Intended for healthcare professionals


When is the best time to sit the MRCS examination?

BMJ 2017; 356 doi: (Published 06 February 2017) Cite this as: BMJ 2017;356:j461
  1. Duncan Scrimgeour, intercollegiate research fellow and specialty registrar in general surgery1,
  2. Jennifer Cleland, John Simpson Chair of Medical Education Research2,
  3. Amanda Lee, chair in medical statistics2,
  4. Peter A Brennan, chairman3
  1. 1Aberdeen Royal Infirmary and the University of Aberdeen
  2. 2University of Aberdeen
  3. 3Intercollegiate committee for basic surgical examinations
  1. duncan.scrimgeour{at}


Duncan Scrimgeour, Jennifer Cleland, Amanda Lee, and Peter Brennan shed some light on when to sit the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination

Advice on when to sit the MRCS is very much anecdotal. The Royal College of Surgeons recommends that candidates attempt Part A during their first year of core surgical training (CST) and Part B in their second year, but both parts are frequently attempted earlier.1 Indeed, an article in a recent issue of the Bulletin of the RCS of England recently encouraged foundation doctors who were contemplating a career in surgery to sit the MRCS during their foundation training.2 As part of our work on the predictive validity of the MRCS examination, we have looked at when candidates are more likely to pass both parts of this exam.

We looked at all UK medical graduates who had attempted both parts of the MRCS from 2008 to 2016, stratifying them by how many months candidates were from graduation before their first attempt at each part. We used this information to make inferences of their likely training grade.

In our cohort of 4317 Part B candidates, 25% had sat Part A in foundation year (FY) 1, 53% in FY2, 18% in CST1, 3% in CST2, with only 1% attempting the exam for the first time more than 47 months from graduation. Those who sat Part A in FY1 were more likely to pass than all other categories of doctors.


Part A pass rate (%) and months from graduation/likely stage of training

Fewer doctors attempted Part B in FY1 and FY2 (10%), or more than 47 months from graduation (10%), with the majority attempting it in CST1 (50%) or CST2 (30%). CST1 doctors were more likely to pass Part B than all other grades.


Part B pass rate (%) and months from graduation/likely stage of training

Certain groups passed Parts A and B with higher scores than other groups. FY1 doctors scored significantly higher than FY2s and CST1s in the Part A exam, and CST1s scored significantly higher than FY1, FY2, and CST2 doctors in Part B.

So when is the best time to sit Parts A and B?

Our results suggest that doctors who sit Part A in FY1 and Part B in CST1 are not only more likely to pass, but are also more likely to pass with a higher mark.

However, it is important to remember that the MRCS should not be treated merely as a hoop to jump through, but as an examination process that will contribute to knowledge of surgery in general. Candidates should only attempt the MRCS when they feel adequately prepared, which may be as a foundation doctor or a core trainee.

We do not recommend that all FY1s attempt Part A, but if these doctors have already decided to pursue a surgical career and feel prepared, then sitting it within the first year of graduation from medical school may increase their chances of success. By contrast, Part B is more clinically oriented and this may be one reason CST1s perform better than foundation doctors. It would seem sensible to attempt Part B after foundation year training.

The MRCS exam

The MRCS is a prerequisite for completion of core surgical training and mandatory for entry to specialty training. It is designed to safeguard patients and ensure high standards.13

It consists of two parts, A and B, and candidates must pass Part A before progressing to B.

Part A is a four hour written exam divided into two papers that use a combination of single best answer multiple choice questions (MCQs) and extended matching MCQs designed to assess knowledge of the general principles of surgery and applied basic science.3

Part B is a half day objective structured clinical exam (OSCE) consisting of 18 stations, designed to test two broad areas: knowledge and skills. Knowledge includes anatomy and surgical pathology, applied surgical science, and critical care, while skills are tested in clinical examination and procedural skills stations and in various communication scenarios.3


  • We have read and understood the BMJ policy on declaration of interests and declare that we have no competing interests.