MRCP(UK) Part 1 has a reputation it does not entirely deserve. Pass rates hover around 40 to 50 per cent for each sitting, which sounds alarming until you look at who is sitting it. Many candidates book the exam before they have a plan, revise from the wrong material, and run out of time to practise questions. The doctors who pass first time are rarely the cleverest in the room. They are the ones who treated Part 1 as a specific skill and trained for it.
Having prepared for the exam myself and taught candidates for it for many years, this is the plan I give to every junior doctor who asks.
Understand what Part 1 is actually testing
Part 1 is two three-hour papers of 100 best-of-five questions each, sat on the same day. The blueprint is published by the Federation of Royal Colleges, and the weighting is not even. Cardiology, gastroenterology, respiratory medicine, endocrinology, nephrology, neurology and infectious diseases carry the most questions. Clinical pharmacology, haematology, rheumatology, dermatology and basic sciences fill the rest.
The questions are not about rare diseases. They are about the mechanism behind common ones. A typical stem gives a short history, one or two investigations, and asks for the most likely diagnosis, the next investigation, or the mechanism of a drug. If you know why a drug works, why a test is abnormal, and what the first-line guideline says, you will answer most questions correctly even when you have never seen the exact scenario.
Give yourself four months, not four weeks
The most common reason for failure is simple. Candidates underestimate the volume. Four months of steady revision, working around a full clinical rota, is realistic for most doctors. Two months is possible if you have protected time. Four weeks is a gamble.
Split the time into three phases:
- Weeks 1 to 8 — systematic coverage. Work through the specialties in order of their weighting, heaviest first. For each one, read a focused summary of the core conditions, then do 100 to 150 questions on that specialty before moving on.
- Weeks 9 to 14 — mixed practice. Switch to random questions across all specialties, in blocks of 50 to 100 under timed conditions. This is where your real score starts to show.
- Weeks 15 and 16 — review and rest. Go back over every question you got wrong, re-read your notes on weak areas, and stop doing new material in the last three days.
Questions are the revision, not a test of it
New candidates often read textbooks for weeks and then check themselves with questions near the end. This is backwards. The question bank should be where most of your hours go from the first week.
Each question you answer, whether right or wrong, should teach you three things: why the correct answer is correct, why each of the other four options is wrong, and the one clinical point you would take into the exam hall. A good explanation does this for you. A bad explanation gives you the answer and a single sentence, and leaves you to look everything else up.
Aim for 2,000 to 2,500 questions before the exam. That sounds like a lot, but at 50 questions a day it is six to eight weeks of practice, which fits neatly inside the plan above.
Learn the pattern of the wrong answers
Best-of-five questions are written to a formula. There is usually one correct answer, one plausible distractor that is correct for a slightly different presentation, and three options that can be excluded quickly if you know the basics. Candidates who fail tend to hesitate between the right answer and the plausible distractor. The fix is to learn what separates them: the single feature in the stem that rules one out. The more questions you do with good explanations, the faster you spot that feature.
Keep a wrong-answer log
A simple notebook or spreadsheet with three columns: the topic, what you got wrong, and the one fact that would have made it right. Review it every weekend. By the end of your revision this log is the most valuable revision document you own, because it is a map of your own weak points rather than a generic summary.
What to do in the last week
Do not start new topics. Do a final timed paper of 100 questions early in the week so you know your pace. Re-read your wrong-answer log twice. Sleep properly for the last three nights. On the day, eat before the first paper, use every minute of the three hours, and answer every question, because there is no negative marking.
A note on resources
Use one well-written question bank and finish it, rather than three banks partly done. Choose one whose explanations cover the mechanism and management, not just the answer, and whose questions are written to current UK guidelines. The question bank at License Medical was written for exactly this purpose, with more than 2,600 best-of-five questions for Part 1 and full explanations ending in a Clinical Tip. You can try the free sample questions on the MRCP Part 1 course page before committing.
Pass rates look frightening on paper. For a candidate who starts four months out, treats questions as the main work, and keeps a log of what went wrong, the exam is very passable first time.
Written by a UK consultant physician for License Medical, an online question bank for MRCP Part 1, Part 2 and the Specialty Certificate Examinations.