Passing the MRCS Part A: How on Earth Did I Do It? My Study Strategy

Wondering how to pass the MRCS Part A exam? Here’s a complete breakdown of my study strategy, resources, and top tips for success.

The part A of the Membership of the Royal College of Surgeons examination is one of the toughest out there. With an average pass rate reportedly as low as 40%, it’s no wonder that many of those who sit this exam end up sitting it more than once. Unfortunately, this is the exact situation in which I found myself last October. I’d sat the part A exam in September 2020, having waited for it to be rescheduled after the April 2020 sitting was cancelled due to none other than *drumroll* COVID-19.

It had been a tough slog, preparing to sit the exam in April 2020, only to be advised a week or two prior that the exam was to be postponed until September 2020. Although the circumstances of the cancellation made complete sense, the dissipation of the pent up stress and preparation felt like one huge deflation.

The date for the September 2020 sitting was eventually announced and I once again began preparation in earnest. In the run up to the exam, I didn’t feel particularly ill prepared or nervous. The exam was to be sat from home virtually, which instantly made it feel all the more comfortable. During the exam, there were several questions which were notably challenging, however, overall it felt like a difficult exam as opposed to truly impossible, although the Principles of Surgery in General (POSG) paper really made me sweat.

A few weeks later, however, and the result arrived in the form of a big fat fail. The pass mark, for the first time in years, had skyrocketed to a lofty 76%. My mark of 71%, which would have ordinarily earned itself a pass, appeared mockingly low in comparison.

I was pretty gutted. It felt like a big set back, particularly when I’d originally anticipated for this exam to have been done and dusted in April 2020 during my second year of Foundation training, instead of the beginning of my Core Surgical Training. Now, I could feel the resit looming in the not-so-distant future, casting a figurative shadow over the months to come.

Talking it through with some of the Specialty Registrars at the trust where I worked helped me reconcile this defeat. I remember one especially encouraging quote:

“It’s not a fail, you just almost passed.”

As it happened, the inflated pass mark did not go unnoticed. There was a palpable uproar on Twitter, with trainees collecting signatures and drumming up support for letters to the Royal College of Surgeons, expressively verbalising their frustration. The Royal College stood resolute, however, issuing a statement which essentially outlined the pass mark was there to stay. Unfortunately, during this outcry, I had my hopes set on some alteration in the pass mark, but when this did not materialise, it transpired that I had also missed the deadline to sign up for the next sitting in January. This consequently delayed my resit to April 2021, which felt an excruciatingly long way away.

The new year arrived in its usual optimistic splendour, and I successfully booked to resit part A in April 2021, painfully parting with over £600, as I also signed up to the popular eMRCS question bank (no endorsement). I conceded that I needed to change my strategy and really revitalise my revision technique. I had trialled active recall during the latter part of my revision for the September 2020 sitting and had found it to be useful, but had not gained the full benefit due to time limitations. Now that I was recommencing my revision, I had the advantage of utilising this technique right from the off.

To cut a long story short, I managed to pass the April 2021 sitting. For me, this felt like one hell of a tough exam. I probably only recognised approximately 10% of questions based on the questions from which I had revised. On the one hand this is probably good, because it was testing the application of knowledge, instead of rote learned facts. On the other hand, the diaphoresis I had experienced during the POSG paper of the September sitting paled into insignificance when compared with that experienced throughout the entirety of this exam.

So, how on Earth indeed did I manage to pass this exam? I thought I’d reflect on the techniques I used which worked best for me and compile them below. There isn’t really a set way to revise for these exams, but there were a few elements which truly revolutionised my revision and maximised my ability to retain information.

1. Spaced repetition.

Now, this is a technique relatively marred by cliché due to its widespread popularity as a well marketed one stop shop for a guaranteed pass in literally every exam ever. It’s ubiquity has almost rendered the phrase entirely devoid of meaning. However, when utilised properly and systematically, I found this revision tool really came into its own.

The way I implemented this system was primarily through the use of a question bank. The questions would repeat various concepts, and the more questions I did, the more repetitions I would encounter. This essentially kept challenging my brain with the same facts, so that it learned them over a period of several repeated, bite-sized exposures. It’s a bit like progressive overload when training for sports, or lifting weights. Small, repetitive exposures to steadily increasing loads can train the musculoskeletal system to better manage the load under pressure.

I used this technique as a mainstay for my revision and then turbocharged it with the next technique, outlined below in more detail.

2. Active recall.

Once again, this phrase is likely to have met the eyes or ears of most folks out there who have experienced the fraught hysteria of exam preparation. But, my honest truth is that this technique truly revolutionised my revision. It gave me a new lease of memory, because facts, which would usually bypass my sieve-like brain, actually wanted to stick around for longer than 0.00000000001s.

Essentially, I wrote down a question and answer for every question I got wrong from the question bank. Every time I went to revise from my notes, I had to actively recall the information, instead of simply reading it from the page. This created neural pathways and associations in my brain, allowing me to assimilate and more easily access that same information again.

Let’s go through an example. I attempt a question about the management of acute cholecystitis, but I answer the question incorrectly. Previously, I would have only written the answer in my notebook, e.g. “emergency laparoscopic cholecystectomy”. However, now, using the principles of active recall, I write the question “what is the management of acute cholecystitis” on a page at the front of my revision notebook, and the answer “emergency laparoscopic cholecystectomy” on a page at the back of the notebook. This way, every time I go through my notebook to revise, I am actually actively recalling the answer instead of simply reading the answer (which I would otherwise guaranteed forget due to lack of engagement with the material). If I cannot remember the answer, I have a glance at the back of the book to check what the correct answer was and then try and remember it for next time. Some people use flashcards for this; I just used a thick A5 notebook because I preferred all the information to be in one place.

Through a combination of active recall and spaced repetition, I was able to see a powerful compounding effect whereby aspects such as anatomical concepts would start to stick so much better.

3. Curiosity.

I first encountered this concept whilst reading Stephen Fry’s autobiography, “The Fry Chronicles”. The idea was so immaculately presented that it stuck. It was simple. Approach new information with curiosity; take an interest in it and use it as an opportunity to learn. For as long as I can remember, new information would terrify me. I used to become so stressed by not knowing something, that my sensory input would just switch off and my mind would defensively shut off, as if afraid that new information would somehow shatter my sense of control.

However, with curiosity as my new mantra, I suddenly felt a wave of confidence which seriously fast-tracked my learning process. I was open to receiving, absorbing and assimilating new information in the most refreshing way. There are still moments where I need to remind myself to stay curious, but it’s become engrained as fairly routine practice now.

4. Etymology.

Finally, etymology is a real nice niche concept. And a total gamechanger for me. Etymology refers to the origin of a word, usually from its Ancient Greek or Latin derivative. There is an extraordinary plethora of weird and wonderful sounding words in the medical library and the majority of them would go right over my head. Moreover, the words would just be devoid of meaning to me and so I would find them difficult to relate to. I would never remember them as I could not relate to them.

So, when I discovered the concept of etymology, it completely obliterated this barrier. I was suddenly able to see through language, as though I had just entered the matrix (I embellish, but complicated medical terminology started to make sense). Not only this, but I started to notice linguistic patterns to many terms that used to bamboozle me. For example, phagus = to eat. Therefore, phagocyte = phago– (eating) + -cyte (cell). It’s a cell that “eats” other cells. Oesophagus = oiso- (to carry) + –phagus (to eat). It’s an organ that carries food. That instantly gives us two words which are now a lot less complicated than they originally seemed.

I think it’s fair to say that none of these methods are hugely revolutionary or unheard of. However, the point of the matter is that, when put together, they enabled me to supercharge my revision technique and actually remember facts pretty well through this simple system:

a) I was curious about a fact and therefore cultivated an interest in the topic,

b) I understood the fact well because I understood it’s origin,

c) I actively recalled the fact repeatedly over a set space of time.

Ultimately, these techniques worked well for me and I therefore aim to improve them in order to further optimise my revision. The next exam, Part B MRCS, requires application of knowledge along with practice, so I will need to be able to retain the information as well as have a sound understanding of the relevant facts in order to perform well in this OSCE (Objective Structured Clinical Examination). I’m dreading it, but I’m also excited to put these skills back into action.

Watch this space for part 2 of this anecdotal study, which could entail either a win or a woe. We’ll just have to see…