FRCR Part 2B (Oncology) - CO2B - advice for candidates

The RCR Exam Board would like to provide advice for all candidates sitting the FRCR 2B exam – whether this is for the first time or as a subsequent attempt. We would also like to highlight specific changes related to the new format of the exam and have  outlined several key aspects for candidates to consider, including:

• The purpose of the exam
• Domain-specific advice
• General advice when preparing for the exam
• Guidance for those re-sitting the exam

• Ideally, the examiners would like all candidates to pass the exam and seek to give credit wherever possible for correct answers provided by candidates.
• There is no “trap door” system whereby one wrong answer automatically leads to a fail on a station – although some errors (which would be hazardous for a patient or lead to unsuccessful treatments) are going to have a bigger impact on the overall score.
• Three domain scores are given across a 4-point scale for each question, and it is possible to score very well in one domain but do badly in another within the same question. 
• Even if a question is unfinished this might not affect the score for one or two of the domains within a question (depending on its structure).
• A huge amount of effort goes into the wording of the slides to ensure that candidates have all the relevant information available to make decisions. 
• The exam questions are carefully phrased to emphasise specifically what we want the candidate to do or say. Information volunteered by candidates that does not address the specific question being asked is unlikely to score anything.
• Over the years, developments in the exam have made it much fairer. All candidates are now tested on the same questions and the marking is much more standardised.
• The pass mark is now modified for each sitting, using a process known as borderline regression, to reflect the difficulty of the questions being asked.
• The three domain scores per question create a much larger number of data points per candidate to give a more detailed assessment.
• A fixed template of domains being tested between sittings should ensure greater reproducibility of exams from one sitting to the next.
• All candidates need to perform under the same time pressure.  

• To test real-life, practical application of knowledge from across the curriculum .
• To ensure successful candidates are ready to make the subsequent transition to consultant, where they will need to be secure enough in their knowledge and skills to handle the pressurised decision-making involved.
• To confirm that candidates can adopt a patient-centred approach to care with good empathy and an ability to communicate effectively with colleagues and patients.
  To draw on experience and knowledge to adapt to situations that can be faced in day-to-day practice.

The RCR has a recorded presentation , made by successful candidates, which describes their strategy for exam preparation. It is worth listening to this and reflecting on the advice given.

Key themes include:

• Gain as much experience as possible across all the main disease sites. If possible, talk to your supervisors to try and ensure this occurs during your training.
• Make every day of your training count. Every clinic, MDT, on-call shift and planning session is an opportunity to learn. Make sure you ask questions and get involved.
• Challenge yourself to make decisions and then check that they are correct with your supervisors. Consider prepping clinics or MDTs in advance and confirm that the decisions made are what you would have expected.
• Proactively get involved in as many aspects of patient care as possible (for example, if radiographers do much of the palliative radiotherapy or “on-treatment” toxicity reviews in your centre, try to learn from them or attend their sessions).
• Regularly plan cases and seek feedback on what you have done. Try to do as many different types of treatment plans as possible during an attachment.
• Work as a group to prepare for the exam (for those without colleagues in your own centre, try to link up with colleagues elsewhere and meet regularly online to practice).
• Try to adopt a concise and logical approach to answering questions that avoids wasting time providing unnecessary information (i.e. unrelated to the question being asked). This requires regular and concerted practice to master.
• Try to retain some work-life balance while preparing for the exam to avoid “burnout”.
• For overseas candidates doing predominantly “radiotherapy only” jobs, try to get day-to-day experience of chemotherapy prescribing from medical oncology colleagues.
• Nerves and/or anxiety are normal and to be expected. Examiners were candidates once and remember what it was like. The best way to deal with this is to practice under exam conditions as often as possible so that you are more prepared for the exam situation when you get there.
• The exam is written by the UK Board and, although we allow for reasonable variations in practice, we are strongly influenced by clear UK guidance where it exists. Candidates would be wise to be familiar with published RCR and NICE guidance on management.

• Use the site-specific and domain-specific feedback to target areas for specific attention when preparing.
• If you are contemplating re-sitting the exam and fell well short of the pass mark previously, carefully consider all the advice above. Often, in this situation, a lack of experience is a key problem, as well as deficiencies in exam preparation. 
• You should also consider if it might be sensible to wait a year before having another attempt at the exam, while actively addressing gaps in site-specific experience, in parallel with further revision and exam practice.