The MRCS Exam: Part A, Part B OSCE, Eligibility and Attempts

The Membership of the Royal Colleges of Surgeons (MRCS) is the exam that closes core surgical training in the UK and Ireland. It has two parts: Part A, a five-hour written paper of single best answer questions, and Part B, an objective structured clinical examination (OSCE). It is one intercollegiate exam, quality-assured by the Intercollegiate Committee for Basic Surgical Examinations (ICBSE) (opens in a new tab) and delivered by the four surgical royal colleges: England, Edinburgh, Glasgow and Ireland. ICBSE says trainees are expected to pass both parts to progress to higher specialty training. ENT trainees need Part A and then the separate MRCS (ENT). For where the MRCS sits on the road to ST3 trauma and orthopaedics, see how to become an orthopaedic surgeon in the UK.

The MRCS at a glance

Who can sit the MRCS?

You need a primary medical qualification acceptable to the UK General Medical Council for full or provisional registration, or to the Medical Council in Ireland for full or temporary registration. International graduates need a qualification from a medical school listed in the World Directory of Medical Schools. If you are not on the GMC or Irish register, send your degree certificate (or an authenticated copy) to the college within five days of booking. You do not resend it for later attempts.

To sit Part B you must have passed Part A within the previous seven years. RCSEd describes Part A as testing the knowledge expected of a trainee two to three years after qualification.

Part A: the written paper

Since January 2017, Part A has been a five-hour exam of two papers on the same day (RCS England Part A page (opens in a new tab)):

• Paper 1: Applied Basic Sciences. 180 questions, 3 hours.
• Paper 2: Principles of Surgery in General. 120 questions, 2 hours.

Every question is a single best answer with five options. Older revision books also include extended matching questions, but the current ICBSE guidance describes SBAs only. That works out at one minute per question in both papers. To pass, you need a minimum level of competence in each paper as well as the combined pass mark, so a strong Paper 2 cannot rescue a very weak Paper 1. The pass mark is standard-set for each sitting.

Since May 2022 Part A has been delivered at Pearson VUE computer-based test centres. Every candidate sits the same exam on the same day, wherever they are. Once your college confirms eligibility (at least six weeks before the exam), Pearson emails you at least four weeks before with a two-week window to book a seat. Book early, because seats are limited. Results come by email about four weeks later, with scores for each paper and each syllabus area.

Next UK sitting: 13 January 2027, with applications to RCS England closing at 5 pm on 29 October 2026.

What Part A covers

The syllabus has ten modules: basic science relevant to surgical practice; common surgical conditions; basic surgical skills; assessment and management of the surgical patient; perioperative care; assessment and early treatment of trauma; surgical care of the paediatric patient; management of the dying patient; organ and tissue transplantation; and professional behaviour and leadership. Paper 1 applies anatomy, physiology and pathology to surgical problems. Paper 2 tests the principles of surgery in general, such as perioperative care and the early care of the injured patient.

Anatomy runs through both parts: Paper 1 and three of the Part B stations. Learn it in three dimensions and with clinical consequences: the nerve at risk in each approach, the anatomy behind each hernia, the compartments of the limbs. How to revise anatomy for orthopaedics applies directly. For physiology and pathology, learn mechanisms rather than definitions. Questions often ask you to interpret a blood gas or an electrolyte disturbance in a surgical patient. The limb, brachial plexus and compartment anatomy you learn now is the same anatomy the FRCS (Tr & Orth) tests later. See brachial plexus anatomy and compartment syndrome.

How to revise for Part A

• Plan by weeks, not by subjects. Split the syllabus into weekly blocks and mix anatomy, physiology and pathology rather than finishing one before starting the next.
• Use a question bank daily, and read every explanation. Clicking through questions without reading the explanations wastes them. Keep a notebook of every concept you got wrong, and every one you guessed right. In the final weeks it becomes your revision list. Active recall for surgical exams covers the method.
• Sit full timed papers. Five hours of SBAs is tiring. Build stamina with at least two full mock days at one minute per question.
• On the day, don't get stuck. If a stem still makes no sense after two readings, choose your best answer, flag it and move on.

Part B: the OSCE

The MRCS regulations (opens in a new tab) set Part B as 17 examined stations of nine minutes each, with a minute's reading time at each station. There may also be preparation stations, a rest station and an unmarked pilot station. ICBSE gives the total as about 3.5 hours. Most stations have one examiner. Some, such as communication stations, have two, each assessing a different aspect of your performance.

The ICBSE candidate guide divides the 17 stations into two areas:

The current RCS England Part B page (opens in a new tab) groups the same stations slightly differently. It lists anatomy and pathology stations with images or props, critical care stations with charts and images, communication stations with actors, and physical examination and surgical skills stations. These may use actors, simulated patients, or real patients at international centres, with skin pads for suturing.

Marking. Each station is marked out of 20 against domain descriptors, and the examiner also gives an overall judgement of pass, borderline or fail. Knowledge is scored out of 160 and skills out of 180. You must pass both knowledge and skills separately. Pass marks are set by the borderline regression method for each circuit, and international centres reuse scenarios and pass marks from UK sittings.

Next UK sittings: 30 January to 14 February 2027 in London and Glasgow, with RCS England applications closing at 5 pm on 19 November 2026. Your exact day is sent with your admission letter at least eight weeks before.

Preparing for the knowledge stations

Anatomy stations use prosections and images: identify the structure, then give its relations, its blood and nerve supply, and what an injury to it causes. Pathology stations ask you to explain a specimen or slide in clinical terms. Critical care stations use charts, results and images. Practise reading a blood gas, a fluid balance chart and a chest radiograph aloud, in a set order, against the clock. The ATLS primary survey is the expected structure for any trauma scenario.

Preparing for the skills stations

Physical examination. Learn a fixed routine for each common system, including hip, knee, shoulder, hand, spine, abdomen, groin, neck, vascular and peripheral nerves. Wash your hands, introduce yourself, confirm the patient's identity, gain consent and expose the patient adequately. Explain to the examiner what you are doing while keeping your instructions to the patient simple. Finish with a summary of the positive findings and a sensible next step.

Generic surgical skills. Treat each task as a short operation: confirm the patient, procedure, site and consent, lay out your equipment, keep the field sterile and handle sharps safely. If the scenario changes, for example the simulated patient's blood pressure falls, stop, reassess and say what you are doing.

Communication. Two of the four stations are history taking, so practise a complete surgical history under time pressure. For breaking bad news, a structure such as SPIKES helps: find out what the patient already understands before giving new information. Listen without interrupting, acknowledge emotion, and end with a plan, safety-netting and follow-up. GMC Good Medical Practice underpins the professionalism judgements. In the station where you give information to another professional, practise a structured handover.

Practise in circuits. Reading will not get you through an OSCE. Run timed mock circuits with a group, in scrubs, with someone keeping time and someone scoring. Record yourself and watch it back. Ask registrars and consultants to watch your examinations and give blunt feedback. Building an orthopaedic exam study group covers how to set one up.

Attempts and time limits

The regulations set firm limits:

• Part A: up to six attempts (since April 2013).
• Part B: up to four attempts.
• One additional attempt at either part may be granted under the Additional Attempt Policy.
• An attempt counts once you start the exam, even if you do not finish. Attempts at any of the four colleges count towards the same total.
• Part B must be passed within seven years of passing Part A. After that you must pass Part A again, which opens a new seven-year window, but your attempts are not reset. For example, a candidate who passed Part A on the third attempt and has used two Part B attempts would have three Part A attempts and two Part B attempts left.

Using up all attempts bars you from any part of the MRCS. You cannot defer to a later sitting: withdraw (refund policies vary by college) and reapply.

Planning the two parts

Sitting Part A in the foundation years or early in core training, while basic science is still fresh, and Part B during core training leaves time for a resit before the ST3 application deadline. Agree study leave with your educational supervisor for both exam dates early, since Part A seats and Part B places fill up. For exam nerves, see managing exam performance anxiety.

Once you have the MRCS, the next exam for trauma and orthopaedic trainees is the FRCS (Tr & Orth) at the end of specialty training.