*Disclaimer:* The notes available online are my **‘revision notes’**. This is not a replacement for text books or local teaching. I have outlined which reference texts I used and my approach in the advice below. I would recommend printing these notes out or electronically annotating the notes to create your own revision set. I found these notes especially useful in the last month where reading the texts again was impossible, but going though my notes gave me a rapid overview. Furthermore, these notes are not exhaustive. Some topics that are very conceptual I didn’t feel the need to make notes for. I learnt it from books/teaching and that was that. Other bits of information tend to disappear if not revised and this is what the notes are for. MOST importantly – reading someone else notes just before the exam will not help you. It will more likely confuse you. But if you use these as a starting point to annotate, then near the end you’ll have a set that makes perfect sense to you.

**Introduction**

If you’re feeling slightly overwhelmed and worried about the Part 1 exams then I promise you that you are NOT alone. It’s scary. MRCP had a bunch of revision questions we could easily access and most people tend to have a fair idea on how they’re going to perform on the day. FRCR Part 1 is different. Lots of reading and reference texts. No question bank that promises to cover everything. (it’s ridiculously difficult to make this happen). Subjects like Physics which the majority of us haven’t thought about for years. I get it. I felt the exact same way too. But it’s definitely doable and the journey can be an interesting (almost enjoyable…) learning experience.

I’ve outlined below my approach to the exam. I am a Leeds trainee and I did pass all 4 papers at the first attempt. I was pleasantly surprised to end up with the Frank Doyle Medal – so I know I’d done something right. This my effort to give back and try to make it slightly easier for others after me. However, this is most definitely not the only way or the only approach. This is me simply sharing my experience and my opinions.

The most important thing to remember is that it’s a vast syllabus but arguably – everything you learn is relevant and can be applied to your clinical work. So start early! You’ll also find yourselves in clinical rotations and will quite naturally want to devote time reading literature relevant to the subsite you’re rotating in. So FRCR Part 1 Prep is something that should continue alongside regular clinical work/reading throughout your ST3 year. I’d recommend starting at least 6 months prior and 2 months of concentrated effort near the end.

GENERAL TIP FOR FRCR PART 1: **PRINT OUT THE SYLLABUS.** Vast expanse of knowledge to cover. Cross off each exam topic as you read it and ensure you cover everything. *Good luck and happy reading!*

**CANCER BIOLOGY**

Molecular Biology of Cancer by Lauren Pecorino – 4th edition : Probably THE best book for cancer Biology. Excellent diagrams, clear explanations and encouragement to think critically.

Good reference book for when you’re stuck with a concept: The Basic Science of Oncology. Ian F. Tannock, Richard P. Hill.- 3rd ed. (there are new editions – this was the one available to me)

**Questions:** *ASTRO Questions *(*American, available online, google Astro radiation/cancer biology questions. 2013 to 2018 papers available online as pdfs.*) Covers Cancer Biology and Radiobiology. Excellent explanations and excellent preparation for exams. If you go through these papers I promise you – you’ll be well prepared.

Course: Local teaching or self study. Course Not needed

**RADIOBIOLOGY:**

Choose one of the two books for conceptual understanding. I used Eric Hall.

- Radiobiology for the Radiologist. 7th Edition. Eric Hall. Earlier versions available online as a pdf

2. Basic Clinical Radiobiology. 4th edition. Michael Joiner, Albert Van der Kogel.

Radiobiology is conceptual and apart from concepts, it also involves being comfortable with reading graphs, solving simple mathematical equations (e.g for BED).

**Questions:** *ASTRO Questions *(*American, available online, google Astro radiation/cancer biology questions. 2013 to 2018 papers available online as pdfs.*) Covers Cancer Biology and Radiobiology. Excellent explanations and excellent preparation for exams.

Course (if needed): The Christie’s School of Oncology run a Radiobiology course led by Dr Catherine West. Truly excellent. Radiobiology is also a conceptual topic and helpful when taught well.

GENERAL MATHEMATICAL ADVICE

Many candidates will not have thought about maths for years! It’s useful refreshing a few concepts that will be keep appearing in multiple topics including radiobiology (cell survival curves), pharmacology (pharmacokinetics and half life), radioactivity (radioactive decay), physics of dose distributions (PDD).

- Log to the base 10 and natural log or e. How to express a number in logarithmic form and be able to convert numbers from log forms to exponential form
- Laws on exponents : Product, Quotient, Power, Zero and Negative exponent laws. https://www.onlinemathlearning.com/expression-exponent.html
- Fractions. How to solve for ‘x’ in simple equations with fractions.
- Reading exponential curves on graphs and expressing exponential graphs as mathematical functions.

If these concepts are familiar to you then that’s helpful. If not – don’t worry. I found myself googling ‘what is a log function’ and ‘what is e?’ at the start of my physics course too! And my advice is quite simply – google the terms. There are so many good you tube videos that take you through the concepts. Khan Academy is also a brilliant resource to refresh your knowledge. It’s a series of video lectures aimed at the high school student – and this is exactly what you need.

**PHARMACOLOGY**

Print off the drug list in the syllabus as available on the RCR website and cross off each drug as you read about it/make notes.

The basic science of oncology editors, Ian F. Tannock, Richard P. Hill.- 3rd ed. **THE CHAPTERS ON PHARMACOLOGY IN Tannock and Hill are excellent.**

Read pdf’s of British Columbia Cancer Drug Manual. Identify drug names from the syllabus and download the relevant pdf. Make notes! http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-drug-manual/drug-index

*Optional: W*ashington Manual of Oncology, 3rd Edition 2015. Authors/Editor: Govindan, Ramaswamy; Morgensztern, Daniel. Publisher: Lippincott Williams & Wilkins.

Understand the concepts of PK and PD. Simple sums in the exams might be expected. https://www.ashp.org/-/media/store%20files/p2418-sample-chapter-1.pdf

**REMEMBER** – you need to understand the concepts. The mechanisms of actions, main differences between similar drugs (cyclophosphamide vs ifosfamide), typical toxicities, mechanisms of resistance, vesicant or not. You need to know whether drugs require dose reduction in renal or hepatic disease (not the exact percentage reduction for ‘x’ level of renal clearance – even in real life you will look this information up! But you do need to know whether you need to check….). Common toxicities of TKIs, whether a drug acts on a surface receptor or not are common questions. Do not forget to pay attention to steroids, antiemetics, opioids, bisphosphonates. Most trainees neglect these drugs and lose marks.

*Questions – none really out there…..*

**STATISTICS**

Statistics at a Glance. Aviva Petrie and Caroline Sabin. 3rd Edition : Literally ALL you need. Excellent book and more than sufficient. Pdfs of older editions available online. Covers both statistical test and trial design. GCP training with further supplement knowledge needed on research ethics. *Does not specifically cover: Mortality ratios, direct and indirect standardisation of mortality ratios and actuarial survival analysis. These are specific topics that might need further reading elsewhere. *

* Questions:* I recommend buying the “medical statistics at a glance workbook” for a thorough understanding

*Online questions* from Medical statistics at a Glance team: http://www.medstatsaag.com

**PHYSICS**

Physics for Clinical Oncology (Radiotherapy in Practice). Amen Sibtain, Andrew Morgan, Niall McDougall. : Excellent book and covers the syllabus for Part 1.

But physics is a conceptual topic and best learnt on your local course and with spending time in the physics department – watch the radiotherapy machines, sim machines. Spend time watching radiographers use image guidance to decide whether to proceed with radiotherapy. Understanding how to use wedges and resultant dose distributions are best learnt after learning the theory and then applying it by trying to forward plan a 3D plan with a physicist. If your course doesn’t arrange for this formally I strongly recommend approaching your physics department. Only then will it all start to make sense.

Simple mathematical calculations will be expected on inverse square law, abutting radiation fields, Monitor unit calculations, PDD calculations. This will involve being comfortable using fractions and solving for ‘x’. No specific mathematical skills in trigonometry or integration/differentiation are needed.

** Questions: **Raphex Questions (American) available online at a cost. Truly Excellent for understanding though. Your local physics department or seniors might have older questions sets. Raphex papers consist of 3 sections: General, Diagnostic and Therapy. ONLY GENERAL AND THERAPY are relevant for the FRCR Part 1 trainee.

Extra Course (if needed): The Christie’s School of Oncology runs a 5 day course and 1 day revision course. BOTH, in my opinion, are revision courses. You cannot LEARN physics or a conceptual topic in 5 days of lectures. But both work excellently as revision courses.

TIPS FROM THE RCR

The RCR produces guidance for candidates sitting the exam. Read the **‘Guidance Notes’ **produced by examiners that look at trends of answered questions by last year’s candidates. Useful information about what’s important, which topics candidates tend to do well in and which topics not so well in. It will help you direct your focus. There is also a helpful document called **‘advice for candidates’** that outlines resources for exams as collected from previous candidates. The link below takes you the RCR page with direct links to both documents.

https://www.rcr.ac.uk/clinical-oncology/examinations/first-frcr-examination

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