Upcoming changes to the CR2B

This change was initiated by the RCR to ensure that we can maintain and demonstrate to our regulator that we have a high quality, fair exam whilst supporting an increase in capacity. It also ensures that the exam stays relevant to the needs of the curriculum and training programmes.

We had expert psychometric advice provided to the project team and regular consultation with training programme directors, heads of school and trainees via the RCR’s Junior Radiologist Forum. We had further input from trainees (specifically feedback from piloting exercises) and current examiners (following piloting, standard setting trials, re-marking exercises).

All RCR exams must meet rigorous standards set out by the General Medical Council (GMC). The changes have been thoroughly reviewed by the GMC and were granted approval in November 2024.

The curriculum being examined, and the level of competence expected, is not changing, so you should prepare and revise your radiological knowledge and skills in the same way as before the change. You should make use of the guidance and resources on the RCR website to ensure you are ready for the format and delivery methods.

Instructional videos and updated exam content on the risr/Assess demonstration site will be available soon. 

The RCR will be using the same exam venues as in recent years. 

On each day of the Oral component, all candidates will be examined on the same set of cases. To ensure that nobody has an unfair advantage by being told about the cases in advance, we must keep candidates isolated. 

Exam venues will have rooms set aside for candidates to wait before and after taking the Oral component. Whilst quarantine times may vary, all candidates should be prepared to spend most of the day at the venue. Quarantine times will be indicated on candidates’ individual timetables. 

You will not be allowed to use electronic devices whilst being quarantined. Paper-based reading material (such as books, printed text or handwritten notes) is allowed. Candidates suspected of breaking quarantine rules will be investigated in line with the RCR’s Exam Misconduct Policy.

The changes introduced to the scoring system ensure that the exam is fair and appropriately discriminates between passing and failing candidates. They should not make any difference to the way you prepare for the exam or answer questions.

The risr/Assess platform (previously called Practique) has been used for some years for the Rapid Reporting and Long Case components and we are happy that the image definition and manipulation features are sufficient for allowing a fair assessment of candidates’ abilities. We have conducted pilots using the new platform for delivery of the Oral component and it has performed well. Image quality checks will be performed ahead of each sitting as part of the exam's routine quality assurance processes.

The new Short Cases are replacing the old Rapid Reporting as the latter does not reflect current radiological practice. Plain radiographic interpretation is an essential skill for radiologists, particularly in the areas of paediatric imaging and chest imaging where the plain radiograph is likely to remain a key imaging modality for the foreseeable future. The Short Case component will not only assess a candidate’s ability to interpret plain radiographs but also their skill in writing accurate and concise reports with appropriate recommendations to the referrer on further imaging or management, allowing for a more in-depth assessment of plain radiographic interpretation skills. We believe it will be a more authentic examination as candidates will now be provided with clinical/patient information for each case and will be given sufficient time (five minutes instead of one minute per case) to review the images and produce an actionable report. The new format allows for more complex plain radiographs to be included in the exam, across a variety of clinical scenarios, and with multiple pathologies. 

This was the subject of extensive and wide-ranging discussion by members of the Project Board and key stakeholders. There were several reasons why the decision was made that the Short Cases would include only abnormal cases. Some of the factors considered are listed below:

• The existing Rapid Reporting does not fully assess a candidate’s ability to identify significant pathology or their ability to compose a concise and accurate report with relevant management advice. Consultant radiologists now have less exposure to plain radiographic reporting during training but will be expected to answer queries from junior radiologists or reporting radiographers for challenging cases throughout their career. Core competence in plain radiograph reporting therefore needs to undergo thorough assessment as part of the exam to ensure that trainees are motivated to master this important component of departmental workload.
• It is unrealistic to ask a candidate to decide whether a case is ‘normal’ or ‘abnormal’ in the absence of relevant clinical history or information about the source of the referral (e.g. general practice versus emergency department). Training radiologists are well aware that, for example, a ‘normal’ chest radiograph does not exclude an underlying lung cancer and that a normal appendicular radiograph does not exclude a fracture in the appropriate clinical setting, so may be reluctant to call a case normal in the absence of clinical information. 
• Access to CT and MRI has increased since the Rapid Reporting component was introduced, so radiologists now have the freedom to use these modalities in the appropriate clinical setting where a plain radiograph appears normal. 
• It is more difficult to create a fair mark scheme for a normal case with appropriate weighting within the structure of the exam without unwittingly demonstrating to the candidate which cases are normal. Abnormal cases included in the exam all contain numerous normal anatomical structures and, as such, will also test a candidate’s ability to recognise normality. 
• Exclusion of normal cases allows the candidate to be assessed on a greater range of pathological conditions, thus making the assessment more robust.

Short, simple statements of your observations, diagnosis and recommendation are all that is needed. You do not need to write full sentences. Sample exam content will be available on the website soon.

Examiners will have access to question-specific marking schemes for each case.

The Oral component is marked by the pair of examiners conducting each session. Scores from all examiners (across both stations) are then totalled.

All Short Case and Long Case questions are independently double marked and scores from both examiners contribute to your total final score.

See the scoring system for more details.

We are not changing exam fees because of these changes.

All candidates will receive a pass/fail notification with a breakdown of their scores across the three components.

From June 2025 all candidates will be assessed using the new format, regardless of any previous attempts.

The type of content used in the exam is unchanged and the same minimum standards for passing the exam apply. Previous exam attempts will still count. 

All candidates are advised to familiarise themselves with the new elements of the exam so that you know what to expect during the exam.