Many overseas pathologists wonder how UK reporting patterns are structured within the NHS. One of the key benefits of working as a histopathologist in the NHS is the use of the RCPath points system. But what does this actually mean?
What is the RCPath Points System?
The RCPath points system is used by the Royal College of Pathologists (RCPath) in the UK to measure the workload of pathologists. The system assigns points to different activities based on their complexity and the time required to complete them. This helps in workload planning and ensures that tasks are distributed fairly among pathologists. You can read more about the points system via the RCPath publicised document here.
Here's a summary of some key features, focusing on histopathology, cytology, and autopsy practice. You can also find the most recent updates on this via the RCPath website here.
1 - 5 Minutes
1 Point
6 - 10 Minutes
2 Points
11 - 20 Minutes
3 Points
21 - 30 Minutes
5 Points
31 - 50 Minutes
8 Points
> 50 Minutes
12 Points
Points Allocation:
Histopathology: Different types of specimens are assigned specific points based on the complexity of the examination. For example, simple biopsies might be assigned fewer points, while complex surgical resections would have higher points.
Cytopathology: Points are allocated based on the type of cytology specimen, such as fine needle aspirations or exfoliative cytology.
Post-Mortem Examinations: Autopsies are assigned points depending on the type (e.g., routine or complex cases).
Workload Management:
Daily/Weekly Limits: The system sets recommended daily or weekly points totals to prevent overworking and ensure manageable workloads.
Job Planning: Pathologists' job plans are often based on achieving a certain number of points per session or week, balancing clinical duties with other responsibilities like teaching or research.
Fair Distribution:
The system aims to distribute cases evenly among pathologists by assigning points based on workload rather than just the number of cases. This helps maintain fairness within pathology departments.
Adjustments:
Complex Cases: Cases requiring additional time or expertise, such as those needing second opinions or further testing, may have adjusted points.
Special Circumstances: Adjustments can also be made for special circumstances, such as when pathologists are in training or dealing with new techniques.
What is the Purpose and Benefit of the RCPath Points System?
Ultimately, every decision in the NHS is made with the aim of improving patient experience and care—a central theme of all work within the NHS.
The RCPath points system benefits patient outcomes in the following ways:
Standardisation of Reports and Quality: Provides a standardised way to measure and compare workloads across different institutions and pathologists.
Efficiency of Reporting and Staff Workload: Helps in resource allocation, ensuring that pathologists are not overburdened and that the quality of work is maintained.
Transparency Among Colleagues: Offers transparency in workload expectations and aids in discussions around job planning and workload distribution.
The RCPath points system is a structured approach to ensuring that pathologists’ workloads are balanced, manageable, and fair, contributing to better patient care and job satisfaction.
If you would like to read more about how staffing and workload for pathology departments are assessed and managed by the Royal College, an updated version of the RCPath Best Practice Recommendations is due for publication soon.
Your IMG Consultant is happy to assist with any negotiations related to your job plan to ensure your experience is taken into account.
For more information on NHS doctor benefits and pay arrangements in the UK, take a look at our IMG Resources library.
FRCPath Part 1 Online
In response to the ongoing challenges posed by the COVID-19 pandemic, the Royal College of Pathologists has continued to offer the FRCPath Part 1 exams online. This includes FRCPath Part 1 in Histopathology, Haematology, and Microbiology.
This means that FRCPath Part 1 can be taken from the comfort of your own home. This development allows the College to continue offering the FRCPath Part 1 exam to both UK trainees and overseas pathologists.
Please note that the delivery of FRCPath Part 2 remains offline, with examinations being conducted in person.
FRCPath Part 1 Delivery
The format of the Part 1 exam remains unchanged – 125 SBA (single best answer) and EMQs (extended matching questions) which aim to assess the candidate's overall knowledge and understanding of histo/cytopathology, basic science underpinning pathology (including microbiology), and full understanding of autopsy practices undertaken in an NHS District General Hospital.
FRCPath Part 2 is available in multiple overseas centres; in Irbid, Jordan, Cairo, Egypt or Dubai, UAE. These centres will be offered on an annual basis in either Spring or Autumn session subject to there being sufficient candidates to run the centre.
All other Diploma practical, Part 1 practical and Part 2 examinations can only be taken in the UK
The online exam is delivered through a company called TestReach.
Candidates will have the opportunity to trial the examination software before the exam to familiarise themselves with it ahead of time. The TestReach system is fully proctored, and candidates will need to complete both an IT systems and environment check before the exam. These checks will ensure that candidates' devices are suitable for the exam and that they are in an environment that satisfies exam conditions, i.e., where they do not have access to textbooks or other revision materials.
For more information on the online examination, see the College website here, or read their FAQs here.
How to Apply
The application window for the Autumn 2024 sitting of the FRCPath Part 1 exam will open at the end of July and close in mid-September. While the examination date has yet to be finalized, candidates are advised to apply early and may withdraw their place for a refund if the examination date is unsuitable.
The cost of the exam is £700. For up-to-date information on exam and application dates, keep an eye on the College website here.
For more information on FRCPath in Histopathology, take a look at our collection of articles and blogs here, where we explore the full examination suite, including a detailed look at the structure and format, fees, preparation, and resources.
If you are looking for general information that any overseas doctors might need to know, check out our IMG Resources library.
We hope this is helpful for any overseas doctors preparing to sit their FRCPath Part 1 exam, and the team here at IMG Connect wish you the best of luck!
Don’t forget to share your progress and successes with us using the hashtag #imgstories on social media. We love to hear from you.
Join the online histopathology community – connect with like-minded histopathologists and dedicated pathology recruiters in the IMG Histopathologists Facebook group.
For regular news and updates on the Royal College and all things histopathology, follow IMG Connect on social media using the links below:
Are you a histopathologist from Hong Kong looking to live and work in the UK? Do you want to know how to find the best jobs for overseas pathologists in the NHS?
With recent experience of working with Hong Kong Pathologists on their journey to the UK, we thought that we’d share a few snippets of information to help get you started.
In this blog we will cover the following topics:
What do Hong Kong doctors need to work in the UK?
As a Hong Kong pathologist, will I fit into the NHS?
What kind of jobs can I find in the UK?
Where can I find NHS jobs in histopathology?
Can I get access to CESR?
What if I don’t have FRCPath Histopathology?
How do I register with the GMC?
What visa will I need to work in the UK? BNO or Tier 2?
Getting started
Skip ahead to the relevant section if you know what you’re looking for.
Requirements to work in the UK
To be eligible to work in the NHS, histopathologists from Hong Kong must have full GMC registration – this requires completion of the Royal College of Pathologists exams in the relevant specialty I.e. histopathology (FRCPath), as well as an English language exam and Certificate of Good Standing (CGS).
From our experience, the majority of Hong Kongers are either aware of the UK Royal College exams or have already completed these as part of their specialist pathology training, so great news - you are more than likely already halfway there!
If you are unsure about the requirements for FRCPath, you can find an overview of FRCPath Histopathology here.
How Hong Kong Pathologists fit into the NHS
Pathologists from Hong Kong are a great fit for the NHS. And no matter your specialist training or sub-specialty interest in within histopathology, our NHS clients would consider you to be a high calibre candidate. Why? The training in Hong Kong is thorough and highly regarded here in the UK among NHS clients.
If you are not sure about how your experience will translate to working in the NHS, then we are here to help - IMG Connect are experienced working with all areas of sub-specialty within pathology, across all major organ sites.
Senior Histopathology Jobs in the NHS
This all depends on the experience and qualifications you gained in Hong Kong. Whilst there are a lot of similarities between our two healthcare systems, there are also a lot of differences too.
Attaining full FRCPath demonstrates the ability to report on cases and as such typically qualifies candidates to work independently as consultants in the UK. Think of it as like the FHKCPath and the accompanying Fellowship of FHKAM (Pathology) examinations.
NHS clients will look out for your experience and training combined with this postgraduate qualification in order to work out what level you will start at.
For consultant histopathologists who have already completed their anatomical pathology specialist training in Hong Kong, you will most likely enter the NHS as a locum consultant or in other senior positions such as Specialty Doctor (SAS), or Specialist Grade. This is generally up to the NHS Client, although, if starting in a specialist position, the aim here is that you will receive support to acclimatise to the UK system, in order to quickly work towards a consultant post. This will be agreed before your arrival in the UK.
There is demand in all areas of histopathology, particularly at the consultant level. So, it is important to understand where you fit into the NHS, and we would be delighted to guide you through the process. Send in your CV or register with us through the buttons above or below, and we will arrange an informal chat with you to discuss your job options in full.
Finding NHS Histopathology Jobs
You can get full access to the most recent histopathology job postings straight to your inbox through IMG Connect.
The latest NHS pathology jobs cover general histopathology and cytology, as well as a number specialised or part-specialised posts where you may report one anatomical area extensively, or perhaps 2-3 areas. With just a few clicks, you can create an account and customise job preferences to receive email alerts on job that suit your professional and personal needs.
Sign up here to receive up-to-date information on NHS jobs which you can tailor to your job preferences and receive straight to your inbox.
CESR for Hong Kong Pathologists
As the UK FRCPath qualification is not commonly taken during the Hong Kong residency programme, CESR presents itself as a more favourable option for some.
CESR is a big process that involves submitting around 800 - 1000 pages of verified evidence that you’ll need to gather from the last 5-6 years of clinical practice, either in the UK or overseas.
Given the Hong Kong Royal College of Pathologists' curriculum is so closely aligned with the UK’s Royal College, pathologists from Hong Kong are actually some of the best primed to attain Specialist Registration via CESR, without working in the UK first.
Whether it’s quicker to complete FRCPath, or to prepare a CESR application directly from Hong Kong, entirely depends on your background and experience. With that in mind, if you want to understand more, please send across a copy of your CV to our team and we can talk you through your options.
For a detailed guide on CESR for histopathologists, see our IMG Resources library.
Routes to the UK for Hong Kong Pathologists
The standard test of knowledge in the Histopathology curriculum in the UK is FRCPath Histopathology, although you do not need this to register with the GMC.
There are four main routes to the UK for Hong Kong pathologists:
The differences between these routes can be best understood through our explainer blog here.
Essentially, whilst FRCPath can be more time-consuming and expensive than other routes, our advice is that it is well and truly worth the investment – histopathology is a consultant-led specialty in the UK and therefore FRCPath Histopathology opens up many more opportunities (particularly for more experienced pathologists) than alternatives such as PLAB or Sponsorship.
Clients look out for FRCPath, and combined with your experience, this will move your CV to the top of the pile.
As discussed above, although Hong Kong histopathology training is well aligned with the UK system, CESR can either be an easier or more arduous route to GMC Registration depending on your level of experience.
Remember however:
CESR = Specialist Registration and FRCPath = General Registration
If you would like to pursue the CESR route and would like to know more about pathology jobs that offer CESR support, do get in touch.
If you are just beginning your journey through the FRCPath Histopathology exams, please see our blog here for an overview of the exams.
We also have an online IMG Histopathologists community on Facebook which as well as providing support and resources on FRCPath, also offers guidance on GMC registration and other aspects of relocating to and working in the UK.
How to Register with the GMC
Once all the necessary components for GMC registration have been completed, Hong Kong IMGs can then apply for full GMC registration with license to practice.
There are further checks involved in the registration process, such as verification of medical degrees, however these are steps that will be taken care of with your IMG Connect recruitment specialist.
However, if you’d like to learn more about these processes, you can find information in our blog breaking down the steps to GMC registration for overseas doctors here.
Visas for Hong Kong Doctors
Honk Kong residents with British National (overseas) status can apply to travel to the UK to live for up to five years with dependent family members, through the British National (Overseas) visa.
You also have the option of securing a Skilled Worker visa, or Health & Care visa to give the most recent term. We know that securing a visa in Hong Kong can be challenging at the moment, so if you think that the Health & Care Visa is a good option for you, don’t hesitate to connect with us to discuss your options.
For a detailed guide to your visa options as a Hong Kong doctor, you can read our blog discussing the differences between the Tier 2 Skilled Worker and BNO visas here.
Getting started
We are here to help with all questions, big or small, whether you are starting out on your journey or ready to look explore jobs. Register below or get in touch to speak with one of our dedicated histopathology recruiters.
We hope this helps and wish you the best of luck in your search!
To receive the latest news and updates on all things histopathology, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation:
The first exam in the FRCPath Histopathology series...
Overseas histopathologists may have questions about the best ways to prepare for the FRCPath Part 1 exam. With so many resources available online, but many of them geared towards UK trainees, it can be difficult to know what is best suited to you as an international candidate.
In this blog we have compiled some of the best resources and guidance for FRCPath Part 1 aspirants. We will also quickly cover some of the recent changes to the exam regarding its delivery and availability in response to the COVID-19 pandemic.
Here we’ll take a closer look into these and other important questions through the following topics:
What is FRCPath Part 1?
How do I get started with my preparation?
What resources are available online?
How has COVID-19 affected the exam?
#IMG Tips
I’ve passed FRCPath Part 1, what’s next?
Skip ahead to the relevant section if you know what you’re looking for.
FRCPath Part 1
FRCPath Histopathology Part 1 is the first exam in the two-part examination series, administered by the Royal College of Pathologists. The content of the exam can be broken down into three sections:
The three-hour exam is designed to assess candidates’ overall knowledge and understanding of histopathology or cytopathology, including the full range of autopsy practices undertaken in a district general hospital in the UK and the basic science underpinning pathology, including molecular biology.
For an in-depth guide to the FRCPath Part 1 exam, or for a breakdown of the full FRCPath Histopathology exam suite, visit our IMG resources library.
Please note that only full FRCPath satisfies the GMC’s postgraduate requirements for overseas doctors.
How to get started with preparation for FRCPath Part 1
The best way for IMGs to begin their exam preparation is with the Royal College website and resources. The FRCPath Histopathology exams are based on the Curriculum for Specialty Training in Histopathology and as a rule, this should always be the starting point for your revision. This will ensure you are focusing on the exam material that will feature in your exam – knowing the curriculum is key! You can find this on the Royal College website here.
Royal College resources include:
Regulations and guidelines – before applying for FRCPath exams, the College recommends you read both the general and specialty-specific regulations and guidelines, found below:
General Regulations and Guidelines
Histopathology Regulations and Guidelines
FAQs - There is also a Frequently Asked Questions (FAQs) document which the Royal College has compiled to help applicants who have questions about online examinations. You can read this here.
Other helpful resources include:
Oxbridge Medica - FRCPath Part 1 Revision Course
This is a 4-day, exam-oriented online revision course. The course includes live-streamed lectures across four days and covers all the major topics of the examination syllabus. The speakers have knowledge of the Royal College exam - some of them are examiners, and all are experienced teachers. The course can be found here.
Duration
4 days
Cost
£300 (£75 deposit)
Next start date
TBC
Pathology Online Hub - FRCPath Part 1 Orientation Course
This is a preparatory course aimed at overseas candidates. The course includes an introduction to the exam, including a mock exam with a detailed discussion of answers and exam tips. The course can be found here.
Duration
1 day
Cost
£40
Next start date
TBC
Pathology Online Hub - FRCPath Part 1 Comprehensive Course
This is a preparatory course aimed at non-UK candidates, including particularly basic and extended questions on the UK system. The course covers topics which are unique to the UK system and includes a one-hour practice mock similar to the exam format and a detailed discussion of the answers with feedback. The course can be found here.
Duration
1 day
Cost
£45
Next start date
TBC
Reading materials
There is no set reading list or official course for FRCPath Part 1 in Histopathology, however the following books come highly recommended by IMGs who have passed the Part 1 exam:
Practical Applications in Histopathology, Cytopathology & Autopsy – Dr Limci Gupta (£78)
FRCPath, Part 1: Examination Preparation Guide – S. Steele (£22.18)
Sternberg's Diagnostic Surgical Pathology Review - Pier Luigi Di Patre, Darryl Carter (£91.95)
Wheater’s Functional Histology – Barbara Young, Phil Woodford, Geraldine O’Dowd (£44.95)
Robbins and Cotran Atlas of Pathology - Edward Klatt (+/- £45)
(Designed to complement Robbins and Cotran Pathologic Basis of Disease, 8th Edition and Robbins Basic Pathology, 8th Edition)
How have the exams been affected by COVID-19?
In response to the challenges of the COVID-19 pandemic, the Royal College of Pathologists has migrated the FRCPath Part 1 exam online.
Candidates all over the world are now able to take the exam from their home countries. This development allows the College to continue to offer the FRCPath Part 1 exam to both UK trainees and overseas pathologists, with minimal disruptions to the exam schedule.
For full details about the online FRCPath Part 1 exam, please see our blog here.
#IMG Tips
Prepare early – getting your revision going as soon as possible will help you avoid those last-minute cramming sessions and increase your chances of passing first time.
Speak to your colleagues and peers – there are so many study materials to choose from - who better to ask for recommendations than histopathologists who have been through the process or are going through it with you?
Familiarise yourself with the curriculum – we cannot stress this enough! Every country’s qualification and practice differ, so being well-versed in the curriculum is the first step on your path to success in the exam.
Prepare for the online format in advance – make sure to fully complete your IT checks well in advance to avoid tech issues on the day (and save yourself an unnecessary headache).
Find a support network – a great way to do this is to join IMG Histopathologists, an online pathology community of UK and NHS histopathology aspirants and dedicated histopathology recruiters. You’ll find advice, guidance and updates about all things histopathology for IMGs. Join the conversation here.
I’ve passed the FRCPath Part 1 exam, what’s next?
Great stuff! This is a massive achievement, and you deserve to treat yourself after all your hard work. With a pass in hand, it's time to look ahead to FRCPath Part 2. For more information on the final exam in the examination series, take a look at our blog where we explore the FRCPath Part 2, including how to sit the final exam, fees and preparation and results.
Head to our IMG library for more useful articles on the FRCPath exams, GMC registration and qualifications you need to help you find your dream job in the NHS.
For regular news and updates, follow IMG Connect on social media using the links below:
IMGs from any country in the world can apply for Specialist Registration, provided certain eligibility criteria are met, though there are different routes available based on a doctor’s qualifications and training.
Here we explore specialist registration in histopathology for overseas consultant pathologists and specialists more closely. We’ll cover the Certificate of Eligibility for Specialist Registration (CESR) specifically, including the application, costs, and eligibility criteria, along with some other topics, summarised in the headings below:
What is Specialist Registration?
What route to Specialist Registration is best for me as an overseas pathologist?
Do I have to complete CESR before I can work in the UK?
Do I need FRCPath for Specialist Registration?
What is the CESR equivalence process?
What evidence do I need to submit for a CESR in histopathology?
How much does CESR cost?
How long is the CESR application process?
#IMG Tips
How do I get started?
Skip ahead to the relevant section if you know what you’re looking for.
Specialist Registration
Specialist registration in any specialty means that you can be appointed to a substantive (permanent) consultant position in the NHS. All physicians who wish to take permanent consultant roles in the UK must show evidence of skills, knowledge, and experience in order to gain Specialist Registration.
Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a histopathologist in the UK.
Routes to Specialist Registration
There are three types of certificates issued by the GMC for specialist registration across all specialties, and the type of certificate you receive depends on which training route you followed.
For pathologists who have completed their full training outside a GMC-approved training programme, CESR is the route they will usually take towards attaining specialist registration. This route does not require further training, but rather the submission of an application.
Doctors who have trained outside the UK or Switzerland, but within an EEA country, will be awarded CCT (Certificate of Completion of Training) after a successful specialist registration application. Specialist Certifications from across the EU are deemed as equivalent by the GMC, and therefore a straightforward application can be made.
Pathology Positions in the NHS without CESR
It is important to note that you attain more senior histopathology roles in the NHS, such as a specialty doctor (SAS), specialist grade or a locum consultant without being on the Specialist Register.
Similarly, overseas doctors do not require CESR before moving to the UK to work in the NHS.
In these NHS roles, you will have better pay and responsibilities that are more appropriate to your level of experience compared to a trainee. While working in these positions, you can collect evidence of your competences, particularly those specific to the UK histopathology curriculum.
These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.
FRCPath for Specialist Registration
Whilst it is always beneficial pathologists to complete FRCPath, overseas doctors looking to join the Specialist Register do not necessarily need to have completed the Royal College postgraduate exams.
The standard test of knowledge in the CCT curriculum are the FRCPath exams, so passing these exams confirms the attainment of the competencies of the Histopathology Curriculum.
FRCPath is only a requirement for doctors looking to attain Specialist Registration via the CCT route.
However, if CESR applicants have not successfully completed these exams, they must provide alternative evidence that demonstrates equivalent knowledge to histopathologists who have passed the FRCPath exams.
Even if the competencies covered by the exams require something that someone in your position would not routinely undertake (in your sub-specialty for example), you must still provide evidence of it – as the evaluators will not make assumptions outside the evidence presented.
CESR Equivalence Process
Equivalence describes the process of assessing an overseas applicant’s training and experience against the current histopathology training programme requirements, in order to be awarded CESR.
The equivalence process involves submitting a written body of evidence to the GMC, consisting of:
training and/or competence
skills and knowledge
The Royal College of Pathologists will assess each application against the relevant Curriculum before providing a recommendation to the GMC, who will then make a decision.
Please note that Equivalence procedures are the responsibility of the GMC. Applications are made through their Certification Department and initial enquiries should be directed there.
Evidence Requirements for CESR in Histopathology
Skills & Experience: The evidence provided for a CESR application in histopathology must cover the knowledge, skills, and qualifications to demonstrate the required competencies in all areas of the Curriculum for Specialty Training in Histopathology. If evidence is missing from any area of the curriculum, the application may be unsuccessful.
Capabilities in Practice: The Royal College of Pathologists has divided the Training Curriculum into 11 different Capabilities in Practice (CiPs) – each comes along with its own descriptor and guidance on where such CiPs would be evidenced.
Applicants are required to gather evidence by area of competence and attach this under the relevant section of the online application.
Generic CiPs
Able to function effectively within healthcare and other organisational and management systems to deliver consistent high-quality patient care.
Able to work within ethical and legal frameworks across all aspects of clinical practice.
Communicates effectively and is able to share decisionmaking, while maintaining appropriate situational awareness, professional behaviour and professional judgement.
Maintains patient safety at the forefront of clinical working. Can utilise quality improvement activity realistically within the constraints of the role.
Able to contribute to and support research.
Behaves as an educator in the context of the role and promotes educational culture.
Able to self-appraise, learn and adapt.
Histopathology-specific CiPs
Able to demonstrate leadership and management within the laboratory setting for the benefit of patient care.
Able to use laboratory and other services effectively in the investigation, diagnosis, and management of patients, relatives, and the deceased.
Able to manage and contribute to a multidisciplinary team effectively.
Able to take, manage and interpret pathological specimens accurately and safely, mindful of risks to self and others.
Audit and Governance: You are required to submit evidence of your active leadership in audit, including evidence that you have completed at least one audit cycle.
Currency of evidence: Your evaluators will be looking for evidence of current competency, generally defined as within the last five years. If you have completed training before this point, it is crucial that you provide evidence of maintaining competency across the whole area of the curriculum.
The GMC asks that only evidence that is strictly relevant is sent as it will help them to process the application quicker. The guidance on compiling your evidence will help you to decide what is relevant and what is not – you can find this on the GMC website here.
As a general guide, the GMC usually expects to see about 800-1000 pages of evidence, divided into four different domains, reflecting those of Good Medical Practice. The GMC recommends that you apportion the evidence provided as shown below:
Domain 1 - Knowledge, skills, and performance
Domain 2 – Safety and quality
Domain 3 – Communication, partnership, and teamwork
Domain 4 – Maintaining trust
Please note, you cannot compensate for evidence lacking in one area by providing more evidence in another area.
The full list of evidence required for each domain can be found on the GMC website here.
The Cost of CESR Applications
All histopathology applying for Specialist Registration must pay a fee. For CESR, this fee is £1,676. For CESR-CP and CCT, the cost is £439.
How long does it take to complete a CESR in Histopathology application?
The GMC estimate that it can take between six and eight months to receive a decision, from the date you submit your CESR application.
As there is a substantial amount of evidence to gather for a CESR application, the process of preparing all the necessary documentation and applying for CESR can take even longer than this, and a typical candidate will usually set out to complete this within 1 – 3 years.
It is worth noting that more senior histopathologists, such as consultants, are more likely to have achieved all the competences outlined in the curriculum.
The indicative period of training for a CCT in histopathology is five years, so it is highly unlikely that you would achieve the competencies required for a CCT in a shorter period of time. Therefore, CESR is not suitable for more junior pathologists.
#IMG Tips
Research/think about the types of evidence you will need and begin to gather your evidence well in advance of making your application.
Gather evidence prospectively – this is much easier than retrospectively trying to pull together the evidence under additional pressures.
Make sure that your evidence is of the highest possible quality and is current – you will be assessed against the most recent curriculum.
Ensure that the evidence you collect demonstrates your competence across the whole of the histopathology curriculum, not just your sub-specialty.
Remember to refer to the most up-to-date Histopathology Specialty Training Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.
Create a CESR ‘to-do list’ with sections under the 11 CiPs headings – organise your evidence directly into these sections to manage your progress.
Do not submit original documents – all your copies, other than qualifications you’re getting authenticated must be accompanied by a proformas signed by the person who is attesting to the validity and accuracy of your evidence (your verifier).
Ask an IMG Connect recruitment specialist about NHS histopathology posts with CESR support. These are not always advertised by the Trusts, but we can help you find a role which aligns well with your career goals in the NHS.
Join the IMG Histopathologists community – as well as support on Royal College exams, our online community of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.
Getting started
Many pathology IMGs likely haven’t completed a UK-approved training programme, but you could be eligible for Specialist Registration with the GMC via the CESR route. Take a look at our guide to CESR Applications for Histopathology for more information on how to apply and what to expect.
If you have any further questions about Specialist Registration, your route to the UK, or would like guidance in finding NHS histopathology posts which offer CESR support, please get in touch with us here.
Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:
Overseas histopathologists wanting to secure a job in the UK via the postgraduate qualification route will need to attain Fellowship of the Royal College of Pathologists in Histopathology or FRCPath in Histopathology, a sub-specialty exam of FRCPath. FRCPath is the UK qualification and a GMC-recognised postgraduate route.
International Medical Graduates (IMGs) from any country in the world can sit the sub-specialty FRCPath in Histopathology examinations, provided certain eligibility criteria are met. These are summarised below along with a broad look at the following topics:
What is FRCPath in Histopathology?
Eligibility for overseas doctors
FRCPath in Histopathology structure and format
FRCPath in Histopathology: Part 1 - MCQ/EMQ
FRCPath in Histopathology: Part 2 - Practical Examination
As an overseas candidate where can I take the exams and how much will it cost me?
How do I apply?
How to prepare and what resources are available?
Passed? What next?
What is FRCPath in Histopathology?
Set against the Curriculum for Specialty Training in Histopathology, the examinations are designed to recognise histopathologists close to the end of their training who can demonstrate sufficient knowledge and technique for independent practice. In other words, completion of the full set of exams (Part 1 & 2) demonstrates your ability to work at consultant level.
Eligibility for overseas doctors:
Below we outline the eligibility for overseas doctors looking to sit both FRCPath Histopathology exams. For international candidates, the eligibility criteria for FRCPath specialty examinations can be a little confusing when looking online so IMG Connect spoke to the Royal College directly in an effort to clarify this.
Time spent in histopathology training is stated as a requirement of eligibility and the Royal College do consider equivalents to NHS training programmes though there is no list of countries with accepted or unaccepted training programmes. The royal college advises you should speak to your Educational Supervisor or Sponsor (if you have one) who can advise you if you are ready or eligible to sit the Examinations if you are unsure. Remember, there are many overseas doctors applying for all parts of the FRCPath exams so don’t be put off applying!
Top Tip: If you have the required months training in a recognised programme in your country for Histopathology specifically, the chances are you will be eligible.
Eligibility for Part 1:You are required to have trained in a recognised training programme in Histopathology for a period of no less than 12 months.
Did you know? Candidates who have passed the FRCPath Part 1 examination in Histopathology who, after appropriate training, can attempt the Part 2 examination in one of the following: Forensic Pathology, Neuropathology or Paediatric Pathology.
Eligibility for Part 2: The Royal College expects you to have at least three years of specialty training specific to Histopathology in your own country. Furthermore, the Royal College strongly advises candidates to attempt Part 2 at least 12 months after passing Part 1.
FRCPath in Histopathology structure and format:
The FRCPath examinations consist of two parts:
Part 1 – One paper comprised of 125 multiple choice questions (SBAs and EMQs)
Part 2 – six-part practical examination held over two consecutive days.
Part 1 examination:
FRCPath Histopathology Part 1 One comprises of 125 multiple choice questions in both single-best-answer (SBAs) and extended-matching-questions (EMQs).
The exam is orientated towards assessing your overall knowledge and understanding of:
histopathology/ cytopathology
basic science underpinning pathology (inc. molecular biology)
full range of autopsy practices undertaken in an NHS District General Hospital
Part 2 Practical Examinations:
The exams consists of six components taken over two days, summarised below:
Part 2 Practical examinations
Surgical history
20 cases in 20-minute slots
Cytopathology
8 cases in 20-minute slots
Macroscopic pathology
4 cases with 20-minute reviews followed by 20-minute discussions
OSPEs
2 20-minute stations
Long cases
4 20-minute stations
Frozen sections
6 cases in 2, 20-minute stations.
One meeting with examiners in separate 20-minute station.
Surgical history: 20 cases are provided in 10 pairs of haematoxylin and eosin (H&E) stained slides in 20-minute slots over 3-hours 20 minutes of the second morning. The cases will represent a range of difficulties, with some proving complex cases requiring detailed description, differential diagnosis and special techniques or cases not diagnosable on a single H&E.
Cytopathology: Held on the first morning of the exam. Eight non-gynaecological cytology cases will be provided in pairs in 20-minute slots.
Macroscopic Pathology: This part is designed to allow candidates to demonstrate their capabilities in discussing gross pathology and familiarity with block selection in the context of the RCPath Minimum Datasets. Four cases provided in the form of photographs of gross pathology specimens. Two 20-minute slots will be provided for 2 cases, followed by 20-minute discussions with 2 examiners.
OSPEs: 2 x 20-minute stations. One of which is conducted face-to-face with 2 examiners while the other is a written exercise only. Possible topics can include management/clinical governance type and MDT type cases.
Long Cases: 4 x 20-minutes stations provided on the first afternoon including cases which cannot conventionally be covered in a single H&E stained section.
Frozen Sections: 6 cases viewed in 2 x 20-minutes stations (3 cases per station) before meeting with a pair of examiners in a 20-minute station. You need to take notes and be able to provide the examiners with a bottom-line diagnosis only, to form basis for discussion in face to face meetings.
Where can I take the exams and how much will they cost me?
The COVID-19 pandemic has caused disruption to Royal College exams across all specialties, and unfortunately the RCPath exams have been affected also. For the most up-to-date news on the RCPath examinations please refer to their website here.
FRCPath Part 1 (current COVID-19 arrangements): In 2022, the Part 1 examination will be offered using online delivery to candidates. This means you can take the exam remotely and will not need to travel overseas to sit the exam, or attend an examination centre. The College will deliver the written components of these examinations through a company called TestReach, the Oral components (including oral OSPE stations) will be delivered using a video-conferencing platform such as Zoom or Microsoft Teams and for the written examinations, candidates will be given the opportunity to trial the TestReach system to familiarise themselves with it ahead of the examination. You can read more about the new, remote examination process further here on our website.
Previously, the Part 1 examination was sat in multiple overseas centres and once the pandemic is under better control globally, it is highly anticipated the Royal College will return to previous set-ups.
The FRCPath Part 1 exam costs £622. You can see how the Royal College breaks down the cost here on their website.
FRCPath Part 2 (current COVID-19 arrangements): Part 2 exams will be held in person in the UK in 2022. There will be no online delivery for the exam.
Keep an eye on the RCPath website for the most up-to-date news on the exams.
The FRCPath Part 2 exam costs £1,308. You can see how the Royal College breaks down the cost here on their website.
How do I apply?
Applications must be made via the Royal College of Pathologists website, with applications only available once an application window is opened by the Royal College. This is usually twice a year, in SPrin and in Autumn.
How do I prepare for RCPath exams and what study resources are available?
With lots of resources available online, we have discussed with consultants the best place to start looking for materials relating to the exams. Most recommended starting with the Royal College, who have created useful resources to help you to prepare for the exams.
Curriculum: Questions are set against the Curriculum for Specialist Training in Histopathology We recommend getting to know the curriculum as early as possible and using it as a road map for your study plan.
Regulations and Guidelines: Before applying for FRCPath examinations, the Royal College recommends you read both the General & Specialty Specific regulations and guidelines:
General Regulations and Guidelines
Royal College - Histopathology Regulations & Guidelines
Sample Questions:Testing yourself against previous exam questions is always a recommended way to prepare. Histopathology Part 1 sample questions
Cancer Datasets and Tissue Pathways: The College’s datasets for Histopathological Reporting on cancers have been written to help pathologists work towards a consistent approach for the reporting of the more common cancers and to define acceptable practices in handling pathology specimens. Whilst these are not specific to FRCPath examinations they are certainly relevant to the wider practice in histopathology.
IMG Connect advice:
Part 2 – food and drink:With multiple exams taking place for Part 2 in one day bring supplies! It will be a long day and there may not be access to food.
Hiring a microscope: For Part 2 you will be required to sit examinations in the UK and will require a microscope. The examination centres will not provide equipment for any applicants so you will need to hire a microscope in advance. There are a few companies easily accessible through a web search, find a microscope and book well in advance of the exam. You can arrange for the company to drop off and pick up the microscope from the exam centre, don’t worry!
I passed the FRCPath exams! What next?
First of all, congratulations! After you have passed both parts of FRCPath in Histopathology you can apply for a full registration with a license to practice. Once the GMC have approved your application, you can work as a histopathologist in the UK.
Don’t hesitate to get in touch with an IMG Consultant to discuss UK job options in Histopathology, including discussions regarding a typical doctor salary in the UK and the most suitable locations for you.
The Royal College makes it clear that individuals who reach the standard required to pass the FRCPath examination in their chosen specialty are deemed to have the necessary professional competence to practice unsupervised. FRCPath also greatly contributes to the Certificate Confirming Eligibility for Specialist Registration (CESR), the alternative route to the Specialist Register for doctors who do not complete their training in an approved UK training programme.
Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:
In response to the high number of inquiries we've had from overseas pathologists about the arrangements for the Autumn sitting of the FRCPath Histopathology Part 2 exam, we've been in contact with the Royal College of Pathologists and have summarised these updates under the headings below.
When will the FRCPath Histopathology Part 2 exam be held?
The publicised dates for the exam are Tuesday 11 and Wednesday 12 October 2022, although these are subject to change due to the ongoing COVID-19 pandemic.
The withdrawal deadline for the exams is Friday 15 July 2022.
Can I sit the FRCPath Histopathology Part 2 exam in Autumn 2022?
The RCPath guidance which asks candidates to wait to sit the Part 2 exam the year after passing the Part 1 exam was in place to avoid overwhelming the limited capacity of the exam centres. Those who were successful in the Spring 2021 Part 1 exam are able to sit the Part 2 exam in Spring 2022. If the College needs to prioritise bookings, it will be done in the same way as previously. Therefore, if there is a requirement for candidates who have passed in Spring 2022 to wait until Spring 2023 to apply, a notice will be put on the News section of the examinations page around the end of May/ beginning of June.
It is therefore important to check regularly for updates to the examinations page, which you can do here.
Where can I sit the FRCPath Histopathology Part 2 exam in Autumn 2022?
Details on the Autumn 2022 sitting of FRCPath Part 2 have yet to be finalised, however, unlike Spring 2022, it may be possible to arrange to sit the exam in Irbid (Jordan), Dubai (UAE) or Cairo (Egypt) if there are sufficient applicants. The availability of FRCPath Part 2 examination centres outside the UK will be indicated on the Royal College website (when the application window opens for Autumn 2022 at the end of May) and candidates should contact the Examinations Department to express their interest in taking the exam in the available centre when they make their application.
We therefore advise that you keep an eye on the RCPath application page here.
Will the College have any microscopes available for me to use for the exam?
The College's overall policy is that the College and centres have no obligation to provide microscopes. Candidates can bring their own as this is equipment they are familiar with, or can hire a microscope. Some overseas centres may be more able to provide microscopes and if that is the case it would be stated on the letter sent to candidates with their centre confirmation.
If you would like to borrow a microscope for your FRCPath Histopathology Part 2 exam, we advise that you check well in advance what the options are for your chosen centre, or are available to you online.
If you have any further questions about the FRCPath exams, your route to the UK as an overseas histopathologist, or any other aspect of GMC Registration, the NHS or relocating to the UK, please get in touch with us here.
We'd also like to invite you to join the IMG Histopathologists online community - as well as support on Royal College exams, our Facebook group of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.
Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:
The NHS offers an extensive training scheme and career development for histopathologists, and the quality and depth of this programme is recognised as a gold standard across the medical community.
The training provided to UK histopathology trainees is regularly reviewed and updated, in keeping with advances and progression in the landscape of pathology around the world and across the profession. This makes the training programme attractive to UK graduates, as well as overseas histopathologists seeking the best training programmes for their field.
In this article, we will explore the training pathway for histopathologists in the UK, covering the following topics:
What is the NHS Training Pathway?
How do you enter the training pathway?
What does the specialty training programme look like for histopathology?
What happens after completing the histopathology training programme?
Can I enter specialty training in the UK as an IMG?
The NHS Training Pathway
The NHS training pathway is the name given to the complete programme undertaken by UK trainees, from medical school to the completion of specialist training within I.e. within histopathology.
It is important for IMGs to understand this as it helps to provide an understanding of at what stage they can most likely enter the system if they are interested in training in the UK.
Entering the NHS Training Pathway
After graduating from medical school, doctors with receive provisional registration from the GMC which allows them to enter the Foundation programme (a two-year work-based training programme).
Upon completion of the first year (FY1), doctors will gain full registration with the GMC and will be able to apply for further study and training in a specialised area I.e. histopathology – this is known as Specialty Training (ST).
Specialty Training in Histopathology
The Specialty Training programme in Histopathology is 5 years long, and whilst doctors may pass through training quicker depending on how quickly they achieve their competencies, this is rarely the case and histopathologist will usually take the indicated time, or slightly longer to complete the Specialty Training programme.
Successful applicants entering into year one of specialty training (ST1), will follow the Royal College of Pathologist’s 2021 Histopathology Curriculum, which sets the expected syllabus as well as required assessments and workload case numbers.
Histopathology training as a run-through programme
Unlike some specialisms where you complete a period of core training before entering into specialty training (requiring two applications), histopathology specialty training works as a run-through programme. You only have to apply once, at the beginning of the programme, as you are recruited for the full duration of Specialty Training.
Foundation Training (FY1 – FY2)
The foundation programme usually involves six different rotations or placements in medical or surgical specialties. These rotations enable trainees to practise and gain competence in basic clinical skills.
Specialty Training (ST1 – ST5+)
ST1)
Year one trainees enter the training programme. In this first stage, trainees will initially develop knowledge of laboratory work, with basic training in all areas of cellular pathology.
Training starts with a 1-2 week induction from the training school. This includes some time in the lab seeing how specimens are prepared and processed. Trainees are taught how to use a microscope, how to approach simple cases under the microscope and the principles of macroscopic assessment and sampling (AKA ‘cut up’). Many training schools do a separate autopsy induction.
When not at block teaching weeks, trainees are rotating through the various specialities in histopathology.
ST2 – ST3
This part of training takes place from year 2 to year 3, with the focus on achieving the FRCPath Part 1 Exam. This will normally be taken after 18 – 24 months of training.
Trainees will consolidate and develop their knowledge base from ST1. Year two trainees are given more independence and are expected to be able to cut up most specimens by the end of this stage.
In many deaneries, this is the time when trainees complete rotations in sub specialities including paediatric pathology, neuropathology and oral pathology. Trainees may rotate to placements in local district general hospitals to gain valuable experience in managing a general histopathology workload.
Autopsy and cervical cytology training continue as mandatory elements of ST2-ST3. Some trainees choose not to continue these specialities when they have completed this stage.
The FRCPath Part 1 exam aims to determine whether you have successfully acquired a core body of knowledge that will underpin your ability to practise in Histopathology.
For more information of the first exam in the Royal College of Pathologists examination suite, take a look at our IMG Resources library here.
Please note, trainees must pass the FRCPath Part 1 examination at the end of ST3 in order to progress to ST4.
Selection
Here, trainees will either choose to continue with general histopathology or peruse subspecialisation in neuropathology, paediatric/perinatal pathology, cytopathology or forensic pathology.
ST3 – ST4
This training takes place from years 3 – 4, where trainees will either continue with general histopathology or peruse subspecialisation in neuropathology, paediatric/perinatal pathology, cytopathology or forensic pathology. Trainees are expected to be competent in the macroscopic and microscopic assessment of all specimens, and will also receive training in leadership, management and teaching in preparation for their future roles as consultants.
The focus during this stage is also on achieving the FRCPath Part 2 Exam, thereby obtaining the status of Fellow of the Royal College of Pathologists.
This final exam is designed to test your practical skills and understanding, and show that you can apply your expertise appropriately and safely.
Trainees who wish to continue in general histopathology may opt to sit further exams in cervical cytopathology and autopsy practice if they wish to continue these as a consultant.
To learn more about the final exam in the in FRCPath examination suite, read our detailed blog here.
Please note, trainees must pass the FRCPath Part 2 examination at the end of ST4 in order to progress to ST5.
ST5+
This is the final stage of training before CCT during which histopathology trainees may wish to peruse special interests in particular subspecialties, such as gastrointestinal, skin or gynaecological pathology. Having passed the FRCPath Part 2 exam, trainees will continue to take on responsibility to enable the transition to independent practice required of those with CCT, i.e. signing out reports without consultant review.
Completion of the Histopathology Specialty Training Programme
Upon completion of the training programme, the choice is made as to whether the trainee will be awarded a Certificate of Completion of Training (CCT) in Histopathology. This will be based on criteria set out in the curriculum by the Royal College. You can find the 2021 curriculum here.
At this point, the histopathologists are entered onto the specialist register and can now take permanent consultant posts in the NHS.
Specialist Registration for overseas doctors
Doctors who completed part or all of their histopathology training outside of the UK are eligible for specialist registration through the CESR or CESR-CP pathways. To learn more about specialist registration for overseas doctors, read our blog here.
Joining the Histopathology Specialty Training Programme as an IMG
It is possible for overseas doctors to join the Specialty Training programme in Histopathology in the UK, however it is very competitive.
IMGs interested in UK specialty training must have:
Full GMC registration
Completion of a minimum 12-month (FY1 equivalent) internship
English language test
PLAB
AND
12 months post-internship experience by the time you begin ST1
Although UK trainees are not given priority for specialty training places, it can be very difficult to join the Specialty Training programme without NHS experience.
So here you have it, the NHS Specialty Training pathway for trainees in a nutshell. This training scheme is the core of training for histopathologists in the UK, and for IMGs looking to join the training programme, understanding of the pathway allows you to better align your overseas training with the relevant stage you would enter into Specialty Training in the UK.
If you have any further questions about your route to the UK as an overseas histopathologist, FRCPath, or any other aspect of GMC Registration, the NHS or the UK, please get in touch with us here.
We'd also like to invite you to join the IMG Histopathologists online community - as well as support on Royal College exams, our Facebook group of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.
Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:
Are you an overseas histopathologist looking to sit the FRCPath exams?
Today we’re bringing you a guide on how to prepare for the FRCPath Histopathology Part 1 exam from Dr Maria, clinical fellow in cellular pathology in London. Maria passed the FRCPath Part 1 exam in March 2021 and is sharing her top tips for FRCPath aspirants, including study planning, revision materials and what you should know about the Part 1 exam.
1. Create a plan and schedule for your study (this is most important!)
I started studying around 3 months before the exam, spending 2-3 hours per day on weekdays and around 5-7 hours on study at the weekend.
REMINDER: This all depends on how much you know already. You cannot focus constantly for hours, so you should schedule your studying time around the way that you know you work best.
Leading up to the exam
Try to keep at least 2 weeks free prior to the exam to re-revise problematic topics and genetics.
The day before exam
Be kind to yourself. Have a good meal, try to relax if you can and avoid stressing too much. Go to bed early and have a good, long sleep.
2. Revision materials
I had been revising using my old notes, where I studied from these books (the best for trainees in my opinion):
Foundation in Diagnostic Pathology series
Dermatopathology
Pulmonary Pathology
Hematopathology
Head and Neck Pathology
Gynecologic Pathology
Bone and Soft Tissue Pathology
Cell and Tissue Based Molecular Pathology
Pulmonary Pathology
Fine Needle Aspiration Cytology
Genitourinary Pathology
Breast Pathology
Neuropathology
Gastrointestinal and Liver Pathology
Diagnostic Pathology series
Diagnostic Pathology: Head and Neck
Diagnostic Pathology: Genitourinary
Diagnostic Pathology: Spleen
Diagnostic Pathology: Thoracic
Diagnostic Pathology: Neuropathology
Diagnostic Pathology: Hepatobiliary and Pancreas
Diagnostic Pathology: Nonneoplastic Dermatopathology
Diagnostic Pathology: Neoplastic Dermatopathology
Diagnostic Pathology: Bone
Diagnostic Pathology: Breast
Diagnostic Pathology: Familial Cancer Syndromes
Diagnostic Pathology: Molecular Oncology
Diagnostic Pathology: Infectious Diseases
Diagnostic Pathology: Gastrointestinal
Diagnostic Pathology: Kidney Diseases
Diagnostic Pathology: Placenta
Diagnostic Pathology: Gynaecological
Diagnostic Pathology: Transplant Pathology
Diagnostic Pathology: Cardiovascular
Diagnostic Pathology: Intraoperative Consultation
Diagnostic Pathology: Cytopathology
Diagnostic Pathology: Paediatric Neoplasms
Diagnostic Pathology: Endocrine
Diagnostic Pathology: Normal Histology
Diagnostic Pathology: Lymph Nodes and Extra-nodal Lymphomas
Diagnostic Pathology: Blood and Bone Marrow
Diagnostic Pathology: Vascular
Diagnostic Pathology: Hospital Autopsy
There are so many books, and it would be too expensive to purchase them all, so stick to what you've got in your department or can borrow from friends or colleagues.
The Pathology Outlines website is also excellent for quick review and genetics! There are also MCQs.
Some trainees study from the Robbins Pathology books, however, in my opinion, this book alone is not enough for the Part 1 exam.
For the MCQs, I used the following resources:
Practical Applications in Histopathology, Cytopathology and Autopsy: an MCQ/ EMQ Resource – Limci Gupta, Jayson Wang, Val Thomas
Anatomic Pathology Board Review – Jay H. Lefkowitch
Robbins Review of Pathology - Edward Klatt, Vinay Kumar
Sternberg's Diagnostic Surgical Pathology Review – Pier Luigi Di Patre, Darryl Carter
Various past papers I found within my network
If you have access to old presentations from FRCPath Part 1 courses, I’d suggest having a look at them. It’s a good idea to use them to review and revise a topic, followed by some MCQs on that topic.
TOPIC
START DATE
DURATION
Breast
27 October 2020
6 days
GIT
2 November
8 days
Liver, GB, Pancreas
10 November
8 days
Skin
18 November
6 days
Endocrine System
24 November
7 days
CNS
1 December
7 days
Renal & Urinary
8 December
9 days
Bone
17 December
5 days
Soft Tissue
22 December
9 days
CVS
31 December
5 days
Thoracic Pathology (Lung & Mediastinum)
5 January 2021
7 days
Lymph Node
12 January
7 days
MGT
19 January
7 days
FGT & Placenta
26 January
8 days
Oral & Nasal
3 February
7 days
Autopsy & Forensic
10 February
7 days
General
17 February
7 days
Cytopathology
24 February
5 days
Clinical Governance
1 March
5 days
Syndromes & Paediatric
6 March
5 days
General Revision
11 March onwards
-
This is a guide to the revision schedule I used for my FRCPath preparation. I actually started studying in December, so I had less time to fit this all in, but I was able to revise faster to cover everything.
3. FRCPath Part 1 Exam
The questions in the FRCPath Part 1 exam are usually quite straightforward, so you either know the answer or you don't, nothing misleading or tricky.
Some key topics you’ll need to know for the exam:
Genetics and the mutation of tumours (and yes...you'll need to learn each tumour that has any typical mutation and its name)
Immunohistochemistry of lesions
Microscopic pictures (all the micro images I had in the test depicted typical morphology)
Genetic syndromes, the mutations behind them and what lesions are most common
Datasets - they are quite wordy, so focus only on pTN, and the stage of each organ system
Audit
Parts of a microscope
There were some questions from general pathology (necrosis, inflammation, etc.), but I’d say most of the questions were from GI, breast, gynae, skin, soft tissue and kidney.
However, you'll have at least a few questions from each of the other organ systems, so it's better to study everything rather than focus on the most common ones only.
#IMG Tips
Prepare early – try to start your preparation early to give yourself enough time to cover all the relevant sections on the Royal College curriculum.
Find the right materials to support your study – it's good to use a combination of resources for your study to reinforce existing knowledge and benchmark your progress. Try to find the right materials for you as early as possible to hit the ground running with your revision.
Familiarise yourself with the Royal College curriculum – we cannot stress this enough! All countries have different training programmes, so being well versed in what the RCPath will be looking for is key.
Join the IMG Histopathologists community – as well as support on Royal College exams, our online community of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.
Getting started
Attaining FRCPath Histopathology is a great first step for histopathologists wanting to find senior roles in the NHS. It can be difficult for overseas trainees to prepare for the first exam in the Royal College examination suite, but this quick guide from a successful FRCPath pathologist is a great start for pathologists pursuing the postgraduate route to GMC registration and finding work in the UK.
For more information on the FRCPath exams, take a look at our IMG Resources library.
If you have any further questions about FRCPath, your route to the UK as an overseas histopathologist, or any other aspect of GMC Registration, please get in touch with us here.
Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:
GMC Registration is a complex process. For histopathologists who’ve qualified outside the EEA region there are two main pathways to consider – FRCPath and PLAB.
Whilst these are the most common routes to GMC registration, this is not an exahaustive list. There are other options such as Royal College sponsorship and GMC-approved qualifications or licensing exams, and you can read more about these here.
Here we will give a summary of both of the main routes and briefly consider their benefits.
PLAB for GMC Registration
FRCPath for GMC Registration
Which is better for me as an overseas pathologist, PLAB or FRCPath?
#IMG Tips
How do I get started?
Professional & Linguistics Assessment Board (PLAB)
The first and most popular route with most junior doctors is PLAB.
PLAB is a two-part exam (one written one practical), and which assesses whether you are at least as capable as a doctor starting the second year of their Foundation Programme Training and can therefore work safely as an SHO in the NHS.
The GMC have created a video summary of the PLAB exams which you can watch here, or for a more detailed overview, see our IMG Resources library.
FRCPath - UK Postgraduate Qualification
The UK postgraduate qualification for histopathology – FRCPath Histopathology - is the most popular and recommended route for overseas doctors who have completed a training or residency programme, and will be looking for senior pathology positions in the NHS.
By completing both parts of the FRCPath you are awarded Fellowship of the Royal College of Pathologists. The Royal College of Pathologists is the professional body that regulates the pathology specialties in the UK. Take a look at our IMG Resources library for complete guides on FRCPath for histopathology to learn more.
PLAB vs FRCPath
Both are legitimate routes and will allow you to register with the GMC and work in the UK. To decide which route is best for you, you’ll need to consider the benefits of each and how they align with your priorities and needs in moving to the UK.
Seniority of Positions in the NHS
Histopathology is a consultant led specialty in the UK, and it would be difficult for an overseas pathologist to obtain a more senior post without FRCPath, or extensive experience from a similar, English speaking healthcare system. PLAB alone will not give overseas doctors access to senior posts in the NHS.
Time
PLAB has two stages and can take anywhere between 3-9 months to prepare from start to finish.
FRCPath has two stages and can take anywhere between 18-30 months to prepare from start to finish.
Cost
FRCPath costs just under £1,930 and whilst the Part 2 exam is an in-person exam, the Part 1 exam can be taken online. You can read about the changes to the FRCPath 1 delivery here.
PLAB costs £1,189, and both exams are sat in person. PLAB 1 can be taken in the UK or several overseas centres, which you can find here. PLAB 2 must be taken in the UK.
For both FRCPath Part 2 and PLAB 2, candidates will have to travel to the UK, meaning that the additional cost of visas, accommodation and flights must be factored in.
It’s important to note that these costs can rise if re-sits of the exams are necessary.
Summary
PLAB, as an exam which assesses a doctor’s ability to work safely in the UK, does not demonstrate ability in histopathology specifically. For this reason, PLAB tends to be a route for junior doctors who have not already chosen their field of specialisation in medicine.
Additionally, PLAB can facilitate GMC registration much faster than other routes – so if you feel you can attain an offer of employment in the UK with your overseas experience only – but GMC registration is the one thing standing in your way – PLAB may be a good option for you.
FRCPath involves two more difficult examinations and takes more time to prepare for. Attaining FRCPath in Histopathology will allow you to jumpstart your career in the UK, you’ll most likely be able to take a consultant role. You would not need PLAB or Core Training in addition to FRCPath.
Additionally, histopathology in the UK is also a consultant-led specialism, and FRCPath demonstrates competency to practice unsupervised as a consultant.
#IMG Tips
Determine your priorities – your goals and timeline for relocating to the UK are important in deciding which route is best for, and this is different for everyone.
Plan well ahead – depending on the route you choose, you may be embarking on a long journey through these exams, so plan how you will fit them into your life and how best to prepare to maintain a good work-life balance at the same time.
Find a support network – once you know which exams you will sit, find a support network of others who are also preparing for the exam. A great way to do this is to join IMG Histopathologists, an online pathology community of UK and NHS histopathology aspirants and dedicated histopathology recruiters. You’ll find advice, guidance and news and updates about all things histopathology for IMGs. Join the conversation here.
Getting started
Once you’ve decided which exams are best for you, it’s time to delve deeper into the exams and what they entail. For more useful blogs and articles on PLAB or FRCPath exams, registrations and qualifications to help you find your dream job in the NHS - take a look at our IMG Resources library.
Or if you have any questions on PLAB or Postgraduate qualifications, feel free to get in touch with our histopathology consultants here.
For regular news and updates, follow IMG Connect on social media using the links below.
The first exam in the FRCPath Histopathology series...
International histopathologists (or cellular or anatomical pathologists as commonly known) looking to secure a job in the NHS via the postgraduate qualification route will need to attain Fellowship of the Royal College of Pathologists. This can also be commonly referred to as FRCPath Histopathology.
The completion of Part 1 and Part 2 of the Royal College of Pathology qualification for Histopathology results in eligibility for GMC registration (with the addition of the English language component). The FRCPath qualification is recommended for overseas pathologists looking to securing senior jobs in the NHS.
The exams can be taken by IMGs from all over the world, provided certain eligibility criteria have been met. Here we’ll take a closer look into these and other important questions through the following topics:
An overview of FRCPath Histopathology
What is FRCPath Part 1 and how is it structured?
Changes to FRCPath Part 1 delivery
Am I eligible to sit this exam?
How much will the exam cost and how do I apply?
What is the best way to prepare for the exam?
#IMG Tips
I’ve passed the FRCPath Part 1 exam, what’s next?
Skip ahead to the relevant section if you know what you’re looking for.
An overview of FRCPath Histopathology
The FRCPath Histopathology exams are administered by the Royal College of Pathologists to test a doctor's knowledge and ability to apply this in the practice of histopathology within the scope of the Specialty Training Curriculum for Histopathology.
The exams are as follows:
FRCPath Part 1
FRCPath Part 2
To read more about the full FRCPath examination suite via our IMG resources, please click here.
Please note that only full FRCPath satisfies the requirements for GMC registration for overseas doctors taking the postgraduate route.
Alternative routes to GMC registration include PLAB and other licensing exams such as USMLE. You can find out more about alternative routes here.
For doctors who are interested in more senior roles in the NHS that are reflective of their current practice, we advise that FRCPath is the best route to take to GMC registration. Histopathology in the UK is consultant-led specialism; and many NHS job postings will have FRCPath as a requirement for doctors who are not on the Specialist Register.
FRCPath Part 1 breakdown
FRCPath Part 1 is the first exam in the Royal College of Pathologists qualification. It is broken down into three sections as follows:
The three-hour exam is designed to assess candidates’ overall knowledge and understanding of histopathology or cytopathology, including the full range of autopsy practices undertaken in a district general hospital in the UK and the basic science underpinning pathology, including molecular biology.
FRCPath Part 1 delivery
In response to the challenges of the COVID-19 pandemic, the Royal College of Pathologists has migrated the FRCPath Part 1 exam online.
This means FRCPath Part 1 may be taken from the comfort of your own home. This development allows the College to continue to offer the FRCPath Part 1 exam to both UK trainees and overseas pathologists.
For full details about the online FRCPath Part 1 exam, please see our blog here.
Eligibility
Candidates for FRCPath Part 1 will generally require experience of Histopathology specialty training to reach the standard required to pass the exam. The Royal College advise that candidates take this exam after one year of specialty training.
Exam dates, applications and cost
The cost of the exam is £673 and the exam are usually held twice a year, in spring and in autumn/winter.
Applications for each sitting open a few months prior and close after around 6 weeks. While waiting for exam dates to be finalised the College advise that candidates should apply early and will be able to withdraw their application for a full refund should the date be unsuitable.
For up-to-date information on exam and application dates, keep an eye on the College website here.
Preparation
There are many resources available to help you prepare for your FRCPath Part 1 exam. As always, we recommend that the best starting point for your study is the Royal College website, particularly the Curriculum for Specialty Training in Histopathology. Your exam is based on this curriculum so familiarising yourself with it as soon as possible will give you the best chance of success.
Other helpful resources for your study include:
Regulations and guidelines – before applying for FRCPath exams, the College recommends you read both the general and specialty-specific regulations and guidelines, found below:
General Regulations and Guidelines
Histopathology Regulations and Guidelines
Social media study groups – there are multiple study groups available across different platforms such as Telegram, Facebook, and WhatsApp. IMG Connect hosts study groups for FRCPath Part 1 – these forums bring together overseas histopathologists in one communicative, constructive, and moderated space for learning, sharing, and support.
If you are interested in joining the IMG Connect FRCPath Part 1 study group, please email info@imgconnect.co.uk to speak to request your admission.
Online courses, videos and other resources - there are some great online courses and resources available to prepare for the FRCPath Part 1 exam. These include everything from full mock exams to flashcards and YouTube videos. We’ve compiled all these which you can access here, through our IMG Resources library.
FAQs - There is also a Frequently Asked Questions (FAQs) document which the Royal College has compiled to help applicants who have questions about online examinations. You can read this here.
#IMG Tips
Prepare early – getting your revision going as soon as possible will help you avoid those last-minute cramming sessions and increase your chances of passing first time.
Speak to your colleagues and peers – there are so many study materials to choose from - who better to ask for recommendations than histopathologists who have been through the process or are going through it with you?
Familiarise yourself with the online format – there’s no bigger headache than a bad connection – go through your IT checks well in advance to avoid (most) hiccups on the day
Join the online histopathology community – connect with like-minded histopathologists and dedicated pathology recruiters in the IMG Histopathologists Facebook group.
I’ve passed the FRCPath Part 1 exam, what’s next?
Congratulations – this is a massive achievement! After a well-deserved break, it’s time to look forward to FRCPath Part 2. For more information on the final exam in the examination suite, take a look at our blog where we explore FRCPath Part 2 and everything you need to know about how to sit the exam, including syllabus, dates, results, fees and preparation.
For more useful blogs & articles on the FRCPath exams, registrations & qualifications to help you find your dream job in the NHS - take a look at our IMG library.
Follow us on social media for news and updates on GMC registration, the Royal College and NHS through the links below:
The final exam in the FRCPath Histopathology series...
International specialists in histopathology, cellular pathology or anatomic pathology looking to secure a job in the UK via the postgraduate qualification route will need to obtain Fellowship of the Royal College of Pathologists or FRCPath Histopathology by examination only.
The completion of Part 1 and Part 2 of the Royal College of Pathology qualification for Histopathology results in eligibility for GMC registration (with the addition of the English language component). The FRCPath qualification is recommended for international pathologists looking to securing senior jobs in the NHS.
The exams can be taken by IMGs from all over the world, provided certain eligibility criteria have been met.
Here we’ll take a closer look into these and other important questions through the following topics - skip to one of these sections if you know what you're looking for:
An overview of FRCPath Histopathology
What is FRCPath Part 2?
Am I eligible to sit this exam?
How is the exam structured and marked?
As an international histopathologist, where can I sit the exam?
How much will the exam cost?
How do I apply for the exam?
What is the best way to prepare for the exam?
#IMG Tips
I’ve passed the FRCPath exams, what’s next?
An overview of FRCPath Histopathology
The FRCPath Histopathology exams are administered by the Royal College of Pathologists to test a doctor's knowledge and ability to apply this in the practice of histopathology within the scope of the Specialty Training Curriculum for Histopathology.
The exams are as follows:
FRCPath Part 1
FRCPath Part 2
To read more about the full FRCPath examination suite via out IMG resources, please click here.
Please note that only full FRCPath satisfies the requirements for GMC registration for overseas doctors taking the postgraduate route. Alternative routes to GMC registration include PLAB and licensing exams such as USMLE. You can find out more about alternative routes here.
For doctors who are interested in more senior roles in the NHS that are reflective of their current practice, we advise that FRCPath is the best route to take to GMC registration. Histopathology in the UK is consultant-led specialism; and many NHS job postings will have FRCPath as a requirement for doctors who are not on the Specialist Register. In most cases, and FRCPath qualification will help you to attain a locum consultant role.
What is FRCPath Part 2?
FRCPath Part 2 is the last exam in the FRCPath qualification. It is designed to recognise candidates who are close to the end of their training who can demonstrate an appropriate approach to independent practice. The assessment consists of six components which are take over a period of two days. The components include both written and face-to-face elements with an examiner where candidates are expected to demonstrate both clinical and practical knowledge as well as special techniques and complex diagnoses. Every section assesses a distinct set of professional skills which are all essential to effective performance ad an independent histopathologist and cytopathologist.
Am I eligible to sit this exam?
The FRCPath Part 2 Histopathology exam is open to candidates from every country, provided they have met certain criteria. This includes the expectation that most trainees will sit the Part 2 exam after at least 3 years of specialty training in Histopathology. There should also normally be a 12-month wait between passing the Part 1 exam and attempting Part 2.
For full details, please see the Royal College website here.
How is the exam structured and marked?
The six stations of FRCPath Part 2 are detailed below:
Surgical Histology
Format: 20 x 20 mins stations, 20 cases over 3 hours and 20 minutes.
This will include twenty cases presented in H&E stained slides in 20-minute slots over 3 hours and 20 minutes. The cases are selected according to a blueprint and include a balanced mix of neoplastic and non-neoplastic material, drawn from a wide range of organ systems. The cases will vary in difficulty from straightforward cases to cases not capable of diagnosis through a single H&E, prompting the use of further techniques and specialist opinions.
Cytopathology
Format: 8 x 20 mins stations, 16 cases
Eight non-gynaecological cases in pairs, in 20-minute slots and will be marked according to pre-determined criteria.
Macroscopic Pathology
Format: 2 x 20 mins stations, 4 cases; 20 mins discussion
Candidates will be provided with photos of 4 cases in the form of gross pathology specimens. Candidates will be provided with clinical information and asked to prepare responses to specific questions and mark on the photos where they would take blocks. There will be two 20-minute slots given to view two cases per slot, followed by a 20-minute discussion with two examiners. The exercise is designed for candidates to show their capabilities in discussing gross pathology and familiarity with block selection in relation to the RCPath Minimum datasets.
OSPEs
Format: 2 x 20 mins stations
The objective structured practical examination (OPSE) includes two 20-minute stations, one of which is a written exercise and the other is conducted face-to-face with two examiners. Topics may include management/ clinical governance type and MDT-type cases, amongst other topics.
Long Cases
Format: 4 x 20 mins stations
Four 20-minute stations of cases which cannot usually be covered by a single H&E section, requiring additional stains. These may include histochemistry, immunohistochemistry and immunofluorescence, among other cases.
Frozen Sections
Format: 2 x 20 mins stations, 6 cases; 20 mins discussion
Six cases for review in two 20-minute stations where candidates should make notes, including a ‘bottom line’ diagnosis only, before discussing these with a pair of examiners in a face-to-face 20-minute station.
Exam marking
Each section of the exam is marked against a pre-determined specimen answer with a pass or fail awarded per section. Due to the importance of cellular pathology in medical practice, only a small margin of inaccuracy is allowed. Failure to distinguish across the benign/ malignant boundary (or other similar errors of equal significance in terms of affecting patient outcome) in 15-25% of cases in any section of the exam will result in a failure of the entire exam, regardless of performance in other areas with no leeway to compensate. Final marks will be approved by the Examinations Committee.
Candidates attempting the FRCPath Part 2 exam have four attempts within which to pass the exam, and 7-years between each sitting to pass the full qualification.
As an international histopathologist, where can I sit the exam?
The exam currently takes place twice a year in Spring and Autumn and are held in the UK and in one overseas centre in Irbid, Jordan.
For up-to-date information on exam centres, visit the Royal College website here.
How much will the exam cost?
The FRCPath Part 2 exam costs £1,416. A breakdown of the cost of the 2019 sitting of the exam can be found on the Royal College website here.
How do I apply for the exam?
Applications for each sitting of the exam open months in advance and are currently closed for the Autumn 2021 sitting. Applications for the Spring 2022 sitting will open in late 2021. Late applications are not accepted. Keep an eye on the Royal College website for up-to-date information on applications here.
What is the best way to prepare for the exam?
There are several resources available to help you prepare for your Histopathology FRCPath exam. As always, we recommend that the best starting point for your study is the Royal College website, particularly the Curriculum for Specialty Training in Histopathology. Your exam is based on this curriculum so familiarising yourself with it as soon as possible will give you the best chance for success.
Other helpful resources for your study include:
Regulations and guidelines – before applying for FRCPath exams, the College recommends you read both the general and specialty-specific regulations and guidelines, found below:
General Regulations and Guidelines
Histopathology Regulations and Guidelines
Social media study groups – there are multiple study groups available across different platforms such as Telegram, Facebook, and WhatsApp. IMG Connect hosts study groups for FRCPath Part 2 – these are forums that bring together international doctors from all over the world in one communicative, constructive, and moderated space for learning, sharing, and supporting international histopathologists.
If you are interested in joining the IMG Connect FRCPath Part 2 study group, please email info@imgconnect.co.uk to speak to our histopathology specialist and request your admission.
Online courses, videos and other resources - there are some great online courses and resources available to prepare for the FRCPath Part 2 exam. These include everything from full mock exams to mock exams targeting specific sections of FRCPath Part 2 and YouTube videos. You can find a full list of these here, through our IMG resources library.
FAQs - there is also a Frequently Asked Questions (FAQs) document which the Royal College have compiled to help applicants who have questions about online examinations. You can read this here.
#IMG Tips
Prepare early – getting your revision going as soon as possible will help you avoid those last-minute cramming sessions and increase your chances of passing first time.
Speak to your senior colleagues and peers – there are so many study materials to choose from - who better to ask for recommendations than histopathologists who have been through the process or are going through it with you?
Food and drink – there are multiple stations on both days of the exams so make sure you’re prepared with lots of fuel for the day as there may be no access to food.
Hire a microscope – for applicants for the UK sitting, examination centres will not have microscopes for you to use so you will need to hire one in advance. There are a few companies who rent microscope and you can find these through a quick web search!
Join the conversation – for news and updates on all things histopathology for IMGs, click here follow IMG Connect on social media and join the conversation.
I’ve passed the FRCPath exams, what’s next?
Firstly, congratulations! The FRCPath exams are not easy so this is an incredible achievement. Once you have passed both passed of the FRCPath in Histopathology, your postgraduate qualifications satisfy the requirements for GMC registration. You can now apply for full registration with license to practice.
Get in touch with our IMG Connect histopathology specialist to discuss your options for specialist jobs in the UK or to find out more about where you fit into the NHS as a histopathology specialist with FRCPath.
FRCPath also plays a big part in the Certificate of Eligibility for Specialist Registration (CESR) application, the alternative route to the Specialist Register for overseas doctors who did not complete their training in an approved UK training programme. You can find out more about CESR in our guide for international doctors here.
The team at IMG Connect hope you find this article helpful and wish you the best of luck in your FRCPath Histopathology Part 2 exam!
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