FFPMRCA Examinations

Following discussion with RCoA Council, it was agreed in 2008 that an examination needed to be created to award post-nominal Fellowships of the Faculty.  The Faculty Board introduced the examination, in line with other international pain examinations, to further drive up the standard and standing of Pain Medicine in the UK and of UK Pain Medicine internationally.

All questions are reviewed by the MCQ Core Group before and again after each sitting of the MCQ paper.   All queries about questions raised by candidates sitting the MCQ paper are discussed in detail at the MCQ Core Group’s meeting held a week after the MCQ paper.  Any questions assessed as being contentious or unclear are discounted from the marking of the paper.

The syllabus for the examination is the Basic, Intermediate, Higher and Advanced Pain Medicine component of the CCT in Anaesthetics curriculum. 

A trainee took and passed the examination has also written an article for Transmitter with a full library of suggested reading. The Training & Assessment Committee has provided a curriculum expansion document.

The Examination fee is set by the RCoA and the FPM and is designed to break even on paper (and in reality lose money once overheads are included). The Examination is subsidised by Fellowship subscriptions in order to not fully pass the cost burden onto examinees. The FPM appreciates that the cost is higher than the FRCA (although still lower than other Colleges) – holding a high standard, well designed, quality assured and continuing improving examination is not an inexpensive endeavour and the comparatively small numbers undertaking the exam mean we benefit less from economies of scale.

Yes.  The Royal College of Anaesthetists (RCoA), Faculty of Pain Medicine (FPM) and Faculty of Intensive Care Medicine (FICM) ensure that trainees, members and fellows are provided with an appropriate breakdown of costs of supporting trainees and in the provision of the examinations that form part of the relevant training programmes.  For the purposes of this analysis, the income and expenditure for FRCA, FFICM and FFPMRCA examinations have been combined, as the vast majority of the functions are managed centrally by the RCoA examinations department to improve economies of scale.

Each department within the College and each Faculty has its own budget which is managed by the relevant head of function and the overall directorate budget is the responsibility of the relevant director.

For further details on the cost of training please click here.

It is entirely understandable for those taking the exam to perceive the actual examination days themselves as the major part of the exam process. In reality, each exam sitting, whether MCQ or SOE, takes a considerable amount of development, both in times of physical days (Standard Setting Groups, Core Groups for question writing, training etc.) and remote development (IT systems, engagement with the Academy/GMC on national assessment changes). A difference in fee between the written and oral components of the exam has been agreed to reflect the different costs of the actual exam days, in similar ratio to that of the FRCA.

The FRCA has been in existence for a considerable time longer than the FFPMRCA and therefore has a bank of question many times bigger, allowing a number of used questions to be released for revision purposes. So far the FFPMRCA has released a small sample of questions (see below). We will continue to release example questions at a rate made possible by question writing. The Court of Examiners is already considering ways to increase question writing to support this.

• FFPMRCA Example questions

For the MCQ: The pass mark for each MCQ exam is set using a modified Angoff method. An Angoffing group, comprising examiners and independent Pain consultants (including junior consultants who have recently attained the Fellowship), grade each question in the paper according to difficulty using the proxy of the likelihood of borderline candidates knowing the answer. A week following the exam a meeting takes place in which the group spends several hours discussing the scores given, with particular regard to the questions where there is disparity in the responses. Once an agreed score for each question has been reached a raw score for the paper can be calculated. The raw score is adjusted to allow for the potential for guessing the correct answers. The t pass mark is set as the adjusted raw score further reduced based upon the Standard Error of Measurement (SEM), a statistic relating to the reliability (Kuder-Richardson 20 score) of the exam. This resulting figure is then rounded down to the nearest whole number to give the pass mark.

For the SOE: At least two standard setting tools are employed in setting the pass mark for the oral component of the exam. Prior to the exam examiners are asked to consider a number of parameters based on pass rate and pass mark, for an exam at this level these parameters are then cross referenced against actual cohort performance to generate a Hofstee chart. During the exam, in addition to candidates being marked on each question, performance at the exam is graded by examiners on a global ratings scale. This global rating is then cross-referenced against performance in individual questions using a linear regression method. The suggested pass marks generated by these two methods (which, to date, have been the same figure) are then used as a basis for discussion between examiners. The individual performance of all candidates whose scores are just above or just below the suggested pass mark are reviewed by the court of examiners in coming to a decision regarding whether they have demonstrated sufficient knowledge and understanding to be awarded the Fellowship. Discussion of these borderline candidates’ performances’ determines the final decision of where the pass mark should be set. Angoff and Ebel referencing methods have also been employed to assist in setting the pass mark.

Please note the proposed changes to the FFPMRCA Examination are not imminent and the points below have been highlighted to ensure you are aware of the forthcoming changes and can adequately prepare and inform your trainees so there is no confusion related to the exams going forward. You can read Dr Vivek Mehta’s (Chair of the Examinations Committee) full article regarding the changes in Transmitter here.

Reason for planned changes:

The Examinations Committee aims to adopt best practices from recent reports (FRCA examinations report and McLachlan report) to cost effectively use best practise in assessment to examine knowledge, understanding, skills, attitudes, behaviours and domains of good practice. To achieve this, significant changes are planned for how the FFPMRCA exam will be conducted over the next few years.

Proposed Changes:

• Transitioning from Multiple True-False questions to Single Best Answer and Extended Matching questions.
• Changing the SOE (Structured Oral Examination) to a more OSCE (Objective Structured Clinical Examination)-style format.

Implementation Timeline:

• Aiming to have a 'proof of concept' exam by autumn 2025.
• Full implementation planned for autumn 2026.

These timelines are currently provisional subject to the GMC’s approval of the changes and may have to be extended.

Communication and Notice:

Further communications and updates will be posted on the Faculty website, and no changes will occur without an extensive period of notice for candidates. We will notify candidates at least a year in advance of any proposed changes (as per the GMC’s requirements). Please note that the coming changes do not affect the current exams or learning at this time so please continue with your programme of learning as normal.