Your guide to the Primary FRCA
The Primary FRCA is the first major hurdle in anaesthetic training, and the breadth of the syllabus can feel overwhelming.
This guide walks you through what the exam involves, how it’s structured, what’s tested, and how to plan your revision – so you know exactly what you’re working towards.
What is the Primary FRCA?
The Primary FRCA (Fellowship of the Royal College of Anaesthetists) is the first part of the FRCA examination, taken during Stage 1 anaesthetic training. It assesses the basic sciences and clinical knowledge that underpin safe anaesthetic practice.
The Primary is made up of three separate components: the MCQ (a written paper), the OSCE (a clinical skills exam), and the SOE (a structured oral exam). Each is passed or failed independently, and you must pass all three to be awarded the Primary FRCA. A pass in the Primary is valid for seven years towards the Final FRCA.
The three components
MCQ
Multiple Choice Question paper
A three-hour written paper of 90 Single Best Answer (SBA) questions, delivered online with remote invigilation. Each question has a stem or clinical vignette, a lead-in question, and five plausible options – you choose the single best answer. There is no negative marking.
The questions broadly divide into pharmacology; physiology and anatomy; physics, clinical measurement, statistics and data interpretation.
With 90 questions in three hours, you have around two minutes per question. Practising under realistic timed conditions is one of the best ways to build both your knowledge and your pacing for the real paper.
You must pass the MCQ before you can apply for the OSCE and SOE.
OSCE
Objective Structured Clinical Examination
A practical, station-based exam taken in person at the College, assessing your clinical and communication skills alongside your applied knowledge of anaesthetic equipment, monitoring and measurement.
You move through a circuit of 18 stations in roughly one hour 45 minutes. Stations cover areas such as history-taking, communication with simulated patients, physical examination, airway assessment, resuscitation, anatomy, equipment, and data interpretation.
Each station is marked out of 20, with pass marks set in advance and summed across the live stations, so it’s your overall performance that counts rather than passing a fixed number of stations. There’s no negative marking.
The OSCE is taken alongside the SOE, and both must be passed to complete the Primary. Each component is assessed independently, so if you pass one and fail the other, you only need to resit the component you did not pass.
SOE
Structured Oral Examination
A structured oral exam, delivered in person at the College, in which two examiners assess your knowledge and understanding through spoken questions. It tests the basic sciences that underpin anaesthesia, your clinical decision-making, and the principles and safety aspects of the equipment used in Stage 1 training.
The SOE is made up of two 30-minute parts. The first covers three questions in pharmacology and three in physiology and biochemistry; the second covers three questions on clinical topics (including a critical incident) and three in physics, clinical measurement, equipment and safety, giving 12 questions in total.
Both examiners mark every question independently, scoring 2 for a pass, 1 for a borderline performance, and 0 for a fail, for a maximum of 48 marks.
The SOE is taken alongside the OSCE, and both must be passed to complete the Primary. Each component is assessed independently, so if you pass one and fail the other, you only need to resit the component you did not pass.
How to prepare
There’s no single right way to revise for the Primary, but a few principles help most candidates:
Start early, at the right time
Give yourself enough time to prepare properly. Most trainees find that starting around six months before their exam strikes the right balance. Just as important is choosing a sitting that fits with your training, your workload, and the rest of your life, so you can give it your best shot first time round.
Cover the breadth
The syllabus is wide. Give yourself enough time to work across every domain rather than cramming the areas you find most comfortable. The exam will find your gaps, so it’s better to find them first.
Use questions actively
Reading textbooks builds knowledge, but practising questions is what trains you to apply it under exam conditions. Active recall – testing yourself, getting things wrong, and learning from the explanation – is far more effective than passive re-reading.
Target your weak areas
Track which topics you score lowest on and return to them deliberately. Spending your time where you’re weakest is more efficient than re-covering what you already know.
Practise under timed conditions
The Primary is as much a test of pacing as of knowledge. Sitting timed mocks in advance means the clock holds no surprises on the day.
Combine resources
A question bank is a powerful tool, but it works best alongside your textbooks, course notes, and clinical experience. Use each for what it does best.
The 2027 changes to the Primary FRCA
From July 2027, subject to GMC approval, the structure of the FRCA examinations is changing. For the Primary, the written MCQ paper will become the Applied Knowledge Test (AKT), and a new Clinical Anaesthetic Sciences Exam (CASE) will replace the current OSCE and SOE components.
What The FRCA is ready for the change
We’re already preparing for 2027: dedicated AKT and CASE question banks will be available in What The FRCA when the new formats launch, so you’ll be covered whichever exam you’re sitting.
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