FRCA - a guide for overseas anaesthetics doctors

  • April 10, 2020

One of the routes to GMC registration for an overseas anaesthetist is FRCA Primary.

IMGs from any country in the world can sit some, not all, of the FRCA examinations. Certain eligibility criteria must be met to sit primary whilst overseas doctors can only take the final part of the exams once they have started working in the NHS (UK). This is explained in further details below where we look at the following topics:

The Royal College of Anaesthetists is the professional body responsible for the specialty of Anaesthetics throughout the UK. Amongst many other duties, its role is to set and monitor the educational curriculum for those training to enter the profession.

What is FRCA? 

Anaesthetists become full members of the Royal College of Anaesthetists and attain Fellowship of the Royal College, and the designation of FRCA, once they have passed the two separate exams: the Primary and Final Examinations. Each exam consists of two parts taken separately.

FRCA is one of the many routes an anaesthetist can take when looking to satisfy the GMC postgraduate criteria for full registration with a licence to practice. It is important to note that Primary FRCA will suffice for the purposes of full registration with a license to practice, and full FRCA is not essential though of course desirable.

What is the structure and content of FRCA examinations? 

Primary FRCA examinations

  • Multiple Choice Question Examination (MCQ)
  • The Objective Structured Clinical Examination (OSCE) and Structured Oral Examination (SOE)

Final FRCA examinations

  • Final Written exam consisting of; Multiple Choice Question exam (MCQ) and a Short Answer Question (SAQ) exam
  • The Structured Oral Examination (SOE)

The FRCA examinations form an essential component of training for anaesthetists in the UK and doctors who wish to complete the FRCA route, will be required to complete the final exam after substantial experience working in the UK. 

As an overseas doctor am I eligible? 

It is important to note that each of the FRCA exams have different eligibility criteria. 

To sit the FRCA Primary Exams, you must be a member of the College or apply for Temporary Exam Eligibility (TEE) – see below. TEE will apply to most overseas doctors. 

Primary FRCA MCQ:

You are eligible to enter the Primary FRCA MCQ paper if you:

  • hold national registration with an overseas Medical Council;


  • have successfully applied for Temporary Examination Eligibility (TEE) with the College 3 months prior to the date of the examination 

Primary FRCA OSCE and SOE:

You are eligible to enter the Primary FRCA OSCE and SOE if you:

  • meet the above criteria for the Primary FRCA MCQ paper
  • have passed the Primary FRCA MCQ paper
  • have been awarded an overseas competency in anaesthetics which is comparable to the UK IAC (see below)

Final FRCA:

You are eligible to enter the Final FRCA paper if you have:

  • completed 30 months of training in anaesthesia
  • at least 18 months must be spent in approved posts in the UK or Republic of Ireland – for international doctors a maximum of 12 months of overseas training in anaesthesia combined with 6 months working in an approved UK post will be accepted;
  • Evidence of having completed the required training will be needed, Core Level Training Certificate

What is Temporary Exam Eligibility (TEE)?

Non-UK Trainee applicants do not qualify for any membership category of the Royal College of Anaesthetists. As such the Royal College has introduced the TEE to allow overseas anaesthetist doctors who do not work in the UK to apply for the FRCA Primary Examinations. 

Applicants must submit a Temporary Examinations Eligibility form three months before any examinations are applied for.

How do I apply for TEE? 

You can apply for TEE using this application form.

Documents required on your first application are:

  • Proof of registration with an overseas Medical Council
  • Proof of attendance at or completion of anaesthetic training, including foundation training (internship) 

If you intend to take the OSCE/SOE exams, you will be asked to provide further documentation to prove you have an equivalent of the UK Initial Assessment of Competency Certificate in Anaesthesia.

The TEE application costs £90, paid by bank transfer. Once payment is confirmed you will receive a TEE number, which you will use to support your application to sit the FRCA examinations. 

What is the UK IAC? And how do I demonstrate equivalence? 

The initial assessment of competence (IAC) is the first anaesthesia training milestone for trainees in the Anaesthesia training programme (ACCS training for anaesthesia, acute medicine, emergency medicine and intensive care). 

The purpose of the IAC is to signify that the trainee has achieved a basic understanding of anaesthesia and is able to give anaesthetics at a level of supervision matching with the individual trainee’s skills and clinical cases. The IAC is not a licence for independent anaesthetic practice. The key point is that trainees are still under the supervision of a named consultant anaesthetist. 

To support an application to sit the FRCA exams you must demonstrate that you have been awarded an overseas anaesthetic competency in anaesthetics which is comparable to the UK IAC.

Overseas anaesthetic competency certificates must be provided on application and prove clinical competency comparable to the UK Initial Assessment of Competency in Anaesthetics. Certificates must be accompanied by a letter of authentication in English from a senior anaesthetic consultant or notary. 

The final decision on comparability of overseas IAC certificates lies with the Chair of the Primary Examination.

How do I apply for the Primary FRCA examinations? 

Applications are complete online, simply click here, register, and follow the instructions for submitting documents and completing your application. 

Where can I sit the FRCA exams? 

Unfortunately, IMGs cannot sit the FRCA exams overseas. 

Exams are held in London, Cardiff, Birmingham, Manchester, Belfast, Sheffield and Edinburgh. You can find up to date exam dates here.

How much do the exams cost? 

Fees for exam diet 2018 / 2019

Primary MCQ


Primary OSCE & SOE


Primary OSCE


Primary SOE


Final Written Exam


Final SOE


What is the syllabus? 

The syllabus for both the primary and final exams are linked to the Training Curriculum

*both include Intensive Care Medicine

How do I prepare? 

With lots of materials online we have discussed with IMGs the best place to start looking for resources and materials relating to the exams. Most successful IMGs recommended starting with the Royal College, who have created useful resources to help you to prepare for the exams. 

At IMG Connect we advise overseas candidates to be fully aware that questions used in the exam are drawn from the UK Anaesthetic Basic Level Training Curriculum. We suggest that you can use the curriculum as a road map to support your study plan. 

Video series: 

The exam run through video series is a useful tool to help familiarise yourself with what to expect on the exam day. 

The Primary SOE support videos are designed to help trainees in preparation for exams.  

The Primary FRCA examination videos also support with study for the MCQ. 

More videos can be found at the College's YouTube Channel

eLearning Anaesthesia (e-LA): 

The e-LA supports specialty training in anaesthesia. It provided materials for professional development of specialists seeking to refresh their knowledge.

Doctors working overseas can gain access to this resource via eIntegrity which provides a portal to all specialty e-Learning platforms.

If you are working outside the NHS, then modules are available for purchase via the eIntegrity website.

There are a number of modules available, of particular note for IMGs is Module 6: Exams Preparation.

e-LA also provides MCQ questions which are an accurate reflection of the questions included in the FRCA examinations.

Virtual Exam tours: 

3D virtual exam tours have been created by the Royal College to provide a virtual experience to ensure that candidates are familiar with the process on the day. 

Successful IMGs have found practice questions are a valuable part of exam preparation. Remember these should be used in conjunction with other forms of research and studies.

I attained Primary FRCA, what next? 

You will simply need to prove your English Language capabilities to satisfy GMC criteria for full registration.

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