How to pass the MRCP

Part 1

“The part 1 syllabus looks like the first year of medical school, only twenty times harder. Three months before part 1, I bought lots of MCQ books and ploughed through them. I went on the Pastest course four months before the exam. I recommend going on a revision course early as it showed me how much work there was. On the Pastest course I was given a folder of questions that previous candidates have memorised, so when I sat the exam I had seen some of the questions before.

Examiners may change the question slightly, but if someone has explained it to you and you understand what you are being asked, you are likely to score very well. Candidate's mark distributions are so close that probably all you need to pass is some past questions. Read and learn Multiple Choice Questions for MRCP by Hugh Beynon. He's a clever bloke. His questions are very difficult, but the explanations are superb and you will learn a lot about weird and strange diseases that creep up because examiners like asking about them. It gives you an insight into how questions are written.”

Part 2

“I recommend Sanjay Sharma's Rapid Review of Clinical Medicine for Part 2. It got me through the written, but I messed up the clinical. If a station goes badly it can mar the whole exam. The clinical component is unbelievably stressful and it is easy to muddle up clinical signs. If examiners are watching you and ticking boxes it is very easy to do badly because it isn't the same as real life. I don't think any clinical exam is like real life.”

Pass rates

“They only let a third of people pass at each sitting. The vast majority of candidates are doing busy district general hospital jobs and cram their revision around that. Most people will pass, just not at their first sitting.”

PACES

“Keep your head during PACES. As you do each station, forget the previous one. Even if you have said something silly, like mentioning a collapsing pulse on a patient with aortic stenosis, forget it. When I failed I was thinking about something I did wrong for the next half hour. Move on and do your best, over and over. I did that the second time. It worked.”

Stress

“Each time you sit the exam, it exposes you to extreme stress, which gets easier to deal with. Courses recreate mock PACES, but because you know it's a mock, however mean and horrible your examiners act, it is nothing like the big day.”

Final advice

“This is going to be one of the most miserable periods of your life. You are working very hard and being a student in your spare time. It feels like a treadmill, and that's exactly what it is. Remember you may not pass this time but if you are determined, you will get MRCP in the end.”

Claire Collett also took more than one attempt before passing MRCP at the end of last year. She recommends, “doing a bit each day and finding someone to revise with as you can motivate each other. I did thousands of MCQs for part 1. For part 2 I did lots of bookwork but with hindsight feel that Ryder's An aid to the MRCP Short Case and Baglia's 250 Cases in Clinical Medicine are the only books worth getting. I revised for PACES by using those two books and by seeing lots of patients. The first time round I got too nervous to think for the PACES exam.”

Part 1

“Part 1 has a pass rate of 35%. It's tough. Many doctors underestimate the scope of clinical knowledge expected. They are unprepared. We may not want incredible detail, but we do want breadth.”

Written exams

“Best of five questions test basic science as well as statistics, clinical pharmacology, and other specialties. Areas that give specialist registrars the knowledge base and powers of deduction to use basic information in clinical settings.

“Part 2 has a pass rate of 60-65%. Candidates tend to trip up on interpretation of scientific information.”

Obstruction

“The college isn't being obstructive by producing an exam that is too difficult or irrelevant. Any assessment will be flawed, but there has to be some sort of written assessment and it has to be wide ranging.”

Revision courses

“Preparation takes months. Crammer approaches are difficult to uphold educationally. There are always instances in PACES where you see they've been taught this way or that way.

Textbooks

“We use the Oxford Textbook of Medicine as our reference. If it isn't in there then it won't be in the exam. We don't look for obscurity.”

Professor Peter Kopelman is the incoming chairman of the MRCP clinical examining board. His area of expertise is PACES.

PACES

“Station 1 is on the respiratory system and abdomen. There is an introductory spiel like, `This 44 year old man gives a three month history of progressively worsening shortness of breath.' Just as in real life, there might be patients without physical signs. At six minutes candidates are warned that there is one minute left, then they are asked to present findings and discuss management and investigations. At the end of ten minutes, candidates move to a patient with abdominal problems.

“The candidate has five minutes outside station 2, on history taking. They read a general practitioner's letter, for example, `Dear Dr X, I'm very concerned about this patient who has had an increase in bowel motion and is passing blood.' They carry out a task in the letter, like `give your opinion.' At 14 minutes the patient leaves, the candidate has a minute to reflect and examiners ask questions.

“Then the candidate goes to station 3 and faces a 10 minute examination of a patient with a cardiovascular problem and 10 minutes with a patient with a neurological problem.

“Station 4 is the communication station. It may be breaking bad news, explaining a procedure to a patient or relative, explaining withdrawal of feeding or a decision not to resuscitate. My colleagues and I vet scenarios before they are used. We rehearse scenarios with simulated patients and agree what a doctor should do. We are trying to replicate real life.

“The last station includes other systems: eyes, skin, and locomotion. Candidates are asked what they find, how they would investigate and manage, so it is more than just a spot diagnosis.

“Candidates fail because they have poor examination technique or poor history taking skills. Others are unable to interpret findings to put together a differential diagnosis. Increasingly young doctors are aware that revision courses only tell you about exam method, and that application and interpretation of physical signs comes from experience.

“My advice to candidates is to be as experienced as you can. Go back to day one of medical training and read a clinical methods book. Appreciate the applied physiology. Understand what physical signs mean. A lot of junior doctors are poor at analysing them. Be observed in your clinical method by a senior doctor prepared to compliment or criticise. Courses can't provide that but the consultant on your post take ward round can.”