The MRCS Part B is the second part of the MRCS and is an in-person practical examination that is required professional development if you want to become a surgeon in the UK.
No-one likes to be put on the spot and have their knowledge questioned directly and it can be tough knowing how to prepare effectively for practical exams, especially if English isn't your first language. This ultimate guide covers everything you need to know to help you pass the MRCS first time.
What Is The MRCS Part B?
The intercollegiate MRCS Part B OSCE is the second and final examination required to gain Membership of the Royal Colleges of Surgeons (MRCS) at the royal college of surgeons in England, Glasgow, Edinburgh or Ireland and to enter specialist surgical training in Great Britain.
The MRCS tests the knowledge, experience and clinical competence expected of trainees at the end of their core surgical training.
While the MRCS Part A is a written paper, Part B is an Objective Structured Clinical Exam (OSCE) similar to the practical OSCE exams used in medical school finals comprised of a series of stations in a circuit around which you rotate.
MRCS Part B Eligibility Criteria
Candidates must have passed Part A before they can take Part B.
In order to be eligible for the MRCS exam, you need to have a medical degree. It is essential that this is deemed acceptable by either the UK General Medical Council (GMC) or the Medical Council in Ireland, so you can be fully, provisionally or temporarily registered.
First time applicants not on the registers of the GMC or the Medical Council in Ireland, must submit their original medical degree certificate or an authenticated copy to the councils of colleges.
Candidates have 4 attempts in which to pass their Intercollegiate MRCS Part B OSCE and must successfully complete this within seven years of passing their Intercollegiate MRCS Part A.
MRCS Part B Application
Applications for Part B of the next MRCS examination can be submitted through each of the Royal College of Surgeons websites. In total, there are four colleges where you can complete an application. These are the Royal College of Physicians and Surgeons of Glasgow; the Royal College of Surgeons of Edinburgh; the Royal College of Surgeons of England; or the Royal College of Surgeons of Ireland.
MRCS Part B OSCE Cost
The exam fee is around £1000 just to sit the full OSCE exam and then there is the cost of online question banks and in-person mock OSCE courses which can set you back a further £500-1k.
MRCS Part B Exam Dates
There are usually three MRCS Part B OSCE sittings in the UK and Ireland each year:
With international dates varying. Exams are held at hospitals and simulation centers around the world in clinical environments with real and simulated patients. There is a closing date to apply a few months before the exam date
MRCS Part B Format
Part B is an objective structured clinical exam (OSCE) that consists of 17 examined stations. Each station is 9 minutes long. There is an additional 1 minute for reading the task instructions before the station starts and 1 minute for moving between stations at the end
There may also be rest or preparation stations but these are not scored or examined by the Royal College. In total, the exam takes approximately 3.5 hours.
You'll rotate clockwise around each of the stations in the circuit and will be guided by an examiner. As it's a long exam they usually break the circuits into two with a 15 minute rest between circuits where you are under real exam and conditions.
At each station you'll be required to undertake a clearly defined task. In Part B OSCE these may include taking a focused history or clinical examination, interpreting an X-ray or performing a simulated practical procedure. At the start of each station there are instructions for the candidate, which briefly outline the scenario and describe the task that you need to undertake. Stations are manned by one or two examiners who score the candidate using a set marking scheme that we'll look at shortly.
The various stations examine the knowledge, applied surgical science and skills of each candidate and are divided up into 4 broad content areas:
Applied Knowledge (8 stations):
- Anatomy and surgical pathology (5 stations)
- Applied surgical science and critical care (3 stations)
Applied Skills (9 stations)
- Clinical and procedural skills (5 stations)
- Communication skills (4 stations) - history taking and giving and receiving information
The MRCS Part B OSCE Syllabus has a full scoring matrix covering basic sciences applied surgical science, surgical pathology and more. The scoring matrix shows the breakdown of stations, scoring, domains tested and even the number of examiners required.
So let's have a look at the scoring in a little more detail.
MRCS Part B Scoring
Each MRCS Part B OSCE station is marked out of a total of 20 marks on a structured mark scheme and in addition candidates will be awarded a separate, overall global rating for the station as a fail, borderline or pass based on the judgment of the examiners at that station.
The 8 Applied Knowledge stations (anatomy, surgical pathology and surgical sciences and critical care) give a score out of 160 marks and the 9 Applied Skills stations give a score out of 180 marks.
The MRCS Part B Syllabus gives the exact marking sheet which the examiners use.
What is MRCS Part B Exam Pass Mark?
To pass Part B you need to pass both the Applied Knowledge and Skills content area and the passing mark for each is set after the exam based on the difficulty of your specific exam that you sat. This is because Part B stations can vary between test centers and the pass mark is personalised to your day and exam circuit rather than being a fixed generic percentage for fairness.
If we look at some of the data from the exam board for Part B we can see that around 70% of candidates pass at each sitting and you need to pass roughly 70% or more of the stations in Knowledge and Skills meaning if you fail 1 or 2 stations in each you can still pass Part B.
When Should You Sit The MRCS Part B OSCE
The Royal College of Surgeons suggests sitting the Part B in Core Surgical Year 2 but lots of people sit it earlier as CST2 is when you want to be focusing on surgical specialty job interviews.
If we look at a research study published in the BMJ in 2017 which surveyed successful candidates between 2008 and 2016 it shows that pass rate was highest for those sitting in core surgical year 1.
How to Pass the MRCS Part B
The MRCS Part B OSCE, like any OSCE or in-person medical exam, doesn't just test your clinical knowledge, but also tests your practical skills and your communication skills which can be more difficult to improve compared to revising for a written exam like Part A where you can jump in and do loads of questions in a question bank.
How Difficult Is the MRCS Part B
The level of difficulty for the MRCS Part B OSCE can be greatly reduced by ensuring that you are fully prepared for the exam. This means having a solid understanding of the syllabus as well as being familiar with the format of the exam. It’s also important to make use of resources such as textbooks and practice questions to consolidate your knowledge. Furthermore, revision courses can be extremely beneficial as they provide you with an opportunity to test your knowledge and identify any areas that require further revision.
The MRCS Part B Syllabus
The best place to start your exam preparation is is MRCS syllabus which is a useful resource for candidates. Within the syllabus, there are several sections that provide candidates with helpful information. These include a background and overview of the MRCS exams, as well as the recommended textbooks that candidates can base their revision and preparation on.
The syllabus also indicates the topics and skills that might be examined in the MRCS exams. The final section of the syllabus is dedicated to MRCS Part B and has some sample questions.
MRCS Part B Past Papers
Once you understand the format and mark scheme for the exam it's time to try and get hold of as much practise material as possible. While there are no formal past papers like you might find for written exams there are often lists of station summaries passed down by previous candidates. Speaking to surgical trainees who have sat passed at their first attempt is extremely helpful and they'll often have a load of past stations, mark schemes and further information that have been shared with them from previous years.
The actual exam uses a bank of questions created by consultants and so the more past stations you can find out about the exam format the better you'll be.
There are a limited number of possible scenarios and if you can narrow these down further it will make your time spent revising much more efficient.
The OSCE consists of lots of practical stations with the critical care applied skills and procedural skills tending to be the hardest sections of the Part bB
The OSCE exam format means your mrcs part b revision needs to include a practical mrcs resource that features surgical science and critical care scenarios. Online questions banks are a great resource, especially those that work on a mobile device so you can access practice questions at work and have on-demand access to practical skills like clinical and procedural skills and giving and receiving information in addition to the broad content areas of the intercollegiate mrcs part b examination syllabus.
MRCS Part B Books
One of the big problems with Part B is knowing how to balance practising skills like history taking and surgical skills and actually going over the required knowledge to be able to answer the questions. Luckily there are a number of books and online resources that cover everything from anatomy and applied sciences to surgical examination. The best books use active recall in the form of anatomy spot tests and viva style questions where you can cover the answer and then test correct knowledge against yourself.
Grab as many of these books as possible either buying from Amazon where most retail for £30 or by picking up some second hand copies from past candidates or on ebay where you can get them much cheaper. There are also a few available to download on pdf too but you'll need to do some searching.
Basic Science for the MRCS which is used for Part A can be used as a general reference book and books like Logan's Illustrated Human Anatomy can be used as a larger anatomy reference guide which has actual cadaveric images rather than just diagrams.
Testing books include the Dr Exam books which are huge but have some good images. Simon Overstall's MRCS Anatomy book features lots of spot tests and Applied Surgical Vivas and Critical Care vivas basically asks viva-style questions and comes with comprehensive answers.
MRCS Part B Videos
While books are really helpful and you should definitely be getting through as many questions as possible videos of examination, anatomy and surgical skills are essential for quickly and efficiently understanding some of the subtleties required to do well on the practical parts of the exam.
Acland's Anatomy videos are excellent as they are cadaveric and are easy to watch although they are a bit dated in terms of their quality. There are some good YouTube channels like anatomy zone for learning anatomy too although many of these like teach me anatomy are just illustrations rather than cadaveric models which is what is needed for the spot tests and gives the best understanding.
YouTube is also great for surgical skills and history and examination and a quick search will show you lots of good examples. Go back over the basic surgical skills course videos which cover basic training and everything needed for the practical skills stations.
MRCS Part B Questions
In addition to books and videos there are also some excellent online resources with banks of spot anatomy spot tests, example questions and videos to help you prepare.
The most popular of these being MRCS Part B Questions and Pass The MRCS while both eMRCS and PasTest which you may have used for the MRCS Part A also have Part B resources too. So let's take a look at each.
MRCS Part B Questions has the most Part B questions with over > 3500 MRCS Part B Questions to practise. It is pretty unique as it has interactive cadaveric anatomy questions and a focus on high quality answers to both anatomy and basic science questions which are usually the hardest part of the Part B exam. The resource has simulated clinical cases and a nice interface that works on mobile although there is no app or way to access the resources offline. It's also fairly cost efficient with 3, 6 and 12 month options available.
Pass The MRCS
Pass The MRCS part b revision is very expensive as it includes a year's subscription to Ackland's video atlas which many people will already have access to especially if you used it for your Part A revision. The questions are a bit less realistic compared to MRCS Part B Questions and the interface is fairly basic but it does have some good questions and answers so it is worth a look if you can't find a free version of Acland anywhere.
eMRCS has a fairly basic Part B question bank with clinical images and some good explanations. It's biggest plus point is it's low price which is just £35 for 4 months and £50 for 6 months.
PasTest comes in at the most expensive for Part B preparation but does feature clinical videos and anatomy videos from Prof Harold Ellis. The questions aren't that reflective of the actual exam however and so if you are happy with your basic surgical knowledge and skills videos and Acland's anatomy videos this might be a little overpriced.
How Long Should You Revise For The MRCS Part B?
Top candidates spend around 4-6-months preparing around their day job during my F2 year and similar to Part A I tried to do a few hours of work around my day job rather than cram things in. I've known people who have dedicated a full year to revising, booking the exam well in advance and a few people who cram and get it done in less than 3-months.
Is the MRCS Part B Exam Difficult?
The highest pass rate for MRCS Part B is 75%, which was recorded during the autumn 2020 exams. More candidates tend to pass Part B of the exam than Part A. However, you only get four attempts to complete Part B, whereas with Part A you get six opportunities so it can seem a bit scarier plus it costs a lot to re-sit the exam.