• Have a Study Buddy who’s taking the exam at the same time.
• Point & Shoot strategy- Get people to ask you specific questions and ask them to be very critical of everything you say – i.e. if it’s not what they’re looking for as an answer, or waffling, or umm-ing/aah-ing, then that’s not as good as hitting them with what they expect.

• There are 18 examined stations, with extra untested stations (not identified) and rest stations.
• There are 2 rounds of 11 stations each (including rest stations). After the first 11 stations, a 20-minute break precedes the following 11 stations.
• Each station is 9 minutes long with a 1-minute interval between stations.
• 2 of the stations are unmanned and are for preparing your communication skills stations.

Marking

• Each examined station is worth 20 marks.
• All examined stations are weighted equally.
  There is a maximum of 360 marks to be scored in the exam. (18 stations x 20 marks)
  This is an OSCE (objective structured clinical examination) style exam.
• The examiner has a marksheet with questions and answers – they can’t give you marks if:

1. You run out of time, and they haven’t asked you all the questions
2. You give answers not listed on their marksheet.

• In addition, there is a lay examiner in the history and communication skills stations – they also give you a proportion of marks, based on your rapport with the patient.
• There are two broad content areas, Applied Knowledge and Applied Skills
• Candidates have to achieve a passing mark in both of these areas. Passing mark varies with each diet. No quota of candidates that must fail.
• There are no immediate-fail stations.
• All stations are based on a clinical scenario with instructions posted on the door.

• 3 x Anatomy
• 2 x Pathology/Microbiology
• 3 x Physiology/Critical care

• 4 x clinical examination
• 2 x history-taking
• 2 x information-giving
• 2 x procedures/operating principles

• Email arrived 6 weeks prior from RCS – informed of candidate number, venue (RCSEng) and things to bring with you. Attach your passport-photo to the document and sign the bottom to confirm your identity.
• Asked to arrive for 8am. (or 1230pm)
• Registration involves:
  • Checking your identity – the signed document with photo, your passport/driving licence.
  • Sticky label with candidate number to attach onto your shirt.
  • Mobile phones go into an envelope and are collected by the staff.
  • Bags and coats are placed in lockers (no need to bring pound coins) and keys taken in by staff.
  • Entire group taken to a briefing room – welcomed and calmed down by chief examiner.
  • Groups of candidates taken to their respective stations (over 3 floors) by staff.
• Everyone wore straightforward, bare-below-the-elbows smart hospital clothes. Some had ties, but tucked in.
• Equipment: Most had their own stethoscopes. (I kept mine in my trouser pocket, and brought it out when the stations required it.) Some brought tendon hammers, measuring tapes, pen torches. (I deemed them unnecessary as stations provided them).
• If starting at an unmanned communication skills station (i.e. to prepare), then those candidates start the exam 9 minutes earlier than the rest.
• Stations are grouped together in their areas (e.g. 3 anatomy in a row), but obviously depends on your starting station.
• Opportunity to visit toilets, and have water during rest stations. (I had a roll of mints to keep up energy levels).

• May use prosections, dry skeleton, individual bones, photographs, imaging (CT/MRI/angiography), living surface anatomy model.
• Practice orientating yourself without touching the specimen, you won’t have the opportunity or time to physically manipulate the specimen.
• Learn especially surface anatomy, and clinical problems due to anatomy (yellow boxes in Prof’s book, and also Moore’s Clinically Orientated Anatomy)
• Limited number of prosections that the RCS can produce- familiarise yourself with prosection available in the DR.

Pathology/Critical Care/Physiology

• May be given blood results, pathology results, ECGs, imaging.
• Use same strategy as for Anatomy – ‘Point & Shoot’ (i.e. targeted, specific answers and move to next question).

Examinations

• Practice exams without speaking and practice presenting succinctly, marks are given for picking out salient features for a specific diagnosis. Usually features are very clear for a specific diagnosis.
• Remember to check for any available clinical information (e.g. charts, results)
• Only 6 minutes to complete the examination.
• Examiner has 3 minutes to ask questions.

History

• Take a focussed history in 6 minutes; remember to include social details, ICE and red flag signs.
• Examiner has 3 minutes to ask questions – be focussed in your answers (point-and-shoot).
• Extra marks from lay examiner for your patient rapport.

Information-giving

• This consists of an examined station, preceded by an unmanned station where you are left alone with a set of notes and some scrap paper.
• Do not assume or lie about anything not given in the notes. The lack of information (I think) is there to put you under stress, and to see how you deal with it.
• You may be asked to speak face-to-face with a patient, relative or colleague; or telephone a colleague (consultant, registrar) about a referral, plan of management, or clinical decisions.
• SBAR is a good approach.

Procedures

• May be technical (e.g. excision, suturing) or related to operating (e.g. ordering a list, theatre equipment placement)
• Practice getting asked questions and talking to the patient while performing the procedure, not enough time to do them serially.

Resources

Books

• How to Pass the MRCS OSCE (Vol1 & 2) Oxford Specialty Training – read and digest when studying alone. Also useful for practising stations with a buddy.
• DrExam (Vol 1 & 2) – chapters on examinations are a useful checklist when practising.  Pathology book somewhat useful.
• DoctorsAcademy (Vol 1& 2) – not useful.
• Kanani critical care – useful to get a breadth of topics, however questions are too broad in some places.
• FRCA revision books – useful for being comprehensive in critical care/physiology.
• Get Through Anatomy vivas – quite useful
• No good single book to cover surgical pathology.
• MRCS Clinical (Parchment-Smith) – useless for current OSCE style exams.
• Master Pass MRCS pictures – useful somewhat, but don’t get bogged down.
• MRCS Part B Anatomy (Mahadevan) – useful for anatomy questions.

Courses

• Pastest (weekend course) – too many people, too little feedback.
• DrExam (2x weekend course) – examination weekend useful, but more useful if you go on it earlier, but most information is already in the books and the DVD; questionable value-for-money. Knowledge/Viva weekend not tailored for current OSCE-style MRCS
• DoctorsAcademy Cardiff (5 day course, can buy separately) – Procedures day useful to revise and be examined, given marksheets. Anatomy days (x2) oriented towards current MRCS-style exam – quite useful practice for getting OSCEd. Comm skills somewhat useful, exams not that useful.
• Bottom-line – current crop of courses not tailored for current MRCS exams. Closest are anatomy and procedure days in Cardiff.

Websites

• PasstheMRCS – useful to an extent in covering basics of main topics, however, needs a substantial bit of extra work to feel confident across all topics. Useful to share with your study buddy.
• Aclands – very useful to get your head around anatomy not covered properly – e.g. head & neck, greater/less omentum, genitals.

People who have taken the MRCS

• MRCS style changed with the Feb 2013 diet of exams. Get those people who have done the exam since then to grill you on topics that came up in their exams to get a flavour of how questions are structured and what answers to give.
• Use the DR prosections to the fullest extent, to practice just answering questions for a solid 30 minutes (three anatomy stations’ worth).
• Questions may be repeated from diets prior to Feb 2013.