., impending cord compression, threatened airway, vascular compromise).
The Oral: think aloud—safely and succinctly
Across two 30-minute stations, you’ll be guided through diverse cases. The best candidates speak in the same structure that the exam rewards in writing:
- Describe succinct observations (start broad, then zoom).
- State the likely diagnosis (or leading differential).
- Say what you’d do next (urgent calls, further imaging, MDT, lab correlation).
- Verbalize safety (red flags, pitfalls, time-critical actions).
Communication matters. Your tone should be calm, organized, and collaborative—like presenting to an MDT: “Key abnormality… The most likely diagnosis… Immediate action… Further work-up would be…”
Scoring and the borderline policy (what it means for you)
- Each component has its own pass mark, set using recognized standard-setting methods.
- You must pass at least two of the three components to pass overall.
- If you fail exactly one component but pass the other two, there’s a borderline allowance based on the Standard Error of Measurement (SEm):
- A fail in a reporting component may still pass overall if it’s within one SEm of that component’s pass mark.
- A fail in the Oral is held to a tighter margin typically half an SEm.
- If you fail two or more components, it’s an overall fail.
- Passes cannot be carried forward; you re-sit all three components if you don’t pass overall.
Strategic takeaway
Aim to clear all three, but if you wobble in one, maximize performance in the others especially in the Oral, where clear structure and explicit safety statements can lift your score.
An eight-week, high-yield prep plan
Weeks 8–6: Build foundations and speed
- Short Cases: 15–20 films/day, strict 4–5 minute limit, write the five-line report every time.
- Long Cases: 3–4 mixed cases per day in the whole structure (obs → interpretation → diagnosis → differentials → management).
- Oral: Two short viva sessions per week; record yourself to trim filler words and tighten flow.
Weeks 5–4: Modality depth + paeds and MSK/CXR emphasis
- Double down on pediatric MSK and chest patterns; build a one-page “don’t miss” atlas of subtle signs.
- Practice device/line interpretation and common on-call emergencies (ED-style mix).
Weeks 3–2: Full simulation
- Short Cases: Full 25-in-120 sessions three times weekly.
- Long Cases: Two complete sets/week (6 in 75) with typed answers and self-marking.
- Oral: Two whole stations/week with peers; invite ruthless, time-boxed feedback.
Week 1: Taper and protect
- One tri-component mock early in the week.
- Light review of your error log; sleep, hydration, and logistics.
- Prepare a “first sentence” for common scenarios to avoid freezing.
Common pitfalls—and how to fix them
- Over-calling normal
When the film is typical, call it normal confidently and move on. Don’t invent pathology to fill silence.
- Blending observations with interpretation
Keep the lanes separate. You earn marks in both if you show the examiner you know the difference.
- Missing the management step
Even a perfect description loses points without a safe following action. Always add a pragmatic recommendation.
- Vague, rambling viva
Use short, declarative sentences. “Key findings are… Most likely diagnosis is… I would now…”
- Time drift
Use anchor times (e.g., check the clock at cases 6, 12, 18 in Short Cases). If behind, trim prose—not content.
Exam-day checklist
- UI familiarity: Rehearse typing concise, structured answers, so the platform isn’t a surprise.
- Time anchors: Short Cases ≈ 4–5 minutes each; Long Cases ≈ 12 minutes each with a small buffer.
- Mental templates: Five-line Short Case skeleton; five-step Long Case structure; viva script (describe → diagnose → manage → safety).
- Physiology: Carb-steady meals, hydration plan, scheduled micro-breaks for eye rest.
- Mindset: Treat it like service safe, efficient, kind to the next team.
Conclusion
FRCR 2B doesn’t reward flourish; it rewards clarity, safety, and repeatable structure under time pressure. If your practice mirrors the FRCR exam’s written and spoken formats short, decisive reports and calm, structured viva answers you’ll convert knowledge into marks efficiently. Build speed with templates, drill the common and dangerous patterns, and make the management step a reflex. On the day, your job is simple: describe cleanly, decide wisely, and recommend safely exactly what radiology is about.
