The Royal College of Surgeons (MRCS) examination is a key step for surgical trainees, consisting of two parts: the written MRCS Part A and the Objective Structured Clinical Examination (OSCE) for Part B. This intercollegiate exam - overseen by the Royal Colleges of Surgeons of Great Britain and Ireland - ensures a consistent standard across all testing sites, evaluating trainees on their clinical skills and the fundamental knowledge needed for further surgical training. Successfully passing both components not only allows trainees to move forward in specialised surgical training but also grants them membership to esteemed institutions.

This comprehensive guide will dive into the benefits of the membership, how to prepare for your MRCS A exams, exam costs and format, and helpful study tips to give you the best chance at passing your exam with flying colours.

More about the MRCS A exam

The Membership of the Royal College of Surgeons (MRCS Part A) is a five-hour, 180-question 2-part written exam for surgical trainees who want to become a member of one of the four surgical royal colleges in the UK and Ireland. The AM paper is three hours and the PM paper is two hours in duration. The MRCS Part A is an intercollegiate exam, therefore the papers taken are the same regardless of which college you sit the exam with.

Applications for the MRCS Part A (and subsequently, Part B) exam are made through one of the four Royal Surgical Colleges:

• The Royal College of Physicians and Surgeons of Glasgow
• The Royal College of Surgeons of Edinburgh
• The Royal College of Surgeons of England
• The Royal College of Surgeons of Ireland

Award of this postgraduate diploma shows that you have the required knowledge, experience and clinical competence to complete core training and progress to specialty training.

Membership of any of the four Royal Colleges of Surgeons is highly respected within the medical profession and provides a range of benefits to its members, including:

• Professional development: Members have access to a range of educational resources and opportunities, including courses, workshops, and conferences, as well as a comprehensive e-learning platform.
• Networking: Membership provides opportunities to network with other healthcare professionals from around the world, enabling members to build valuable connections and collaborations.
• Recognition: Membership is a mark of professional excellence and demonstrates a commitment to the highest standards of surgical practice and patient care.
• Support: Members have access to a range of support services, including advice and guidance on professional and personal issues.

Who should take the MRCS A exam?

For candidates applying for the following specialties, you must sit and complete the MRCS exams:

• Cardiothoracic Surgery ST3
• Plastic Surgery ST3
• Emergency Medicine ST3
• Trauma & Orthopaedic Surgery ST3
• General Surgery ST3
• Thoracic Surgery ST4
• Oral & Maxillofacial ST3
• Urology ST3
• Otolaryngology ST3 (MRCS (ENT))
• Vascular Surgery ST3
• Paediatric Surgery ST3

How is the MRCS A exam split?

Paper 1 (Applied Basic Sciences)

This is generally scheduled for the morning and spans three hours, broken down into two segments of 90 minutes - each with a brief 10-minute break for comfort. It consists of 180 questions in total.

Paper 2 (Principles of Surgery in General)

This is taken in the afternoon of the same day, takes two hours to complete and has a total of 120 multiple-choice questions.

Is MRCS a degree?

No. The MRCS exams grant candidates the opportunity to apply for specialty training in surgery, as well as acts as an exit requirement from core surgical training.

What are the criteria for sitting the MRCS A exam?

To be eligible for the MRCS exam (both part A and B), candidates need to hold a primary medical degree that is recognised by either the UK's General Medical Council (GMC) or Ireland's Medical Council. If you graduated from a medical school outside of these countries, make sure to have your qualifications verified by the respective Councils. For more information on eligibility criteria and verifying your qualifications, visit the official Intercollegiate MRCS Exam website.

It’s important to make a plan for how you’re going to tackle your MRCS A preparation. To prepare effectively for the five-hour examination, you have access to various resources such as:

• The official MRCS syllabus
• Recommended textbooks
• Practice questions and mock exams

It’s recommended to make full use of these materials to thoroughly prepare for your MRCS Part A study period. There  are also a variety of methods that candidates employ to prepare for this exam, however, the three most common strategies are:

Answering practice questions at random

Candidates answer a large volume of MRCS Part A practice questions completely at random. This is how questions will be presented in the exam, so it helps you to get into the mindset of quickly switching from one specialty to the next.

To really make the most of your practice questions:

1. Identify any weak areas that need improvement
2. Dive into focused reading to deepen your understanding
3. Test yourself again on questions you got wrong to gauge your progress

By using question banks like our Pastest MRCS Part A practice to streamline this process, you can filter by topic and difficulty to get detailed explanations and keep track of your revision over time.

Taking a specialty-based approach

Another, more methodical approach is to plan a study schedule, and to answer questions on each specialty in bespoke sessions, before reviewing all of them a few weeks out from the exam date.

Taking a comprehensive syllabus-based approach

If time and inclination allows, some candidates prefer to study the medical syllabus more comprehensively, providing a thorough knowledge base for a future career in Medicine. This entails methodical study of individual specialties using reputable textbook chapters and accompanied by answering many relevant questions as in (2) above.

MRCS exam resources

There are several online question bank subscriptions that provide assistance in studying towards the MRCS Part A exam. Pastest has the largest bank of SBA questions on the market - with over 4300+ SBA questions covering every speciality in the exam - as well as Past Papers that allow you to simulate recent exams.

Evidence shows that using Pastest increases your chances of passing the MRCS A, as shown here:

Answering questions is a great way to ensure that you’re learning to recognise patterns. It’s a key skill that you’ll need in order to pass the exam. However, pattern recognition alone will only get you so far. If you know WHAT the answer is, but don’t fully understand WHY, then you may not be in a position to work out a similar, but differently worded question.

While answering questions, make sure that you’re engaging in active learning; that is to say, make sure you take the time to understand WHY a question is right or wrong. Pastest’s Dynamic Explanations are a great tool to achieve this, as each possible answer has its own explanation, unique to the context of the vignette. Supplement your learning by doing further reading. Pastest’s Expanded Explanation feature offers a topic overview, as well as information on Clinical Presentation, Differential Diagnosis, Diagnosis/Intervention, Management and Prognosis, and links out to external resources, all available as further reading after each question.

We also have further information on MRCS A exam insights that detail the kinds of questions that have come out each year since 2021, so candidates can see how questions have changed throughout the exam periods.

Exam cost, location & dates

The MRCS Part A exam is usually held in January, May and September each year.

Currently, the MRCS Part A exam is delivered in partnership with Pearson Vue at their network of computer-based test centres.

Pearson Vue Centres

Pearson Vue has nearly 6,000 test centres across the globe in over 180 countries. You’ll need to choose a test centre location that is convenient for you to travel to, and that has availability for the dates you want to take the exam. Keep in mind that test centre availability can be limited, especially during peak exam periods.

When selecting a test centre, make sure to take note of the opening times and any special instructions or rules for that location. Some test centres may have specific requirements for what you can bring into the testing room, or how you should behave during the exam.

Be aware that these centres are not just being used for the MRCS A exam, you will see candidates sitting a wide range of other exams from driving theory tests to risk management qualifications.

How to prepare for MRCS A test day

Once you’ve selected your Pearson Vue test centre, it’s time to prepare for test day. The MRCS Part A exam is a rigorous assessment of your surgical knowledge and skills, so it’s important to give yourself plenty of time to study and review the exam content.

On the day of the exam, make sure you get plenty of rest the night before and eat a healthy meal or snack before you arrive at the test centre. You’ll need to bring appropriate identification with you, such as a passport or driving licence, so be sure to double-check the identification requirements for your test centre location.

When you arrive at the test centre, take the time to read through all of the instructions and candidate rules carefully. These will outline what you can and can’t do during the exam, as well as any procedures for requesting breaks or assistance during the test.

During the exam

The MRCS Part A exam is a computer-based test, so you’ll need to be comfortable using a computer to navigate the exam content. Make sure you read each question carefully and take your time to consider your answers before submitting them. Don’t rush through the exam, even if you feel like you’re running out of time.

If you have any questions or concerns during the exam, raise your hand and a test centre administrator will assist you. Remember, the goal of the exam is to test your knowledge and skills as a surgical trainee, so try to stay focused and relaxed throughout the testing period.

Candidate Eligibility Candidates who wish to sit the MRCS A exam must hold a medical degree that is acceptable to the UK GMC (General Medical Council), for full or provisional registration or to the Medical Council in Ireland for full or temporary registration. The Intercollegiate MRCS Exam website provides further clarity on requirements and how to check if your medical qualification is acceptable.

You must also have a valid passport as a form of ID to sit the examination, or an alternative qualifying photographic ID from the country in which you are testing.

Visa application

For candidates who require a visa to travel to the UK for the MRCS Part A exam, the Royal College of Surgeons (RCS) can provide a visa letter to support their application. However, it is important to note that the RCS does not automatically produce this letter and candidates need to request it.

To obtain a visa letter from the RCS, candidates should follow the steps below:

1. Check visa requirements: Candidates should first check the visa requirements for their country of residence to ensure that they require a visa to travel to the UK for the exam.
2. Register for the exam: Candidates should register for the MRCS Part A exam through the official website of the RCS.
3. Request a visa letter: Once registered for the exam, candidates can request a visa letter from the RCS by contacting the Membership Services team via email or phone. Candidates should provide their full name, passport details, and the dates of the exam in their request.
4. Submit visa application: Once the candidate receives the visa letter, they can use it to support their visa application to the UK authorities. It is important to note that the visa application process can take several weeks, and candidates should plan accordingly to ensure they have sufficient time to obtain their visa before the exam.

In summary, candidates who require a visa to travel to the UK for the MRCS Part A exam can obtain a visa letter from the RCS to support their application. Candidates should check visa requirements, register for the exam, request a visa letter, receive the letter from the RCS, and submit their visa application. By following these steps, candidates can ensure a smooth visa application process and avoid any unnecessary delays.

Learning disability guidelines

The Royal College of Surgeons (RCS) is committed to providing equal opportunities for all candidates who wish to sit for the MRCS Part A exam, including those with learning disabilities. To ensure that candidates with learning disabilities are able to access the exam and perform to the best of their abilities, the RCS has developed a set of guidelines that outline the support available to these candidates.

The guidelines provide information on the following areas:

1. Reasonable adjustments: The RCS acknowledges that candidates with learning disabilities may require reasonable adjustments to enable them to take the exam. These may include additional time, separate accommodation, the use of a scribe or reader, or the provision of a computer.
2. Supporting evidence: Candidates with learning disabilities are required to provide supporting evidence of their disability when applying for reasonable adjustments. This may include a report from a specialist or an educational psychologist, or a medical report from a doctor or consultant.
3. Requesting adjustments: Candidates should make a request for reasonable adjustments as early as possible, preferably at the time of registration. The request should be made in writing and include details of the specific adjustments required.
4. Confidentiality: The RCS respects the privacy and confidentiality of candidates with learning disabilities and will only share information about the disability with relevant staff members who need to know.
5. Exam format: The RCS has taken steps to ensure that the exam format is accessible to candidates with learning disabilities. The exam is available in large print, Braille, and audio format, and candidates can use a computer to answer the questions if required.
6. Support on the day of the exam: Candidates with learning disabilities are entitled to additional support on the day of the exam, including the provision of a scribe or reader, and access to a quiet room if required.

The RCS guidelines for candidates with learning disabilities are designed to ensure that these candidates are able to access the exam and perform to the best of their abilities. By providing reasonable adjustments and additional support, the RCS is able to level the playing field for candidates with learning disabilities, enabling them to demonstrate their knowledge and skills on an equal footing with their peers.

In conclusion, the RCS is committed to providing equal opportunities for all candidates, including those with learning disabilities. By providing reasonable adjustments and additional support, the RCS is able to ensure that these candidates are able to access the MRCS Part A exam and perform to the best of their abilities. Candidates with learning disabilities are encouraged to familiarise themselves with the guidelines and to request any necessary adjustments in a timely manner to ensure a smooth and successful exam experience.

Exam format

Part A of the MRCS is a five-hour MCQ examination consisting of two papers that must be completed on the same day (180 Applied Basic Sciences questions in the morning, 120 Principles of General Surgery questions in the afternoon). The two papers assess general surgical sciences, applied and core knowledge across a range of specialty areas.

The syllabus is divided into the following 10 modules which you’ll be assessed on during the MRCS Part A exam:

• Module 1: basic science knowledge relevant to surgical practice
• Module 2: common surgical conditions
• Module 3: basic surgical skills
• Module 4: the assessment and management of the surgical patient
• Module 5: perioperative care of the surgical patient
• Module 6: assessment and early treatment of the patient with trauma
• Module 7: surgical care of the paediatric patient
• Module 8: management of the dying patient
• Module 9: organ and tissue transplantation
• Module 10: professional behaviour and leadership skills

Further information regarding the breakdown of the MRCS A syllabus can be found on the official site (downloadable PDF).

Guidance to candidates

Below is some general guidance and tips for candidates before sitting the MRCS A exam (please note that some of these relate ONLY to the paper format of the exam):

• Upon starting your paper check through each page to ensure it has printed correctly and the coloured flash at the top of the front page of your question booklet matches the answer sheet.
• MRCS Part A questions contain five possible answers of which there is only one single best answer.
• All questions are equally marked.
• Only one answer is permitted per question, you will not gain a mark if more than one box is marked for the same question. Marks will not be deducted however for an incorrect answer.
• Do not make any marks on your answer sheet other than inserting your candidate number and indicating your answer with a bold horizontal line in the boxes provided.
• Papers are marked by machines so ensure answers are marked clearly for each question.
• Mark the box with a clear horizontal line; faint lines or deviating from the instructions may result in no marks for that question.
• Ensure you record your answers in the answer sheet rather than the question booklet.
• Images may be included in either or both papers.

How are MRCS A results calculated?

The RCS uses the Angoff procedure where a number of ‘marker’ questions (20%) are taken from previous exams to maintain standards and consistency. After each examination, the performance of candidates on each question is scrutinised as well as their performance on the overall test. Candidate feedback is taken into consideration, as well as statistical analysis to identify outlying performance statistics. The RCS panel (consisting of practising surgeons, specialist basic scientists, trainers, trainees, and a patient representative) then review every identified question in detail to determine whether to exclude that specific question from the overall examination.

The performance of candidates on the ‘marker’ questions is reviewed with other statistical data from present and previous examinations and compared to a benchmark Angoff exercise. Considering all this data the panel decides upon a pass/fail mark.

• As each MRCS Part A exam is different, the pass mark will be different each time.
• As different cohorts of candidates take each MRCS Part A exam, the pass rate will be different each time.
• The process to set the pass mark for the MRCS Part A is the same for every exam.
• The standard required to pass the exam remains constant for all MRCS Part A exams.
• The MRCS A process includes providing feedback to all candidates, regardless of their result, by the RCS. This feedback is designed to give candidates an indication of their performance in the Part A examination as a whole, as well as their performance in the Applied Basic Science (ABS) paper and the Principles of Surgery in General (PoSG) paper.

The MRCS A process includes providing feedback to all candidates, regardless of their result, by the RCS. This feedback is designed to give candidates an indication of their performance in the Part A examination as a whole, as well as their performance in the Applied Basic Science (ABS) paper and the Principles of Surgery in General (PoSG) paper.

The feedback format is designed to provide candidates with a clear understanding of their strengths and weaknesses, and to help them identify areas where they need to focus their study and preparation for future exams. Candidates are provided with an indication of their performance in the main content areas in relation to other candidates in their cohort. This can be helpful in identifying areas where they need to improve or focus their study.

It is important to note that feedback is not provided on the content areas of imaging, data interpretation and audit, medico-legal aspects of surgical practice, and surgical care of children. This is because the relatively low number of questions in these areas makes it difficult to provide meaningful feedback. Therefore, the total maximum marks available in both the ABS and PoSG papers will not be equal to the combined total of the maximum marks in the content areas.

Additionally, since the RCS is not providing feedback on the smaller content areas, the combined total of the content areas will not match the overall raw score in both the ABS and PoSG papers. Candidates should keep this in mind when interpreting their feedback and assessing their performance in the exam.

Overall, the feedback provided by the RCS is intended to be constructive and helpful to candidates, and to assist them in their preparation for future exams. Candidates should take the feedback seriously and use it as a tool for improving their knowledge and skills in preparation for the next stage of their surgical career.

How to study for the MRCS A exam

Below are our top tips to ensure MRCS A exam success:

1. Create a study plan

As the old saying goes - failing to plan is planning to fail. Developing a well-organised study plan is essential for doing well in the MRCS Part A exams. This exam covers a wide range of subjects, and without a strategic approach, it can be overwhelming to manage the vast amount of information.

Start by dividing the syllabus into manageable sections, allocating dedicated time for each subject based on its complexity and your personal strengths and weaknesses. Set realistic and achievable goals for yourself - such as the number of topics or chapters you aim to cover each week. Regularly review and adjust your plan as needed, ensuring you stay on track while maintaining a healthy study-life balance.

2. Active learning

Active learning methods are essential for success in the MRCS Part A exam. Instead of just reading and memorising, engage your brain by practising with questions, using flashcards, creating concept maps, teaching others who are also studying for the exam, and applying knowledge to clinical scenarios.

3. Master anatomy and surgical principles

To succeed in the MRCS Part A exam, you’ll need a strong grasp of anatomy and surgical principles. Focus on learning human and surgical anatomy, and key surgical concepts. Use various resources like anatomy atlases and dissection videos to enhance your understanding. Be sure to grasp the reasons behind different procedures and the anatomical structures involved, and test your understanding through practice questions and mock exams.

What is the pass mark for MRCS Part A?

According to 2020/2021 data, the pass mark for the MRCS Part A varies per year, but is generally around 40%. Read more about passing MRCS Part A - straight from one of our customers!

How many attempts can you make for MRCS Part A?

Candidates have six attempts in which to pass their Intercollegiate MRCS Part A exam. This is based on meeting (or exceeding) the combined pass mark for the two papers.

When will MRCS Part A results be released?

As there are multiple exam sittings per year, results are released within approximately 4 weeks of each exam date.

For further information on how Pastest can assist you in passing the MRCS A, check out our blog and our related posts below. Good luck!