MRCS A- an in depth guide on how to crack your exam in first attempt

Let's face it, taking an international exam can be challenging. It's not just about the exam itself, but also not knowing how, what, when, and where to start. Without clear guidance on what to expect and how to prepare, it can seem intimidating. However, once you overcome the initial uncertainty and anxiety, it's just a matter of preparing for the exam and passing it, which anyone who has graduated from medical school is more than capable of doing.

I began my MRCS A journey in late 2019 when I was in my first year of surgical training. I was still new to the world of surgery, learning the basics. Deciding to take this step was something I knew I had to do, and I was fortunate to have someone in my life who helped me overcome the initial hurdles and clear the path ahead. However, I understand that not everyone may have access to such guidance, and many of my colleagues struggled to find a starting point.

The lack of a mentor or guidance can be a significant hurdle. Since clearing my exam in 2020, I have been approached by numerous colleagues asking for guidance. This made me realize that it's not just about talent, but also about the availability of knowledge and guidance that can prevent many from reaching their full potential. It saddens me to hear that some people who have carved a path for themselves hesitate to help others follow that path, leading to misinformation and discouragement for those who aspire to take a similar journey. But that's a rant for another time.

Given the many questions I have received, I decided to create this post to help as many people as possible. In this post, I will break down step by step and in-depth how to prepare for the exam, which resources to use, how to use them, and the do's and don'ts when it comes to preparing for the big day. With so many academies and resources available, it can be confusing and easy to get lost. Personally, I prepared for my exam with the help of a friend, using only the resources listed below, and I am proud to have ranked among the top 10 candidates who took the exams, receiving a certificate of achievement for an outstanding score from The Royal Colleges. So if I can do it, so can you.

I will be addressing this common questions that were asked to me. Feel free to click and expand:

        Disclaimer: I am not certified to give any advice. This is solely         based on my personal experience and what worked for me and         what I felt helped me. Having said that, I hope you find this         helpful 🌸

1. What is MRCS A exam? Format and syllabus

 MRCS A is a 5 hour long MCQ exam which is divided in to 2 parts, taken on the same day, Paper 1 is 3 hours long and Paper 2 is 2 hours long.

Paper 1: Applied Basic science

Paper 2: Principles of Surgery in General

To pass the exam, you need to achieve a minimum passing mark in both papers separately. The exam is intercollegiate, meaning it is common to all four Royal Colleges, and the passing criteria are the same regardless of which college you choose. You can take the exam with any of the four colleges, and it doesn't matter which one you choose for MRCS A as you can choose a different one for your part B. The college you take your part B with is the one you will be affiliated with and become a member of. So, choose the one that suits you best. For example, I personally took my MRCS A with RCS Edinburgh simply because it was more affordable. I then took my MRCS B with RCS Eng and am now a member of RCS Eng. So, whichever college suits your needs, go for it.

Nowadays the exam is being conducted online. A detail on this can be found here

2. How much time do you need to prepare for your MRCS A exam?

It might sound cliché, but yes, the time required to prepare for an exam like MRCS A can vary from person to person, depending on individual circumstances such as work schedule, routine, personal life dynamics, and prior knowledge in surgery. Generally speaking, if you are working alongside and can only allocate 2-3 hours a day for studying, it's advisable to start 3-4 months before your exam date. This allows you to feel prepared, have days off in between, and avoid overwhelming yourself. However, if you have recently studied for another exam or have more time available due to not working, you may be able to prepare in 1-2 months. Nevertheless, planning ahead and knowing yourself and how much time you can dedicate to studying each day is always beneficial.

I personally took my MRCS A exam during my first year of surgical training in Pakistan. Let me tell you, surgical training in Pakistan is incredibly busy. You work non-stop, sometimes even for 30-36 hours continuously, without any off days to compensate for that. It's intense and challenging, but I was determined to prepare for my exam alongside my training, and I did it.

I started my exam preparation three months in advance and even took an elective rotation in March 2020, one month prior to my exam, to allocate more time for studying. However, due to the COVID-19 pandemic, all exams were cancelled, and I had to re-book my exam for October 2020. I restarted my preparations in August, during a time when most of the elective work at hospitals was affected by COVID-19, making it relatively easier to manage my time and focus on studying.

3. What resources to use?

When it comes to choosing resources for MRCS A exam preparation, the sheer number of options available can be overwhelming. However, based on my personal experience, I found the following resources to be highly effective in covering most of the MRCS A syllabus:

1. eMRCS online subscription - This is a paid subscription service (£35 for 4 months, £45 for 6 months), but it is worth the investment. This online resource is a must-have for your preparation, as it simplifies and streamlines your studying process. It's user-friendly, allows you to track your progress, flag and save topics for later review, and retake MCQs that you got wrong initially. It includes approximately 2200 MCQs covering various topics, organized by different specialties. I will provide more details on how to efficiently use this resource in the next section.
2. Pastest offline resources- This is another very helpful adjunct that can help increase your knowledge if you have enough time. However, from my personal experience, I found it a bit too complex and extensive, which was not essential for MRCS A. Again, that is my personal experience and some people may not agree. Having said that, there are a few topics that are worth giving a read if you have a couple of extra days because I found out while doing the past paper recalls, there were 3 or 4 scenarios which were repeated in approximately every other exam, but were not covered in eMRCS for some reason, but Pastest had them. So the only topics I would recommend doing from Pastest are the ones of subspecialties if time allows, otherwise at least reading Abdomen, Pediatric surgery, Trauma and Orthopedics (click on any of these topics to open the resource). All of the other offline Pastest resources are available on Google Drive links of Samreen Malik
3. Fawzia Sheets - It is an absolute must. It is only a collection of 30 MCQs which you need to learn on your fingertips. You can expect anywhere from 2-8 MCQs in your exam taken directly from here. That's a no-brainer, DO IT. I cannot find the link to this, but I will find it and link it for sure.
4. Past paper recalls- If you have ever given an exam you would know how important the final few days before your exam are and what you read and study in those days can directly affect your performance on the exam day. Past paper recalls are the best way to revise and for that focussed studying just before your Exam. I would highly recommend spending 2-3 hours daily in your last few days before exam doing past paper recalls. Again I will be talking in detail on how to effectively do them in the sections below
   

4. How to effectively use the resources?

In the beginning when you are just starting to study, it is always good to start with doing MCQs as many as possible, as many times as possible. eMRCS is the best way to kick start your preparations. I am now going to talk on how I divided my time to effectively prepare for my exam. Feel free to adapt whatever means you feel works best for you as every one have their own way of studying, but this is just for guidance if you are struggling with starting and not knowing how to go about studying.

What I found useful was to divide the total number of MCQs on total number of days you have and then aiming to do them every day. Let's make it easy. For example you have 4 months to study, I would recommend dividing it in a way that allows you to go through all the MCQs atleast twice or thrice. You can do this by completing your 1st cycle of MCQs in the 1st 2 months. That is a long time and more than enough time to do it even if you have a hectic schedule with it. Now that we have established you have 60 days to complete 2200 MCQs, this roughly means you need to aim to do 36 MCQs each day to maintain that steady pace without overwhelming yourself.

There are obviously going to be days when you will not be able to complete 36 MCQs, more so in the start of your preparations when getting used to eMRCS and also getting in to the routine of studying. Do not feel disheartened as it is a very normal thing to go through and everyone feels the same. What is important is to not give up and continuing to try and meet the 36 MCQ mark. Once you get used to it and once you get in to the habit it will become easir. Also, remember there are days when you will have more time and more energies like on weekends or other off days, that's when you can make up for the lag and catch up your pace.

It is always useful to start with the topics you feel more drawn to like a topic that you find interesting, or a topic you find easy as it will help with boosting yourself in terms of getting something done and that sense of achievement. Once you are in the flow you can move on to your less favourite topics or topics that you hate- I know we all have those topics that we absolutely hate. Some people like to get their hands dirty with these less favourable topics just to get done with them, if you're one of them- you do you, more power to you. In short whatever your strategy is and whatever works for you. I am just sharing what worked for me.

Whatever your style of studying is, It is absolutely necessary to study the detailed description under each MCQ and getting the core concept right. In the exam, that is what is going to make all the difference. In my personal experience the description is good enough in the context of the exam, but if you feel you need to learn more about it, it is always worth going to the internet and searching more details on the topic. You can also read it from one of the text books of your liking like Raftery is a good read for basic sciences. Again it is not necessary but if you want to expand your knowledge, why not.

eMRCS also allows you to keep a track of how well you did in some of the topics and what topics need more attention. In the beginning even if you are getting only 50-60 %, that is fine, keep going.

Once you have gone through all your MCQs, then you can start revision by again using the same strategy of dividing the number of MCQs to the number of days for your 2nd and 3rd revision. You will notice this time it is a bit more quick. As I said keep practicing as many MCQs as many times as possible.

Your last month before the exam is when you should start incorporating past paper recalls and Fawzia sheets. At this stage I would highly recommend finding someone who is giving the exam with you and try and do the past paper recalls as a part of group study. You would realise on the day of your exam that you would remember whatever you have discussed in your group study so vividly. It also helps with understanding the recalls as sometimes it can be very confusing and all of you can help each other out. Try and complete past paper recalls of the last 5 years at least.

Read each and every MCQ in the recall, try to solve them, if in any doubt go back to eMRCS or search online and take your time to go through it in depth and to solve them. This is very important as I found out that 55-65 % of my exam MCQs were in one way or the other related to these recalls. The structure of the questions can be different but the concepts are all the same. So please spend good amount of time in getting your concepts right. Initially each recall can take a lot of your time but as you do more and more of them it gets easier as you would see a lot of repetitions and by the end of 5 years of recalls you will have most of the MCQs already on your fingertips.

Fawzia sheets are very straight forward and again very useful. It takes 1-2 hours of your time and can easily be done in the last few days before your exam

5. Some extra tips to prepare yourself for the day of the exam.

I think we all agree it all comes down to how well you deliver on the day of the exam that actually matters. Yes being well prepared is important and helps boost your confidence but it will not matter if you do not know what to expect in the exam and how to put your best foot forward. In the end it all comes down to the day of your exam. No matter how much you have prepared for that day, let's not forget it is a very stressful and nerve wrecking exam which does test your limits. Here are a few tips that can help prepare yourself to be the most efficient version of yourself.

1. Rehearse and Repeat- MRCS A is a time based exam and as mentioned before, it has 2 papers. 1st paper is of basic sciences comprising of 180 MCQs in 180 minutes. Although it might sound a bit tight, remember most of the MCQs are straight forward and you will probably be doing it in 30 seconds. You have enough time to complete paper A, key thing to remember is to not over think. Paper 2 is when things get tricky. It is a total of 120 MCQs in 120 minutes. Most of the MCQs are scenario based and it takes a while before you can answer them. This is when you need to be mindful about the time limits and be efficient with it.

eMRCS has this option where you can simulate test setting. You can do timed MCQs like 10 in 10 minutes, 60 in 60 minutes so on and so forth. I would highly recommend using this as a means to drilling your mind to simulate the exam setting and getting in to that habit of focussing for 2 hours continuously as you will be doing in the exam. During your last 15 days of exam do at least one such time based test of 120-180 MCQs as this will allow your mind to get used to be focussed for extended amount of time and getting into that rhythm. You will realise how doing this exercise will greatly help in your actual exam when there is so much going on, one less thing to worry is not a bad idea- is it?

2. Not spending too much time on one MCQ- This is simple maths, when you are in a time restraint it is never a good idea spending a lot of time on any MCQ. If you feel it is taking too long skip the question and come back to it in the end. Getting one MCQ right at the expense of attempting 5 other questions that you could have done in the same amount of time is not worth the risk. Focus on completing all the MCQs. If you are in doubt take a guess. Remember there is no negative marking. So attempting all the questions takes precedence over leaving them because you were unsure.

3. Having enough rest- Again I can not emphasize how important this is. Having a good night sleep can help your mind be more relaxed and endure stressful environment in a much more efficient way than with little or no sleep at all. I know this is against what our mind and body is trained to do, and it might not be something that is as easy as it sounds, but having good rest and sleep can improve you efficiency by 15-30 %.

4. Having a good meal- Your brain relies on glucose for it's energies and needs this to function properly, so it only makes sense to not starve your brain before a 5 hour long exam. Keep a small chocolate bar with you for when you get break between the two exams and drink enough water.

5. Relax- You have done the best of what you could, you have done your part and stressing never helps anyone. In the end of the day it is just another exam. If for some reason it does not work out you will have another chance at it. So take deep breaths and believe in yourself.