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The higher fellowship exam for UK anaesthesia trainees — subspecialty knowledge across obstetric, paediatric, cardiothoracic, neuro, vascular, regional and intensive care anaesthesia. MCQ + SAQ + SOE format mapped to the RCoA 2021 curriculum with an AI-adaptive question bank by practising UK consultants.
Full Final FRCA bank, AI Tutor and timed mocks — $29/month or $99/year. All paid exam banks included.
Constructed Response Question paper assessing applied anaesthesia, perioperative medicine and critical clinical reasoning.
90 single-best-answer questions · 3 hours · mapped to the intermediate-level anaesthesia curriculum.
Structured oral examination usually scheduled separately from the written papers.
The September 2026 written diet lists CRQ on 9 September 2026 and MCQ on 11 September 2026. The Final Written fee in the 2026-27 calendar is £620.
Approximate question distribution across the RCoA 2021 curriculum for Final FRCA. Used to drive iatroX adaptive sequencing.
Source: official Royal College of Anaesthetists (RCoA) blueprint
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.
A pragmatic phased approach used by recent ST4-ST5 trainees who passed Final FRCA.
A live item from the iatroX bank. Try it before launching a full session.
A 62-year-old man (ASA III) with chronic pain following a spinal cord injury at T6 has severe spasticity. He is scheduled for insertion of an intrathecal baclofen pump. What is the main advantage of intrathecal over oral baclofen?
Why iatroX is built differently for Final FRCA.
Every iatroX item is tagged to a blueprint topic, so your performance dashboard mirrors the structure of the exam itself.
The engine surfaces your weakest topics first, in real time, instead of marching you through a static syllabus.
Incorrect items return at increasing intervals to interrupt the forgetting curve and lock knowledge into long-term memory.
Timed full-length simulations that mirror the official exam structure under realistic conditions.
One iatroX subscription includes the Final FRCA bank, the Socratic Tutor inside supported sessions, and every other premium iatroX exam bank.
Cancel anytime · 7-day money-back guarantee on annual
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.
Three components: MCQ paper (~90 single-best-answer items, 3 hours), SAQ paper (12 short-answer questions, 3 hours), and SOE (two ~30-minute structured oral examinations). The SAQ component requires structured, well-organised written responses — not just bullet points.
Two diets per year — typically March/April and September/October. SOE is often scheduled separately from the written papers, allowing candidates to focus on written components first. Confirm 2026 dates and application windows on the RCoA website.
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.
Approximately £880 for the combined written components (MCQ + SAQ) and £680 for the SOE — total around £1,560 in fees. RCoA reviews fees annually. Revision courses (e.g. RA-UK, BJA Education, college-specific) add significant additional cost.
Approximately 7% (6-7 questions across MCQ and SAQ). Topics include interpreting anaesthetic and critical care trial methodology, RCT power calculations, recognising mortality endpoints vs surrogate endpoints. Routinely tested but variably prepared.
Yes. A single iatroX subscription (£29/month or £99/year for UK users; $29/$99 elsewhere) includes the Final FRCA bank alongside Primary FRCA, FFICM and every other premium iatroX exam bank. No add-ons or per-exam fees.
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Reviewed by Dr Kola Tytler MBBS CertHE MBA MSt MRCGP · Last reviewed 12 May 2026
See our methodology and editorial policy.