Examiner tips: Do’s and don’ts for the CR2A exam
Article by: Dr Adam Thomas
Ready to sharpen your exam preparation and master the single best answer format? CR2A examiners Dr Adam Thomas and Dr Ian Hagan share their insights to help candidates excel.
Preparation
Do
Visit the RCR CR2A exam web page – read the purpose of assessment and look at the multiple resources available (such as exam dates/fees, FAQs and sample questions).
Familiarise yourself with the single best answer question format: clinical vignette, lead-in question and options. Understand that this format is about the application of knowledge rather than factual recall. It is the synthesis of medical, radiological and clinical knowledge that distinguishes the most successful and impactful radiologists.
Be aware of the scope of the assessment – questions can come from the whole syllabus (including relevant anatomy, techniques, applied physics and interventional questions).
Allow plenty of time for preparation – approximately six months of consistent preparation.
Pick a well-known textbook that you like the style of as a base or framework but accept this alone will not be sufficient.
Use the R-ITI modules – they are based on the curriculum that you are being tested on.
Look at review articles (for example, Clinical Radiology, RadioGraphics, AJR, EJR and Insights in Radiology). We try to keep question topics up to date and classic textbooks may not cover all of modern practice and developments. Review articles often feature ‘pearls and pitfalls’ summaries which can be helpful in distinguishing options in single best answer questions.
Be proactive in obtaining as broad a clinical experience as possible, including attending clinical meetings and MDTs, performing and observing interventional procedures, etc. Questions increasingly test practical competence – applied knowledge rather than factual recall. The exam favours those with broad clinical experience supplemented by extensive reading.
Try to learn which features (be they clinical, patient demographic or in combination with other studies) make a diagnosis specifically correct when revising differential diagnoses of imaging findings. These features will often be found in the question stem to aid selection of the ‘single best answer’.
Make sure you are aware of all the different organ-specific features of multisystem disorders – their diagnosis often relies on sharp-eyed radiological detective work – exactly the skills and knowledge we hope the successful candidate will demonstrate.
Don’t
Think that cramming a few weeks before the exam will work.
Focus on book work at the expense of clinical experience in the department – many questions test whether people have been attending and learning from MDTs, practical day-to-day experience including on-call, involvement in interventional radiology procedures and attending interesting case meetings.
Focus too much on your favourite specialist area(s) – marks are divided equally between six categories (cardiovascular/IR and respiratory, musculoskeletal, neuro/head & neck, GI, GU & breast, and paediatrics) so there is a limit to how much you can compensate for weaker areas.
Ignore areas such as breast radiology – there will always be questions on breast radiology in both papers (see also nuclear medicine and intervention).
Rely on exam books (not written by people involved in the exam, as they may not be representative of questions in the exam itself) or exam courses (as the same goes for exam books, but they can be useful to highlight personal areas needing additional focus or improvement, and for experience of answering questions under time pressure).
Rely on ‘past questions’ provided by colleagues or online – apart from being against the regulations to disseminate exam questions, they may have been remembered incorrectly by the person passing them on or have the wrong answer listed as correct. Plus, there may be different versions of similar questions but with different correct answers.
Worry about memorising tumour staging classifications – it is more important for you to gain experience of how these influence the patient’s radiological and clinical management (ideally experienced in an MDT environment).
In the exam
Do
Understand that the information in the stem is relevant and not there to mislead.
Read questions carefully and pay attention to features such as age and sex of the patient, clinical setting and symptoms, anatomy, etc – these may be the features which make one answer more likely than another when considering conditions with overlapping radiological features.
Be aware that with the single best answer format there will be more than one plausible answer. You are looking for the answer that is the ‘most correct’, not just an answer that is true.
Take the question ‘very literally’ – if it asks, ‘what is the most likely diagnosis’, that is what it means – NOT the diagnosis you would least like to miss, or the diagnosis that makes you look most intelligent.
Choose the investigation that would genuinely be the most appropriate investigation in current normal clinical practice if a question asks for the ‘most appropriate next investigation’, rather than the fanciest or most expensive test.
Don’t
Pick the first answer that seems plausible – there will usually be more than one plausible answer, but you are looking for the answer that is more correct than the others.
Panic if having read the question stem the answer you were expecting isn’t among the options – go back and check you have not misread the question/overlooked a key bit of information and then judge each option on its own merits based on the clinical scenario, imaging features and patient demographics.
Overthink things – if you have a broad clinical experience, you will most likely have come across the majority of situations encountered in the stems. Your ‘gut instinct’ is probably correct – check that your choice is consistent with all the information provided and if so, stick with it. You are unlikely to be correct if you talk yourself out of your initial choice after much agonising, unless you have spotted some information that directly contradicts it.
After the exam
Do
Have a well-earned rest!
Don’t
Write down questions you have seen in the exam for others. It is explicitly against the regulations, it will not help you and it could mislead others you pass it on to (you may misremember it, or they may incorrectly extrapolate to a similar question with a different correct answer). Dissemination of a well-performing question may also mean that it has to be deleted as it will no longer be useful.