Education

1. FRCPath Examination
in Clinical Biochemistry
Dr Ruth Ayling
Chair, Panel of Examiners

2. Part 1 Part 2
FRCPath overarching structure
Clinical
Biochemistry
Clinical Biochemistry
Stage A
examination
OSPE
MCQ
1x 3 hour paper
(125 questions)
Module 1
OSPE
Practical
M
Module 2
Cases/Critical appraisal
Oral
Module 3
Dissertation

3. Stage A examination
– primarily a competency test but….
• you are also expected to build a significant knowledge base in Y 1
– engaging with a well structured Year 1 programme is essential

4. Step Out of your Comfort Zone

5. Stage A examination
OSPE
• 3 hours
• 19 stations (9 minutes per station)
• Practical procedures
• Calculations
• Interpretation of clinical data

8. Stage A Q1 Answer

10. Stage A Q2 Answer

11. Keys to your success
• Part 1 FRCPath Knowledge
– take a long run-up
– adopt a systematic approach
– correlate book knowledge with ongoing day to day experience
– insist on regular feedback from your trainers

12. FRCPath Part 1
• 1x3hour MCQ
• 125 questions (86.4 secs/question)
• Single best answer
• No negative marking

13. MCQ Format
A Chemical Pathology SpR is preparing for FRCPath
Part 1
What type of mock exam is likely to be most
helpful for preparation?
A Essay
B MCQ
C Oral
D OSPE
E SAQ

14. FRCPath Part 1 MCQ
Theoretically, osmolality can be measured using any of the
colligative properties of a solution.
In clinical laboratories, which colligative property is most
commonly used to ascertain the osmolality of serum and
urine?
A Depression of freezing point
B Elevation of boiling point
C Lowering of vapour pressure
D Oncotic pressure
E Osmotic pressure

15. Content of Part 1 examination
Topic area No of
questions
Acid base homeostasis, blood gases 5
Calcium and bone disease 5
Cancer and tumour markers 5
Cardiovascular and lipids 10
Diabetes and endocrinology 10
Inherited metabolic disease, genetics, paediatrics,
pregnancy, screening
15
Kidney, water and electrolytes 15
Laboratory techniques 15
Liver, proteins, enzymes 15
Miscellaneous
(eg IT, audit, QC, statistics, governance)
15
Nutrition and gastroenterology 10
Therapeutic drug metabolism and toxicology 5

16. Part 1 Part 2
FRCPath overarching structure
Clinical
Biochemistry
Clinical Biochemistry
Stage A
examination
OSPE
MCQ
1x 3 hour paper
(125 questions)
Module 1
OSPE
Practical
M
Module 2
Cases/Critical appraisal
Oral
Module 3
Dissertation

17. Keys to your success
• Part 2 FRCPath Skills and knowledge application
– Wide ranging workplace-based experience with feedback
• Shift lots of glass
• Get your lab coat on
• Optimize all clinical opportunities
– Get people to set you practical exercises
– Practice oral exam technique
– Do a mock exam
– Attend a course?

18. FRCPath Part 2 OSPE
3 hours
19 stations (9 minutes per station)
• analytical outputs
– e.g. electrophoretic strips, chromatography scans
• clinical scenarios
– e.g. sample requirements, investigation protocols
• quality control and/or external quality assurance data
• calculations
– eg analytical, physiological or pharmacological

19. FRCPath Part 2 Module 1 Practical
3 hours
• Part A Experimental design
• Part B Data analysis
• Part C Practical exercise

20. Practical Paper
Part A
• Write a validation exercise for a change of assay
from a Jaffe based creatinine assay to an
enzymatic based creatinine assay.
• At the same time the renal team would like to
move from the MDRD to the CKD-Epi equation.
Detail a plan for this and how you would
implement these changes.
•

21. Practical Paper
Part B
• Using the data provided write a validation
report and detail the clinical advice you will
give to clinicians.

22. • Part C
Using the samples required, measure enzymatic and Jaffe creatinine
and determine if any differences are observed
You are supplied with a Patient sample spiked with 100 nmol/L bilirubin,
1 calibrator sample and 1 QC sample
Jaffe Method: reagent 1, reagent 2, water
Take 50 uL sample, 250 uL R1, 2700 uL of water, 200 uL of R2
Incubate for 5 mins at room temperature, read absorbance at 500 nm
Wait a further 5 mins and read absorbance again
The change is absorbance is proportional to the concentration of
creatinine. The calibrator value is 385 umol/L, the method is linear up to
1500 umol/L
Enzymatic Method: reagent 1, reagent 2, water
Take 20 uL of sample, 800 reagent 1, 265 reagent 2, 2000 ul of water
Read absorbance at 548 nm at 10 mins
Product is stable for 5 mins

23. Answer notes
• A passing candidate will be able to produce results from at
least one of the assays. The practical has a strong element
of time management in it as multiple reading as have to
take place. Despite the samples being spiked with 100
nmol/L of bilirubin no difference between the results has
been observed of this assay. Therefore the correct result
should be to say that no difference was observed.
• Excellent candidates will present their laboratory data in a
neat and concise manner, using tables where appropriate
and showing clear calculations etc.

24. Part 1 Part 2
FRCPath overarching structure
Clinical
Biochemistry
Clinical Biochemistry
Stage A
examination
OSPE
MCQ
1x 3 hour paper
(125 questions)
Module 1
OSPE
Practical
M
Module 2
Cases/Critical appraisal
Oral
Module 3
Dissertation

25. FRCPath Part 2 Module 2
Written component
1hour – 6 clinical cases
2 hours – 2 journal evaluation exercise
Oral
2x20 minutes

26. Clinical Case

27. Answer notes
• Candidates would be expected to:

28. Management Question
You are three months into your Consultant appointment and are asked to
represent Pathology) on the Trust’s established General Practitioner (GP)
Liaison Group. This meets every two months to review clinical and support
services provision by the Trust.
After two meetings it is clear that there is general dissatisfaction with the
Pathology services and Chemical Pathology seems to be singled out for much
non-specific criticism. (‘Too slow’ and ‘unhelpful’ are familiar comments from
the more vociferous GP’s).
You ‘volunteer’ to conduct a formal review of user satisfaction among the
GP’s as the basis for changes in service provision.
What approaches to gathering the required information would you consider
and why? What do you feel will be the key aspects of the services to GP’s on
which you will need to seek opinion

29. Answer notes
Approaches to Gathering Information
Background Existence of any current service agreement and standards. Previous audits
(if any) of service to GP’s Formal log of complaints from GP’s (general or discipline
specific)
New Information Audit of current service Questionnaire – validity? Design? Visits to
selected GP’s (possibly with questionnaire) Views of laboratory staff
Aspects of Service for User Opinion/Level of Satisfaction
May include: Access (‘opening hours’) Request form design (personalised;
multidisciplinary) Phlebotomy Services (?domiciliary visits) Turnaround times Transport
of Samples and Reports Availability of Consultant advice Electronic Data Interchange
POCT Support Management data on Pathology usage by practice CPA Status
(awareness!) Participation in Clinical Audit
Pathology handbook/Information sheets/CD (covering much of the above information)
Some of the above will require an overall opinion, others (eg. consultant advice) may
require discipline specific information.

30. Concluding Remarks
• FRCPath examinations provide a rigorous and fair test of
cognitive skills
– Part 1 knowledge
– Part 2 skills and application
• Together with workplace-based assessments they sample
all aspects of the curriculum
• Candidates who are fully engaged in a well structured
training programme have high probability of success