This workflow is for the Primary FRCA candidate who already uses BMJ OnExamination and wants a concrete routine — when to follow its difficulty feed, when to override it, and when to stop drilling topics and move to timed mixed blocks. It addresses the written MCQ, not the OSCE or SOE. The principal limitation to design around is that the feed is driven by the filters you set and does not, on its public pages, adapt difficulty for you — so the structure has to come from you rather than from the platform.
What BMJ OnExamination offers for the Primary FRCA right now
Vendor-reported, from the product and platform pages as observed on 19 July 2026; confirm current numbers on the product page.
| Item | Vendor-reported detail (19 July 2026) |
|---|---|
| Bank size | 1,080 single best answer questions across pharmacology, physiology and physics/measurement |
| Difficulty control | User-selected "Select Questions" difficulty and topic filtering |
| Analytics | Peer-benchmarked performance graphs, high-impact ranking, a daily question; no published percentile or predicted pass score |
| Mock tests | Timed mocks curated by the BMJ editorial team |
| Access and price | 1 month (£46.99) to 12 months (£156.99) — verify current pricing |
| Components | Written MCQ only — no OSCE or SOE |
Read the "adaptive" label carefully: this is curation you drive, not a difficulty-adapting algorithm. That is precisely why the workflow below imposes floors and switch-points rather than trusting a feed to balance itself.
The exam this workflow is preparing you for
The Primary FRCA MCQ is 90 single best answer questions in three hours, remote-invigilated, split into three equal domains of 30 — pharmacology; physiology (including biochemistry and anatomy); and physics, clinical measurement, statistics and data interpretation. The MTF format was retired in September 2023, so the paper is SBA throughout. Passing it opens the OSCE and SOE. Note the flag: from July 2027 the RCoA moves to a two-paper Applied Knowledge Test plus a Clinical Anaesthetic Sciences Exam. This workflow covers the current format, which runs until then — verify your sitting against the RCoA 2027 changes hub.
Baseline week: a small, blueprint-stratified unseen sample before you personalise
Before you let filters and leaderboards shape your habits, take an honest starting picture. In week one, sit a small, blueprint-stratified unseen sample — about 30 items, 10 from each domain — timed, with no assistance. Use an unseen iatroX Primary FRCA block or an official College sample, and record first-attempt accuracy by domain. This is your reference point; every later number is compared with it, not with the moving home-screen average. Only after the baseline should you begin personalising the BMJ OnExamination feed.
First pass: set domain floors so a rising score cannot hide unattempted areas
The single biggest risk with a filter-driven bank is a rising overall percentage sitting on top of an untouched domain. Prevent it by setting domain floors before you start: a minimum number of first-attempt items you will complete in each of the three domains each week, with physics, clinical measurement and statistics given parity with the two comfortable domains rather than left to last. Use the topic filter deliberately to hit floors, not to avoid weak areas. If a domain is behind its floor, it takes priority regardless of what the daily question or high-impact set offers.
Error taxonomy: separate the six failure types
Not all wrong answers mean the same thing, and they need different fixes. As you review, tag each miss as one of six types: a genuine knowledge gap; a misread stem; premature closure (committing before reading all options); a definition or convention error (common in physics and measurement); a calculation error; or a time-pressure error made only when the clock is running. A week of tagged misses tells you whether you have a content problem, a technique problem or a pacing problem — and the tag, not the topic, decides the fix.
Review interval: not everything deserves an immediate repeat
Re-answering the same stem the same day mostly trains recognition, which inflates repeat accuracy without building transfer. Instead, route by tag. Knowledge gaps get a short source read and a fresh transfer question later in the week, spaced, rather than an immediate repeat — take any drug specifics from the SmPC/electronic medicines compendium. Misreads and premature closure get slow, deliberate stem practice. Calculation errors get drilled as a calculation type under the clock. Time-pressure errors get timed blocks, not more untimed tutoring. The aim is to spend review time where the tag says the problem actually is.
The mixed-block switch: objective criteria
Topic-filtered practice is for building; timed mixed blocks are for proving. Reduce the former and increase the latter when three objective criteria are met: each of the three domains has been attempted above roughly 80%; first-attempt accuracy has been stable for about two weeks rather than still climbing steeply; and you are starting to recognise items on the feed. At that point the marginal value of more filtered drilling falls, and timed, random, full-length blocks become the better use of time.
Exit criteria: what "ready" looks like
Readiness is not bank completion. Treat yourself as ready to taper when five things hold together: coverage floors met across all three domains; first-attempt accuracy stable on unseen, mixed, timed blocks; pacing inside roughly 120 seconds per item; retention holding on spaced re-tests rather than decaying between sessions; and an official-material calibration — a College sample sat cold — agreeing with your unseen-block trend. Completion of the 1,080-item bank is an inventory statistic; these five are a readiness signal.
Worked example: a seven-day plan around clinical work
For a trainee working clinically, using BMJ OnExamination for one job — building and repairing recall — and iatroX for unseen measurement. No proprietary-algorithm claims are made for either tool.
- Day 1 (Mon) — BMJ OnExamination: 40 physics and measurement items to hit that domain's floor; tag every miss.
- Day 2 (Tue) — 40 physiology items including anatomy; spaced re-test of any Monday knowledge-gap misses.
- Day 3 (Wed) — 30 pharmacology items; then a 30-item unseen, timed, mixed iatroX block, first-attempt recorded by domain and compared with your baseline.
- Day 4 (Thu) — targeted work by tag: calculations under the clock, plus the weakest physics sub-topics.
- Day 5 (Fri) — one timed BMJ OnExamination mock under full conditions.
- Day 6 (Sat) — review the mock by tag; two short source reads on the worst topics.
- Day 7 (Sun) — a 60–90-item unseen, timed, mixed iatroX block; update your coverage floors and compare with Wednesday.
This is the two-bank pattern from "The two-Q-bank rule" — learn on one bank, measure on a different, unseen one — and the calibration logic in "Your Q-Bank Percentage Is Not Your Exam Score". For the analytics detail behind these decisions, see the companion Primary FRCA analytics audit.
Decision checklist: continue, supplement, switch or stop
| Signal (measurable, not sunk cost) | Action |
|---|---|
| Domain floors being met; first-attempt rising across all three domains | Continue the filtered first pass |
| A domain stuck below its floor, or unseen mixed first-attempt lagging the bank percentage by more than 10 points | Supplement — force the weak domain and add unseen mixed blocks |
| Floors met, first-attempt stable, recognition creeping in | Switch toward timed mixed mocks |
| Exit criteria all met and an official sample agrees | Stop drilling; taper and rest |
Frequently asked questions
Is BMJ OnExamination enough for Primary FRCA on its own? For the written MCQ, 1,080 SBA items (vendor-reported, 19 July 2026) plus the College's own materials can serve as a main bank for many candidates. But it does not measure you on genuinely unseen, mixed, timed items once you start recognising questions, and it does nothing for the OSCE or SOE. Treat it as a strong single bank for one component within a wider plan, 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 — clinical stations and spoken reasoning that no written SBA bank rehearses. Within the written paper, the physics, clinical measurement and statistics domain is the one most likely to be under-practised if you let filters steer you toward pharmacology and physiology, which is exactly why this workflow sets a floor for it.
How many BMJ OnExamination questions should I complete per day for Primary FRCA? Quality and spread beat volume; a sustainable pattern is roughly 30–50 first-attempt items on weekdays with every miss tagged and reviewed, rising at weekends with a timed mock. Let your domain floors, not a round number, drive the daily mix, and protect at least one timed, unseen, mixed block each week as your measurement.
When should I stop using BMJ OnExamination and move to mixed mocks? When each domain is attempted above roughly 80%, first-attempt accuracy has been stable for about two weeks, and you are recognising items on the feed. Those three objective criteria — not 100% completion — mark the point to reduce topic-filtered practice and increase timed random blocks, adding the College's materials and an unseen second bank.
How should I combine BMJ OnExamination with iatroX without duplicating practice? Give each a single job. Use BMJ OnExamination to build and repair — filters, explanations, tagged review — and use iatroX only as the unseen, timed, mixed measurement layer that confirms transfer. Because the item pools differ, an iatroX block is genuinely unseen, so it neither repeats BMJ OnExamination items nor corrupts your calibration; that separation is the whole point of running two banks.
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 workflow 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).