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MRCP Part 1 Exam: Instant Insights
  • 23 Jun 2023
  • MRCP
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Updated following the 2023/2 sitting.

Check out our latest insights about the MRCP Part 1 April 2023 exam. We’ve been busy collecting candidate feedback, and we’re already using this to inform the development of our MRCP Part 1 resource over the coming months. Here’s a summary of what we’ve found out so far:

MRCP Part 1 April 2023 Exam Content

It's been noted that many exam questions have been very direct in recent sittings especially within Paper 1, lacking detail such as blood investigations or physical findings, with two or even three choices all potentially correct.

We heard about a range of question styles in the exam, from pure knowledge-based questions with no vignette and one-liners about genes and mutation, to brief vignettes that offered very few clues about the answer and lengthy Neurology questions with vignettes spanning four to five lines of text. If there is a vignette though it is pertinent to the question.

Don’t expect a straight recall test though, candidates also struggled with complex patient scenarios involving challenging clinical reasoning.

It’s worth noting that there were no negatively phrased questions (e.g. “which of the following options is NOT…”) and the majority of questions asked you to select the “most likely” answer from several plausible options.

Tricky topics

Clinical Pharmacology and Therapeutics was back to being the trickiest topic in the exam followed by Clinical Sciences, Renal Medicine, and Neurology. One candidate mentioned that new concepts were being tested in Molecular Science based questions and to have an up-to-date knowledge of reading NEJM articles. 

Specific tricky topics mentioned included:

- Gestational Diabetes Mellitus and management.

- Spirometry interpretation.

- How to calculate FEV1/FVC.

- Neutropenic sepsis.

- Glomerulonephritis and its different subtypes.

Candidate advice

Many candidates gave advice to future exam takers and here's a selection of their thoughts:

"Build strong concepts...about 80% of the exam is concept-based, 20% is about facts...know details of pathophysiology, and learn to differentiate the close dd of a disease. Basic science and pharmacology are the game-changers for the Part 1 exam."

"Give extra time to study pharmacology. It's obvious that the RCP loves testing about mechanism of action of drugs, and if the drug has more than one mechanism of action, you should know, because they will ask about the least used one."

"Statistics is an area of potential scoring and is less difficult and less complicated than other departments. It would be fruitful for the candidates to concentrate on this."

"Basics are very important. Instead of focusing on minute details of every disease, the basic sciences, the pathology, receptors, site of action of drugs, side effects of drugs. The treatment was very basic."

"It’s not like USMLE. A detailed study including 2nd line, 3rd line treatments, all side effects, mechanism of actions, and sometimes unnecessary details is a must. Special emphasis should be given to clinical sciences where there is chance of losing plenty of marks. Take at least 6 months to prepare. This is no ordinary exam."

Common topics

According to Pastest users, questions on the following topics have regularly appeared in recent MRCP Part 1 exams:

- Ankylosing spondylitis - clinical features.

- Patterns of inheritance of genetic conditions.

- Atypical pneumonia organisms.

- Causes of renal interstitial disorders.

- Headache differentials.

- Mode of action of antidiabetic drugs.

- Haematological malignancy diagnosis.

- Statistical tests and their uses.

- Pain management in palliative care.

The Online MRCP Part 1 Exam Experience

If you’re sitting a remote exam for the first time, we’ve got a great blog to help you prepare, which includes a video from a previous MRCP Part 1 online candidate: How To Prepare for an Online Exam

Here’s some advice and insight from candidates who've previously sat the exam online:

- Try not to let your gaze wander around the room, it could be just for a few moments whilst you gather your thoughts, but the proctor may ask to see your room again.

- Some candidates reported inconsistencies from the proctors regarding finishing the exam early; one candidate was told they could leave the first paper when they finished but then was told in the afternoon they had to stay until the end.

- Ensure that all other household members are aware that you aren’t to be disturbed. Candidates with home-schooling children reported that this was easier said than done!

- You are allowed toilet breaks, but when you return you’ll have to show the proctor around the room again. One candidate suggested that he had to go through rigorous checks which took almost 10 minutes of his exam time.

- To avoid stress on exam day, make sure that you’ve received your personal ID as well as the exam ID and password via email. If you haven’t, check your spam/junk folders. In addition, be sure to read the emails carefully, one candidate was confused because they received the link for the second paper before the first paper, and struggled to start the exam.

- Inform neighbours that you will be sitting an exam; candidates reported being disrupted by hedge trimming and drilling through walls while trying to concentrate!

- Some candidates found it difficult to pick up their laptops and show the proctors around the room with the built-in webcam. If you have the option of using an external webcam, that might be easier.

Are you preparing for the MRCP Part 1 exam? We can help! Take out our free MRCP Part 1 trial today, and see what it’s like to get the Pastest Advantage.

Read on to see more insights from previous exam sittings... 

Insights from the January 2023 MRCP Part 1 Exam

Usually, it's Clinical Sciences or Clinical Pharmacology that are thought of as the trickiest topics in the exam, but this time round Pharmacology was the one to swot up on with 25% of candidates reporting that was the hardest area with questions regarding lung function tests and Light's criteria especially tricky.

Specific tricky topics mentioned included:

- Calculation of FEV1/FVC ratio.

- Porphyria metabolism.

- Causes of Heyde syndrome.

- The first signs of adrenoleukodystrophy.

- Life expectancy of Von Hippel-Lindau Syndrome.

Insights from the November 2022 MRCP Part 1 Exam

Historically Paper 2 was considered the trickier of the two papers but recent diets have seen several stating that Paper 1 contained some very ambiguous questions. Paper 1 often contains a high number of Basic Science questions so dust off your old UG notes whilst revising. It's a long day and you’ll likely experience some exam fatigue, so re-energise away from the screen on your break. One candidate said: "Pastest questions rely on the fact that you already have the basic MRCP knowledge, and test your clinical reasoning and deductive skills, very similar to the actual exam. I found the quality of the questions to be of a similar standard. Some of the questions were virtually identical!"

Insights from the August 2022 MRCP Part 1 exam

As is the norm, Clinical Sciences was referenced as the trickiest topic in the exam, though Psychiatry came in not far behind which is not usually the case. Neurology and Clinical Pharmacology were also heavily mentioned by candidates as areas in which they struggled.

Specific tricky topics mentioned included:

- Raynaud's Phenomenon.

- Postpartum & Riedel's thyroiditis.

- Clinical signs of osteoarthritis.

- Calcium absorption and how Vitamin D affects this.

- Serotonin syndrome.

Insights from the May 2022 MRCP Part 1 exam

We asked candidates which specialties they found the most challenging in the exam. The most frequently mentioned were Clinical Sciences & Clinical Pharmacology which are often considered the most difficult subjects, although for the May 2022 exam Dermatology was also mentioned as being tricky. 

Specific tricky topics mentioned included:

- The differential on pancytopenia patients.

- Second line maintenance treatment for gout.

- Paraneoplastic syndromes.

- Theophyline levels.

- Resuscitation of a pregnant woman.

Insights from the February 2022 MRCP Part 1 exam

The most frequently mentioned were Clinical Sciences & Clinical Pharmacology which are often considered the most difficult subjects, although for the February 2022 exam Ophthalmology was also heavily discussed. 

Specific tricky topics mentioned included:

- Side effects of azathioprine.

- Patient with features of McArdles with other options of Beckers duchennes.

- Chemotherapy medications that are not commonly widespread.

- Hyperchloremic metabolic acidosis.

- Genetics and chances of inheritance.

Insights from the November 2021 MRCP Part 1 exam

We asked candidates which specialties they found the most challenging in the exam. The most frequently mentioned were Clinical Sciences & Clinical Pharmacology which are often considered the most difficult subjects, although for this exam Neurology was also heavily discussed. 

Specific tricky topics mentioned included:

- Lateral medullary syndrome.

- Management of aortic dissection.

- Oncology drug mechanisms.

- Cannonball metastases.

- Prevention of clostridium.

Insights from the August 2021 MRCP Part 1 exam

Both papers were considered equal in difficulty by many candidates. A large number of the questions were direct and lacking information. 

We asked candidates which topics they found the most challenging in the exam. The most frequently mentioned were Clinical Pharmacology & Therapeutics, Clinical Sciences and Cardiology.

Other tricky topics of note included:

- Variation of fevers from returning travellers with LFT interpretations.

- Achondroplasia and the chance of having child with it.

- Enzyme inhibitors and inducers.

- Thyroid disorders and investigation findings.

- Hypokalemic metabolic alkalosis with GI obstruction.

Insights from the May 2021 MRCP Part 1 exam

We asked candidates which topics they found the most challenging in the exam. The most frequently mentioned were Neurology, Respiratory, Pharmacology and Statistics.

Other tricky topics of note included:

- Psychiatry.

- Drug mechanism of action.

- Glomerulonephritis.

- Sudden cardiac death (Long QT syndrome).

- Diabetic patients with underlying health conditions.

There were no questions relating to COVID-19 in this exam.

Pastest Customer Outcomes

- 73% of candidates who answered our survey passed the May 2021 exam.

- Users that passed answered 1400 more questions on average than users that did not pass.

- Candidates that did not use our Past Papers achieved a pass rate of only 45.7%. Those that did, achieved a pass rate of 76.7%.

Insights from the January 2021 MRCP Part 1 exam

- Paper 2 was considered much more difficult, with long vignettes and a lot of data interpretation.

- The toughest topics as voted by our customers were:

- Dermatology (lots of rashes!)

- Basic Sciences

- Neurology

- Clinical Sciences formed a large part of Paper 1, with a high number of Mechanism of Action (MoA) questions coming as a surprise to candidates.

- As well as difficult topics, many candidates said that choosing between two plausible options was the most difficult aspect of the exam.

- Ensure you read the question thoroughly as some deviated away from the vignette to catch you out.

- Paper 1 contained a number of short vignettes testing basic science, especially genetics, biochemistry and anatomy.

Pastest Customer Outcomes

- 65% of candidates who answered our survey passed the September 2020 exam.

- On average, successful candidates answered over 4800 questions in our Part 1 question bank. Unsuccessful candidates answered around 2400 on average. Questions, questions, questions... Volume really is key to passing this exam!

Common Topics from recent exams

The following topics were present in three consecutive sittings of the MRCP Part 1 exam – September 2020, January 2020 and September 2019:

- Skin manifestations of systemic disease.

- Hypertension management.

- Blood gas interpretation.

- Type 2 diabetes management.

- Bleeding disorders.

- Site of action of diuretics.

- Calculating sensitivity.

- Asthma management.

- Dementia.

- Ankylosing spondylitis.

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  • 23 Jun 2023
  • MRCP