Information Regrading MRCS(Membership of the Royal College of Surgeons).

                                                          MRCS


It is the membership of the royal college of surgeons.All royal colleges of surgeons have worked together to produce the intercollegiate MRCS.


Examination:-

MRCS examination consists of two parts.
Part A is a written paper using multiple choice questions
Part B is an objective structured clinical examination.

All four colleges use the Part A MCQ paper.The Part B OSCE is used by three UK colleges,leading to the intercollegiate membership diploma,MRCS.Currently the royal college of surgeons in Ireland uses its own Part B examination,leading to membership of the royal college of surgeons in Ireland.


Entry Requirements:-

To meet the entry requirements for the part A examination,candidates must hold a recognized medical qualification.There is currently no limit to the number of times a candidate can write the Part A examination but in the near future it may change to 6 attempts.

Part A:-

Part A of the MRCS is a four hour long examination consisting of two multiple choice papers,each of two hours duration comprising 135 questions each.The paper cover generic sciences and applied knowledge,including the core knowledge in the all specialties.
Note:- There is a short break between the two halves.


Syllabus of Part A:-

Each paper is constructed to test across the syllabus.As a guide,the number of questions covering each topic include:

Paper 1- Applied basic sciences
Paper 2- Principles of surgery in general

Paper 1 of Part A:-

Applied surgical anatomy- 45 MCQS

Ths include the gross anatomy as well as questions on developmental and imaging anatomy

• Abdomen,pelvis and perineum 12 MCQs
• Thoras 6 MCQS
• Head,neck and spice 9 MCQS
• Upperlimb and breasts 8 MCQS
• Central,peripheral and autonomic nervous systems 4 MCQS
• Lower limb 6 MCQS

Physiology- 45 MCQS

This includes 12 questions on general physiological principles covering thermoregulation,metabolic pathways,sepsis  and septic shock, fluid balance,metabolic acidosis/alkalosis,and colloid and crystalloid solutions

System specific physiology include

• Respiratory system 6 MCQS
• Gastrointestinal system 4 MCQS
• Renal system 6 MCQS
• Endocrine system(including glucose hemeostasis) 4 MCQS 
• Cardiovascular system 6 MCQs
• Thyroid and parathyroid 4 MCQS
• Nervous system 3 MCQS

Pathology - 45 Questions 

This includes 20-25 questions on general principles of pathology:-

• Inflammation 3 MCQs
• Vascular disorders 3 MCQs
• Surgical hematology 1-2 MCQS
• Wound healing and cellular healing 1-2 MCQS
• Tumours 6 MCQS
• Disorders of growth 3 MCQS
• Surgical immunology 3 MCQS

System specific pathlogy ( 22-26 questions)

• Nervous systerm 1-2 MCQs
• Breast disorders 4 MCQS
• Endocrince systerms 1-2 MCQS
• CVS 3 MCQs
• Lymph reticular system 1-2 MCQS
• Respiratory system 1-2 MCQS
• Genitourinary system 3 MCQS
• Musculoskeletal system 3 MCQS
• GIT 5 MCQS

Syllabus for Paper 2:-

Clinical problem solving - 135 MCQs
This includes 45 questions on principles of surgery and 90 questions on surgical specialities


Principles of Surgery in general:-

• Preoperative care 8 MCQS
• Surgical techniques 6 MCQs
• Post-operative care 4 MCQS
• Oncology 8 MCQS
• Management/legal topics 4 MCQS
• Microbiology 6 MCQs
• Emergency medicine 9 MCQS

Surgical Specialities - (90 MCQS)

• Cardiothoracic 6 MCQs
• Upper gastro intestinal 4-5 MCQS
• Hepatobiliary and pancreatic 5 MCQs
• Colo rectal 6 MCQS
• Trauma/orthopedics 7-8 MCQS
• Oro-maxilla-facial 2 MCQs
• Neurosurgery 6 MCQs
• Plastics 6 MCQs
• Pediatrics 6 MCQs
• Vascular 7 MCqs
• Abdominal 9 MCQS
• Breast 4-5 BCQS
• Endocrine 6 BCQs
• Transplant 3 BCQs
• ENT 6 MCQS
• Urology 7 MCQS

The Part B OSCE Tests:-

It includes clinical knowledge and its application,professionalism,procedural skills including decision-making,problem solving ,situational awareness and judgement,organization,planning and patient safety communication skills.

There are 16 stations and 4 rest stations each of 9 mins.Candidates will start at different points in the circuit.The stations assess the knowledge and skills in five main subject ares. 12 stations test generic knowledge and are compulsory for all candidates.To allow for differences in training,there are 4 specialty stations.Candidates select their specialty context at the time of application.

In each of the 5 subject ares,six domains are tested


Subjects:-                                                                                   

1. Anatomy and surgical pathology                                
2. Surgical skills and patient safety 
3. Communication skills 
4. Clinical skills
5. Applied surgical science and critical care

Domains:-

1. Clinical knowledge
2. Clinical skills 
3. Technical skills
4. Communication
5. Decision making and problem solving
6. Organization and planning

Most of the students are examined by the surgeon.The marking scheme is a matrix in which the stations are marked using several domains.There is a structural mark sheet for each station.The mark sheet includes a holistic judgement of the candidate.Candidates must reach overall pass mark set for Part B.They must also achieve a minimum  score in each of the domains

A variant of the contrasting groups method is used for setting the overall mark.

Anatomy and surgical pathology

• Three stations - two manned and one unmanned
• in the manned stations there is questioning of applied anatomy 
• in the unmanned station there are projection images and photographs

Surgical skills and patient safety

• Two manned stations 

1. Surgical skills will be tested for example,knot tying and suturing
2. Patient safety will be tested hand for example washing,patient positioning,use of tourniquets etc

Communication skills. 

• Three stations -  two manned and one unmanned
• The manned stations examine skills such as talking with colleagues and relatives
• The unmanned station tests written communication skills such as preparing a discharge letter

Applied surgical science and critical care

• Three stations - one manned and two unmanned 
• The manned station tests the application of patho physiological processes
• The two unmanned stations tests interpretations of images and results

Clinical skills.

• Five stations
• Two manned(one generic and one specialty) for history taking.
• Three manned( one generic and two specialty) for physical examination

General advice for giving MRCS papers

1.Try to give MRCS part 1 after house job.It is available in Pakistan .

2. MRCS 2 - Ideally done after 2 years of surgical training.