The Ultimate Guide to Rapid Reporting for FRCR 2B
Rapid reporting component of Final FRCR Part B
Check out this excellent online resource where you can attempt more than 100 mock rapid reporting packets: https://www.medmantra.com/elearning/frcr/frcr-2b-rapid-reporting
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HIGHLIGHTS OF THE BOOK
The last examination for the Fellowship of Royal College of Radiologists (UK) in Clinical Radiology is the Final FRCR Part B. It has three parts, namely: viva (oral), long cases (reporting session), and rapid reporting. Rapid reporting is considered to be one of its very difficult parts. It (the rapid reporting session) is conducted just after the end of the long cases session.
There are three scoring components in Final FRCR Part B examination. The primary one includes two orals (viva) while the other two are rapid reporting and reporting (long cases) sessions. The scores from two orals are combined to give one score for the purposes of results presentation. The combined result of all the components is the main score, and pass / fail depends on that. A fail in even one of the components means you will have to retake the entire examination. In a rapid reporting session, the candidates are expected to report 30 plain films. Each correct diagnosis carries one mark. So a candidate can score a maximum of 30 marks if all the diagnoses are correct. Marks are allocated as shown below (dependent upon the type of image):
|Image type||Candidate response||Mark|
|Normal Image||Correctly classified||+1|
|Incorrectly classified (appropriate false positive)||+½|
|No answer given||0|
|Abnormal Image||Correctly classified and correctly identified||+1|
|Correctly classified but incorrectly identified||0|
|Incorrectly classified (false negative)||0|
|No answer given||0|
Regarding the scoring system, one commonly asked query is: What is an “appropriate false positive” candidate response?
The answer is as follows:
To understand “appropriate false positive” candidate response, please consider the following scenario: A Royal College examiner contributes a few films to a rapid reporting packet. This examiner submits a radiograph as a "Normal" film. However, a candidate while attempting the examination finds a "Subchondral Cyst" in this film which was submitted as a "Normal" one. The candidate marks the film as "Abnormal" and writes the diagnosis of "Subchondral Cyst". When an examiner checks this answer, he/she takes a relook at the film and confirms "Subchondral Cyst" as a finding. In this scenario, the marking examiner may consider the candidate response as “appropriate false positive” and may award ½ mark to the candidate for this response.
Following the marking exercise, each candidate will have a score between 0-30.
An overall rapid reporting mark is then awarded on the basis of total marks achieved using the scale below:
|Total marks||Overall mark|
Following the compilation of marks, each candidate will have a score of 4-8 in each component of the examination (two orals, the reporting session and the rapid reporting session). The pass mark in each component is 6, making the overall pass mark 24. In addition to achieving a score of 24 or above, candidates must obtain a mark of 6 or above in a minimum of two of the four components.(Reference: The Royal College of Radiologists. Final FRCR Part B Examination Scoring System. Downloaded from:
Points to Remember
In the rapid reporting component of the examination, there is no margin of error. One is certain to fail even with a score of 26/30 in rapid reporting (unless one performs exceptionally well in viva or reporting session).
The two "Mantras" of rapid reporting are: "Checklists" and "Practice"!
It is very important to always follow a comprehensive checklist of all review areas for each body part. It is essential to exclude all expected pathologies in a given radiograph. Comprehensive checklists for various body parts are given at the end of this article.
Attempt as many mock examinations or packets (i.e. sets of 30 plain films with approximately 15-17 abnormal films) as possible. More of such exposure will improve your performance in the actual examination by fine-tuning your review areas and developing a habit of looking at the edge-of-the-film abnormality. Following is an excellent online resource available where you can attempt more than 100 mock rapid reporting packets:
Never forget to look at the side marker, to avoid missing dextrocardia or situs inversus.
Any pathology in the examination setting has to be definite with no inter-observer conflict (even if subtle). In the examination, you would find most abnormalities easily identifiable. If you are unsure or confused, it is likely a normal film. If you are finding it difficult to detect an abnormality, then the film is likely normal. During the examination, just adopt your routine practice of reporting plain films. It’s a different situation in examination due to non-availability of clinical information. This will increase your level of difficulty and may lead to over calling normal films, which you need to avoid. Imagining abnormalities also must be avoided. Avoid wasting time by not pondering too long over a difficult-to-diagnose film. You should have sufficient time remaining to re-check all normal films.
If there are multiple views in a case, check them with attention. Such cases are mostly abnormal. Most of the times, abnormality is evident only on one view. If you don’t have enough time, just mark these type of cases as abnormal.
If you are short of time, then don’t waste time counting the exact rib number or toe; just mention fracture rib or metatarsal. If you are short of time, it is appropriate to write “#” instead of “Fracture”. Also, it is appropriate to use short forms if you are short of time.
There is no negative marking in rapid reporting, so you must answer all the questions. During the last few minutes of the examination, if you are short of time, just mark all remaining cases as normal. You have nothing to lose in this scenario.
Please note that in the actual examination, normal and abnormal cases can be clumped together. For example, if you come across 4 or 5 normal films in a row, don’t be tempted to overcall pathology. Develop a habit of trusting your instincts.
If you are short of time or are confused about the specific name of a fracture or a radiological sign, then it is appropriate to write a brief description of the abnormality instead of writing a wrong name.
Most abnormalities in the examination will be relatively easy to diagnose. Most of the films will have a single significant abnormality. Even if there are more than one, it will be part of a single diagnosis (e.g. tibial plateau fracture associated with knee lipohaemarthrosis). If not, then write the most clinically significant one (e.g.: pneumoperitoneum over gall bladder calculi). In rare cases where you find two pathologies like pneumothorax and a lung mass, or osteoporosis and a vertebral wedge compression fracture, or pneumomediastinum with a rib fracture and you are confused, then it is appropriate to write all important pathologies.
Systematic and consistent approach is a must to be successful in rapid reporting component of the examination. Apply a uniform technique when attempting mock tests so you can judge your reporting style and know if you are over calling or under calling the abnormality.
In case of a fracture extending into an adjoining joint, mentioning intra-articular extension is important to secure a full mark. In skeletal radiographs, always look for soft tissue swelling which may point to an underlying bone fracture. Similarly, foreign bodies and soft-tissue gas may also serve as pointers to significant adjoining abnormality. Always check and trace the outline of each bone in a radiograph with attention. Erosions / foreign body / lines / tubes should always be specifically looked for.
Prosthetic valve, laminectomy, calcified hilar lymph nodes, fused vertebrae, splenomegaly, soft tissue calcification except for vascular calcification, severe osteoarthritis, basal ganglia calcification in child etc. are ABNORMAL.
Basal ganglia calcification in adult, calcified lymph nodes in abdomen etc. are NORMAL.
In knee, shoulder and skull x-ray films, always look for fat-fluid level.
Rapid Reporting Comprehensive Checklists
Registered users of MedMantra.com can download a FREE Printable Rapid Reporting Comprehensive Checklists PDF file for ready reference and personal use. You may print the checklists on one sheet of paper (front and back) and always keep with you while practicing rapid reporting packets.