Sitting the MRCS Part A Exam

Written by: Dr Frank Hartley

Introduction

During my FY2 I completed the Membership of the Royal College of Surgeons (MRCS) Part A examination. The exam represents the first step towards becoming a surgeon and both parts (Part A and B) must be completed in order to be eligible for higher speciality training (usually 2 years post completion of FY2).

Timing

I sat the exam in the September of FY2, as this was the time that best aligned with the demands of my foundation rotations, and meant that the exam was done and out of the way prior to starting the application process for Core Surgical Training (CST). Whilst it is definitely not essential to complete the exam during foundation years, I had always planned to attempt it as the pass rate is highest for F1/F2s, and I wanted to get it out of the way as soon as possible. There are a couple of reasons for this - first of all, the examination is focussed on physiology concepts, which are rarely encountered in day-to-day clinical practice. This means that the more time that passed since medical school - the longer since the pre-clinical lectures where these concepts are taught! The other is that some FY1 placements are usually less demanding than those at SHO level. I had a job in Obstetrics & Gynaecology where I was supernumerary and this meant a much more normal working week without the pressures of on calls. This gave me a lot of time to revise. I also worked my first rotation of FY2 in Emergency Medicine at 80% less than full time, which is when I sat the exam.

Revision Strategy

It’s important to remember that no revision strategy works for everyone, and we all revise and learn slightly differently. However, the strategy I used seems to be fairly similar to a number of friends and colleagues who were also successful in passing the examination. I started revising properly around 3-4 months prior to the exam. At the start this was just 1-2 hours per day, to familiarise myself with the challenge ahead, and for the final month this stepped up to 2-3 hours on days I was working, aiming for a full day on my days off. For me personally I knew it was not sustainable to keep this up for longer than a month, especially while working on ED with a busy rota full of twilights and night shifts. It’s also really important to take the time to relax - I still watched every Arsenal game, and loved cooking nice meals!

Question Banks

In terms of actual revision, I used the Pastest Question bank, as well as eMRCS and Teach Me Anatomy. I believe that the ‘Past Papers’ on Pastest represent the most accurate reflection of the actual exam - with many questions very similar to those in the actual paper.

My strategy revolved around completing all the Past Papers on Pastest first. I then made brief notes on each question - a few bullet points about the diagnosis, or why a certain investigation was indicated first. This meant that I could identify the questions I kept getting wrong/any gaps in my knowledge. It also helped me realise what I needed to cover in terms of the anatomy and my weakest areas.

I then worked through the notes on the Teach Me Anatomy site and used the questions on there to test my knowledge of each topic as I went along. After completing a region e.g. head and neck, I went back over all of the questions for that region to further cement my understanding. In the two weeks before the exam I went back over some Pastest questions to solidify my revision.

Cost and Booking

Another important consideration is the cost of the exam. The exam itself is expensive (£625), and once you add in the question banks it can add up to around £900. You need to ensure that you are first of all in a position to pay for the exam itself, and that if you fail you will be able to think about sitting the exam again within 6-12 months. If possible, this will ensure that the revision you have done is still fresh when you retake the exam. Unfortunately, this is tough while on the salary of a foundation doctor, particularly if you have other financial commitments. Also be aware that this amount is payable around 2-3 months prior to the actual date - I found planning early and saving over a long period helpful.

Also - with the popularity and demand (somehow!) of exams these days it is really important to book your test centre as soon as the booking window opens. A friend of mine only narrowly avoided having to sit their exam in Gloucester when they live in Glasgow due to a last minute cancellation. Others faced over an hour commute to theirs and someone in my sitting in Manchester had travelled from Northern Ireland. So book early to avoid a long, long journey which is stress you don’t need.

On The Day

Be aware that the exam has a very different feel to medical school exams. Make sure to read the centre rules very carefully as they are pretty strict and very different to anything I had at university - we were not allowed chewing gum and had to turn out our pockets each time we left the exam room for some water! If you have friends that are also planning on sitting the exam - it was really nice to know a few people in my sitting to chat with during the waiting and meet up with afterwards to debrief. I appreciate this is not always possible, but I would really recommend planning something nice to look forwards to straight after.

Another thing I would mention is to not be too harsh on yourself during the exam - the standards are much higher than the exams that we sit during medical school, and you are not expected to have covered everything in the same way that you would on the UKMLA syllabus. The pass mark for my exam was just under 60% and just over half of candidates passed. The exam is 5 hours across 2 papers: Paper 1, Applied Basic Science (3 hours, 180 Marks) and Paper 2, Principles of Surgery in General (2 hours, 120 Marks). There was 1 hour in between. I used the hour break to eat some food, call my partner and get some much needed caffeine on board before returning for paper 2.

Waiting for Results

The official ruling is that the exam results should be out a month after the exam, but ours were delayed by a week. I found this out from social media a couple of days before they were initially due to be released. Be aware the results may be released later than initially advertised and try not to be too fixated on the particular date. It sounds cliche but I would try and just forget about it as best as you can - I had lots of nice stuff planned and also had used some of my annual leave and zero days for the exam so had quite a bit of time in work which was a good distraction. I also noticed throughout revision and after the exam I was enjoying some of the opportunities to apply the knowledge I had gained during my studies in my clinical work - facial bone x-rays started to make a bit more sense, and I was definitely noticing a better understanding of examination findings.

Conclusion

Looking back, preparing for MRCS Part A during FY2 was a challenge, but a manageable one with some planning and consistency. It taught me a lot about how to balance clinical/shift work with revision, and how to stay disciplined without letting the exam take over my life. If you are thinking about sitting it during your foundation years, I would say it is entirely possible with the right approach, a bit of structure- and breaks! It is a demanding exam, but also a very rewarding milestone, and passing it gave me a real sense of momentum as I moved towards applying for CST.

If you are sitting the exam soon, sending you the very best of luck!