How difficult is the Primary FRCA?
The Primary FRCA has a reputation for a reason: it’s widely seen as one of the most demanding postgraduate medical exams in the UK. This isn't just because of its pass rate, but also because of how it tests you, particularly considering the breadth of subjects and level of conceptual understanding required. It covers a broader scientific base than most trainees expect, goes deeper than undergraduate medicine, and splits that load across three separate exam components.
Read on as we explore the question: how difficult is the primary FRCA?
Is the FRCA hard?
The short answer is yes.
Part of the reason is because the Primary FRCA isn't one exam, but three. First, you sit a 90-question SBA paper covering pharmacology, physiology, biochemistry, anatomy, physics, clinical measurement and statistics. Pass that, and you move on to the OSCE (16 practical stations) and the SOE (a structured viva with four examiners).
All three components must be passed, and they’re structured to test different skills, including factual recall, clinical application, and the ability to explain concepts clearly under pressure.
It’s a mix that makes the Primary FRCA distinctive. The MCQ alone covers more basic science than most doctors have touched since their second year. Topics like gas laws, the Hagen–Poiseuille equation, and receptor pharmacokinetics sit alongside clinical measurement and equipment questions that rarely come up in day-to-day practice. Then the SOE asks you to talk through those same concepts out loud, in five-minute blocks, with two examiners listening.
Most successful candidates report revising for around six months before the MCQ sitting, then moving straight into OSCE and SOE preparation. It's a sustained effort. And adding to the pressure is that you're fitting it around clinical work, on-calls and the rest of training.
For a full breakdown of the exam structure, dates and eligibility, see our complete guide to the Primary FRCA.
What are the Primary FRCA pass rates?
The RCoA publishes pass rate data after every sitting. The numbers are worth understanding, especially because a recent rule change has shifted the pass rates.
MCQ (SBA) pass rates
The Primary FRCA MCQ pass rate has historically averaged around 60%. However, that average masks a wide range. Individual sittings over the past few years have come in anywhere from roughly 45% to over 73%.
Two factors contribute to this spread. First, the candidate mix varies between sittings. Sittings with a higher proportion of Temporary Examination Eligibility (TEE) candidates (who historically pass at a lower rate, around 30%) pull the overall figure down. In 2023/2024, TEE candidates made up 26.4% of the cohort. By 2024/2025, that proportion had dropped, changing the overall numbers.
Second, the RCoA stopped applying the Standard Error of Measurement (SEM) adjustment from February 2025. Previously, the Angoff-derived pass mark was reduced by a few marks (typically 8–10, or about 2% of the total) in the candidate's favour. This adjustment is now gone; the pass mark is now the raw Angoff score, which means the bar is slightly higher than it used to be. The RCoA's own 2024/2025 annual report confirmed that the lower pass rate in that year's February sitting was consistent with what they'd expected after removing the SEM.
Since September 2023, the paper has been entirely SBA, with no Multiple True/False questions. You sit 90 questions in three hours, with no negative marking, and are scored one mark per correct answer.
OSCE and SOE pass rates
The clinical components are sat together on the same day (on a first attempt) at the RCoA in London. Pass rates for the OSCE and SOE fluctuate between sittings, and they're generally published alongside the MCQ data on the RCoA website.
The SOE uses a 0–1–2 scale per question (0 for fail, 1 for borderline, 2 for pass) across 12 questions marked independently by two examiners. Maximum score: 48. Pass mark: 37. That's a very tight range. And accumulating borderline scores across several questions can tip you below the threshold even without a single outright fail.
For the OSCE, each of the 16 stations is marked out of 20, with the pass mark per station set using the Angoff method. Those individual station pass marks are summed to produce the overall pass mark. Data from recent sittings shows the OSCE pass mark sitting close to the mean score, meaning the margin between passing and failing is often narrow.
First-attempt vs overall pass rates
The 60% average for the MCQ includes candidates on their second, third or later attempts. But the RCoA doesn't routinely publish a clean first-attempt figure in the same way that, say, the MRCS data is broken down.
What we do know is that candidates who start revising early, use a structured question bank, and sit the exam during or shortly after core training tend to perform better than those who delay.
Why do candidates keep failing the Primary FRCA?
A significant number of candidates need more than one attempt. The reasons tend to fall into a few recurring patterns.
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Gaps across the syllabus
The RCoA's annual reports consistently note that candidates who fail the MCQ tend to perform poorly across multiple topic areas rather than just one. This rules out the common strategy of "I'll focus on pharmacology and physiology and hope the physics doesn't come up." It always comes up.
The syllabus tests 30 questions each in pharmacology, physiology and physics/clinical measurement. So, if any of those areas is weak, it could cost you 30 potential marks.
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Not enough question practice
Reading textbooks builds knowledge, but the SBA format tests your ability to pick the single best answer from five plausible options under time pressure. Candidates who rely mainly on reading without working through hundreds of exam-style questions often struggle with the specific demands of the paper. The Pastest Primary FRCA QBank includes over 1,162 SBA questions mapped to the RCoA curriculum, with detailed explanations for every answer. So, adding something like this to your revision sees you learning from each question, not just scoring it.
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Starting too late
Three or four months sounds reasonable until you factor in on-calls, annual leave and the sheer volume of material. Most candidates who pass on their first attempt start around six months out, building gradually from textbook reading to question practice to timed mock papers.
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Underestimating the OSCE and SOE
Some candidates pour everything into the MCQ, pass it, and then treat the clinical components as an afterthought. The SOE in particular requires dedicated, regular practice. The ideal is two to three times a week with a study partner, covering different topics in each session. You need to be able to talk through concepts clearly and in a structured way, under time pressure, with examiners probing your understanding. You won’t get this from reading alone.
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Losing momentum between OSCE stations
Candidates tend to score worse on the station immediately after a difficult one. It's a natural reaction to dwell on what just happened instead of focusing on what's in front of you. Practising full mock circuits can help because it trains you to reset between stations.
What does "borderline" vs "fail" mean on the Primary FRCA?
The definition of borderline vs fail depends on which component you're talking about, because the Primary FRCA uses different marking systems across the MCQ, OSCE and SOE.
In all three components, the board of examiners reviews borderline candidates' results before confirming final marks.
MCQ
On the MCQ, there's no formal "borderline" grade on your result. You either pass or you don't.
The pass mark is set before each sitting using the modified Angoff method. This means a panel of examiners estimates, for each question, the probability that a minimally competent candidate would get it right. Those estimates are combined to produce the pass mark.
The Angoff method is built around the concept of the borderline candidate, so the pass mark itself represents what that just-good-enough candidate is expected to score. However, your result slip won't say "borderline"; it'll say pass or fail.
SOE
On the SOE, borderline is an explicit marking category. Each of the 12 questions is scored 0 (fail), 1 (borderline) or 2 (pass) by two independent examiners. A borderline score means the examiners judged your answer as sitting between a clear pass and a clear fail on that question. With a pass mark of 37 out of 48, a run of borderline scores (even without any outright fails) can leave you short.
OSCE
On the OSCE, each station is marked out of 20 against an Angoff-derived station pass mark. You receive a total score, and the pass mark for the whole exam is the sum of the individual station pass marks. Borderline performance across several stations can mean falling just below the overall threshold.
How many attempts are allowed for the Primary FRCA?
Six attempts per component (MCQ, OSCE, and SOE) counted separately. Failing the OSCE doesn't count against your SOE attempts, and vice versa.
A few rules apply to those six attempts. You must wait at least six months between MCQ attempts, and you reapply and pay the fee (currently £410) each time. On a first attempt at the clinical exams, you must sit both the OSCE and SOE together. If you fail one, you only resit that part next time.
For your sixth attempt at any component, the RCoA requires evidence of additional educational training. This could be a written recommendation from your College Tutor, attendance at a recognised FRCA course, evidence of question practice, and details of further clinical exposure. This isn't a formality; your College Tutor must formally support the attempt.
There are also time limits. Once you pass the MCQ, you have three years to pass both the OSCE and SOE. Miss that window, and your MCQ pass expires. Once all three are passed, the full Primary FRCA is valid for seven years towards eligibility for the Final FRCA.
How does the Primary FRCA compare to the MRCS and MRCP?
Trainees often ask how the Primary FRCA stacks up against other postgraduate exams, particularly the MRCS Part A and MRCP Part 1.
Primary FRCA vs MRCS Part A
The MRCS Part A has a first-attempt pass rate of around 55–61% for UK graduates, depending on the sitting. This is broadly similar to the Primary FRCA MCQ, but the exams can feel quite different.
The MRCS Part A is a five-hour endurance test: two papers, 300 questions, completed in a single day. The Primary FRCA MCQ is shorter at three hours and 90 questions, but it covers a heavier load of basic science.
Where the Primary FRCA becomes harder overall is the additional clinical components. After passing the MRCS Part A, you move on to the MRCS Part B (a clinical OSCE). After the Primary FRCA MCQ, you face both an OSCE and a structured viva, both of which must be passed within three years. The multi-component structure means there are more points at which the process can stall.
Primary FRCA vs MRCP Part 1
The MRCP Part 1 pass rate has generally sat a few percentage points higher than the Primary FRCA MCQ in recent years. It's a two-paper, five-hour written exam with 200 best-of-five questions. It’s a bigger paper, but it covers clinical medicine rather than basic science.
The MRCP distributes its clinical assessment differently: PACES (the clinical component) is a separate exam taken later in training and assessed independently. The Primary FRCA bundles the written and clinical assessments closer together.
Neither exam is objectively "harder"; they test different knowledge bases and different skills. But the Primary FRCA's combination of deep basic science and a three-part structure within a gated timeline is what gives it its particular reputation.
How to give yourself the best chance of passing the Primary FRCA
There's no shortcut past a broad and demanding syllabus. However, there's a clear pattern among candidates who pass efficiently:
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Start with the RCoA curriculum: print it, and work through it topic by topic. Candidates who skip this step often discover too late that they've missed entire sections.
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Build your revision around a question bank. Textbook reading gives you knowledge; exam-style questions teach you how to apply it under pressure.
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Use spaced repetition. Revisit topics at increasing intervals, using your question bank performance data to decide what to revisit first.
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Practise the clinical exams early and often. Don't wait for your MCQ result: start SOE and OSCE practice as soon as your written revision is well under way.
For more helpful tips, see our guide to preparing for the primary FRCA.
Start your Primary FRCA revision with Pastest
Pastest has been producing medical exam revision resources for over 50 years. Our Primary FRCA QBank includes over 1,162 exam-style SBA questions written by practising clinicians. Detailed explanations for each question mean you're learning from every question you get wrong (and reinforcing what you get right). Performance tracking shows your scores by topic, so you spend your revision time where it needs to go.
If you want structured video teaching alongside your question practice, the Primary FRCA Exam Essentials course covers the full syllabus in 60+ on-demand lessons with integrated SBAs and viva-style questions. It’s perfect for trainees fitting revision around shift work.
Get started with your Primary FRCA revision now, or contact us to learn more!