Final FRCA: question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Obstetric anaesthesia — neuraxial in pre-eclampsia, failed intubation drill, PPH
• Paediatric anaesthesia — airway, fluids, weight-based dosing, recognising deterioration
• Cardiothoracic anaesthesia — OLV, post-CPB complications, valve surgery
• Neuroanaesthesia and neurocritical care — TIVA, BP targets, neuromonitoring
• Trauma and emergency anaesthesia — major haemorrhage protocols, damage control
• Vascular anaesthesia — AAA repair, carotid endarterectomy, peripheral revasc
• Day-case and ambulatory anaesthesia — patient selection, fast-track principles
• Regional anaesthesia — advanced blocks, fascial planes, indication-led choice
• Pain medicine — acute, chronic, cancer pain, neuromodulation
• Intensive care and resuscitation — ARDS ventilation, sepsis, ECMO indications
• Management, ethics, governance — incident reporting, duty of candour, mortality review
• Critical appraisal and statistics — interpreting anaesthetic and critical care trials

Drawn from the RCoA 2021 curriculum, AAGBI/OAA/APAGBI/DAS guidelines and item density in iatroX.

• Obstetric anaesthesia — DAS obstetric difficult airway guidelines, neuraxial in severe pre-eclampsia (platelet thresholds), PPH management algorithm (uterotonics → manual compression → balloon tamponade → IR/surgery), maternal collapse algorithm
• Paediatric anaesthesia — APAGBI guidelines, airway management (uncuffed vs cuffed ETTs in children, age-appropriate sizing), fluid prescribing (Holliday-Segar 4-2-1 rule), recognising the deteriorating child (PEWS)
• Cardiothoracic anaesthesia — one-lung ventilation strategies (hypoxia management, CPAP/PEEP titration), post-cardiopulmonary bypass complications (RV dysfunction, vasoplegia), TAVI vs SAVR anaesthetic approach
• Neuroanaesthesia — TIVA principles for craniotomy, BP targets in elective vs emergency neuro, neuromonitoring (MEP, SSEP, BIS), recognition of intraoperative stroke
• Major haemorrhage and trauma — Major Haemorrhage Protocol activation, balanced resuscitation (1:1:1 plasma:platelets:RBC), tranexamic acid timing (within 3 hours of injury), REBOA indications
• Intensive care — Surviving Sepsis Campaign 2021 bundles, ARDS protective ventilation (low tidal volume, prone position, ECMO eligibility), recognising septic vs cardiogenic vs distributive shock
• Regional anaesthesia advanced — adductor canal vs femoral, ESP vs paravertebral, fascia iliaca, recognising LA systemic toxicity (LAST) and intralipid management per AAGBI
• Critical appraisal — interpreting anaesthetic and critical care trial methodology, RCT power calculations, recognising mortality endpoints vs surrogate endpoints in surgical/anaesthesia trials

Observations from UK anaesthesia trainees and recent Final FRCA candidates. Verify against current RCoA, AAGBI, OAA, APAGBI and DAS guidance.

Candidate-reported observations — not official guidance.

1. SOE communication — structured answers under time pressure require deliberate rehearsal. Examiners assess clarity of decision-making more than completeness. Practising with senior consultants is essential.
2. Obstetric anaesthetic emergencies — pacing through high-stakes scenarios (failed intubation in obstetrics, peripartum cardiomyopathy, amniotic fluid embolism) under SOE pressure. Algorithms must be ingrained.
3. Paediatric drug doses and equipment sizes — weight-based dosing under time pressure (e.g. adrenaline 10 mcg/kg, atropine 20 mcg/kg, suxamethonium 1-2 mg/kg). Speed is examined.
4. Difficult airway algorithms — DAS 2015 obstetric, paediatric DAS, ICU DAS difficult intubation pathways. Failure to escalate at correct time costs marks.
5. Statistics in trials — biostatistics in anaesthetic trials (POISE-2, PRO-CESS, ENGAGES, PREVENT), particularly mortality endpoints, hazard ratios, intention-to-treat analyses.
6. Governance scenarios — incident reporting (SUI, SI), duty of candour (statutory and professional), mortality review, never events. Common SOE topic.
7. Critical care interface — when to refer to intensive care vs theatre vs HDU. Recognising the deteriorating post-operative patient.
8. Regional vs general anaesthesia for elderly hip fracture — recent evidence (REGAIN trial), recommendations for awake neuraxial vs spinal vs GA in frail patients.

A pragmatic phased approach used by recent ST4-ST5 trainees who passed Final FRCA.

1. Weeks 1–8

   Foundation pass across all 12 blueprint topics. 30 questions/day with the iatroX adaptive engine. Read Yentis Anaesthesia A-Z and current AAGBI guidelines (consent, monitoring, regional). Subspecialty case-by-case rotation review.

2. Weeks 9–13

   Targeted weak-area drilling. Practise SOE-style answers daily with senior trainees or consultants. Major incident scenarios and trauma protocols. Daily critical appraisal of one paper.

3. Weeks 14–17

   Two timed MCQ + SAQ mock papers per week under exam conditions. SOE practice in pairs/groups — structured-answer technique under time pressure with clinical scenarios. Recognition of when to escalate.

4. Weeks 18–20

   Bookmark review only. Targeted reading on practice-changing trials, recent AAGBI updates, MHRA safety updates. Confirm RCoA bookings. Sleep, hydrate, do not learn new material.

Dedicated Final FRCA question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

Primary FRCA is the earlier-training fellowship — basic sciences and core anaesthesia. Final FRCA is the higher-training fellowship — subspecialty practice across obstetric, paediatric, cardiothoracic, neuro, vascular, regional and intensive care anaesthesia. Both are required for CCT in anaesthesia. Final FRCA is typically taken in ST4-ST5 after Primary has been passed.

The current Final Written assessment has a 90-SBA paper lasting three hours and a separate 12-question constructed-response (CRQ) paper. The structured oral examination is a separate component. The announced Final AKT replaces the written structure with 100 SBAs in three hours; the current RCoA FAQ gives January 2028 for its first sitting. Match preparation to your booked component.

Check the current RCoA calendar for the exact written and oral dates and application windows. The wider transition starts in July 2027; the first Final AKT is scheduled for January 2028 in the current format FAQ. Existing passes and transition eligibility can affect the route available to you.

FRCA is the anaesthesia fellowship; FFICM is the intensive care fellowship from the Faculty of Intensive Care Medicine. Dual training (CCT in both anaesthesia and intensive care medicine) requires additional time and passing both fellowships. Single-specialty trainees pass either depending on their CCT pathway.

Use the current RCoA calendar for the fee of each component you intend to enter. Budget separately for any optional revision course or learning subscription; a question-bank purchase does not include the College examination fee.

Practise interpreting study methods, effect estimates, uncertainty and the difference between clinical and surrogate outcomes. Use the College curriculum and current sample material to organise coverage rather than treating an illustrative topic percentage as an official weighting.

Full Final FRCA bank access is included in all-access. Up to 10 new sample questions per day are shared across exams, with no account required. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.