FPM Exam Handbook

Published: 18/05/2022

Scope and Depth of the Examination

The examination is set according to the curriculum of the CCT in Anaesthesia of the RCoA Pain Medicine and generic modules (Appendix A). The curriculum is based on spiral learning and each successive level of training builds on previous level(s). The examination therefore is based on the Stage 1, Stage 2, Stage 3, and Stage 3 Special Interest Area (SIA) in Pain Medicine training.

The specialist domains of the Stage 3 SIA in Pain Medicine of the curriculum, namely spinal cord stimulation, intrathecal drug delivery, cancer pain and paediatric pain medicine will not be specifically examined. However, the general Pain Medicine curriculum requires knowledge of these areas, so candidates should be aware that questions on them may arise (and have done so in the past), albeit in less detail than that expected for sub-specialist practice.

The science underpinning all parts of the syllabus is also a very important area of learning in working towards the examination and will be reflected in the questions asked. 

Scope and depth for the component parts of the examination are addressed below. 

The MCQ examination

The general aim of MCQs is to test breadth of knowledge: depth of knowledge is more fully assessed in Structured Oral Examinations. The MCQ bank is designed with this in mind. The questions will be particularly focused on the knowledge required to be a Pain Medicine consultant; areas examined will include both practical clinical knowledge and knowledge of relevant sciences as laid out in the RCoA and IASP curricula. A small number of questions will also be used to assess candidates on the more generic high-level skills required of a consultant; for example the ability to interpret the results of clinical trials relevant to Pain Medicine.

Three types of multiple-choice questions will be used:

1. Multiple True False (MTF)

These are the kinds of MCQ everyone is familiar with: each question consists of a stem followed by five, items each of which may be true or false.

2. Single Best Answer (SBA)

Each question consists of a stem, lead-in question and five options.  The stem has a maximum of 60 words focusing on a single problem.  The lead-in is precise and poses a single question.  The five options are all possible solutions or responses.  However, one of the options will be the best response.

3. Extended Matching Questions (EMQ)

Each question features a list of eight options (A to H) which can be lists of relevant items such as procedures, symptoms, technical machinery or figures.  These options (the ‘stem’) will feature five separate questions.  Each separate question will have an answer that can be selected from the list in the stem. (Please see exam questions bank

The marking system

One mark will be awarded for each correct answer in the MTF section. Four marks will be awarded for each correct EMQ and SBA question. There will be no penalty for incorrect answers.  The marks for all three sub-sections are added together to give a total mark. The pass mark is set by the examiners using assessment methods approved by the GMC.  


The Structured Oral Examination (SOE)


The Clinical Structured Oral Examination (SOE) of the FFPMRCA examination is 50 minutes in duration and will comprise a long case followed by three short clinical questions (SCQs). The long case will have a 10-minute preparation time during which the candidate will be given the opportunity to read a case history and view relevant investigation results provided. During this time the candidate may make notes on paper provided for this purpose. Thereafter, during the next 20 minutes, the clinical long case will examine a candidate’s in-depth knowledge of the assessment and management of a complex chronic pain patient. Knowledge of clinical assessment tools and investigations relevant to clinical practice and available treatments will be required. The final 20 minutes of the Clinical SOE will be given to the three short clinical questions. The topics of these questions could be any aspect of clinical pain medicine. No patients or actors will be participating in the Clinical SOE of the FFPMRCA examination. There will be two examiners for the Clinical SOE. The exam is closely audited and an auditor may be present but they take no part in the assessment of the candidate.


The Science Structure Oral Examination (SOE) of the FFPMRCA examination will comprise four sections, anatomy, physiology, pharmacology and a section covering psychology, epidemiology and clinical measurement. The total SOE will last 30 minutes. There will be two examiners for the Science SOE. The importance of the scientific basis of Pain Medicine for the FFPMRCA examination must be emphasised. The exam is closely audited and an auditor may be present but they take no part in the assessment of the candidate.

The marking system 

Two examiners are present for each part of the SOE.  Each examiner marks every question independently.  There are 10 questions. Pass = 2, Borderline performance = 1 and Fail = 0. The pass mark is set using assessment methods approved by the GMC.