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career focus

How to pass the MRCS

Dedication, preparation, and application are Stephen
Brennans top tips for passing the MRCS
New regulations
The regulations for sitting the new MRCS (Membership
of the Royal College of Surgeons) exam have changed.
You can now sit the first part (the written MCQ and
extended matching questions EMQ) as soon as you have
started basic surgical training, and the subsequent parts
(the oral and clinical exams) as soon as you like after
that. Although many consultants and registrars will tell
you that the old primary was much harder in their day,
the MRCS is still a real challenge and a hurdle that must
be overcome.

resuscitating the patient and taking informed consent I

would take the patient to theatre. With the patient placed
supine on the operating table under general anaesthetic,
etc. It just sounds so much better. There are three
excellent books available for viva practice and you need
all three of them. Questions for the MRCS Vivas1 is
probably the best, and the other two are Viva Practice for
the MRCS2 and Surgical Critical Care Vivas for the
MRCS,3 both available from the website.
No amount of reading will help you pass the viva,
however. You must get practice at answering questions.
Find a consultant or registrar that you get on with and
get them to grill you. Keep getting them to ask you
stuffin the coffee room between cases, while you are
both scrubbing up, etc.

Ask a friendly anaesthetist

Practice should make perfect
I passed the MRCS within 14 months of becoming a
senior house officer, and these are some words of advice
I would give to anyone thinking of doing the same.
Firstly, if you have decided early on that you wish to
pursue a career in surgery then early preparation is vital.
Ideally, this will have started in your preregistration
house officer year. To sit the first part (the written) there
are two critical points. First, give yourself six months of
preparation. You must lock yourself away from everything and everybody for this time and practise multiple
choice questions (MCQs). I can say hand on heart that
for the first part I did no fewer than 5000 MCQs. Get
examples of these from medical book shops and online
companies such as and is an excellent website
with useful information and plenty of practice in MCQs.
Wherever you get the practice, however, make sure that
on the day of the exam you have 5000 questions under
your belt.
The second key piece of advice is that you must sit
both papers MCQ and EMQ togethertrust me, you are
only wasting your time if you dont do this. There is so
much overlap of content between the two that it is
impossible to study for either one independently. The
questions in the MCQ book from the Royal College of
Surgeons of Edinburgh are the most realistic and similar
to the real thing, so make sure you read this book from
cover to cover. It can be purchased online from the
colleges website (


The viva


Be under no illusion regarding the viva; this is by far the

most difficult part of the exam. I suggest you book
yourself on the MRCS viva practice course run by Pradip
Datta at the Royal College of Surgeons of Edinburgh; it
lasts for two days and costs about 200. I cannot speak
highly enough of this course, and on occasions retired
master surgeon Professor Alistair Munro gives a guest
lecture. The course teaches you not only what you will
be asked but more importantly how you should answer.
For example, when you are asked how to perform an
appendicectomy (and you will be), you need a sharp and
concise opening answer. Instead of stuttering on about
McBurneys point, why not open with, After thoroughly
4 MARCH 2006

Get an anaesthetist to ask you about the critical care

stuff because, to be honest, anaesthetists know more
about fluids and inotropes, etc. than us surgeons. If you
have a day off or if your nights allow you some sleep
then spend a few days with an anaesthetist (preferably
one who doesnt have a trainee with them that day); they
are usually more than happy to teach you. You never
know, you might end up getting to put in a few central
lines as well. In the viva itself be prepared to be handed
a few thingsa pen and paper to draw the brachial
plexus, the oxyhaemoglobin dissociation curve, the loop
of henle (and explain how it works); a bone of some sort
to identify what muscles attach to it (I got a clavicle); and
an x ray of some sort to identify the anatomy (I got a
sagittal view MRI of the pelvis and was asked about the
blood and nerve supply to the bladder. Ouch.).

How to fail the clinical

If you have made it to the clinical you are almost home
and dry. There is no excuse whatsoever for failing it. I
cannot give you any advice on how to pass, so therefore
I will just give you some words of wisdom on how to fail.
Firstly, turn up late smelling of cigarettes and with the
top button of your white shirt undone. Wear brown
shoes and leave your cufflinks at home. Then dont
introduce yourself to the patient, and avoid eye contact
at all times. You know for certain that you will get one
orthopaedic joint to examine so dont practise this under
the supervision of a consultant in outpatients. Hand held
Doppler examination at the vascular station should be
done by technicians anyway so dont bother learning
how to do this.
And finally, they will surely ask you about the most
bizarre and rare conditions, such as Chiladitis syndrome, so forget about inguinal hernias, varicose veins,
thyroid lumps, incisional hernia, hydrocoeles, ganglions,
and basal cell carcinomas. Good luck.
Stephen Brennan specialist registrar in general surgery
Aberdeen Royal Infirmary, Scotland

Garner J, Goodfellow P. Questions for the MRCS vivas. London:

Hodder & Arnold, 2004.
Chan C, Hart A. Viva practice for the MRCS. London: Pastest, 2001.
Kanani M. Surgical critical care vivas for the MRCS. Greenwich Medical Media Ltd, 2002.