MRCP ( UK ) Part 1 Exam: start off Pack for Overseas Graduates
Najeeb Ahmed , Turab Arshad SYED
Each year, a large number of overseas medical graduates decide to pursue their postgraduate medical training in the United Kingdom . Not only they are aspiring for quality education in specialist areas, but they also provide much needed services for the NHS. The number of such doctors willing to train in the United Kingdom has increased steadily, and over the past few years the number of applicants to the General Medical Council for limited and specialist registrations has increased notably. Last year alone, approximately 9000 doctors were registered with the GMC for the first time. With the GMC now conducting PLAB more often then it was ever before, it is safe to say that this number will continue to grow during the coming years in unprecedented levels. This article intends not only to highlight the importance of this exam in career progression, but also to give the overseas doctors an insight on how to properly plan their attempt for the Part 1 MRCP.
WHY IS IT SO IMPORTANT
Generally speaking the MRCP exam forms the backbone of postgraduate training in medicine and almost all of its related specialist fields. It is expected that most of the doctors undergoing SHO training will pass their MRCP at the end of the training period and therefore successful completion of MRCP is an essential requirement to gain entrance to Type 1 or Type 2 Specialist Registrar programmes.
In the milieu of overseas doctors, its importance is manifold. With the growing number of applicants and fierce competition to obtain a training job, what can an overseas doctor do to increase his chances of finding a proper training job? The answer is simple and that is, to enhance his CV. Probably, the best way forward is to pass the MRCP Primary exam.
HOW DIFFICULT IS IT??
It is essential that one must be aware of the difficulty of the exam before the preparation itself kicks off. MRCP Primary exam is indeed an arduous chore. Not long ago there was a fixed pass percentage of only 35 %, i.e. effectively 65 % of the candidates had to fail. This along with negative marking made passing Part 1 MRCP a formidable task indeed. However, the current MRCP Part 1 pattern is criterion marked, and a pass percentage is allotted for every exam. Candidates scoring that percentage or above are declared pass. The pass mark usually hovers around b/w 62-64% but thankfully there is no negative marking. All in all the Part 1 still remains a very hard nut to crack.
THE FORMAT OF THE EXAM
Broadly speaking, MRCP part 1 comprises of two papers of 100 “Best of Five Questions” each. All questions carry equal marks and there is no negative marking.
Speciality wise distribution of questions is as follows:
Cardiology = 15
Clinical haematology/oncology = 15
Clinical pharmacology/therapeutics/toxicology = 20
Clinical science = 25
Dermatology = 8
Endocrinology = 15
Gastroenterology = 15
Infectious diseases, tropical medicine
and sexually transmitted diseases = 15
Nephrology = 15
Neurology = 15
Ophthalmology = 4
Psychiatry = 8
Respiratory medicine = 15
Rheumatology = 15
The Clinical Sciences Portion comprises of:
Cell, molecular and membrane biology = 2
Clinical anatomy = 3
Clinical biochemistry and metabolism = 4
Clinical physiology = 4
Genetics = 3
Immunology = 4
Statistics, epidemiology and evidence-based medicine = 5
Questions from each speciality are evenly distributed throughout the two papers. The good thing is that the royal colleges are very particular in maintaining this speciality wise distribution of questions so there are no hidden surprises. There is a possibility that in future, the current pattern of Best of Five questions will be partially replaced by a portion of ‘n of many’ questions. However it is largely speculative and there has not been any formal announcement from the Royal Colleges in this regard.
CHOOSING THE BEST TIME TO GIVE THE EXAM
Most of the overseas doctors aspiring to pass part 1 MRCP initially come to the UK to appear in their PLAB part 2 exam. They are expected to arrive 2-3 weeks earlier then the exam, join some preparatory courses and then give the exam.
My advice to anyone who is in a similar situation would be to plan PLAB 2 in accordance with the attempt at part 1. Part 1 is conducted three times a year in January, May and September. A good idea is to get a PLAB 2 date approx 3 months earlier then your Part 1 exam so u would have a window period of 3 months to settle down, join a clinical attachment and give the final touches to the preparation of your exam. Remember, it is quite challenging to prepare for an exam in an alien environment, with multiple antagonist factors acting at one single time, so the correct strategy is to do the bulk of your preparation when you are back home and to give final touches while you are here in UK.
THE BEST WAY TO PREPARE
This is indeed the most difficult issue to be addressed. Obviously, there is no perfect way to prepare for this exam; however the most important points are summarized below,

• Do not entrap yourself in reading lengthy texts like Harrisons or Oxford Textbook of Medicine. These are for reference purpose only, and to be used whenever you are stuck up in a difficult question while practising.
• A good thorough read of Kumar & Clark is usually enough to equip you with all the facts required to pass the exam.
• Try to arrange for yourself a big FAT pool of Best of Five Questions. The more obese the pool, the better!
• DO AS MANY BOF QUESTIONS OF EACH SPECIALITY AS YOU POSSIBLY CAN. IT IS ABSOLUTELY VITAL. MORE IMPORTANTLY, TRY TO DO QUESTIONS REPEATEDLY AS THIS WILL HELP YOU MEMORIZE HIGH YIELDING FACTS AND FIGURES WHICH ARE DIFFICULT TO GRASP WHILE YOU ARE READING
• Try to do those questions, which are accompanied by very thorough explanations.

RESOURCES TO PREPARE FOR THE EXAM
 As I have pointed out earlier, a very exhaustive collection of BOF is absolutely essential for passing this exam. Questions are available either in paperback books or online websites, which may offer up to 2000 questions. The medium that you would like to use is entirely up to you. Paperbacks are convenient, but online websites offer detailed feedback and analysis of performance based on responses of other candidates using the same website.
ELECTRONIC
A large number of websites are available which have huge pools of BOF questions.
The best site and which i have found the most useful is www.onexamination.com. This site has quality questions and the best part of it is that up to 5-10 of these questions somehow popup in the exam. In addition, its use is also quite cost effective, and they give 50% discount for MDU (Medical Defence Union) members, which can reduce the cost to only 30 pounds. Usually, one web resource is quite enough but if you want a lot of questions then www.pastest.com & www.1 23doc.com are other useful sites. The Royal Colleges of Physician has also launched its own web resource for preparation of MRCP. This is available at www.medical-masterclass.com. Initially, everybody was terribly excited, as coming from the colleges itself it seemed to be the answer to all problems. Unfortunately, the quality of the service, nor its content lived up to its name and the feedback from current members does not merit a very high recommendation.
Good old Paperbacks:
A number of different BOF books are available. The most popular ones are those published by PASTEST. Since the aim is to do “ as many questions” as possible, any book on which u can lay your hand on will be beneficial provided it has accurate answers and adequate explanations. The following books are quite popular:

• PASTEST, Best of Five for MRCP Part 1 (Geraint Rees)
• Best of Five for MRCP Part 1 (Helen Fellows, Simon Noble, Harry Dalton)
• PASTEST, Revision Book for the New MRCP Part 1 (K. Binyamin)
• MRCP Part 1 BOF in Basic Sciences (P. Easterbrook, Kefah Mokbel)  

COURSES
If you are an overseas doctor, who has just come to this country then you can conveniently forget about attending any courses. The MRCP Courses range from 350-450 pounds and are usually only 2-3 days long. They are a bad bargain, especially when you are low on funds. The course material is sometimes useful, but surely one of your kind friends will be able to pass it on to you, once he has passed his exam. However, if you doing a SHO job where there are funds allocated specifically for these kinds of courses, then you must take this opportunity. Other then this, it’s a big NO. If you do decide to attend one, the PASTEST course is the most popular.
GREY AREAS FOR OVERSEAS DOCTORS – REQUIRING MORE EFFORTS
 After talking to a number of overseas doctors who have successfully written Part 1, the more knotty portion of the exam appears to be the Basic clinical sciences part. Unfortunately, there is no text available which can give the precise level of knowledge required for Basic sciences in relation to part 1, however a little reading from the standard textbooks, particularly for Immunology, Oncology, Genetics, Statistics & Pharmacology can sometimes work wonders. All basic sciences questions are clinically oriented, so memorizing mere facts is usually not very helpful. Here again, doing a lot of questions provides the clinical orientation to the theory, which you may have read elsewhere. Remember! majority of candidates failing the exam fail marginally i.e just by 2-3 % (4-6 Questions) so identifying your OWN grey areas and working on it can be a key to success.
DAY OF THE EXAM
Plain and simple, you should be low on fluids & high on energy. A good nights sleep is absolutely essential. Visit the exam centre, the day before if possible and try to be early rather then late. During the paper itself, there is ‘sufficient’ time and at no point you will feel that you are racing against time. However, do keep track of your progress throughout the paper and make sure that you exactly know the questions you have left unmarked and others which you need to come back and review. I will not try to come up with intellectual suggestions of how to make a right guess for a question you don’t know. Its your intuition during the paper which will do the trick and i really hope that it works for you on that particular day.
CONCLUSION
Passing the MRCP part 1 is quite a task, however proper planning combined with hard work can make even impossible things happen, and definitely this exam is much less then impossible. Indeed, what complicate matters for overseas doctors is the difficult conditions in which they have to prepare for the exam and it makes proper planning all the more important and a more practical way of actually preparing for the exam an absolute essential. I hope the little information, which I have managed to gather here will be helpful to you. Good Luck.