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MRCP Exam

Part 1

The MRCP(UK) Part 1 exam is designed to test a candidate's knowledge and understanding of the clinical sciences which are relevant to medical practice, and of common or important disorders at a level appropriate for entry into specialist training. Each paper is three hours' long, and contains 100 best-of-five MCQs. Candidates will be tested on a wide range of common and important disorders in General Medicine as set out in the published syllabus. The composition of the Papers is as follows:

Specialty Number of questions*
Cardiology 15
Clinical haematology and oncology 15
Clinical pharmacology, therapeutics and toxicology 20
Clinical sciences 25
Dermatology 8
Endocrinology 15
Gastroenterology 15
Neurology 15
Ophthalmology 4
Psychiatry 8
Renal medicine 15
Respiratory medicine 15
Rheumatology 15
Tropical medicine, infectious and sexually transmitted diseases 15
200
* approximately

Part 2 Written

The MRCP(UK) Part 2 Written Examination has a three-paper format. All Papers in the MRCP(UK) Part 2 Written Examination are 3 hours in duration ,and contain up to 100 MCQs. The questions will usually have a complex clinical scenario, may include the results of investigations and may be illustrated. Questions are asked about the diagnosis, investigation, management, and prognosis of patients using multiple choice questions that are either one from five, where a candidate must choose one from five possible answers, or two from 10, where candidates must chose two answers from a list of 10 options.

The composition of the Papers is as follows:

Specialty Number of questions per 100*
Cardiology 10
Dermatology 5
Endocrinology and metabolic medicine 10
Gastroenterology 10
Haematology/Immunology 5
Infectious diseases and GUM 10
Neurology/Ophthalmology/Psychiatry 10
Oncology and palliative medicine 5
Renal medicine 10
Respiratory medicine 10
Rheumatology 5
Therapeutics and toxicology 10
100
* approximately

A proportion of the questions will be on adolescent medicine and medicine for the elderly.

MRCP PACES

A really excellent article on the MRCP PACES, in the early years, is provided by this reference.

Dacre J, Besser M, White P; MRCP(UK) Clinical Examining Board. MRCP(UK) PART 2 Clinical Examination (PACES): a review of the first four examination sessions (June 2001 - July 2002). Clin Med. 2003 Sep-Oct;3(5):452-9.

Summary

The PACES examination consists of five clinical stations, each assessed by two independent examiners. Candidates will start at any one of the five stations, and then move round the carousel of stations, at 20 minute intervals until they have completed the cycle. There is a five-minute period between each Station.

You should note that an excellent guide to the administration of entire examination is provided by the "MRCP Omnibus".

Stations 1 and 3

These are often known as the "physical examination" stations. The emphasis in these stations is on the demonstration of comprehensive and correct physical examination technique, the ability to detect physical signs, the ability to construct a differential diagnosis, the ability to suggest sensible and appropriate treatment and investigation plans, and the ability to treat a patient with dignity and respect.

 Before seeing each case, the candidate will receive written instructions as to what is required of him/her.

Stations 2, 4 and 5

‘Standardised’ scenarios for Stations 2 and 4 are provided from MRCP(UK) Central Office and are generated by the Scenario Editorial Committee of the Clinical Examining Board. Host centres are currently told to recruit appropriate surrogates who fit the scenario and are available on the day. Examiners have been told that is not necessary to match the age exactly – a difference of a few years either way is fine, providing the surrogate can roughly pass for the age indicated in the scenario. Changes of the Scenarios are not allowed by any of the Colleges, unless they are merely typographical, or have been approved by the College concerned.

Station 2

The history-taking skills station aims to assess the candidate's ability to gather data from the patient, to construct a differential diagnosis, to deal with concerns the patient may have, and to construct a management plan that is explained to the patient clearly, and to treat the patient with dignity and respect.

The features are:

• written instructions for the case, usually in the form of a letter from the patien t's GP are given to the candidate during the five-minute interval before the station
• 14 minutes are allowed for the history-taking, followed by a 1-minute period of reflection followed by five minutes for discussion with the examiners
• the two examiners are present throughout observing the interaction with the patient.

Station 4

This video is intended to provide you with a brief overview of this Station.

The communication skills and ethics station aims to assess the candidate's ability to guide and organise the interview with the subject (who may be a patient, relative, or surrogate, such as a health care worker), explain clinical information, apply clinical knowledge, including knowledge of ethics, to the management of the case or situation, provide emotional support and treat the patient with dignity and respect.

Other features are as follows:

• written instructions for the case are given to the candidate during the five-minute interval before this station
• the two examiners are present throughout
• 14 minutes are allowed for the patient interaction, followed by one minute to reflect, followed by five minutes for discussion (after the patient has left the station)

Confused about the ethics part?

Download the overview of ethics for MRCP(UK) PACES - for Station 4 scenarios - here.

Station 5

This is a video which is intended to provide you with a brief overview of this Station.

The integrated clinical assessment station aims to assess the way in which the candidate approaches a clinical problem in an integrated manner, using history taking, examination, and communication with a patient or a surrogate patient.

Other features are as follows:

• written instructions for each of the two cases, usually in the form of short notes or referral letters are given to the candidate during the five minute interval before this station.
• the two examiners are present throughout
• for each case, 8 minutes are given with each patient to take a focussed history, carry out a relevant examination, and respond to the patient's concerns. Two minutes are for describing the positive physical findings and to give your preferred diagnosis and any differential diagnosis (after the patient has left the station).

A really helpful article on the MRCP PACES Station 5 assessment, entitled "T he new MRCP PACES station 5", by Gautam Mehta, Bilal Iqbal  . is accessible here.