The FRCA Final Written is the penultimate component of the Fellowship examination, testing clinical anaesthesia and intensive care medicine at intermediate curriculum level. It consists of two papers sat on different days — the Constructed Response Question (CRQ) paper and the Multiple Choice Question (MCQ) paper. The MCQ paper contains 60 SBA questions.
iatroX covers the SBA component. This guide focuses on that paper, though the revision strategy applies broadly to both components.
Format and sitting pattern
The Final Written runs three times per year — typically March, July, and October. The SBA paper is three hours for 60 questions, giving you three minutes per question — considerably more time than most medical MCQ exams. This extra time reflects the complexity of the questions, which often present multi-layered clinical scenarios requiring integration of anaesthetic, surgical, and ICU knowledge.
Topic weighting
The Final Written maps to the intermediate level anaesthetic curriculum. The approximate distribution across the SBA paper is as follows.
General anaesthesia and perioperative medicine account for roughly 14 per cent — preoperative assessment, risk stratification (ASA, P-POSSUM), enhanced recovery, and management of common perioperative complications. Regional anaesthesia accounts for 10 per cent — neuraxial techniques (spinal, epidural, combined spinal-epidural), peripheral nerve blocks (ultrasound-guided and landmark), and management of complications including local anaesthetic toxicity and epidural haematoma.
Airway management accounts for 8 per cent — DAS difficult airway guidelines, failed intubation drill, CICO (cannot intubate, cannot oxygenate) pathway, and awake fibreoptic intubation indications. Obstetric anaesthesia accounts for 8 per cent — regional anaesthesia for caesarean section, general anaesthesia for category 1 section, management of obstetric haemorrhage, pre-eclampsia and eclampsia, and the failed intubation in obstetrics protocol.
Paediatric anaesthesia accounts for 6 per cent. Cardiothoracic and neuroanaesthesia account for 8 per cent collectively. Trauma and emergency anaesthesia account for 8 per cent.
Intensive care medicine is the single largest domain at roughly 16 per cent — mechanical ventilation strategies (including lung-protective ventilation, prone positioning, ARDS management), sepsis (Surviving Sepsis Campaign guidelines), acute kidney injury, sedation and delirium on ICU, nutritional support, and organ donation.
Pain medicine accounts for 8 per cent — acute pain management, chronic pain assessment, and neuropathic pain pharmacology. Preoperative assessment, equipment and safety, and medicolegal topics make up the remainder.
Guideline priorities
The essential guidelines cover DAS Difficult Airway Guidelines (2015 and subsequent updates), AAGBI guidelines (anaesthesia-associated anaphylaxis, perioperative blood transfusion, cell salvage), NICE guidelines relevant to anaesthesia and ICU (sepsis, acute kidney injury, head injury), Surviving Sepsis Campaign International Guidelines, ICS Standards, and Faculty of Pain Medicine guidance.
RCOA safety guidelines are frequently tested — safe anaesthesia, checking anaesthetic equipment (AAGBI checklist), and crisis management (including malignant hyperthermia).
ICU preparation
The 16 per cent ICU weighting catches candidates who have spent most of their training in theatre. If your ICU exposure has been limited, allocate disproportionate revision time to this domain. Focus on ventilation strategies (modes, settings, weaning), sepsis bundles, vasopressor pharmacology, AKI staging and management, and the principles of organ support.
Revision strategy
Three to four months. Given the breadth, allocate the first six weeks to the three largest domains — ICU, general anaesthesia, and regional anaesthesia. Weeks seven to ten should cover obstetric anaesthesia, airway management, and the subspecialty areas. The final two to four weeks should be dedicated to mock exams and weak-area revision.
iatroX's FRCA Final question bank contains over 1,500 SBA questions mapped to the intermediate curriculum. ICU and subspecialty anaesthesia content is weighted according to exam proportions. The adaptive algorithm ensures ICU receives appropriate emphasis if your performance data shows it as a weak area. Full mock exams simulate the 60-question, three-hour format. All included at £29 per month or £99 per year.