FRCR (Oncology) - a guide for overseas oncologists
November 09, 2021
Overseas clinical or radiation oncologists wanting to secure a role in the UK via the postgraduate qualificaiton route will need to attain Fellowship of the Royal College of Radiologists (FRCR Oncology) in order to register with the GMC. FRCR Oncology is the UK Royal College qualification and the recommended route for oncologists looking to work in the UK as a specialist or consultant.
IMGs from any country in the world can sit the FRCR (Oncology) examinations, provided certain eligibility criteria are met.
These are summarised below along with a broad look at the following topics - skip to one of these sections if you know what you're looking for:
Clincal oncologists become full members of the Royal College of Radiology and achieve the designation, FRCR, once they have passed the three separate postgraduate medical exams that make up the FRCR (Oncology) examination suite. The FRCR (Oncology) examinations aim to test a candidate’s knowledge and clinical understanding against the Specialty Training Curriculum for Clinical Oncology and the exams are a pre-requisite for anyone looking to go into a specialty training post as an oncologist in the UK. For more senior candidates, absence of FRCR (Oncology) will make it very difficult to attain locum-consutant posts unless you have a recognised equivalent or specialist registration in clinical oncology.
The First FRCR Examination expects candidates to have acquired a broad knowledge of those subjects that relate to the investigation and management of patients with cancer. Candidates are examined against the Clinical Oncology curriculum. A new curriculum is being implemented from summer 2021, with all trainees expected to transfer to the new curriculum by August 2022 at the latest. Further details are available on the curriculum webpages. If you are unsure what curriculum you should be using for your studies in 2021 then please refer to the Royal College website page discussing the FRCR (Oncology) Part 1 exam here.
When registering via the postgraduate route, only full FRCR satisfies the GMC postgraduate requirements for registration as an overseas doctor. There are three parts to the FRCR examinations:
FRCR (Oncology) Part 1(CO1) > comprises four papers of single best answer (SBA) questions. The written papers for the four subjects are held twice a year over two consecutive days.
FRCR (Oncology) Part 2A (both must be passed in one sitting in order to attain a pass)
two separate single best answer papers
FRCR (Oncology) Part 2B
a reporting session
a rapid reporting session
an oral examination
The FRCR (Oncology) examinations form an essential component of training for clinical or radiation oncologists in the UK. For overseas doctors relocating to the UK, FRCR is one of two options to support full GMC registration (postgraduate qualification or PLAB route). For doctors who wish to secure a senior clinical oncology job in the NHS reflective of their current practice, we advise that FRCR would be the best route to choose. FRCR is often an essential requirement for many job postings in the UK when a candidate does not already have Specialist Registration in Clinical Oncology or a recognised equivalent postgraduate qualfication.
Eligibility for FRCR in Oncology:
First FRCR: To be eligible you must:
hold a Primary Medical Qualification (PMQ) that is recognised by the GMC for registration purposes.
have completed courses covering the syllabus in the subjects listed below.
Cancer Biology and Radiobiology
There is no requirement to have held a clinical oncology training post in order to attempt the First FRCR Examination.
Final FRCR Part A: To be eligible you must:
have passed the First FRCR examination
must have passed the First FRCR examination and have completed three years of supervised clinical oncology training covering the examination syllabus.
In exceptional circumstances, with support from the Training Programme Director and at the discretion of the Medical Director (Education and Training), this minimum training period may be reduced to two years and six months.
Final FRCR Part B: To be eligible you must:
have passed the Final FRCR Part A, First FRCR and have completed three years of supervised clincal oncology training
Content and structure for FRCR (Oncology)
First FRCR Examination: It is delivered through a digital platform and as such is now also available at a larger number of test centres than before. The First FRCR Examination comprises four papers of single best answer (SBA) questions. The written papers for the four subjects are held twice a year over two consecutive days. Further general information on the examination shows in the guidance notes for candidates here, however it can be summarised as below:
Cancer Biology & Radiobiology
50 questions over 2.5 hours
40 questions over 2 hours
50 questions over 2.5 hours
40 questions over 2 hours
Each SBA question comprises a stem (a question or statement) and five items (answers) [labelled (a) to (e)]. Candidates are asked to decide which one of the five items represents the best answer to the question given in the stem. The four modules break down as below:
Cancer Biology and Radiobiology: the processes of cancer cell transformation and tumour development and how these processes may be demonstrated, and the response to ionising radiation of cells both individually and grouped as tissues.
Clinical Pharmacology: the structure, action, use and evaluation of drugs used in the treatment of a patient with cancer.
Medical Statistics: with special reference to clinical trials and assessment of results, and the epidemiology of cancer.
Physics: the application of physical principles and methods in clinical radiotherapy, physical basis of the therapeutic uses of radioactive isotopes, radiation hazards and protection. A knowledge of SI units is expected.
Final FRCR (Part A): The examination expects candidates to have a wide knowledge of malignant disease and the management of patients with cancer. The main emphasis is on radiotherapy and drug therapy, but a good knowledge of general medicine, surgery and gynaecology is expected. You will be examined against the specialty training curriculum for clinical oncology and the clinical oncology syllabus. The Final FRCR (Part A) Examination comprises two papers of 120 single best answer (SBA) questions. It is held twice a year, normally in February and August/September and you are given three hours to answer each of the papers. Read the college's Purpose of Assessment to see this information in detail - however below we summarise the content and structure for FRCR Part A.
No. of Questions
Head & Neck
No. of Questions
*The miscellaneous section contains questions on thyroid cancer, sarcoma, uknown primary, regulations, palliative care and a small set of questions that do not specifically fit into a defined site specific category.
FRCR Part 2B (Oncology) (CO2B): The exam requires you to have a wide understanding of malignant disease and management of patients with cancer. The biggest emphasis here is radiotherapy and drug therapy, though a strong knowedge of general medicine, surgery and gynaecology is expected also. You will be examined against the specialty training curriculum for clinical oncology and the clinical oncology syllabus.
The exam has both a clinical and oral component. Read the Royal College's Final FRCR Purpose of Assessment to understand the format and content in more detail, however a brief summary of both part is below:
Clinical Examination: This is the practical element and will involve you rotating round five strictly timed clinical assessment 'stations' where your skills are assessed by a pair of examiners. This part is to test the skills and competencies that are essential for safe and effective clinical practice as a clinical oncologist in the NHS. Patients with real clinical signs are used throughout this examination, allowing you to temonstrate your knowledge and judgement in as a realistic a scenario possible.
The clinical examination will assess your ability to:
identify important clinical signs using effective examination techniques
give a rationale differential diagnosiss
order and interpret appropriate investigations
identify the main treatment options
select an appropriate, safe and sensibe management plan
recommend a safe radiotherapy technique, understanding and communicating the likely outcomes & side effects
recommmend a safe systemic treatment schedule, understanding and communicating their likely outcomes and side effects
clearly discuss a likely prognosis in the case presented
clearly demonstrate an ability to treat the patient sesitiviely, ensuring their comfort and dignity
Oral Examination: The strcutured oral examination assesses in-depth issues surounding radiotherapy planning, diagnostic imaging and clinical decision making and case management. Communication and ethical scenarios are addressed during this examination. It will mirror day-to-day clinical discussions and MDT meetings, essential elements to a Clinical Oncologist's role in the UK. There are several slides per question, and your answers can lead to further questions on subsequent slides by the examiners. The questions build as the discussion develops, and this oral examination allows each step of the case to be assessed and discussed as it would be in a real-life clinical scenario.
The strucutred oral examinations allow for fair, valid and reliable assessments due to:
uniformity of questions asked
pairing of examiners (junior and senior) allowing for oingoing training and accurate data capture and marking
four independent judgements of your performance
the examination is blueprinted against both the curriculum and the range of RCR-desingated skills required to be a competent oncologist in the NHS
the use of an objective marking scheme which details the essential points required to pass each qustion
As an overseas candidate, where & when can I sit the exams and how much will they cost me?
This link takes you to the examination updates section. Information on the dates, fees and venues for the FRCR examinations can found here.
How do I apply for the FRCR examinations?
UK Trainees are given priority for examination places, whilst overseas candidates are offered the remining places via a ballot system following the application closing date. If you've had your exam deferred due to cancellations over the last year, you will be prioritised.
The Royal College urges anyone applying to read the examinations guidance before doing so. Applications are made online via the Royal College website here.
How should I prepare for the FRCR Oncology exams?
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 IMGs recommended starting with the Royal College, who have created useful resources to help you prepare, see below:
Syllabus: The syllabus should always be your go-to for your studies. This is what you will be tested on, so it should be the foundation of your studies and preparation. As of May 2021 the new curriculum has been approved by the GMC but is pending full publication. You can find this on the Royal College website here.
Clinical Oncology Curriculum implementation tools - a variety of tools are available to support the implementation of the new curricula. This page is very useful and has many different tools within the page. You can access it here.
Remote proctoring guidance - this is a new system and as with anything techy, problems can arise! Use this section of the Royal College to familiarise yourself with the new system with the new normal. Access this page here.
First FRCR examiners' reports - a guide for candidates and trainers preparing for future sittings. Access this here.
Trainees share their experiences of the Final FRCR examination - a two-part audio series featuring trainees talking about their experiences of preparing for and taking the examination.
Final FRCR examiner reports - a guide for candidates and trainers preparing for future sittings. Access the examiner reports archive here.
Final FRCR Part B demonstration films - clinical and oral demonstration videosAccess the Part B demonstration films here.
Sample oral questions - sample questions for the oral component of the Final FRCR Part B examination. You can access the sample questions here.
Connect with the Royal College - connect with the Royal College on YouTube to see their numerous videos that can be used for training and information purposes. Their channel can be found here.
I passed the FRCR Oncology exams! What next?
First of all, congratulations! After you have passed all three parts of your FRCR examinations, you can apply for a full registration with a license to practice. Once the GMC has approved your application, you can work as a doctor in the UK. This exam will form an integral part of any CESR application (if that is your route to specialist registration) and in most cases, if you have previous and relevant expereince, will allow you to practice as a locum consultant clinical oncologist whilst you are not an accredited specialist on the specialist register.