The journey towards a final FRCA clinical performance exam

We're pleased to share an update on the exciting work underway to develop a new Clinical Performance Exam (CPE) for the Final FRCA.

Why are we changing?

We are currently in the process of redeveloping both the Primary and Final FRCA examinations in line with recommendations from internal and external exam reviews. Subject to GMC approval, the new exam formats will be introduced in the 2027/28 academic year.

The revised Final FRCA will form a part of the programme of assessments for Stage 2 anaesthetic training. One of the most significant changes is the replacement of the current structured oral examination (SOE) with a new face-to-face clinical performance exam (CPE) - a more applied, real-world assessment format. 

As FCPE development leads, our goal has been to develop a CPE that not only reflects the realities of contemporary anaesthetic practice but also aligns closely with the Stage 2 Anaesthesia curriculum. This format will enable candidates to demonstrate analytical and critical thinking, apply clinical judgment, and manage competing priorities—reflecting the real-life complexity of challenges that anaesthetists commonly face in all areas of our broad clinical practice. 

The new format

Whilst the current SOE remains a valid and robust method of assessment, the new format will move away from the direct question-and-answer interaction between candidate and examiner and instead be a clinical performance exam. This will enable candidates to demonstrate complex decision-making, prioritisation skills and nuanced clinical reasoning. In addition, the new format will aim to increase the reliability of the examination by increasing the number of stations and ensuring validity by aligning with the Stage 2 Anaesthesia curriculum and the clinical context that anaesthetists commonly encounter in everyday practice. 

The clinical performance exam will be arranged as a timed circuit of stations. These stations will feature simulation-based scenarios, ultrasound scanning, interactions with examiners and role-players, data interpretation, and management of clinical situations. The scenarios will allow the candidate to explore management strategies, clinical challenges, and decision-making. They will encompass the full spectrum of anaesthetic practice, including theatre, critical care, pain medicine, obstetrics, paediatrics, and perioperative medicine.

The first pilot 

Over the past year, Final FRCA examiners and the exams team have been working collaboratively to develop and refine questions that align with the objectives of the assessment format. On 20 May 2025, we ran our first pilot of the new format, involving ten stations. Each station included two minutes of reading time followed by eight minutes of assessment time.

The stations featured a range of interaction types. In some, candidates engaged in shared decision-making conversations with role-players. In others, they discussed the scenario and management plan directly with the examiner, simulating consultant-level planning discussions. We also included an ultrasound scanning station to assess applied anatomy relevant to regional anaesthesia.

Candidate and examiner feedback

The feedback and auditing of the pilot allowed us to evaluate the authenticity of the questions, as well as the timing, logistics, and consistency of the marking system. Indeed, many candidates described the format as authentic, clinically relevant, and highly relevant to real-world scenarios they would expect to face, and examiners agreed it has strong potential to replace the SOE as a fair and robust Stage 2 assessment. Candidates appreciated the broad curriculum coverage of the stations, which assessed technical skills, application of knowledge, and non-technical abilities. They also valued the opportunity to demonstrate both breadth and depth of knowledge and found the timing and circuit flow manageable. Candidates’ and Examiners’ suggestions—particularly around the clarity of candidate instructions and alignment with the mark schemes—have been invaluable and are already being used to refine the next version of the exam. 

Shaping the exam: lessons learnt

It was exciting for us to see this format of the exam finally in real life after months of planning. The logistics on the day went extremely smoothly, and the engagement of the volunteer candidates, including their slight nervous energy, gave the pilot a very realistic exam feel. Running the pilot gave us confidence in the logistics and circuit flow. It also surfaced areas for improvement, including ensuring candidate instructions and briefs are standardised for clarity and fairness, ensuring artefacts (charts, scans, equipment) are authentic, well-timed, and used to enhance the scenario and, training actors and, where appropriate, using clinicians to maintain realism in role-play. These lessons will guide the next phase of development.

What’s next?

We’re now focused on developing a second pilot, which will run on 17 November 2025. New questions are already in development, and we’re building in the insights we gained from this May pilot. We’ll be putting out a call for volunteers shortly—please do keep an eye out, and save the date if you’re interested in being part of the next phase of development.

Thank you to everyone who has supported us so far—especially the anaesthetists in training and examiners who contributed to the first pilot. We’re committed to developing this new format in a way that is rigorous, collaborative, and true to the everyday realities of anaesthetic practice.

Dr Hasanthi Gooneratne and Dr Balaji Packianathaswamy are FRCA Clinical Performance Exam Development Leads.

Read about the volunteer candidate experience of the FRCA Clinical Performance Exam pilot in this companion blog from Dr Ceejay Ochukpue.