MRCS Part A, January 2023 Exam: Instant Insights

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Updated following the 2023/1 sitting.

Similar to the September 2022 sitting, candidates were surprised by the breadth of topics covered within the exam and the RCS has certainly looked to shake things up since they cancelled the exam back in January last year. Histopathology, as an example, was flagged as an area that was unexpectedly over-represented.  

The decision to insert the MSRA exam into the Core Surgical Training (CST) pathway, prior to MRCS Part A, has not been well received by candidates who feel the exam is too GP-focused and has little relevance to surgical training.  

Once again candidates were able to sit the exam in a Pearson Vue centre - check out the useful RCS guidance on what to expect!

We’re using this research to improve our MRCS Part A resource, but that’s not all! Read a summary of everything that we know so far below…

MRCS Part A Exam Content - January 2023

  • The Histopathology questions were particularly tricky, several featured terminology that some candidates had not seen before. 
  • Questions were quite short in length, typically 2-3 sentences, and it wasn't always necessary to read the vignette to answer the question. 
  • Negatively phrased questions did appear in the exam as well as questions that referenced the country of origin as a clue to the answer.
  • Paper 2 had negative questions whereas Paper 1 was more positively phrased. The negative element of the question was bold and underlined. The negative phrase was least’.  
  • There were no scoring questions, i.e. “what is the Gleason score?”, physiology of healing questions or special centres question, i.e, “what part of brain does this?”
  • Other comments from candidates included:
    • Prioritise anatomy, physiology and pathology in that order. Malignancy and fractures seem to be a common theme so those should be practiced really well too.
    • Review your medical school content - physiology was similar to final year medical school exams.
    • There seemed to be more specific pathology questions than I was anticipating in paper 1 in terms of cells types/characteristics expected in biopsies from specific cancers and also immunology cell questions.
    • Try practicing without using calculators and remember certain normal values such as calcium, sodium, potassium etc. in order to manage your time.

Common topics

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

  • Upper limb innervation.
  • Thyroid tumours.
  • Testicular mass.
  • Slipped upper femoral epiphysis.
  • Breast cancer genetics.
  • Inguinal anatomy/herniae.
  • Acid base balance.
  • Pulmonary embolism management.
  • Pharyngeal arches embryology.

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

MRCS Part A Exam Content - September 2022

  • After suggestions the May exam would feature some changes that did not materialise, this sitting included a number of topics and questions that candidates were not expecting.  
  • While anatomy images with specific sections highlighted were used in the May exam, only a couple of X-rays were used this time around. 
  • There was a heavy focus on histopathology rather than anatomy. There were also a number of questions on the histological diagnosis of colorectal cancers and Inflammatory bowel disease. 
  • Paper 2 had negative questions whereas Paper 1 was more positively phrased. The negative element of the question was bold and underlined. The negative phrase was least’.  
  • There were no scoring questions, i.e. “what is the Gleason score?”, physiology of healing questions or special centres question, i.e, “what part of brain does this?”
  • Other comments from candidates included:
    • Questions were long. Reading the entire question and all five options was a challenge while ensuring that too much time wasn’t spent on an individual question.
    • Be very sure of anatomy in terms of sensory innervation of the face and the anatomical relationship in the abdomen.
    • Even though the concepts are clear, try reading some topics in detail for rare conditions and topics. Read the whole vignette carefully and understand what is being asked..

MRCS Part A Exam Content - May 2022

  • Despite warnings of change after the cancellation of January’s exam, there were no nasty surprises according to candidates. 
  • In addition to X-rays and ECGs, anatomy images with specific sections highlighted featured in the exam. 
  • Vignettes were generally around 3 lines long, though a handful were slightly longer and contained observations plus past medical and drug history.
  • Several questions regarding blood gas results were included and Thyroid Cancer was also a hot topic across both papers. Compared to previous sittings there were fewer Trauma-themed questions.
  • There were no scoring questions, i.e. “what is the Gleason score?”, physiology of healing questions or special centres question, i.e, “what part of brain does this?”
  • 'Basic science knowledge relevant to surgical practice' was easily considered the hardest topic in the exam with 52% of candidates rating it so. This was followed by 'Perioperative care of the surgical patient' and 'Common surgical conditions' (both at 10%).
  • Other comments from candidates included:
    • Different indications for tissue flaps or skin grafts, require more depth, not so many questions but would advise candidates to acquaint themselves with these issues of plastic surgery.
    • Try to remember normal values of everything covered during preparation as I could not find normal values in a separate tab like the Pastest papers. Although only in a few questions, normal values were supplied but I don't think they were enough to answer several questions.

Insights from the September 2021 Sitting

  • If the question contained a vignette it was necessary to the understanding of the question; candidates felt there were no red herring questions in this exam, and only a small number of questions contained no vignette (calculation based). Questions also tended to be positively phrased.
  • One candidate who'd previously sat the January 2021 papers stated that 60-70 questions were repeated in this exam.
  • Fatigue can really play a part in the exam. It's a long day, ensure you've had as much sleep as possible and that you keep your energy levels up, especially heading into Paper 2. 
  • 'Basic science knowledge relevant' to surgical practice was considered the hardest topic in the exam with 27% of candidates rating it the most difficult. This was followed by 'The assessment and management of the surgical patient' (22%) and 'Professional behaviour and leadership skills' (9%).
  • Trauma featured heavily in this exam, with head injuries, fractures in the elderly and young, CT scans and pneumothorax-based questions all included.
  • There were 2-3 questions with the same answers in the papers, with very similar vignettes. One candidate felt it was almost as if it was placed to trick them.
  • ECGs were once again included in the exam, and these images were very clear.
  • Other comments from candidates included:
    • Lots of management of wrist fractures. Heavy weighting towards urology. LOADS of examples of blood gases with most likely clinical scenario being the answer options.
    • They were not testing the 'common' surgical conditions - lots of focus on rare presentations or conditions.
    • Fracture management and use of grafts or flaps in plastic surgery were particularly tough questions personally.
    • Traumatic Chest came up at least 4 times. Multiple thyroid neoplasm and a large focus on lymph drainage for pelvic cancers.

Insights from the April 2021 Sitting

  • Hyperparathyroidism came up more than once, along with a handful of plastics questions, including burns (but not asking to calculate fluids). The papers also asked about pharyngeal arches more than once.
  • A lot of paediatric hip disorders questions were included with limited info to deduce correct diagnosis. Candidates needed to be good at knowing the duration of symptoms/presence of gait abnormalities/limited movement.
  • Basic Science Knowledge relevant to surgical practice was considered the hardest topic in the exam with 46% of candidates rating it the most difficult, this was followed by Surgical Care of the Paediatric Patient (13%) and Common Surgical Conditions (10%).
  • A number of candidates who had also sat the January 2021 exam felt this diet was slightly easier with more straightforward questions that had only one possible answer, compared to finding the best option.
  • A small selection of images were included in the exam (3 in total, including an ECG) which differed to the January 2021 exam.
  • Negatively phrased questions appeared in the papers so be wary of these; often they included the line "Which of the following would not be in the scenario here?"
  • Other comments from candidates included:
    • Some questions required more input of background knowledge and understanding (those based on certain diseases and identifying structures of X-rays for e.g.).
    • Question on eye signals and the functionality of the nerves in the eye - 2 images, patient looking in front and down - needed extra knowledge to know the answer.
    • Questions were very much confusing especially one with low oxygen saturation and lateral 5-10th rib fracture. Facial skull fracture and the type of investigation method MR arthrogram vs CT arthrogram.
    • Lots of questions about the parasympathetic nervous system regarding 3rd cranial nerve.

Insights from the January 2021 Sitting

  • One of the strangest things that we heard about this sitting was that there were a lot of questions that you might expect to find in a physician’s exam – so much so that one candidate called an MRCP colleague to say “Hey mate, I’ve just sat your exam!”
    • Specifically, candidates reported lots of medicine endocrinology (renin and aldosterone), calcium and parathyroid metabolism and radial fractures in the elderly.
  • Be on the lookout for alternative procedure names. Some questions were worded using unusual, uncommon terminology – for instance, to describe a certain type of plastic surgery.
    • However, watch out for questions that appear to be the same. Candidates reported repeated vignettes with one question phrased positively, one phrased negatively.
  • Candidates reported that you always need to read the vignette in order to answer the question. There were only a few questions with just a stem and no scenario, mainly testing physiology.
  • There were no images in this exam.
  • Candidates reported more "proper” clinical scenarios requiring applied knowledge than they were expecting, and not as many simple, pure anatomy recall questions.
  • Other comments from candidates included:
    • “A lot of questions regarding ECGs and stress response of surgery.”
    • “Lots of questions about calcium and electrolytes.”
    • “Some anaesthetics questions which were tricky.”
    • “Focus on blood results and trends in endocrine conditions.”
    • “Learn your anatomy well, especially limbs.”
    • “Know your vertebral levels. Know your endocrinology.”

Insights from the September 2020 Sitting

  • Despite their inclusion in the January 2020 exam, there were NO images present in this exam
  • The most difficult modules as voted by our customers were:
    • Basic science knowledge relevant to surgical practice
    • The assessment and management of the surgical patient
    • Common surgical conditions

Perplexing Paper 2 (PoSG)

Many candidates have reported that the Principles of Surgery in General (PoSG) paper contained questions that were significantly harder, and that the style of questioning was different to what they expected.

We’re still working with candidates to understand the nuances of what might have changed, but it appears that many PoSG questions were longer than expected, and missing key information, that was instead inferred by a clinical presentation.

Here’s what some candidates had to say:

“The PoSG paper was tougher and trickier than l anticipated...”

“I felt that the questions were more granular.”

“Paper two was not straight forward. It was tricky, as many questions did not contain any key words. Some of them could only be solved be ruling out other options.”

“The actual paper has questions which lacks lot of clues and are very incomplete questions. Thus it is difficult to make an answer from the stems as most seem similar.”

“Clinical surgery questions had a lot of nuance and required a lot of in-depth thought to answer, compared to simple recall of factual knowledge in basic science section.”

Insights from the January 2020 sitting

- The exam featured an image! This was unusual in recent years for the MRCS Part A exam, but we first noticed the inclusion of an image in the April 2019 sitting. The MRCS Content guide does specify that images may be included in either paper. That said, this X-Ray was supposedly very easy to interpret. 

- The questions in Paper 1 were direct, testing knowledge particularly around anatomy and physiology, and with very few questions on evidence-based medicine or surgical techniques. Questions in Paper 2 were more reasoning-based, and a number of them contained several plausible answers.

- In order to ace the exam you need to know your anatomy back-to-front. (No pun intended!) One candidate mentioned that the Pastest MRCS Part A Qbank is great for revising anatomy, as you can filter your questions down by anatomical region.

- It’s a long day with a 3 hour exam in the morning and another 2 hours in the afternoon so pace yourself and ensure you keep your energy levels up.

- Finally, watch out for negatively-phrased questions in the exam. While there didn't appear to be many, they were all fairly obvious – with clear formatting (bold and underline) highlighting the negative element. For example: “Which of these is the least likely”.

Comments from candidates who sat the January 2020 exam:

“Start mock exams early about one month prior to exam, I think reaching a score of about 80% before exams is the target to make you feel safe about your preparation, it will also hone your time-keeping, making you aware of how much time you have for each question.”

“Take it as early as possible after graduation from Med School when your basic science knowledge is much fresher.”

“Practice lots of questions, but make sure you have a good understanding of anatomy and make sure you prioritise this.”

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