When should I sit the MRCP?

Since the inception of the foundation programme, many deaneries have been actively discouraging trainee doctors from working towards membership exams because they feel candidates should be concentrating on attaining prescribed competencies. Study leave and funding are scarce in foundation year 1, and are often limited and difficult to obtain in year 2, making a further disincentive to early acquisition of the part 1 exam for membership of the Royal College of Physicians (MRCP).

Competitive edge

Having seen first hand, however, the difficulties that selection panels face when trying to differentiate between applicants at specialty training year 2 (ST2) level applying for year 3 posts, I would argue that obtaining full membership at the earliest opportunity is essential for gaining a competitive edge.

The Joint Royal College of Physicians Training Board has recently submitted blueprints to the Postgraduate Medical Education and Training Board suggesting that MRCP part 1 needs to be completed for exit from ST2, and that all parts of MRCP should be passed by the end of ST3, contrary to the person specifications for application in 2007. Although this system allows time for essential multiple attempts at each stage of MRCP, it will create a cohort of applicants with identikit qualifications, many of whom will be hard to differentiate at the time of the ST3 applications. Of more concern is the future of those who haven’t passed the practical assessment of clinical examination skills (PACES) by the end of ST3. Contingency plans are unclear—trainees shouldn’t risk falling foul of this and allowing a barrier to their professional progression to occur.

False economy

When considering a career in a medical subspecialty, to stand out from the crowd trainees need to start planning their exam strategy at the end of foundation year 1, with a first attempt at MRCP part 1 midway through their foundation year 2 and, ideally, completion of PACES by the time they apply for ST3 subspecialties (see figure¹). If no exams are taken during the foundation years, as has been recommended by most deaneries, to complete full MRCP by the time of ST3 application there would realistically be just one opportunity to sit part 1 in ST1, and a total of 18 months to complete all stages of MRCP in the desired time frame, with little leeway for re-sits. Trainees should invest in their success and prepare thoroughly for each exam; skimping on revision can be a false economy given the costs of re-sitting the exams repeatedly, notwithstanding the cost of failure on career progression.

Optimum route to sitting the MRCP

Taking MRCP part 1 early (that is, January of foundation year 2) will enable trainees to pursue a more flexible and comfortable approach to these exams (which have high failure rates), while still allowing time to supplement their CVs with clinical audits, case reports, and teaching. It’s important not to concentrate exclusively on membership and neglect other areas that will boost your portfolio and make you competitive.

Twofold advantages

Critics will argue that foundation doctors cannot commit to a specialty at such an early stage, but many trainees will know inherently where they want to pursue their careers. The benefits of acquiring MRCP early are twofold: when applying to specialty training (both for ST1 and ST3) candidates will be showing real aptitude and interest in the specialty, and in their clinical practice they will be supporting practical skills obtained through the foundation programme with excellent theoretical knowledge. Many medical trainees have seemingly worked this out for themselves already: in an audit of doctors starting ST1 and ST2 training in one deanery in August 2007, 59% had attempted or obtained MRCP part 1 during their foundation year 2, and all indicated that they intended to try to obtain PACES before the end of their ST2 year.

Fundamental to this is competitive advantage. By acquiring MRCP early, applicants are showing initiative and dedication in going the extra mile, and in today’s climate the value of being ahead of the game must not be underestimated.

Competing interests: The author has considerable interest in postgraduate education, particularly in relation to the MRCP, and is the editor of the widely used text Essential Revision Notes for MRCP. He was previously royal college tutor at Hope Hospital and currently acts as a medical adviser to Pastest, who are well known providers of medical education.

This article was first published in BMJ Career Focus (2008;336:13 doi: 10.1136/bmj.39427.726447.CE).

   

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