This audit is for the anaesthetics trainee who already owns, or is about to buy, BMJ OnExamination for the Primary FRCA and wants to read its analytics honestly rather than be reassured by them. It addresses the written single-best-answer MCQ, not the OSCE or the structured oral. The principal limitation is simple: the platform computes its percentages on the questions you chose to attempt, in the modes you chose, so the home-screen average is a study metric, not an exam-day estimate.
What BMJ OnExamination offers for the Primary FRCA right now
The figures below are vendor-reported, taken from the BMJ OnExamination Primary FRCA product and platform pages as observed on 19 July 2026. Treat every count, price and feature as provisional and confirm the current numbers on the product page before you buy.
| Item | Vendor-reported detail (19 July 2026) |
|---|---|
| Bank size | 1,080 single best answer questions, mapped to the Primary FRCA curriculum |
| Question format | SBA only, matching the current MCQ paper; the multiple true/false format the College retired in September 2023 is not used |
| Domains | Pharmacology; physiology; physics, clinical measurement and data interpretation |
| Difficulty control | User-selected "Select Questions" difficulty and topic filtering |
| Analytics | Performance graphs benchmarked against peers, "High Impact Questions" ranking and a daily question; no published percentile or predicted pass score |
| Mock tests | Timed mock tests curated by the BMJ editorial team |
| Explanations | Answer explanations with key learning points |
| Access and price | Subscriptions from 1 month (£46.99) to 12 months (£156.99), in monthly tiers — verify current pricing |
| Mobile and trial | Mobile app with offline access; 10 free questions per day |
| Exam components | Written MCQ only — no OSCE or SOE simulation |
One point governs how you should read the rest of this article. BMJ OnExamination is often described as an "adaptive" bank, but on the pages we checked it does not publish or claim a proprietary adaptive-difficulty algorithm, a national percentile or a predicted pass score. What it offers is user-selected difficulty filtering, peer-benchmarked performance graphs, an editorially ranked "high impact" set and a daily question. This audit treats the product as what it demonstrably is; verify the current feature language yourself rather than assuming the feed adapts difficulty for you.
The exam this dashboard is trying to predict
The Primary FRCA MCQ is a single computer-delivered paper: 90 single best answer questions in three hours, sat under remote invigilation. It is built from three equally weighted domains of 30 questions each — pharmacology; physiology, including biochemistry and anatomy; and physics, clinical measurement, statistics and data interpretation. The multiple true/false format was discontinued in September 2023, so the paper is now SBA throughout. The MCQ is a gateway: passing it lets you sit the Primary FRCA OSCE and the Structured Oral Examination (SOE), which test applied and viva knowledge no written bank can rehearse.
Two things follow. First, the Royal College of Anaesthetists' own guidance and any official sample material are the calibration standard; a vendor bank is a training tool, not the blueprint. Second, note the flag: from July 2027 the RCoA replaces this structure with a Primary FRCA Applied Knowledge Test (two SBA papers) and a Clinical Anaesthetic Sciences Exam in place of the OSCE and SOE. Everything below describes the current format, which runs until then — verify your sitting against the RCoA 2027 changes hub.
Every metric on the dashboard, defined
You cannot audit a number you have not defined. Here is what each metric means and what it does not.
First-attempt accuracy is the percentage you answered correctly the first time you ever saw an item. On BMJ OnExamination this shows in the performance graphs, and it is the number closest to unseen ability — but only within the topics you have attempted, and only if you answer before reading the explanation. Repeat accuracy is your score on items you have already seen; it climbs quickly because you are recognising a specific stem, so a near-ceiling score means little. A wide gap between the two says you are memorising items, not mastering physiology, pharmacology and physics.
Percentile and peer benchmark. BMJ OnExamination's headline social feature is peer comparison: performance graphs that benchmark you against other users. This is directional, not absolute — the cohort is other subscribers who chose the same items, not the national Primary FRCA population, and it shifts with who else is revising. There is no formal national percentile and no published predicted pass score, so do not read the peer graph as a probability of passing.
Coverage is the share of the blueprint you have attempted at all — the metric most candidates never open and the one that matters most for a three-domain paper. Difficulty here is something you control: the "Select Questions" filter lets you choose difficulty and topic, which is useful, but it means your running percentage is partly a product of the filters you set, not an independent measure of standard. Time per item matters because the real paper gives you 90 questions in 180 minutes — roughly 120 seconds each. Use the timed mock mode to see whether you are inside that budget; an untimed tutor percentage tells you nothing about pacing.
Why the headline percentage is not your exam score
Two mechanisms bias the pool the dashboard scores. First, the difficulty and topic filters are yours to set, so drilling hard pharmacology items makes your percentage reflect a deliberately harder, narrower slice than a random paper. Second, human nature: candidates favour the domains they enjoy and avoid the ones they fear, which for most Primary FRCA candidates means physics, clinical measurement and statistics get neglected. Either way, your headline percentage on that self-selected pool is not comparable with an unseen, blueprint-mixed, timed block. This is exactly why we published "Your Q-Bank Percentage Is Not Your Exam Score": the denominator is doing the talking. A rising number can mean you are improving, or it can mean you have quietly stopped attempting the third of the exam that scares you.
The blueprint audit BMJ OnExamination will not run for you
Instead of trusting the home-screen average, lay your attempted-question distribution beside the official Primary FRCA weighting. The written paper is deliberately balanced — three equal domains of 30 items each — so any large deviation in your attempts is a study-plan error you can fix.
| Primary FRCA domain | Official weighting (90-item paper) | Example attempted share | Flag |
|---|---|---|---|
| Pharmacology | 30 (33%) | 46% | Over-sampled |
| Physiology (incl. biochemistry, anatomy) | 30 (33%) | 34% | On target |
| Physics, clinical measurement, statistics, data interpretation | 30 (33%) | 20% | Under-sampled — the classic gap |
Fill this in from your own account data. The classic Primary FRCA failure is a candidate who is strong and heavily practised in pharmacology and physiology but has attempted only a fraction of the physics, clinical measurement and statistics items — then loses a third of the paper. The method is the blueprint-coverage matrix from "Question-bank completion is not coverage"; BMJ OnExamination gives you the attempts, you build the matrix.
The readiness test — five conditions for a credible signal
A number only counts as a readiness signal when it is earned under exam-like conditions. Require all five: the block is unseen (never-attempted items, not flagged re-runs); timed at roughly 120 seconds per item; mixed across all three domains rather than filtered; sat with no assistance (no explanations, notes or paused clock); and a sufficiently large sample (a full 90-item mock or several mixed blocks, not a 20-item quiz). A 78% on a topic-filtered, untimed tutor quiz is simply not the same evidence as 78% on a fresh, timed, mixed, full-length block.
Algorithm override rules
Because you drive the filters, low-volume-but-testable material slips through the net. Set a weekly quota and force these in rather than waiting for them to feel appealing: physics and clinical measurement (flow, humidification, pressure measurement, the gas laws); statistics and data interpretation (error types, sensitivity and specificity, basic study design); calculations under the clock; the anatomy inside the physiology domain; and the less-loved corners of pharmacology such as pharmacokinetic maths. A rising overall percentage must never hide a domain you have never attempted.
Worked dashboard example: from analytics to next week's quotas
Picture a candidate five weeks out: overall first-attempt 70%; pharmacology 76%; physiology 68%; physics, measurement and statistics 55%; time per item 84 seconds untimed; and physics only about 18% of everything attempted. Read it honestly — the physics score is both low and thinly sampled, so the "70%" is propped up by the two comfortable domains, and the untimed pace tells you nothing about the 120-second budget. Next week's quotas then write themselves, with no pass prediction attached.
| Domain | Dashboard reading | Next-week quota | Mode |
|---|---|---|---|
| Physics, measurement, statistics | 55% first-attempt, ~18% of attempts | 120 new items | Topic-filtered, then timed |
| Physiology | 68% first-attempt | 60 new items | Topic-filtered |
| Pharmacology | 76% first-attempt | 40 items | Timed mixed |
| Whole-blueprint check | not measured cold | one 90-item timed mixed mock | Unseen, no filters |
Nothing in that plan claims the candidate will pass; it simply moves effort to the measured gap and forces one honest, unseen, timed check.
Seven-day pattern: BMJ OnExamination for one job, iatroX for unseen transfer
This is written for a trainee revising around clinical shifts, using BMJ OnExamination for one defined job — building and repairing written recall — and iatroX for unseen transfer measurement. No proprietary-algorithm claims are made for either tool.
- Day 1 (Mon) — BMJ OnExamination: 40 physics and clinical-measurement items, topic-filtered, every miss reviewed and logged as a one-line rule.
- Day 2 (Tue) — 40 physiology items, including the anatomy that lives in this domain; tag each error by type.
- Day 3 (Wed) — 30 pharmacology items plus a spaced re-test of Monday's misses; then switch tools for a 30-item unseen, timed, mixed iatroX Primary FRCA block and record first-attempt accuracy by domain.
- Day 4 (Thu) — 40 more physics and statistics items on the weakest sub-topics; redo flagged items.
- Day 5 (Fri) — one timed BMJ OnExamination mock test under full conditions.
- Day 6 (Sat) — review the mock; two short source reads on the worst topics, taking any drug specifics from the SmPC/electronic medicines compendium rather than a half-remembered dose.
- Day 7 (Sun) — a 60–90-item unseen, timed, mixed iatroX block; compare with Wednesday to see whether the week transferred.
That is the two-bank pattern from "The two-Q-bank rule": one bank to learn on, a different, unseen bank to measure on, so you never mark your own homework. If you want the fuller step-by-step, see the companion Primary FRCA workflow.
Decision checklist: continue, supplement, switch or stop
| Signal (measurable, not sunk cost) | Action |
|---|---|
| First-attempt accuracy rising across all three domains; each domain attempted above ~80%; unattempted first-pass items remain | Continue |
| Bank percentage high but unseen mixed first-attempt lags by more than 10 points; physics or statistics under-sampled | Supplement — add unseen mixed blocks and force the missing domain |
| Coverage floor met and first-attempt stable, but pacing runs over 120 seconds or accuracy falls under time | Switch emphasis to timed mixed mocks |
| Repeat accuracy near the ceiling on almost everything, first-attempt plateaued, unseen blocks confirm the standard | Stop drilling; taper and rest |
Bottom line
BMJ OnExamination is a large, well-mapped Primary FRCA SBA bank with useful peer-benchmarked graphs, editorial mock tests and clear explanations, and it is a strong option for the written paper. But its dashboard measures your training pool, not the exam, and it does not, on its public pages, describe a proprietary adaptive-difficulty engine or a predicted score. Use it to find and drill weak, thin domains, especially physics and statistics; use a separate unseen, mixed, timed source — the College's own materials and a second bank — to decide whether you are ready, and remember it does nothing for the OSCE or SOE. The number that forecasts your exam is the one you earn on questions the system did not choose for you.
Frequently asked questions
Is BMJ OnExamination enough for Primary FRCA on its own? For the written MCQ, a bank of 1,080 SBA items (vendor-reported, 19 July 2026) is a substantial spine, and combined with the College's own materials many candidates could pass the paper using it as their main bank. But "enough" turns on two things it does not do: it does not measure you on genuinely unseen, blueprint-mixed, timed items once you begin recognising questions, and it does nothing for the OSCE or the SOE. Treat it as a strong single bank for one component, not a complete Primary FRCA programme, and verify the current count on the product page.
Which Primary FRCA component does BMJ OnExamination not reproduce well? The OSCE and the structured oral. BMJ OnExamination is a written SBA product; the OSCE tests clinical stations — equipment, anatomy, data, resuscitation, communication — and the SOE tests spoken reasoning under examiner pressure, and no SBA bank rehearses either. Within the written paper itself, it also under-rehearses the physics, clinical measurement and statistics third whenever difficulty or topic filters steer you toward the more comfortable pharmacology and physiology domains.
How many BMJ OnExamination questions should I complete per day for Primary FRCA? There is no magic number, and daily volume matters less than first-attempt quality and blueprint spread. A sustainable pattern for a trainee working clinically is roughly 30–50 new first-attempt items on weekdays with full review of every miss, rising at weekends with a timed mock. Doing 150 rushed items you never revisit is worse than 40 you analyse, so protect at least one timed, unseen, mixed block each week as your real signal rather than chasing a round total.
When should I stop using BMJ OnExamination and move to mixed mocks? Move when three measurable conditions hold: you have attempted at least about 80% of each of the three domains, your first-attempt accuracy has stabilised, and you have begun recognising items rather than reasoning them out. At that point repeat accuracy climbs for the wrong reason and the marginal value of filtered practice falls. Shift the centre of gravity to timed, random, full-length mixed mocks — the College's materials and a second unseen bank — to test transfer and pacing.
How should I combine BMJ OnExamination with iatroX without duplicating practice? Give each tool one job. Use BMJ OnExamination as your build-and-repair bank — first-pass learning, explanations and spaced review of misses — and use iatroX only as the measurement bank: fresh, unseen, timed, blueprint-mixed blocks you have never seen, run once or twice a week to check transfer. Because the item pools differ you are not re-answering the same questions; you are separating "have I learned it" from "can I retrieve it cold", which is the entire point of the two-Q-bank rule.
Editorial notes and references
Written by Dr Kolawole Tytler, NHS GP and founder of iatroX. Last checked 19 July 2026; BMJ OnExamination question counts, prices and features are vendor-reported as of that date and change without notice — verify the current figures on the product page before purchase. Disclosure: iatroX operates a competing Primary FRCA question bank, so this audit confines iatroX's role to the unseen-measurement job BMJ OnExamination does not claim to perform, and takes no position on price. Corrections are welcome via the feedback route on iatrox.com.
References: Royal College of Anaesthetists — Primary FRCA examination guidance and the RCoA 2027 changes hub (rcoa.ac.uk; verify the current and future format there); BMJ OnExamination Primary FRCA product page (onexamination.com; vendor-reported figures); iatroX Primary FRCA bank (https://www.iatrox.com/frca-primary); iatroX comparison hub (https://www.iatrox.com/compare); "Your Q-Bank Percentage Is Not Your Exam Score" (https://www.iatrox.com/blog/qbank-percentage-not-your-exam-score).