MRCS Part A – All you need to know

James graduated from University College London in 2019 and undertook his foundation training in the Severn Deanery. He is currently based in Melbourne, Australia and aims to apply to Core Surgical Training for the 2022 year. He sat MRCS part A in April 2021 and passed with 89% at the first attempt.

What will we cover?

What is the MRCS Part A exam?

The MRCS award is a requirement for entry to higher surgical training (ST3) and consists of two parts, A and B, which must be sat sequentially. Part A is written, whilst part B is an objective structured clinical examination (OSCE).

Sitting any examination is a daunting experience. The MRCS part A examination is often talked about due to its high pass mark (~73%) and relatively low percentage of successful participants (~35%). However, with the right preparation, commitment and belief, there is no reason anyone should not succeed!

There are three annual sittings, in January, April and September. These have been held digitally since COVID-19, and consist of two papers of 5 hours total duration, containing 300 single best answer questions.

What is the breakdown of marks for each section?

PAPER 1 – APPLIED BASIC SCIENCES (180 Marks – 60%)

Breakdown;

  • Applied surgical anatomy – 75 marks
  • Applied surgical physiology – 45 marks
  • Applied surgical pathology – 37 marks
  • Pharmacology – 8 marks
  • Microbiology – 7 marks
  • Imaging – 5 marks
  • Data interpretation and audit – 3 marks 

 

Split into two, 90 question papers (15-minute break between or option to continue immediately)
3 hours in duration

 

PAPER 2 – PRINCIPLES OF SURGERY IN GENERAL (120 Marks – 40%)

Breakdown;

  • Common surgical conditions – 45 marks 
  • Perioperative management – 35 marks
  • Trauma – 30 marks
  • Surgical care of children – 7 marks
  • Medico-legal aspects – 3 marks

 

2 hours in duration

How to prepare for the MRCS-part A exam?

I found doing little and often was the key to build the foundations of my knowledge required for the exam. Leaving 3 months in relaxed rotation or 4/5 in a busier one should be ample time to cover the core content. I allowed approximately 4 months of time, with the first 2 allowing for sporadic 1-2 hours every few days, before 3-4 hours daily in the latter 2 months.

It is a new challenge matching revising with work, and it is important to allow time for YOU. Make sure you exercise, eat well, socialise and get plenty of sleep during this time. Book study leave for the day far in advance, and really use this last-minute time to hone exam technique.

My practical experience consisted of 4 months of general surgery at the point of sitting which, whilst helpful, was by no means a necessity or prerequisite to success in the exam.
As many will say, foundation years are the ideal time to sit exams – you remember far more than you think from finals and getting it out of the way before F3 / Core training is a valuable (and point scoring) use of time.

Once you have a basic outline in place – book your exam. £550 is a very motivating form of carrot.

What are the main topics to focus your revision on?

It is important to remember there is a significant overlap with medical school finals content, meaning a lot of material requires only a brief recap. However, there are several areas that receive more focus due to the nature of the examination (see breakdown above).

1) Anatomy – heavily assessed, particularly on application and understanding of structures (yes, you will have to learn the brachial and sacral plexi again)

2) Physiology – particularly applied to stress responses

3) Basic general medicine / perioperative medicine

  • Perioperative prognostication scores
  • General anaesthetic principles (fluid compartments, clinical pharmacology, Intensive therapy aftercare)
  • Enhanced recovery principles
  • Calcium / Phosphate / Sodium / Potassium balance


4) Trauma and the critically unwell patient – an understanding of ATLS principles and interventions is useful.

What resources did I find most useful?

There are a wealth of resources available, and it’s easy to be sucked down the wormhole of one over another.

For content and clinical conditions;

1) Teach me anatomy
An excellent resource with succinct pages dedicated to all surgical specialities as well as theatre etiquette and perioperative care.

2) Teach me surgery 
Again, an excellent guide to what should be expected – the right level of depth, great images and sections on clinical relevance.

3) eMRCS textbook  
This resource comes with the eMRCS question bank, and is useful to consolidate knowledge of surgical conditions in particular. It is not so comprehensive when it comes to physiology, however, the question style is most similar to what appears in the exam.

4) Wikipedia
When in doubt, or in need of clarification, there is almost always a useful explanation available.

5) ATLS 10th edition  

6) MRCS curriculum  

Which question bank to use?

1) eMRCS 
This question bank contains around 2200 questions, across all assessed areas. Its question style is most similar to what is encountered in the exam, however, it’s textbook is not exhaustive, particularly for basic sciences. The majority of people I know sitting the exam used this resource.

2) Pastest 
A varied question bank, with over 4000 questions. Explanations are not as good as for eMRCS and it does not have a textbook feature. Questions were generally harder, with several steps and occasionally felt designed to catch you out, something which does not occur in the real exam. It is a useful resource to consolidate areas of weakness.

3) BMJ OnExamination 
I did not use BMJ, although it offers a further 2000 or so questions.

How to put all these resources together?

There is no ‘right’ way to revise. It is also important not to get fixated on what other people know or how they phrase it – the result that matters is your own! Having a buddy to discuss topics you don’t understand or throw ideas around is very helpful though – you can always learn something from everyone.

Personally, I covered the background theory outlined by MRCS and made my own notes before attempting question banks. My own medical school notes were also very useful to recap physiology and common conditions. I used the banks to consolidate my knowledge and sat several ‘mocks’ in the days prior to the exam.

Anatomy and particularly structural arrangements can be tricky to visualise. I found putting significant time into detailed diagrams of vessels, nerves and organs was a brilliant way to commit them to memory.

By the time of sitting the exam, I estimate I had completed around 7000 questions. Some people did only questions, others stuck to theory, but understanding the concepts in question was key to a high score.

What to expect on the exam day?

Get a good night sleep and go about your normal routine in the morning. Have your computer ready, ensure it is comfortable, quiet and eat well – it’s a long day!

Time is generally not a limiting factor. There are an array of question difficulties and my recommendation would be to bank the questions you know, and flag those which you want to think more about. As with all medical exams, taking the time to read the question carefully and understand exactly what is being asked is crucial. Avoid overthinking, if you have a gut instinct about something then trust your preparation!

As mentioned, the basic sciences exam was split in two, with the option of a 15-minute break. There is also a break between papers for approximately 1 hour to allow for lunch.

FOLLOWING THE EXAM

Enjoy the downtime, socialise with friends and forget about results. Whatever happens, you will have learned how to revise around work and a large amount of core surgical content. Even In the event you are not successful, you are likely only playing for a few percentage points at the next sitting.

Final Thoughts

MRCS part A is yet another obstacle in our medical lives, but with solid preparation, success is very much in your hands. It is a hurdle worth jumping early and provides 3 points for a core surgical training application – another step towards your goal. Self-belief is vital – knowing you can deliver and backing your knowledge is half the battle.

I wish you every success and the best of luck!

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