Preparing For The MRCP(UK) Part 1 Exam

Updated: 12 hours ago

Introduction

The Membership of the Royal Colleges of Physicians of the United Kingdom, or MRCP(UK), is a three-part postgraduate examination which doctors are required to complete in order to be able to proceed to higher specialty medical training in the UK. There is some relaxation to this rule currently due to the backlog caused by reduced availability for candidates to sit the exams during the COVID-19 pandemic, but normally it is mandatory for the full MRCP(UK) diploma to be attained by doctors, usually Internal Medicine Trainees (IMTs), before they can start their ST3 or ST4 posts (depending on whether they are entering a Group 1 or 2 specialty).


The MRCP(UK) Part 1 comprises two three-hour papers of 100 multiple choice questions (single best answer of five) each. The number of questions for each specialty varies, and it is useful to have an idea of this distribution when planning your revision schedule. It would be more strategic to spend more time on a specialty that may make up a bigger part of the exam than a specialty which may only be represented in a handful of questions.


The overall result is scaled based on the relative difficulty and performance of other candidates in the exam. The scaled pass mark for Part 1 is 540, and it is often quoted that this corresponds to a raw percentage of around 60-65%. This is a Pass/Fail exam – meaning as long as you pass, there is no added “advantage” to gaining a higher score; I have not heard of the specific exam mark being a factor in any subsequent job application or interview process. The MRCP Part 1 is not an easy exam, with pass rates for the 2021 sittings ranging from 41-55%; but as you progress with your preparation, you should find the prospect of taking the exam becoming less and less daunting!


When should I sit Part 1?

Part 1 can only be taken after a minimum of 12 months of postgraduate clinical practice. This means that UK medical graduates can sit the exam at the start of Foundation Year 2 (FY2) at the earliest. Based on current IMT portfolio requirements, Part 1 must be completed by the end of the first year of IMT.


If you are certain that you want to apply for IMT to pursue a higher medical specialty, I would advise sitting Part 1 sometime during FY2. The “statistics” also support this, with the MRCP(UK) exam board reporting that the highest pass rates (70%) are achieved by trainees who first attempt the exam between 12-24 months after graduation.


This is not compulsory of course, and it is most important to sit the exam when you are ready (rather than rushing without having adequate time to prepare). At present, passing Part 1 during FY2 does not provide any additional points for IMT applications. Although, when I applied for IMT, the application form did include a question on whether I had passed Part 1, and anecdotally I have heard about interview panels asking applicants whether they had already completed Part 1. This is purely speculative on my part, but perhaps panels may view an applicant who has taken Part 1 earlier as demonstrating more “commitment to the specialty”.


How long do I need to prepare?

There is no one-size-fits-all answer to this question, and will vary from individual to individual depending on your personal study habits and preferences. A recommended study period of 2-6 months is probably the most commonly quoted, and I would suggest allowing 3-4 months for your Part 1 preparation. Start too early, and it may be a struggle to maintain focus and motivation if the exam date is still ages away. Conversely, we all know how stress-inducing it can be to leave studying to the last minute. It is important to keep track of when the application window for the next exam diet opens and sign up as soon as you are able to. Officially signing up for the exam and paying the (not insignificant!) fee should serve as an intrinsic boost of motivation for revision. The application window usually opens around 2 months before the exam date.


What resources should I use?

Question banks

The single most important resource, in my opinion, for Part 1 preparation is the question bank. There are multiple options available and you will likely recognise these from your medical school days. Question banks contain thousands of questions that test and enhance your knowledge, requiring active engagement with the material and offering the opportunity to track your improvement.


These are just a few of the most widely used question banks:-

§ Pastest

o The largest question bank, with more than 7,000 questions as well as an extensive collection of past papers

o A mobile app is available and questions can be downloaded for offline use

o Check out their blog also, where they offer insights into the most commonly tested or tricky topics based on feedback from candidates who have just taken the latest exam


§ PassMedicine

o Contains over 4,000 questions and is the most affordable question bank (£30 for 4 months)

o A textbook of notes for a range of topics is available, which I used as a rough outline of the “curriculum” for this exam, given that this is not explicitly provided elsewhere


§ BMJ OnExamination

o Has over 3,000 questions, and also offers a mobile app to download questions for later offline use


It is worth checking with your local Trust library or medical education office if they have existing subscriptions for any of these (or other) question banks. These question banks also offer discounts at times, for example during Black Friday sales, so do look out for these. I used both Pastest and PassMedicine, but I believe it is enough to focus on just one question bank if you work through it comprehensively. I would advise against trying to do more than two question banks, as there will be just too many questions to get through and you may run out of time without getting your money’s worth.


I aimed to do around 30-50 questions per day initially and gradually increased this as the exam date approached. This did vary depending on my work schedule, for example, after a long on-call shift I would only do 10-20 questions to keep some “momentum” going, whereas on an off day I would aim to do more than 50. Use any commute or downtime to sneak in a few questions if possible, as every little bit adds up. Having said that, it is crucial to take breaks and to have days when you avoid revision completely – it is no easy feat to balance a full-time medical job (with clinical pressures being greater than ever) alongside studying for a challenging postgraduate exam. Do look after yourself and prioritise your well-being.


A pitfall that some (myself included) fall into with using question banks is developing a habit of answering questions on “auto-pilot”. This is where we fail to engage any active recall – for example by answering questions without thinking deeply, ignoring any associated explanations and answering repeat questions (that we were incorrect on the first time) correctly purely by remembering the right answer. Be sure to think carefully and try to figure out the “point” of each question. Keep track of topics that you may be struggling to grasp and make notes around these (an example for me was renal tubular acidosis). Most, if not all, question banks have a “reset” function so once completed you can go back and answer the questions all over again. This is helpful to compare and track your progress since the first time round.


Official sample questions

The MRCP(UK) website offers free access to 199 sample questions, and it is often suggested that these are the closest to the “real thing”. The typical recommendation is to save these questions until about the last couple of weeks before the exam, and to use these as a sort of mock test (under timed conditions) to gauge what your actual exam performance may be. As mentioned above, the raw percentage to achieve a pass in Part 1 is estimated to be around 60-65%. If you obtain a percentage of 65% and above in these sample questions, you should be well on your way to being ready on exam day. If not, do not be disheartened and keep up the effort as there will still be time to work on your preparation.


Books

It may seem strange to advise studying for a medical exam without using any books at all, but this is entirely possible (I personally did not use any). Nevertheless, it may be useful to have one reliable written resource, and I have heard good things about Kalra’s Essential Revision Notes for MRCP. Unless you are starting your revision very early and have plenty of time, it would be better to focus on subjects that require improvement (e.g. topics that you notice you tend to struggle with in question banks) rather than reading every single page from cover to cover.


Flashcards

Flashcard apps such as Anki and Quizlet are efficient ways to utilise a self-testing approach. I used flashcards to write my own notes (in the form of questions) and test myself on these regularly at spaced intervals. I limited these to topics that I found challenging, in order to avoid simply copying and pasting piles of notes from other resources into a flashcard format. You can create your own flashcards or search for decks made by other users. If you are revising from flashcards made by someone else, do check that the notes are updated and relevant to local contexts, for example, for subjects such as NICE heart failure or blood pressure management guidelines.


Courses

There are courses available for Part 1 revision, such as this, although I personally did not attend any. I would not consider these a compulsory part of your preparation, although I am sure these would be valuable if you find that your learning benefits from having direct interaction with experienced teachers. If eligible, do ensure that you claim the cost of attending a course from your study budget. In a similar vein, do attend any Trust or Deanery teaching that is targeted to MRCP(UK) preparation – for example the East of England has delivered several webinar sessions covering topics relevant to Part 1.


Final remarks

The MRCP(UK) Part 1 may be challenging, but with the right preparation there is no reason to be intimidated by it. By the time you come to sit this exam, you would have successfully passed dozens of school and university exams to reach this point – think of this as just another stepping stone in your journey to being the best doctor you can be. Good luck!


By Dr John Lee (Internal Medicine Trainee)

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