6 cases in 75 minutes
Each case may comprise of one or more imaging modalities (often a combination of two or more), for example ultrasound images, CT scan and a plain radiograph. You must report all 6 cases. For each you will be given a brief history and relevant clinical data to help and guide you (as in day to day practice).
You will need to type your report in the spaces provided on the screen and your answer should include your observations, interpretation, diagnosis/differential diagnosis and further management plan.
What is the scoring system?
The long cases component of the exam is marked out of 30. There are six cases and candidates can get up to 5 marks per case. No half-marks are awarded.
All cases are independently double marked. The final score is the average of the two examiner marks. The marking framework allows for a difference of up to 1 mark between the two examiners. If the difference is 2 marks or more, the case is flagged for review asnd discussion.
There is specific marking guidance for each question which indicates key findings, diagnoses and recommended management. Examiners will use the following mark scheme descriptors alongside the individual question mark schemes to allocate marks:
| Marking descriptors | Score |
|---|---|
| Detects all major findings and most minor observations. Makes correct diagnosis or differential diagnoses using clinical information provided. Makes safe further management plans with clear recommendations (including MDT or specialist referral if appropriate). Demonstrates a clear understanding of likely further management required by different MDTs. Report is clear, logical and concise. May demonstrate knowledge beyond the core curriculum. | 5 |
| Detects most major findings (including those marked essential) and most minor observations. Makes correct diagnosis or differential diagnoses using clinical information provided. Makes safe further management plans with clear recommendations (including MDT or specialist referral if appropriate). Report is clear, logical and concise. | 4 |
| Detects most major findings (including those marked essential) and some minor observations. May or may not reach the correct diagnosis but demonstrates sensible clinical reasoning. Safe differential diagnoses offered. May not know full management plan but demonstrates enough knowledge not to compromise patient safety. Report is clear although it may not be ideally structured | 3 |
| Fails to detect most major/critical (essential) observations. Fails to make correct diagnosis or provide reasonable differential diagnoses. Inappropriate further management or failure to refer to appropriate MDT. Unstructured, scattergun report. | 2 |
| Fails to detect major observations or places undue importance on minor or incidental observations. Makes an incorrect or inappropriate diagnosis, failing to consider clinical information. Incoherent, rambling report. | 1 |
| No answer provided or answer is entirely incorrect or inappropriate/unsafe patient management. | 0 |
A standardised process is used for setting the pass mak for each sitting based on the content/cases used. Therefore the pass mark may be different for different sittings depending on performances and difficulty of the questions.
(Source: Final Examination for the Fellowship in Clinical Radiology (Part B) Scoring System. Published by: The Royal College of Radiologists)
Top tips for the 2B long cases
Report as you would in day to day practice
- Think about what information you include in your day to day reporting and simply type the same. If normally you would recommend urgent surgical referral, then write ‘Recommend urgent surgical referral’ If normally you would refer to the lung MDT, then write ‘referral to the lung MDT is advised’ etc. Your clinical knowledge and experience should help your interpretation and guide your search for additional features. Relevent neagtives should be included e.g. absence of metastatic disease in sites common for a particular malignancy. Your report must be clear, logical and concise.
Use the following structure when you report the cases
- Observations: Record observations from all the imaging studies available, including relevant positive and negative findings.
- Interpretation and diagnosis: State interpretations of the observed findings; e.g. whether the mass or process is benign, malignant or infective, giving your reasons, and give the diagnosis or differential diagnoses.
- Further management: Write a safe further management plan with clear recommendations. Include any further investigations, specialist referrals or MDT reviews here and demonstrate an understanding of why these have been selected.
Write someting in EVERY section for EVERY case!
- Even if you don’t have a clue about the answer, simply by typing something sensible in each box, you may get some marks for that question. So attempt all cases.
Timing is everything
- Anyone can write a decent report after spending half an hour looking at the images, however it is very difficult to spend approximately 12 minutes on each case. You will not have time to check your answers so you have to be very very strict with time management. We recommend aiming to spend no more than 7-8 minutes on each case to allow time for difficult cases or those needing a lot of description. It may be that case number 6 is the longest and hardest and if you have 5 minutes left at the end it will not be enough!
Practise typing under pressure
- You will be typing so fast you hands will probably ache. Practising will really help. Try reporting 3 CT scans in 30 minutes and typing the reports as you go.
Use bullet points and keep answers succinct
- You wont have time to type full sentences (unless you’re a particularly good touch typer) so use bullet points. It keeps things clearer, makes it easier for you to see if you have missed anything and makes it easier for the examiners to mark.
Practice on the RCR examination demo site
- The RCR have developed their own software for the examination and you should practise using this software on their demo website prior to the exam. You will require a PIN number to access the long cases examination demo. Unlike in previous exams, you will NOT have the opportunity to practice immediately prior to the start of the examination at venues, so practising on this demonstration site is essential to help you become familiar with the exam format! Here are the links:
- RCR exam demonstration site
- Long cases exam PIN access number
Do NOT use acronyms or abbreviations!
- Many clinical errors have arisen from the use of acronyms and what is common in one institution may not be common elsewhere. Avoid if at all possible!
Report imaging in chronological order
- If there is more than one radiograph / imaging modality then check the dates and report each one in chronological (time) order.
Use our up-to-date list of all UK FRCR 2B courses, recommended books and online resources
Watch this short instructional video from the RCR
- This short instructional video from the Royal College of Radiologists demonstrates how to select, view and move through examination cases in the rapid reporting exam using the image viewing software. Alternative link to the short instructional video.
What are the best online resources?
Revise Radiology FRCR 2B Question Bank and Courses
Pass the FRCR 2B first time!- 240 Long case FRCR 2B questions
- Also 4-day courses with 4 mock exams
Revise Radiology FRCR 2B Question Bank and Courses
Pass the FRCR 2B first time!- 240 Long case FRCR 2B questions
- Also 4-day course with 4 mock exams
Online mock exams
- Revise Radiology Paid long cases (240)
- RadCases Paid long cases (500)
- RadBytes Paid long cases
The long cases component is one of three parts of the Final FRCR (Part B) exam. Information on the two other components can be found below:
If you have anything you would like to add to this page or know of any useful tips/resources for future exam candidates, then please contact us and we will consider adding to this page!