Intended for healthcare professionals

Career Focus

How to pass MRCPCH and DCH

BMJ 2004; 328 doi: (Published 01 May 2004) Cite this as: BMJ 2004;328:s177
  1. Peter Cross, freelance journalist
  1. Londonpetercross{at}


As part of our series to help you succeed in the current postgraduate royal college exams, Sabina Dosani and Peter Cross give the lowdown on the membership exam of the Royal College of Paediatrics and Child Health (and the Diploma of Child Health) and interview examiners and candidates for their tips on passing it.

The Royal College of Paediatrics runs two exams: the Membership of the Royal College of Paediatrics and Child Health (MRCPCH), required for entry into higher specialist training, and the Diploma of Child Health (DCH). The DCH is designed primarily for general practitioners but is also suitable for any doctor involved in looking after children—for example, child psychiatry or ear, nose, and throat surgery. DCH is not a requirement, but an additional qualification.

Part 1a is written and consists of multiple choice, best of five, and extended matching questions, It is based on general aspects of child health and is now common to people taking MRCPCH and DCH. Candidates sitting DCH go on to a separate clinical exam.

Part 1b is similar: multiple choice, best of fives, and extended matching questions on the scientific basis of paediatrics and extended knowledge.

Part 2 consists of written and clinical exams. There are two papers with best of fives or extended matching questions about case histories, data interpretation, and photographic material. From October 2004 the clinical is going to be a multistation exam. There will be two communication stations: one history taking and management planning station, one video station with six to eight videos, and six clinical short cases. The short cases will include child development, examination of the cardiovascular system, a neurology and neurodisability case, and three others. Most stations will be nine minutes each. History taking and videos are double stations.

Pass mark

The college was unable to tell us what the pass marks for the new style exam will be, “because the structure is going to be new.” The pass mark will vary with each exam, and “DCH is going to have a higher pass mark. It is a voluntary exam and if one was going to have a 20% pass mark, everyone would say that is not appropriate. While clearly people have to do a lot of preparation and work for it, getting a national training number is a bigger hurdle.”

How much does it cost?

  • Part 1a £135

  • For those going on to DCH clinical after part 1a £210

  • An extra £75 for DCH certificate and to be able to use letters DCH after your name

  • Part 1b £135

  • Part 2 written £280

  • Part 2 clinical £400.

The fees are applicable only to those sitting the exam in the United Kingdom. Fees vary in other countries.

Who writes the questions?

A panel of paediatricians recruited by the Royal College.

The examiner's view

“Would you like this person to be your specialist registrar tomorrow? That's the criterion we use for this exam,” says Tom Lissauer, officer for examinations at the Royal College of Paediatrics and Child Health. “In our exam a lot is about dealing with emergencies because that is the most important thing we require of a newly appointed SpR.”


Handling children is a key part of it


Before the new style clinicals, examiners will see the children and agree what they expect candidates to achieve. Tom explains, “We are looking for candidates to demonstrate they are used to handling parents and children. If children are not happy we are looking for candidates who are able to handle that.”

Tom believes that the main reason why candidates fail is a lack of experience: “There is a temptation for people to take the exam too early,” he says. “Everybody is so keen to progress that they just have a go and see what it's like. That is not the wisest way.”

The college doesn't recommend any books or revision material, other than, “our past papers and stuff on the web.”

“One problem,” says Tom, “is that people spend too much time learning how to take the exam and not enough time going back to the basics of knowledge and experience. If people think they are going to pass the exam by practising millions of multiple choice questions that is a poor way of preparing.”

The candidate's view

“For part 1 do lots of practice questions, which you can get from books,” advises Meena Patel, senior house officer at Great Ormond Street, London. She did part 1 in her first year of SHO training, and part 2 in her second year, passing both first time. The college has sample papers that Meena used as the basis of her revision rather than using books first.

“I did lots of questions,” she continues, “mainly from the Pastest series and Churchill Livingstone. The Pastest books are very good. I particularly like the one by Beattie. And go on courses. I went on a Pastest as they give you a huge range of questions.”

Would you like this person to be your specialist registrar tomorrow?

“It's not a pleasant thing,” said Meena reminiscing about part 2. “Because this is a new style of exam we weren't sure what to expect. It was quite stressful. The main advice everybody gave me for the written is to do lots of questions as you are revising, then look at books rather than the other way round. The more questions you do the more likely you are to come across cases that will come up.”

There still aren't many revision books focusing on the new part 2. Meena recommends “the Churchill Livingstone series: they've got good data books, they've got picture books. A great book I used was Grey Cases for the MRCPCH Part Two.”

She used these books to look up and learn answers to questions rather than trying to read them. “Everyone does different things but a lot of people advised me to do that,” she explains. “The same questions come up year after year so the more you see the more you recognise. That is one of the most useful things.”

“With the clinicals, learning is different,” says Meena, “Do lots of practice with registrars grilling you with viva questions so when examiners do the same you're not thrown.” She adds: “Put a bad case behind you and don't let it fluff you. If you get flustered you are at a disadvantage for your next short case or OSCE station.”

Meena suggests candidates think carefully about when to do the exam: “Do part 1 early, but part 2 needs clinical experience,” she says, “In certain jobs like neonates it is difficult to find patients suitable for exam practice. Busy jobs make it difficult to study.”


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