MRCP(UK) Part 2 Written is the second of the three MRCP examinations and the last written paper before PACES. Where Part 1 asks whether you know the medicine, Part 2 asks whether you can use it: read a full set of results, decide what is going on, and choose the next investigation or the first treatment. It has a higher pass rate than Part 1, but it is sat under tighter time pressure and it punishes candidates who have not practised at the real pace. This guide covers the format, eligibility, marking, dates and a revision approach that works for doctors in full-time clinical posts.
What MRCP Part 2 tests
The syllabus is the same breadth of internal medicine as Part 1, but the emphasis shifts from knowledge to decision-making. A typical question gives a history, examination findings and a table of results, sometimes with an ECG, radiograph or clinical photograph, and asks for the most likely diagnosis, the most appropriate next investigation, or the most appropriate management. The basic sciences recede; what remains is pattern recognition, interpretation of data, prioritisation, and knowledge of current UK guidance on the common and the dangerous conditions.
As in Part 1, the specialties are weighted by a published blueprint. Cardiology, respiratory medicine, gastroenterology, neurology, endocrinology, nephrology and infectious diseases carry the most questions, and clinical pharmacology and therapeutics runs through every specialty in the form of prescribing decisions, interactions and adverse effects.
Format of the exam
Two papers on the same day, each lasting three hours and each containing 100 best-of-five questions. The stems are considerably longer than in Part 1, often a full paragraph with a block of results, so the time per question is the real constraint: under two minutes each, including reading. There is no negative marking, and every question should be answered. The exam is computer-based and runs at centres in the UK and internationally.
Who can sit it
You must have passed MRCP Part 1, and the pass must be within the previous seven years at the time you sit Part 2 Written. There is no requirement to have passed PACES first; the two Part 2 components can be taken in either order, and many candidates take the written paper first because it needs less arrangement. You do not need to be in a UK training post or to hold GMC registration to sit it.
How it is marked
The two papers are combined into a single scaled score and compared with a pass mark fixed by standard-setting for that diet, so the pass mark varies slightly between sittings and is published afterwards. Pass rates are usually in the region of sixty to seventy per cent, higher than Part 1, which reflects both the selection effect of Part 1 and the closeness of the questions to everyday ward work. You are allowed six attempts, after which further entry requires evidence of additional educational experience. Results come out around four to five weeks after the exam.
When the exam runs
There are three diets a year, usually in March, July and November, with application windows opening about three months before each. Centres fill early, so apply as soon as the window opens. Dates, fees and the current blueprint are published by the Federation of the Royal Colleges of Physicians at mrcpuk.org, and that is the source to check.
Is Part 2 harder than Part 1?
Most candidates find Part 2 less daunting in content and more daunting in pace. The questions describe patients you have seen, and the knowledge required is the knowledge you use on the take. The difficulty is that two hundred long stems in six hours leaves no slack, so a candidate who reads slowly or dithers over answers runs out of time in the second paper. The second difficulty is the detail of management: the examiners expect the first-line treatment under current NICE or Royal College guidance, not an older regimen or a reasonable alternative.
How to revise
Because Part 2 tests application, the preparation that works is a high volume of exam-length questions answered against the clock, each followed by reading the explanation in full. Aim for two thousand or more questions before the exam. Work through the bank by specialty in the first two months, keeping a short list of the management decisions you got wrong, then spend the final month on mixed blocks of 100 questions timed to three hours, so that the pace becomes familiar. Repeat your two weakest specialties in the last fortnight.
Practise reading results the way the exam presents them. A Part 2 stem often hides the one abnormal value that changes the answer in a table of twelve normal ones, so the habit to build is scanning every result against the reference range before reading the options. Reference ranges are provided in the exam, but knowing the common ones by heart saves time you do not have.
Make the explanation do the work. A good explanation says why the diagnosis fits the whole picture and not just the headline finding, names the next step under current guidance, and explains why each of the other four options would be the wrong call for this patient. Read it even when you were right; being right for the wrong reason is the commonest way to lose the same mark twice.
The topics that decide the result
Management questions dominate, and within them the examiners return to the same ground: the first-line drug and the second-line drug for the common conditions, when to escalate, when to refer, what to stop. Interpretation questions cluster around blood gases, ECGs, spirometry and lung function, bone and calcium profiles, liver screens, thyroid function in the unwell patient, and genetic or immunological results. Infectious diseases and tropical medicine carry more weight than most candidates expect, as does the medicine of pregnancy. Pharmacology appears as prescribing in renal and hepatic impairment, drug interactions and the recognition of adverse effects from a clinical picture.
Common reasons for failing
Candidates who fail Part 2 usually ran out of time, having never practised a full-length paper against the clock. Many revised knowledge rather than decisions, and so recognised the diagnosis but chose an outdated or second-line treatment. Some neglected the smaller specialties, where the questions are easier but only if you have covered them. And some changed answers on reflection; in best-of-five questions, change an answer only when you can say exactly what was wrong with the first.
Preparing with License Medical
Our MRCP Part 2 Written question bank holds more than 2,000 best-of-five questions built around the longer, results-heavy stems of the real paper, written by a UK consultant physician, with explanations that walk through the differential, give the next step under current UK guidance and end with a Clinical Tip. Try the free MRCP Part 2 questions first. If you are still at the first stage, start with the complete guide to MRCP Part 1.
Frequently asked questions
Can I sit PACES before Part 2 Written? Yes. The two Part 2 components can be taken in either order, provided Part 1 was passed within the previous seven years.
How much time should I allow? Three months of steady preparation alongside clinical work is typical, with the final month given over to timed full-length papers.
Are images in the exam? Yes. Clinical photographs, ECGs, radiographs and occasionally histology appear, so include image-based questions in your practice.
What if I fail? You can re-enter at the next diet. Use the breakdown of your score by specialty, which the Federation provides, to direct the next round of revision at the specialties that cost you marks.