The FRCR 2B marking scheme, decoded.

What changed in June 2025

The reformed 2B scores each viva case on five domains rather than a single global impression. Cases are double-marked by two examiners and averaged, there are no half marks, and the pass standard is set for each sitting rather than fixed in advance.

The practical consequence: the examiners are not asking themselves "did they get it?" They are working down a list. This is the list:

The five domains, one by one

01 - Knowledge

Do you know the condition: what it is, what causes it, what happens next if nothing is done. This is the domain most preparation already covers, and the one least likely to fail you on its own.

02 - Observation

Did you see the finding, and did you name it in words that commit you? "There is an abnormality in the right upper zone" observes nothing. "There is a cavitating right upper lobe mass" scores. Precision of language is the difference.

03 - Clinical reasoning

Can you get from the finding to a working diagnosis out loud: a ranked differential, the one discriminating test, and a commitment. Listing five possibilities and refusing to choose is not reasoning - it is hedging, and examiners mark it as such.

04 - Clinical safety & management

The domain that decides borderline cases. What do you do, in what order, with the urgent action first - and what is the one dangerous mimic you must rule out before your plan is safe. "Refer to MDT" without the immediate safety step is where confident answers quietly fail.

05 - Communication

The viva is spoken. Who do you tell, how urgently, and does your answer sound like a radiologist handing over - structured, committed, finished - or like someone thinking aloud. This domain is scored on every single case, and it is the one almost nobody rehearses.

A right diagnosis can still lose the case

Because the diagnosis feeds only part of the scoresheet, the maths allows an uncomfortable result: a wrong diagnosis with safe, structured reasoning can still score, and a right diagnosis with unsafe management fails.

Name the tumour and forget the cord compression pathway - the safety domain is gone. Spot the fracture and stay silent on who you would phone - the communication domain is gone. There are no half marks to soften it, and a zero is not a blank: it is an examiner deciding the answer failed.

The RCR's examiners' reports flag the same pattern every sitting: marks are lost after the finding is named - on the next step, the management, the urgency, the handover. Rare diagnoses are not the problem. Common cases handled incompletely are.

The maths of passing: threes, not brilliance

The standard is a safe, structured, committed answer on every case - not a brilliant answer on a few. Twelve solid answers beat six dazzling ones and six gaps, because every case is scored on the same five domains and the misses accumulate.

That reframes preparation entirely. You are not training to impress; you are training to be reliably complete. Consistency across all five domains, case after case, is a trainable skill - which is precisely what makes the 2B passable on a schedule.

How to train each domain

Each domain maps to a specific, rehearsable habit:

1. Knowledge and observation - study the scored answer, not just the picture: the finding named in the words that commit you, plus the discriminators.
2. Reasoning - drill the same answer shape on every diagnosis until the structure is a reflex: recognition, next step, management, communication, killer mimic.
3. Safety and management - learn the pathway with the urgent action first, and always name the dangerous mimic before you close.
4. Communication - say it out loud, against the clock, and get the spoken answer scored. Reading silently does not train the domain that is marked.
5. Track readiness - readiness is a number, not a feeling: mastery per subspecialty and the weak domains named, so you fix gaps before exam day.

For the wider exam format - stations, case counts, double-marking - see the companion guide: how the FRCR 2B viva is marked.