Intended for healthcare professionals

Career Focus

# How to pass MRCPath

BMJ 2004; 328 (Published 12 June 2004) Cite this as: BMJ 2004;328:s237
1. Peter Cross, freelance journalist
1. Londonpetercross{at}medix-uk.com

## Abstract

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 Pathologists and interview examiners and candidates for their tips on passing it.

MRCPath is a different exam for different specialists. There is, for example, an exam for haematologists, one for immunologists, histopathologists, forensic pathologists, biochemists, and molecular geneticists; a whole portfolio of examinations for different subspecialties. MRCPath is unique among membership examinations as it is also taken by non-medics including vets and toxicologists. For histopathology and immunology exams, there are typically only two or three candidates.

You can download a free 70 page booklet of regulations for the different MRCPath exams from the college's website: www.rcpath.org/index.php?PageID=517.

We expect most people to pass

Although MRCPath is taken at the end of specialist training it isn't an exit exam, because the royal college considers the CCST to be the exit qualification. Part 1 is usually taken after one to three years of higher specialist training. It is a test of knowledge, understanding, and practical aspects. Candidates are usually just into SpR level. Part 2 is taken after a minimum of four years training. Many of the MRCPath exams have OSPEs, objective structured pathology examinations. Most contain a clinical component. It is also possible to apply for membership on the basis of published works.

## Pass rate

The royal college told us that it doesn't “have the IT support” to know the exact pass rate, but estimates it at around 80%.

## How much does it cost?

• Part 1: All specialties (except histopathology, new medical microbiology, and virology)

• Part 1: written £250

• Part 1: practical and oral £250

• Part 2: all specialties (except histopathology, new medical microbiology, and virology)

• Part 2: practical or oral £275

• Parts 1 and 2: histopathology examination (and part 2 related subspecialties)

• Part 1: written £250

• Part 2: practical £525

• Parts 1 and 2: new medical microbiology

• Part 1: multiple choice question £250

• Part 2: written £250

• Part 2: practical and oral £275

## Who writes the questions?

Questions are compiled by a group of examiners.

## The examiner's view

“We are unique in being the only multiprofessional college,” says Clair du Boulay, chairman of the examinations committee, “and our exams reflect that. MRCPath isn't an exam that most people fail as candidates are usually well prepared. Our exam isn't a screening exam but a test of competencies towards the end of training. We expect most people to pass. It is criterion referenced. We don't have a set percentage to fail.”

Clair explains that people who fail tend to be those who haven't been in proper training programmes. “Others fail because they are no good,” she continues, “Some don't put in the time and effort. The majority of people who fail don't know their stuff. They make mistakes diagnosing and would be dangerous. I would be up for failing someone who was a non-communicator, but so far we fail people who don't know enough.”

Clair feels the exams are designed to test knowledge, skills, aptitude, attitudes, and communication. “For example, a histopathologist will have to do an autopsy as part of their part 2,” she says. “We don't recommend people put themselves forward unless they are in a proper training programme in the United Kingdom or overseas. They need to have proper supervision that prepares them for exam.”

Some of the candidates who have failed the exam include overseas doctors who had been working as professors in their home countries. “We recommend doctors from overseas work in a UK training programme for a short time before sitting the exam,” says Clair, “There are enormous cultural differences in how people are taught. They come here and see that it is OK to ask a question. That's an advantage as in a viva they will be able to have a debate.”

She explains a college dilemma: “We often wonder if the exam should be tailor made for the UK and test British diseases. But is it fair for someone who has worked in Africa to be tested on essentially UK health problems? Diseases are different in different parts of the world and our view is that our examinations are really to test people in the UK.”

According to Clair, it is important for candidates to “demonstrate they have taken into account a range of differential diagnoses. We are not looking for right and wrong. We are looking for safe practice and for doctors to say when they don't know. That's what patients need.”

## The candidate's view

“A lot of people struggle to get part 1,” says Daniel Scott, consultant histopathologist at Harrogate District Hospital, who passed the MRCPath last year and took up a consultant post afterwards. “People look at it as a mountain of knowledge: hundreds of papers, hundreds of articles, thinking Oh my God, where do I start?'” Daniel's solution was, “a problem orientated approach. Some people read every article over the last two years thinking they're bound to come up because they are trendy and new. That is a failing attitude because it is not focused. I made a list of all the topics that were going to be covered and for each I read one or two articles, sometimes from a text book, sometimes from a journal.” He particularly liked Recent Advances in Pathology and Progress in Pathology and Current Diagnostic Pathology, edited by C S Herrington. For general articles, Daniel recommends the CPD Bulletin in Cellular Pathology by Sanjiv Manek and Robbins Pathological Basis of Disease.

He then spent four months producing revision material: “Some people claim to have read one thousand page test books twice, and either I don't believe them or they have an amazing ability to concentrate and read a book. Remember that no examiner will expect you to write a four page essay on an incredibly rare disease. Examiners aren't that unrealistic. A lot of my work was putting my base together: photocopying articles and putting them on four lever arch files. And for the last month I hardly looked at a book but read those lever arch files three or four times.”

Daniel elaborates on how important it is to think about marks: “Because of closed marking you can't afford to fail one part of the exam,” he warns, “They are marked out of ten. Three is a fail, four is a pass, and five a good pass. You've got to average 16 for the four passes. If you get three that means that you have to make it up with a five, and it is virtually impossible to get a five. A lot of people look at a question and think That's my weak answer and I won't invest much time on it' but you've got to be able to answer four questions.”

Exams are full of myths

“Not many people fail on autopsies,” says Daniel, “but people get tripped up because they don't present themselves in a professional manner. It's your first physical exposure to the examiner, your chance to get that examiner confident in you. You know what you're doing, you're capable, you're competent, and you know you've got some interpersonal skills and can present your findings formally.”

“Exams are full of myths,“ says Daniel, “autopsy has special techniques, done very occasionally to specific parts of the body, like the spinal column or middle ear, and people get really hung up about these. There are stories about people being asked to do these things, but I don't know anyone asked to do anything pretty difficult. It's there to test your training. You are much more likely to be asked about dealing with a coroner and death certification.”

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