How does one prepare for MRCS part A exam?

Disclaimer : All of the content I mentioned below has been my experience and understanding of the situation and I do not claim that this is the only way to do things. The idea of this post is to give some clarity of what to expect down the MRCS path. Feel free to disagree with me totally!!

Credentials for answering the question :

1. I passed MRCS Part A in first attempt with around 80% score.
2. I took this exam during second year of my residency in General Surgery. Around one and half year after joining MS.
3. I took the exam in my home town of Hyderabad with exam centre being a hotel. My knowledge from guiding my junior colleagues is that they are using the same centre each year for Hyderabad. The link to google maps is here : Hotel Inner Circle
4. I took this exam in January of 2016 and finished Part B in January of 2017. Although the exam pattern has changed a little, the underlying issues in preparation still remain the same.
5. Following MRCS and MS from Osmania General, I was accepted to the ChM program from University of Edinburgh a year ago and I am likely to finish it by 2019.

Result letter for Part A :

University acceptance letter :

As said earlier, these statements are not to brag but to state that, with proper effort and technique, any result can be replicated in a wide variety of circumstances.

So, Why MRCS ?

A valid question indeed for most exam takers. I tried to elaborate a few reasons as to why I found it useful.

A better way to learn Surgery

• Unlike Indian exams which tend to focus on memorising a few facts and coughing them up in the exam followed by joining as resident in a department only to discover that you have no clue as to how and what to do, MRCS focuses more on the actual ground reality.
• The exam focuses on how, why and what of important clinical scenarios you are likely to encounter in real life rather than asking what the surname of a scientist is.

A path to be a better doctor

• My understanding of human body, its interaction with disease and recovery have much changed with this exam.
• You are taught to put patient first above everything else.
• From taking a proper consent to eliciting sensitive history without breaking the patient privacy to following a proper protocol in clinical examination of various organ systems to performing a surgical procedure in a methodical manner, MRCS does it the best.
• Each module they test has direct correlation to better patient care and I haven’t come across such thing in NEET-PG.
• Having said that, we cannot blame the existing exam system in India as it is designed to narrow down the contenders for a limited number of posts unlike the UK where the exam is designed to make you fit for the job you will be posted as the number of contenders for the exam are less.

A career in the UK

• MBBS followed by MRCS with english language test in the form of IELTS / OET can make you eligible for GMC registration which translates to a job in the UK.
• Check this link for more on GMC registration post MRCS and the accepted PG degrees, Acceptable postgraduate qualifications

Training / fellowships in the UK

• Landing a training / residency post in the UK is not easy for an international graduate, however it is not impossible.
• That being said, you can progress your career via the CESR pathway which assesses your ability to progress to being a NHS consultant based on work place based assessments among others.
• For more guidance on CESR pathway for General Surgery, https://www.gmc-uk.org/-/media/d…
• This system is quite unique compared to USA or India where you need a PG degree / residency to progress your career.
• MRCS with good deal of UK experience and having some publications / audits to your name can help secure a good fellowship in your area of interest. E.g., Liver transplant, Arthroplasty / Arthroscopy, Spine surgery, Minimal access surgery etc.

Masters programs in the UK

• I always felt that MRCS opened new doors and expanded the potential of your surgical career.
• Most universities in the UK offer a lot of postgraduate masters programs in different areas of surgery and the key requirement they look for in most cases is MRCS with 3–4 years of experience post MBBS.
• Now, apart from adding value to your CV and improving your chances of landing a good job, these courses can give you a taste of what the pattern of learning and testing is in the UK and much of the western world. And trust me, it is indeed quite different!

Money ??

• I don’t deny its importance but I have limited experience with the so called high paying jobs in th Middle East post MS and MRCS.
• I have been approached by a HR asking me to consider relocating to Middle East but I didn’t know if that could be trusted.
• But even if you choose to relocate to UK, they pay you decently compared to India with good work hours, over time compensation and adequate paid vacation time.
• I think its probably around 39000 to 45000 GBP per annum for a post of registrar cadre which you are likely to land post MRCS with 3–4 years of work experience. Check this glass-door link for more, NHS Specialty Registrar Salaries

Now, before we go any further try to check if any of the above reasons is why you chose MRCS, otherwise it will end up being a wild goose chase and won’t be worth the time and money you invest.

Once you decide on going ahead, we will start with the basics and work on the prep part at the end

Eligibility for MRCS ?

• You need MBBS degree with complete registration after internship from a WHO recognised medical school / college. Use this link to check if your college is on the IMED, World Directory of Medical Schools Search
• Practically, nothing else.
• But my advice is try having some experience in basic surgery before applying for this exam as it tests your applied knowledge rather than random facts. This can be gained only if you work on good number of clinical cases.

What if I am Orthopaedics / ENT postgraduate ?

• The exam tests your basic surgical knowledge and not the speciality.
• You are more likely to be asked to perform a basic knee exam / hernia exam rather than do a Whipple’s procedure.
• For ENT, the part A of the exam is same but part B is different. For more on MRCS-DOHNS, use this link UK Trainees — JCST

Which college to apply for ?

• Now since the exam is an intercollegiate exam, you can choose to sit the exam with any of the four royal colleges. The question paper is same for all 4 colleges.
• For more details, check this link Kesha Megharaj’s answer to What is the difference between the MRCS in England and the MRCS in Edinburgh?
• My personal favourite is Edinburgh college as they offered the exam at a cheaper price, timely response to e-mails and conducted exam in my home town. Apart from all this, membership to Edinburgh college grants you exclusive access to its online webinars which are indeed of finest quality and truly unparalleled. Check this link for more Webinars | The Royal College of Surgeons of Edinburgh
• The exam is an international MRCS with centres around the world. In India you can take the exam in most of the major metros across the country.
• It does apply to Part B too.

Exam pattern :

• Part A is an MCQ based exam involving testing of applied basic sciences and principles of surgery.
• It has 2 papers taken on same day with an hour break between two.
• It has around 300 questions in all. 180 in paper 1 and 120 in paper 2.
• The recent guidelines from the college suggested removal of EMQ (Extended Matching Questions) from paper 2 with effect from September 2018 session.
• No cause to panic, the number of questions and method of testing might change but the content they test remains the same.

How much do I need to score to pass the exam ?

• The target of the exam should be a good pass and we need to understand that it is not a competitive exam unlike others.
• If all the candidates score the required cut off of 67% (variable at times), they all can pass. Rarely happens though.
• DO NOT worry about the low pass rate. If you put in decent efforts, it is an easy exam to pass.

How much for the exam and the whole deal ?

• The exam fee is variable between colleges but for Part A, it should be around 45 to 50,000 INR. (approx. 500 GBP)
• The preparation for the exam including online resources is expected to cost around 30–40k INR.
• Overall, I remember spending around 2–2.5 lacs for Part A, Part B, online resources, books, coaching for Part B etc.
• I won’t comment if its cheap or expensive but try not to book the exam with a poor preparation which leads nothing but waste of an attempt / money. Yes, you have limited number of attempts for each part.

How much time should I take for Part A prep?

• I found 4–5 months to be a comfortable prep time.
• If you are majorly occupied with work, then you need to increase or decrease the preparation time accordingly.

Now the fun part, what books / online resources to use ?

• I didn’t find textbooks / notes to be of any help at all.
• Yes, it is possible to pass the exam with good figures without reading the prescribed text book and finishing the online question banks alone!!!
• Only a few books were of some help.

I have put the resources / books in the order in which I used them and co-incidentally, it is the same order in which I found them most to least useful.

MRCS Part A: 500 SBAs And EMQs, 2/e, Pradip K Datta et al

• A good first book to know the “lay of the land”
• I might as well go as far to say that my resolve for taking the MRCS exam increased after finishing this book.
• Whole book has MCQ’s and related explanations and the clarity of concepts is beautiful, well written by the guru of FRCS exams himself Mr Datta.
• It is available online but I suggest buying it from your regular medical bookshop as it is much cheaper that way. Buy MRCS Part A: 550 SBAs and EMQs: Second Edition (Postgrad Exams) Book Online at Low Prices in India

e-MRCS

• By far the most useful online resource for MRCS Part A.
• At a reasonable price, you get a good number of practise questions to work on and revise the syllabus.
• Around 1500 questions for 30 GBP / 4 months.
• Check this link to the site : eMRCS
• Try making a note of all the questions which you failed to mark correctly and revise only these topics as you are likely to make more mistakes in the same area

Pastest MRCS

• Good quality questions of around 3000 or so although a bit pricer than eMRCS.
• Try finishing 50–100 questions a day and focus on areas where you make mistakes often by reading up the explanation at the end of the answer.
• Check this link : MRCS Part A Online
• They give access to Anatomy lectures by Prof. Ellis which are probably the best I came across till now.
• Along with questions, you also get access to video lectures for each topic of the exam which explains concepts in more depth.
• Again, pricier but worth it.

BMJ One Exam

• Offers around 3000 practise questions for 100 GBP / 4 months.
• Questions are not as tough as Pastest and not as easy as eMRCS but are mid way.
• Same strategies used for above 2 resources apply here too.
• Try not to subscribe to all the online resources at once and complete one Qbank before going to another.
• Link to website : MRCS Part A Paper 1 and 2 Exam Revision

SBA MCQs and EMQs for the MRCS Part A Pack: 2 (Oxford Specialty Training: Revision Texts)

• After using all of the above resources, you will end up doing around 10,000 MCQs which should be more than enough, but if you think you need some more questions, then use these books.
• This is not a particularly great material but okayish.
• As said earlier, try to source your books from the local book retailer rather than buying online. Link to buy these online https://www.amazon.in/MCQs-EMQs-…

TRASH :

I decided make a list of books that are absolutely useless and and I would whole heartedly suggest anyone preparing for MRCS to stay a mile or two away from the books and the people who read them.

Basic Science for the MRCS: A revision guide for surgical trainees by Raftery(Author) — — — — — WASTE OF TIME, DON’T READ

MRCS Part A: Essential Revision Notes by Catherine Parchment-Smith — — — — NOT RECOMMENDED

MRCS Applied Basic Science and Clinical Topics (Postgrad Exams)Paperback — 2013 by Parker et al, — — — — ABSOLUTE WASTE OF TIME.

Take home messages :

1. Decide why MRCS and why now, otherwise you will end up wasting time and money.
2. Plan your schedule properly to avoid miscalculation of time and book in advance avoiding hurry before deadlines.
3. Stick to solving MCQs from online question banks. Revise the questions / topics that went wrong and try not to repeat them.
4. DO NOT place reliance on reading too many textbooks or guide books which are absolutely useless and teach you stuff you don’t actually need for the exam or clinical practice.

Anything else ?

General surgery alumni, Osmania General Hospital

• This is the link to the Facebook page in which I tried putting together illustrations, case notes, important notes of practical importance over a period of 4 years. This should serve as a good supplement for MRCS preparation.

SURGERY RESIDENCY-MADE EASY

• This is link to the blog where I posted more articles about which resources to use for each module of surgical residency from Anatomy to critical care, from procedural skills to patient communications. Although intended for MS / DNB General Surgery, it’s still helpful for most surgical trainees / junior doctors / MRCS exam takers.

It is an easy exam to pass and an easy exam to fail. Stick to schedule and put in efforts daily.

Good luck to us all !!

Links to important websites :

1. Intercollegiate MRCS / DOHNS UK Trainees — JCST
2. Royal College of Surgeons, England Intercollegiate MRCS Part A — Royal College of Surgeons
3. RCS Edinburgh Courses, Events & Exams Search Results Page | The Royal College of Surgeons of Edinburgh