MRCS Examination Guide

The following document was written by Mr Max Whittaker MBBS (Lond), MRCS (Eng) in February 2008. Mr Whittaker wrote this guide to answer basic questions and offer practical advice for candidates preparing for the surgical membership examinations.

The MRCS Examination

Since deciding on a surgical career, the prospect of completing the MRCS examinations has been constantly present at the back of the mind of every surgical trainee. Despite their importance, it can be difficult to find clear, practical information to guide you through the process — much of the most useful advice is passed on by word of mouth from those who have recently sat the exams.

The following guide attempts to answer some basic questions, offer simple preparation advice, and dispel some of the anxiety that surrounds these examinations.

Current MRCS Structure (Part A and Part B)

The MRCS is now a two-part examination delivered by the Intercollegiate Examination Board on behalf of the four surgical Royal Colleges.

Part A — Written Knowledge Examination

Part A consists of a single sitting with two papers, each of two hours' duration. The two papers are:

• Paper 1: Applied Basic Science — anatomy, physiology, pathology, pharmacology, and microbiology as applied to surgical practice.
• Paper 2: Principles of Surgery-in-General — perioperative care, surgical technique, surgical infection, nutrition, wound healing, trauma, transplantation, and oncology principles.

Marks from both papers are combined to give a total Part A score. Candidates must achieve the required standard in both papers to pass Part A overall.

Part B — Objective Structured Clinical Examination (OSCE)

Part B is a clinical examination conducted as an OSCE. It assesses the candidate's ability to perform clinical skills, take a history, communicate with patients, and demonstrate knowledge in a structured clinical setting. The current Part B syllabus and station structure are updated periodically — consult the relevant Royal College website for the current blueprint.

Historical MRCS Structure (for Context)

Mr Whittaker's original guide was written during the transition from the old three-part structure to the new two-part system. The old system is described below for historical context; it is no longer in operation.

Old Part A: Applied Basic Sciences

• Duration: 3 hours
• 180 Single Best Answer (SBA) questions (as of January 2008)
• Topics: anatomy, physiology, pathology, pharmacology

Old Part 2: Clinical Problem Solving

• Duration: 3 hours
• 180 Extended Matching Questions (EMQs)
• For each scenario, select the single most likely option from the list

Tips for Written Papers (MCQ, SBA, EMQ Format)

These principles from Mr Whittaker apply equally to the current Part A format:

• Technique matters as much as knowledge. Candidates who approach questions methodically often outperform those who have revised more but have poor exam technique.
• There is no negative marking — attempt every single question. Never leave a question blank.
• There are no trick questions. The questions are designed to test your knowledge straightforwardly. Do not read too much into the wording — answer what is being asked.
• Transfer your answers as you go. Filling in your answer sheet question-by-question as you progress avoids the risk of transcription errors and the panic of trying to copy answers in the final minutes.
• Work by elimination. In any SBA or EMQ, several options will be clearly incorrect, leaving you with two plausible answers. Eliminating wrong options improves your odds significantly.
• Trust your first instinct. If unsure, your initial answer is usually correct. Changing answers without a clear rationale tends to reduce scores.

How to Revise for the Written Papers

Finding the motivation to revise while working a busy clinical schedule is challenging. The most productive revision tends to happen in the final two to three weeks before the exam when the stakes feel real. For this reason, wading through large textbooks from cover to cover is often inefficient.

• Use practice questions to identify your areas of weakness, then focus your reading on those topics.
• Many good question banks provide detailed explanations for each answer — these alone can provide sufficient learning content without needing to read entire textbooks.
• Aim for consistent daily practice sessions rather than occasional marathon revision days.

Revision Resources for Part A (Written Papers)

• Pastest MCQ and EMQ books — widely regarded as the best for detailed feedback and explanation of answers. Also available as an online subscription with a larger question bank.
• Onexamination.com — a large source of questions classified by topic, with good feedback and the ability to compare your score against other online users sitting the same exam.
• Intercollegiate MRCS syllabus document — available from the Royal College websites. Revising to the syllabus ensures you do not miss high-yield topics.

Old Part 3 — Oral Examination (Viva)

The old Part 3 viva consisted of three stations, each with two ten-minute vivas. The subjects were:

Anatomy Station

• Applied surgical anatomy
• Operative surgery

Physiology Station

• Critical care physiology
• Applied surgical physiology

Pathology Station

• Applied surgical pathology
• Principles of surgery

Oral Examination Scoring

Each oral section was scored from 1 to 4:

• Score of 3 or above — satisfactory performance
• Score of 2 — may be compensated for by a score of 4 in another section
• Score of 1, or more than one score of 2 — definite failure

Revision Resources for Part 3 Oral

• Applied Surgical Physiology Vivas — Mazyar Kanani, Martin Elliott
• Surgical Critical Care — Mazyar Kanani
• General Pathology — David Lowe

Old Part 3 — Clinical Examination

The Part 3 clinical examination consisted of four bays:

• Head and neck, breast and axilla, skin
• Trunk and groin
• Vascular
• Orthopaedic

Each bay contained two 7-minute sections, usually representing one longer case and several short cases. The scoring system was:

• Each section scored 1 to 4
• A total score of 24 was required to pass
• A combined score of 4 from a pair of examiners in more than one bay resulted in definite failure

Clinical Examination Technique

Establish a consistent routine for every patient encounter and apply it automatically:

1. Introduce yourself by name and role
2. Obtain consent for the examination
3. Ask about any pain or tenderness before you begin
4. Expose the relevant area adequately
5. Perform the requested examination systematically
6. Wash your hands after the examination
7. Thank the patient
8. Assist in redressing if appropriate

When asked to describe or classify findings, structure your answer logically:

• Classify and sub-classify answers — for example, causes of renal failure: pre-renal, renal, post-renal; lumps: use a surgical sieve or superficial versus deep.
• Lead with common causes first, then proceed to rarer ones.
• If the examiner allows the conversation to develop, direct it towards an area you know well.

Revision Resources for Part 3 Clinical

• Clinical Cases and OSCEs in Surgery — M. Ramachandran, A. Poole (good theoretical content)
• Surgical Short Cases for the MRCS Clinical Examination — C. Parchment-Smith (similar content with good clinical photographs)

Old Part 3 — Clinical Communication Skills

The communication skills component consisted of two stations. Candidates had five minutes to read an information sheet explaining the scenario before entering each station. The scenarios were divided into:

• Information giving — possible scenarios included breaking bad news, obtaining informed consent, and discussing the treatment of a condition.
• Information taking — usually structured history taking from an actor or examiner playing the patient role.

Contact Information

For official information about the MRCS examination, contact the relevant Royal College:

• Royal College of Surgeons of England
  35–43 Lincoln's Inn Fields, London WC2A 3PE
  Tel: 020 7869 6281 | Fax: 020 7869 6290
  rcseng.ac.uk — MRCS
• Royal College of Surgeons of Edinburgh: rcsed.ac.uk
• Royal College of Physicians and Surgeons of Glasgow: rcpsg.ac.uk
• Royal College of Surgeons in Ireland: rcsi.com

Good luck!!