MRCS Part A, Jan 2021 Exam: Instant Insights

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Ever since the MRCS Part A exam earlier this month, we’ve been working with customers and exam candidates to understand the differences and nuances that defined this sitting. We’re using this research to improve our MRCS Part A resources, but that’s not all! Read a summary of everything that we know so far below…

Due to the ongoing impact of COVID-19, the MRCS Part A was once again delivered as an online exam. 79% of our survey respondents said that they felt adequately prepared for the remote format, however, 23% of candidates said that there was an element of the exam that they didn’t expect.

While the majority of candidates said that they would prefer to sit future exams online rather than in-person, the percentage of these candidates has dropped from the previous sitting. In September 2020, 74% of candidates said that they would prefer to sit future exams online, whereas in January 2021 this figure reduced to 60%.

MRCS Part A Exam Content

  • 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, but that’s not to say that one won’t crop up in a future sitting. Both the April 2019 and the January 2020 exams featured images.
    • Candidates did report one ECG to interpret 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.”

Tricky Topics

According to our customer survey, these were the trickiest modules in the exam:

  • Basic science knowledge relevant to surgical practice
  • Common surgical conditions
  • Perioperative care of the surgical patient

The Online MRCS Part A Exam

  • Candidates who logged in before the start time were able to begin the exam earlier than expected – which caught some users off guard; they were expecting a countdown timer and some time to mentally prepare before the exam began.
  • One candidate reported that they had taken the exam face-to-face twice before, and felt under less time pressure in the online sitting, as there was less admin required in transferring answers to marksheets.
  • Some candidates said that they had difficulty concentrating and getting into an exam mindset in the comfort of their own home. One candidate said this caused him to have a slow start. His advice: “Warm up just before the exam by answering some Pastest questions.”
  • The rules and monitoring take some getting used to. You can’t gaze off into the distance, or look around the room, causing some candidates to report neck strain, eye strain, fatigue and headaches. It also means that you cannot use your own body to help you answer questions! One candidate commented: “For example, if there’s a question about foot anatomy, I’ll look at my own foot to visualise the underlying structures.”
  • Another difficulty that some candidates faced was using the on-screen notepad in the exam interface. Candidates were NOT allowed to bring a pen and paper into the exam.

Are you preparing for the MRCS Part A exam? We can help! Take out our free MRCS Part A 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 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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