As you step out of your last medical school exam, you realise you have been sitting high-stakes exams every year for a decade. Whilst the summer sun slowly warms up your glass of undrinkable prosecco, you look to the future, excited by the anticipation of your emancipation from the hospital library. After all, when will you next need to sit an exam? Sure, there’s the MRCS, but you don’t need to worry about that for at least another couple of years, right? Surely by then the novelty of spending hours poring over textbooks will finally have returned...
Fast-forward to F1: You’re working fifty hour weeks, your Trust has underpaid you for the last three months despite fifteen angry emails, and you still haven’t seen half your friends from medical school since starting work because you are never off work at the same time. To make matters worse, the consensus among your senior colleagues is that NOW IS THE TIME to be sitting your MRCS Part A, a shock compounded when you find out the exam costs £526 and the pass-rate is only 40%.
My Guide to Passing the MRCS Part A
This is all terrifying stuff, even for the most stoic budding surgeon, so in this article I am going to take you through my step-by-step guide to nailing the MRCS Part A, starting with a few soothing truths:
- Even though only 40% of all candidates pass, well-prepared candidates almost always pass first time.
- Most foundation trainees will be allocated to a community job, so don’t beat yourself up if you feel too tired to study after a busy medical take. I didn’t even touch a textbook until I started my community psychiatry placement.
- Around 60-80% of the exam material overlaps with stuff you learned at medical school, which is why you want to sit the exam shortly after your medical school finals.
- Pretty much everything can be learned from books and question banks, so don’t worry if your clinical experience is lacking; I had only worked two days of a surgical placement when I took the exam.
- Everything you learn for the exam is useful when you finally start a surgical job. Even though you might think you’re wasting your twenties jumping over a high, expensive and incredibly fragile hurdle, afterwards you’ll look like a boss when your consultant grills you in theatre.
When to book the MRCS Part A exam
The first key to success is prior planning. Find out from your colleagues which of your three placements is the most relaxed, book the exam for the slot straight after this, and make sure you give yourself at least three months of this placement to study in.
The next trick is to book your exam the instant you have chosen a date. Once that £526 is gone you’ll be much more motivated to study!
How to allocate revision time for the different MRCS Part A topics
To allocate time efficiently you need to know 1) what you need to learn and 2) which resources to use. My advice would be to check out the breakdown of topics tested in the exam and how many marks are awarded for each.
Below is my summary and recommendation of how to split up your time.
The exam consists of two papers, a Basic Science paper worth 180 marks (60%), and a Principles of Surgery in General (PoSG) worth 120 marks (40%). Your scores for these are then added numerically and a total out of 300 is calculated.
If you can get 220 of these marks then you’ve passed!
Looking at the breakdown of marks allows you to focus your time most efficiently.
MRCS Part A Paper 1: Basic Sciences
Basic Sciences Breakdown:
- Anatomy - 75
- Physiology - 45
- Pathology - 37
- Pharmacology - 8
- Microbiology - 7
- Imaging - 5
- Data interpretation and audit - 3
The MRCS A Paper 1 breakdown shows you that by learning Anatomy and Physiology really well you can easily score at least 90 of your 220 marks. These are relatively simple to learn, require no clinical judgement or experience, and are covered in a glove-fitting breadth and depth of detail by our favourite book: Andrew T Raftery - Basic Sciences for the MRCS.
You’d be a fool not to use this book as a reference while studying for the MRCS. I’m sure the exam setters use it to write questions. My technique - test yourself with Pastest questions. If you get a question wrong, make notes on the relevant paragraph or chapter in Raftery. Soon you’ll be hitting high 90s in the anatomy and physiology questions!
Pathology is 37 marks, and harder to revise for. The section in Raftery is a bit weak. My recommendation for these 37 marks would be to only use the Pastest questions, learning the facts you don’t know from Wikipedia. You probably know most of it already but there are some random histological facts that come up repeatedly that you wouldn’t think to learn without Pastest.
The above also applies to microbiology and pharmacology the same obscure facts come up repeatedly so just use Pastest. Don’t even think of opening a microbiology textbook!
Phew – so it turns out the longest of the two papers isn’t that hard after all. Now let us move on to the second paper: PoSG.
MRCS Part A Paper 2: Principles of Surgery in General (PoSG)
Principles of Surgery in General Breakdown:
- Common and acquired surgical conditions - 45
- Perioperative management - 35
- Trauma - 30
- Surgical care of children - 7
- Medico-legal issues - 3
The most striking thing about this mark breakdown is that trauma attracts almost as many marks as the rest of the surgical specialties put together! This makes trauma the highest-yield study target in the whole exam, so make sure you use Pastest’s Qbank question filters to complete and understand all the trauma questions. The Advanced Trauma Life Support (ATLS) course manual is a comprehensive reference and is available online.
There is a great trauma chapter in the Pastest MRCS Part A Essential Revision Notes textbook that you should make full notes on and revise several times. This is much more concise than the ATLS course manual, and more appropriate for the level of the exam.
The first 45 marks, common and acquired surgical conditions, are easy to study for, but the breadth of knowledge is quite large. However, there should be a decent overlap with surgical finals, so all that time in the final year you spent learning about the anus is not wasted. I used the Pastest MRCS Part A ERN textbook as a reference for all of these topics.
The topic you will probably know least about will be paediatric surgery and the relevant embryology; make sure you spend a bit of time learning this properly early on so that you can revise it later. The same goes for head and neck surgery. The examiners are obsessed with salivary glands, so get your head around these early on in your study.
Perioperative care is also really important and is best learned by doing questions. The Pastest question bank is good for this and eMRCS also has a lot of relevant questions.
There we have it: an entire breakdown of the syllabus and how to tackle it.
MRCS Part A Study Schedule
In summary, my technique for passing involved completing both the Pastest and eMRCS question banks, whilst using the Pastest MRCS Part A ERN textbooks and Raftery to make notes on the questions I got wrong.
I spent about 3 months revising during a relaxed psychiatry rotation, took a week of leave beforehand to focus and cram, using almost exclusively those four resources. I probably answered around 6000 questions in total, and given that this allowed me to clear the pass-mark by 20%, it seems likely that 3000-4000 questions would be enough to get most people a pass.
Remember, the more you prepare the more likely you are to pass!
Good luck!
Written by Dr Eirion Slade
- 01 Jun 2021
- MRCS