Stephen Parker BSc DipMedEd MS FRCS (Gen)
Consultant General Surgeon University Hospitals of Coventry and Warwickshire NHS Trust
Coventry, UK
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5Preface
MRCS Applied Basic Science and Clinical Topics has been written as a resource for candidates who are preparing for postgraduate surgical examinations, in particular Parts A and B of the Intercollegiate MRCS Examination. It has its foundation in my experience as a general surgical consultant with a strong interest in medical education. The content has evolved over time, shaped by feedback from previous candidates who have identified what they would have wanted when preparing for their examinations.
The book aims to fill the gap between large surgical textbooks and smaller revision aids. This has necessitated a selective approach to the topics included and the depth in which they are discussed: the basic science topics have been chosen for their direct bearing on clinical practice and the clinical topics are those commonly encountered both in the wards and in postgraduate surgical examinations.
Each chapter presents the basic science and clinical topics in a consistent format, in accordance with the MRCS syllabus. The clinical chapters aim to cover the whole breadth of surgical specialties at a level appropriate for the MRCS examination. Variations in surgical practice will inevitably mean that there will be disagreement with some of the views and recommendations that are presented. In potentially contentious areas I have attempted to include opinions that are not too extreme, are supported by current research evidence and will hopefully satisfy most examiners.
Within the space available, the book cannot hope to be exhaustive. Nevertheless, I hope that it will be a useful tool when working in and studying a particular surgical speciality, as well as serving as a revision tool and aide-mémoire immediately prior to the examinations.
Stephen Parker BSc MS DipMedEd FRCS(Gen)
October 2012
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11The MRCS Examination
The Membership of the Royal College of Surgeons (MRCS) examination is a summative assessment of candidates in the generality of surgery, whether in core surgical training or outside a training programme. Its purpose is to determine that a trainee has acquired the knowledge, skills and attributes required for the completion of core training and for those trainees following the intercollegiate surgical curriculum programme, to determine their ability to progress to higher specialist training. Passing the MRCS is mandatory to progress from ST2/CT2 to ST3/CT3.
Format of Part A
There is one 4-hour examination consisting of two 2-hour multiple choice question (MCQ) papers that are sat consecutively. Paper 1 tests applied basic sciences and has single best answer (SBA) questions. Paper 2 tests principles of surgery-in-general and has extended matching questions (EMQs). Candidates score one mark for each correct answer. To pass Part A the overall pass mark has to be met. The pass mark is set using a modified Angoff method. A score of at least 50% on each paper has to be achieved. Candidates can have an unlimited number of attempts at this part.
Format of Part B
Part B is now in an objective structured clinical examination (OSCE) format. There are 16 stations and four rest stations, each of 9 minutes. Candidates start at different points in the circuit. The stations assess knowledge and skills in five main subject areas:
- Anatomy and surgical pathology
- Surgical skills and patient safety
- Communication skills
- Applied surgical science and critical care
- Clinical skills
Twelve stations test generic knowledge and are compulsory for all candidates. To allow for differences in training, there are four speciality stations. Candidates select their speciality context at the time of application. In each of the five subject areas, six domains are tested:
- Clinical knowledge
- Clinical skill
- Technical skill
- Communication
- Decision making and problem solving
- Organisation and planning
Most of the stations have surgeon examiners and all examiners must have completed a training course. The marking scheme is a matrix in which the stations are marked using several domains. There is a structured mark sheet for each station. The mark sheet includes a holistic judgement of the candidate. Candidates must reach the overall pass mark set for Part B. They must also achieve a minimum score in each of the domains. A variant of the contrasting groups method is used for setting the overall mark.