As the prefaces to successive editions of this book suggest, the Final Fellowship of the Royal College of Anaesthetists (FRCA) examination has continued to evolve since its inception in 1996, now almost three decades ago. The perception that the basic science components were little different from those examined in the Primary FRCA led to a change in emphasis from ‘basic’ to ‘clinical’ science. Some saw the change as little more than cosmetic, albeit that the College asserted that the structured orals were intended to test ‘the understanding of basic science to the practice of anaesthesia, intensive therapy and pain management’. The College has always included the proviso that ‘it is accepted that candidates will not have acquired a detailed knowledge of every topic during the period of recognised training’, and the examination is linked specifically to the curriculum, but hitherto this statement on occasion contrasted uneasily with the bitter perception of some candidates that they had been examined almost to destruction on scientific minutiae. This perception, against a background of muted unease about this section of the exam, has long since been acknowledged by the College, which decided therefore to introduce greater clinical emphasis into the science oral. The change of emphasis initially was relatively subtle, but in the current iteration of the SOE, it is much more explicit, with a clinical scenario usually prefacing discussion of a basic science topic. That change notwithstanding, you will be expected to discuss the clinical science subject in some depth because both the College and its examiners are reluctant to dilute the rigour of what for most candidates will be the last examination in anaesthesia that they are likely to take.