A Trainees guide to preparing for

MRCPI in
General
Medicine

Table of Contents

INTRODUCTION_____________________________________________________________________________ 2
EXAMINATION OVERVIEW ____________________________________________________________________ 3
GENERAL GUIDELINES _______________________________________________________________________ 6
SINGLE BEST ANSWER FORMAT _______________________________________________________________ 7
KNOWLEDGE REQUIRED_____________________________________________________________________ 12
SAMPLE QUESTIONS ________________________________________________________________________ 19
RESULT GRADES ___________________________________________________________________________ 26
PART II CLINICAL ___________________________________________________________________________ 28
APPENDIX 1 MARK SHEETS _________________________________________________________________ 33

Would you like help preparing for the MRCPI in

General Medicine?
This guide is designed to help you prepare for the MRCPI in General Medicine examination.
It was developed with the intention of improving Trainees understanding of the MRCPI Part
I, Part II Written and Part II Clinical examinations structure, content and administration.
We will provide an overview of the examinations, including an outline of the topics covered
and the structure of the examinations. We will also provide general administrative
information about the exams and the marking process.
In addition to using question banks, books and online tutorials, we recommend preparing for
the MRCPI exams by following your curriculum for Basic Specialist Training in General
Internal Medicine, gaining clinical experience in hospital posts involving the care of
(emergency) adult medical patients, attending study days and tutorials, and studying up-todate postgraduate clinical textbooks and current medical journals.
Remember, success in the MRCPI General Medicine examination is:

An essential requirement for satisfactory completion of

Basic Specialist Training (BST)

An entry requirement Higher Specialist Training (HST)

A requirement for becoming a Member of the Royal

College of Physicians of Ireland

Examination Overview
This chapter covers Part I and Part II Written examinations objectives, the MRCPI
qualification route map, how the examinations are structured and the
differences/similarities between Part I and Part II Written examinations.

Examination Objectives
The objectives of the MRCPI examination are to:

Provide a knowledge and skills-based examination for the attainment of a BST certificate
Assist in the selection of trainees suitable for entry into Higher Specialist Training in
medicine
Select doctors who would become Members of the College and would have the
collective interest and ability to promote the standards of specialist medical practice
nationally and internationally
Encourage the study of general medicine
Encourage the development of clinical skills
Set standards of medical practice
Assess knowledge and understanding of all examination topics and their applications in
the clinical setting
Provide feedback on progress and identify areas of deficiency or gaps
Provide an educational event and an opportunity to broaden knowledge and ultimately
encourage trainees to become better doctors

Rules and Regulations

The following conditions apply to all candidates:

You must pass the Part I examination to be eligible to apply for the MRCPI Part II Written
examination, unless you have been granted an exemption (for exemption rules, please
refer to the RCPI website).
You have seven years from the date of successfully passing MRCPI Part I in which to
pass your MRCPI Part II Written.
You must pass the Part II Written to be eligible to apply for the MRCPI Part II Clinical
examination.
You have two years from the date of passing MRCPI Part II Written in which to pass
MRCPI Part II Clinical
Extensions for the above mentioned periods are not permitted and if the periods
allocated elapse, you will have to re-sit the examinations.

The route to MRCPI

MRCPI Part I
General
Medicine
Examination

1st attempt 12 months

from completion of
undergraduate degree

You have 7 years from

the date of sitting the
MRCPI Part I in which to
obtain MRCPI Part II
Written

Fail
Re-Sit Exam
(Unlimited
attempts)

Pass

MRCPI Part
II General
Medicine
Written

Successful candidates
have 2 years from the
date of sitting MRCPI
Part II Written in which to
pass MRCPI Part II
Clinical

Fail
Re-Sit
Written

Pass

MRCPI Part
II General
Medicine
Clinical

Pass

Fail
Re-Sit
Clinical

MRCPI
conferring

Part I Examination Structure

The MRCPI Part I examination has 100 single best answer style questions that take three
hours to complete. The average answering time for each question is 1.8 minutes. Each
correct response is awarded one mark, giving a maximum score of 100 points.
The questions...

are spread across the specialities

include the science underlying the medical practice and medical disease
include basic skills required in general medicine
cover common or important diseases in hospital or community practice as outlined in
your curriculum for Basic Specialist Training in General Internal Medicine

Part II Written Examination Structure

MRCPI Part II Written consists of two examination papers. Each paper consists of 75 Single
Best Answer format questions. 2.5 hours are allocated to each paper (a total of five hours)
with a one hour break between the two papers. There are no basic science questions. The
stems (vignettes) are generally more descriptive and longer than the Part I examination. The
average answering time is two minutes per question. Interpretation of investigation and quick
data analysis are required.
For best practice, you should refer to the curriculum for Basic Specialist Training in General
Internal Medicine, as the MRCPI examination is blueprinted (matched) with this curriculum.
In addition, you should refer to the examination syllabus which is available on the RCPI
website.

Part I vs. Part II Written A Brief Synopsis

MRCPI Part I

MRCPI Part II

Number of Questions
Number of Papers

100
One paper

150
Two papers (75 questions per paper)

Length of
Examination

Three hours

2.5 hours for each paper (total 5

hours) with 1 hour break

Average Time Per

Question

1.8 minutes

2 minutes

Format
Areas of Knowledge
Blueprint

Single best answer

BST GIM curriculum
BST GIM curriculum

Single best answer

BST GIM curriculum
BST GIM curriculum

Vignettes

Included in the majority

of questions

Included for the majority of questions

and are longer than Part I

General Guidelines
This chapter covers some guidelines for answering questions and preparation for the
examination.

Advice on answering Questions

Here is some general advice for answering questions:

There is no negative marking so attempt each question

Taking the time to read and understand the question is crucial
Scan for the important elements of the question

Preparing for the Exam

Preparation for the MRCPI examination is essential. The best way to prepare for the
examination will depend on your own learning style. The ability to succeed in the
examinations reflects your knowledge, expertise and decision-making ability.
Having an understanding of how the examination is laid out and how questions are
constructed can help you develop answering strategies. Key ways to prepare for the
examination include:

Spending time gaining clinical experience in suitable hospital posts

Becoming familiar with your curriculum for Basic Specialist Training in General Internal
Medicine
Checking the RCPI website and reading examination-relevant information
Studying up-to-date clinical textbooks and reading current medical journals
Practising single best answer questions by using books or online resources
Taking study leave where possible
Attending tutorials
Practising as many questions as possible

If you fail an exam, you should analyse your examination results letter in order to identify
areas of potential weakness

Single Best Answer Format

This chapter provides an overview of the single best answer format, discusses the
question structure (stem, lead-in and options/distracters), answering guidelines,
examination marking sheet and marking guidelines
Both parts of the MRCPI Written examinations utilise a Single Best Answer question format:

Each question has only one best answer

Each question focuses on an important concept, typically a common or potentially acute
clinical problem
Each question assesses application of knowledge and not the recall of isolated facts
The stem of the question poses a clear question, and generally makes it possible to
arrive at the answer with the options covered
Questions are complete, concise, clear and unambiguous

Structure

Stem
(example:
clinical case
presentation)

Lead-in
Question
(What's the most
likely cause?)

Series of
Options
(with 1 most
correct answer
& 4 distractors)

The Stem
The stem is written in such a way that the question could potentially be answered without
looking at the list of options. The stem includes as much of the items as possible and it is
usually long, while the options are short. Generally, the stem will include a case, case
history, examination findings, lab or test results and any other relevant information.
Although the majority of the questions are presented in this format, some questions may
pose a general scenario followed by a lead-in and options.

The Lead-In
The lead-in presents the question as a single dilemma and poses it in such a way that you
should be able to anticipate the options. The lead-in questions typically (but not exclusively)
include questions such as:

What is the most likely cause/diagnosis/explanation?

What is the most appropriate investigation/treatment/next step in management?

The Five Options

The options provided:

are relevant to the stem and follow logically from it

are supported by information in the stem, so that you can anticipate their appearance

Depending on the case and the lead-in question the list of options could include any of the
following sets:

sites of lesions
list of nerves
list of muscles
list of enzymes
list of hormones
types of cells
list of neurotransmitters
list of toxins
molecules
vessels
spinal segments
laboratory results
physical signs
autopsy results
result of microscopic examination of fluids
muscle or joint tissue
DNA analysis results
serum levels
underlying mechanism of the disease
medications
hemodynamic mechanism
viruses
metabolic defects
vitamins and dietary elements
amino acids
endocrine structure

Example of the Single Best Answer Question Format

Case, S. M., Swanson, D. B. (2002), Constructing Written Test Questions for the Basic and Clinical
Sciences, Pennsylvania: National Board of Medical Examiners

Stem
A 32-year-old man had a 4-days history of progressive weakness in his extremities. He has
been healthy except for an upper respiratory tract infection ten days prior to admission. His
temperature was 37.8 (100F), blood pressure was 130/80mm Hg, pulse was 94/min, and
respiration 42/min and shallow. He had symmetric weakness of both sides of the face and
the proximal and distal muscles of the extremities. His sensation was intact. No deep tendon
reflexes were elicited; the plantar responses were flexor.
Lead-In
Which of the following is the most likely diagnosis?
Options
A.
B.
C.
D.
E.

acute disseminated encephalomyelitis

Guillain-Barr syndrome
myasthenia gravis
poliomyelitis
polymyositis

Answer
D

When considering the question and the possible options, note that all of the options provided
are possible answers, however, they are less correct than the keyed answer. Candidates
are instructed to select the most likely diagnosis, which in this case is B Guillain-Barr
syndrome.

Advice on Marking Sheets

It is advisable to mark this sheet throughout the examination rather than leaving it to the
end, as you may run out of time and risk losing marks. If you want to re-read and check
the marking sheet, you are advised to limit this to groups of about five questions.
If you write your answers into the question book and then transfer them over, you MUST
ensure that you leave sufficient time (approximately 30 minutes) to transfer the answers
to the answer sheet. We will not take into account that you have answered the questions
anywhere but the answer sheet.
You receive no marks if two options are accidently marked so it is important to pay
attention to the line of marking.
There is no negative marking so you should attempt all questions.

10

Sample Examination Marking Sheet

11

Knowledge Required
This chapter provides an overview of the knowledge required for the written
examinations. It discusses the blueprint, the curricula, the types of questions and the
knowledge they aim to test and the associated skills.
The MRCPI written examinations aim is to assess your knowledge, skills and readiness for
entry to Higher Specialist Training. These knowledge and skills are outlined in the curriculum
for Basic Specialist Training in General Internal Medicine. You are strongly advised to follow
your curriculum when preparing for the examination.

MRCPI Part I
Below is the blueprint for the Part I examination, with the number of questions allocated for
each knowledge area.
Specialties and Sciences

Number of Questions

Anatomy, Bacteriology, Biochemistry, Ethics, Genetics,

Immunology, Metabolic, Physiology, Principles of evidence
based practice and Statistics

5-15

Cardiovascular

5-15

Dermatology

2-8

Endocrinology

5-15

Gastroenterology

5-15

Haematology

5-15

Infectious diseases

2-8

Nephrology

5-15

Neurology

5-15

Ophthalmology in the context of General Medicine

0-3

Psychiatry

0-3

Respiratory medicine

5-15

Rheumatology

5-15

Therapeutics and Pharmacology

5-15

12

Part II Written
Below is the blueprint for the Part II Written examination. The number of questions allocated
for each knowledge area is presented in percentage.
Specialties and Sciences
Cardiology
Dermatology
Endocrinology & Metabolic Medicine
Gastroenterology & Hepatology
Immunology & Haematology
Infectious diseases & Genitourinary Medicine
Neurology, Ophthalmology & Psychiatry
Oncology & Palliative Care
Nephrology
Respiratory Medicine
Rheumatology
Therapeutics & Toxicology

Percentages
10%
5%
10%
10%
10%
5%
10%
5%
10%
10%
10%
5%

13

Types of Questions
These are the types of lead-in questions:

Basic science (Part I only)

What is the underlying cause?
What is the underlying diagnosis?
What change to medication would you advise?
What is the correct management, or the next step in management?
What is the cause for the diagnosis?
What would be the most useful measurement?
What is the likely cause of results?
What is the likely explanation for results?
What is the likely organism?
What is the most likely toxin?
What is the physical sign most likely to be present?
What would be the treatment plan?
What investigation should be carried out?
Which is the best treatment?
Which test to administer?
Why did the medication fail?

Associated Skills
The following knowledge and skills are integrated into the questions:

Management of emergencies in medicine

Application of knowledge of disease including mechanism
Interpretation of clinical information
Interpretation of data
Interpretation of images
Planning investigations
Planning drug therapy
Planning non-drug therapy

Knowledge of Basic Science

This is applicable to Part I only. There are no basic science questions in the Part II Written
examination. Basic science questions may or may not have an associated vignette and
include knowledge from the areas of anatomy, bacteriology, biochemistry, ethics, genetics,
immunology, metabolic, physiology, principles of evidence-based practice and statistics.

14

Identifying Underlying Cause/Diagnosis

The most frequently used lead-in question requires you to identify the most likely cause or
diagnosis. However, it is important to note that the stem prior to the lead-in can challenge
you to approach the questions from a variety of dimensions. An underlying cause/diagnosis
question might provide clinical data, graphs or a description of a disease mechanism, by
which you have to arrive at the correct conclusion.

Managing Emergencies
Managing emergencies in medicine questions would generally describe a case brought into
the emergency department (ED) or describe a case with emergency symptoms presentation.
You might be asked to think of a variety of aspects in the management of acute patients. For
example, the next steps of management, most likely cause, possible diagnosis, initial
therapy, investigations or which medication to stop/start.

Knowledge of Disease Including Mechanism

Knowledge of disease includes symptoms, presentation, indicators, causes, examination,
investigations, diagnosis, sequelae and potential complications. Understanding the
molecular and cellular basis of diseases is also vital for dissecting the mechanisms of
disease pathogenesis and for designing appropriate and effective treatments. The
examination assesses the understanding of the molecular mechanisms that underlie a range
of human disorders, including the possible therapeutic targets and treatments for those.

Interpretation of Data and Clinical Information

The ability to critically appraise information from a variety of sources and evaluate its
applicability to patient care is paramount to the physicians work. The type of data and
clinical information might include:

laboratory findings
examination findings
history

test findings (X-ray or spirometry)

clinical trials results

15

Planning Investigations
Planning investigations requires the skill of selecting the most appropriate investigation for a
presented case. You will need to consider appropriateness in terms of the following sample
of reasoning:

match to the suspected diagnosis

potential elimination of differential
diagnosis
most reliable data

more information than other tests

sensitivity of a test (false-negative
rate)
risk to patient

Interpreting Images
Questions with attached images can include images such as x-rays, MRI and CT scans,
gram stain, ECG, sketches, diagrams, graphs, images of skin and other body parts, blood
cells images, images of the eyes and more.
You will be asked to interpret the image and provide the correct answer in relation to that
image. Images are generally provided alongside a case presentation.

16

Planning Drug Therapy

Drug-related questions test your knowledge of a number of possible domains related to
drugs and how these factors may interact and impact on the most appropriate drug therapy
selection, such as:

Drug administration
Correct/safe dosage
Drug responses
Overdose signs and symptoms and
how to best treat an overdose
Contraindications

Drug/disease interaction
Drug/drug interaction
Drug/nutrients
Drugs and pregnancy
Side effects and allergies

Consideration for Selection of Drug Therapy

17

Planning Non-Drug Therapy

Planning non-drug therapy questions are set to test your knowledge of a number of possible
non-drug options that are available for patients and your ability to select the most
appropriate non-drug therapy for the presented cases.

Toxin-Related Question
Questions might be related to toxin exposure. In these questions you are tested on your
knowledge of the following:

How poisons work

Global classifications of toxicity
Types of toxicity
Chemical, biological and physical toxins
Toxicology
Microbiology
Clinical features of toxin exposure
Diagnosis
Treatment
Degree of exposure and acute toxicity
The assessment and treatment of acute or chronic poisoning
Adverse drug reactions and overdose
Reading and interpreting toxicology
Factors influencing toxicity such as age and length of exposure

Example of Laboratory Findings Prediction

Laboratory findings prediction questions test your knowledge of the connection between
hypothesised disease and its associated laboratory findings.

18

Sample Questions
Basic Science
An independent t-test study to investigate the impact of a new hygiene protocol on the
rates of contamination of stethoscopes. A random sample of stethoscopes were swabbed
before the new hygiene procedure and a second random sample was tested after the
intervention. A reduction in contaminants was observed. The results showed that the
second sample contamination test was significantly lower and that p=0.03. What does
p=0.03 mean?
A. 3% of stethoscopes were contaminated
B. if the experiment was repeated 100 times, the same result would be found at least
three times
C. the probability that a difference between the two sample groups occurred by
chance is 3%
D. the probability that this intervention has reduced the contamination rate is 3%
E. the rate of contamination was reduced by 3%
ANSWER C

19

Identifying Underlying Cause/Diagnosis

A 55-year-old woman presented with acute and slightly painful oedema in her lower left
leg. On examination, her leg seemed tender, showed pitting oedema and was slightly
discoloured.
What is the most likely diagnosis?
A.
B.
C.
D.
E.

deep vein thrombosis

early heart failure
idiopathic oedema
pulmonary hypertension
venous insufficiency

ANSWER A

A 20-year old male microprocessor factory employee was complaining of immense

weakness and fatigue with palpitations which were worse in the afternoon. His breathing
was fast and was worsened by walking fast, climbing stairs and by any kind of exertion. He
has a history of formation of ecchymotic patches on injury and daily episodes of vertigo.
Which of the following is the most likely diagnosis?
A.
B.
C.
D.
E.

aplastic anaemia
benzene toxins exposure
exposure to ionizing radiation
myelodysplastic syndrom
parvovirus B19

ANSWER A

A 77-year-old woman presented with an insidious onset of fatigue and a burning sensation
of the tongue on swallowing food. Six years earlier, she had undergone a total gastrectomy
for early gastric cancer, which was curative. On physical examination, she was pale and
had a depapillated, smooth, shiny red tongue with some central fissuring, findings that
were consistent with a beefy red tongue. What is the most likely diagnosis?
A.
B.
C.
D.
E.

chronic pancreatitis
coeliac disease
pernicious anaemia
poor diet
vitamin C over the counter usage

ANSWER C

20

Managing Emergencies
A 32-year-old male smoker presented to the emergency department after two days of chest
pain radiating to both arms. The pain occurred at rest and was associated with shortness of
breath and palpitations. The patient denied any drug use. He told the triage nurse that his
father had suffered a myocardial infarction at the age of 35. He presented with a hard
cough and was found to be tender over the anterior part of his chest wall; his EKG and
chest X-ray were read as normal. What is the most likely cause?
A.
B.
C.
D.
E.

chlamydophila pneumoniae
costochondritis
myocardial infraction
rheumatoid arthritis
sepsis

ANSWER A

Knowledge of Disease Including Mechanism

A 30-year-old woman with diabetes who had poor glucose control, hypertension, and
hyperlipidemia was referred for an evaluation of a rash of one-month duration. She
reported no history of fevers, chills, or joint pain, nor had she taken glucocorticoids or had
contact with anyone with similar symptoms. Her medications included insulin, pioglitazone,
labetalol, fenofibrate, and n3 fatty acid esters. Her blood glucose level was 260 mg per
deciliter (14.4 mmol per liter), the triglyceride level was 8168 mg per deciliter (92.2 mmol
per liter), and the total cholesterol level was 611 mg per deciliter (15.8 mmol per liter).
Levels of glycated hemoglobin and rheumatoid factor and other cholesterol levels (lowdensity lipoprotein, very-low-density lipoprotein, and the ratio of low-density to very-lowdensity lipoprotein) could not be assessed because of a grossly lipemic specimen. Which
of the following is most likely to occur in this patient?
A.
B.
C.
D.
E.

acute cholecystitis
diabetes insipidus
eruptive xanthomata
hypothyroidism
nephrotic syndrome

ANSWER C

21

Interpretation of Data and Clinical Information

A 52-year old man has had increasing dyspnoea and cough productive of purulent sputum
for two days. He has smoked one pack of cigarettes daily for 30 years. His temperature is
37.2C (99 F). Breath sounds are distant with a few rhonchi and wheezes. His leukocytes
count is 9000/mm3 with a normal differential. Grams stain of sputum shows numerous
neutrophils and gram-negative diplococci. X-ray films of the chest show hyperinflation.
Which of the following is the most likely diagnosis?
A.
B.
C.
D.
E.

asthma
bronchiectasis
bronchitis
pulmonary embolism
streptococcal pneumonia

ANSWER C

Planning Investigations
A 22-year-old female student complains of muscle weakness that increases when she
practises her daily swim and improves after periods of rest. In addition she mentioned
diplopia when studying. On examination she seems to have mild ptosis of left eye but
neurological examination is otherwise normal. What would be the most appropriate
investigation to confirm diagnosis?
A.
B.
C.
D.
E.

electro myelo gram

magnetic resonance imaging
nerve conduction studies
pre-ganglionic acetylcholine receptor anti-bodies
tensilon test

ANSWER E

22

Interpreting Images
A 21-year-old woman is admitted with this rash covering most of her body. She had a fever
of 38.3 0C (100.94 F). Which of the following is the most appropriate treatment?

A.
B.
C.
D.
E.

aciclovir
flucloxacillin
ganciclovir
paracetamol
varicella Zoster immunoglobulin

ANSWER A

23

Planning Drug Therapy

A 45-year old woman presented in clinic with six-month history of progressive
breathlessness, lethargy and dry cough. Her eosinophil count was 1.4 x 109/Litre. She was
diagnosed in the chest clinic with a very rare condition. Which one of her usual medications
is implicated in this condition?
A.
B.
C.
D.
E.

amiodarone
bendrofluazide
diazepam
diclofenac
popranolol

ANSWER D

Planning Non-Drug Therapy

A 53-year old married women with chronic renal failure described low energy levels,
disturbed sleep, lose of pleasure in life, guilt and hopelessness. Depression is suspected.
She refuses to consider anti-depressants but is willing to try talk-therapy. Which of the
following psychological treatment is likely to be most effective?
A.
B.
C.
D.
E.

cognitive behavioural therapy

family therapy
psychoanalysis
psychodynamic therapy
supportive therapy

ANSWER A

24

Toxin-Related Question
A 35-year-old man arrived to the Emergency Department complaining of dry mouth and
blurred vision. His symptoms rapidly progressed over the next two hours to include diplopia,
dysphagia and weakness in his arms. You ask to talk with him directly, but he is having
difficulty speaking. He was previously healthy. On physical examination, he is afebrile with a
heart rate of 80 beats per minute, blood pressure of 120/80 mm Hg and a respiratory rate of
12 breaths per minute. His pulse oximetry is 98% oxygen saturation. He has a hoarse
voice, bilateral ptosis, a weak gag reflex, and bilateral proximal upper extremity weakness.
He has no lower extremity weakness. Sensation is intact in all extremities. His mental status
is normal. The patient denies having a flu-like illness within the last month. There is no family
history of stroke or other neurological disorders, and he does not have hypertension or
hypercholesterolemia. What is the most likely diagnosis?
A.
B.
C.
D.
E.

botulinum poisoning
Guillian-Barr syndrome
hyperthyroidism
hypothyroidism
mysthenia gravis

ANSWER A

Lab-Findings Prediction (from NBME)

A 34-year-old woman has had severe watery diarrhoea for the past four days. Two months
earlier she had infectious mononucleosis. She abuses drugs intravenously and has
antibodies to HIV in her blood. Physical examination shows dehydration and marked muscle
weakness. Laboratory studies are most likely to show:
A.
B.
C.
D.
E.

decreased serum K+ concentration

decreased serum Ca2+ concentration
increased serum NCO3- concentration
increased serum Na+ concentration
increased serum pH

ANSWER D

25

MRCPI Part I General Medicine Examination Sample Results Letter

Dr Joe Blogs
Address

MRCPI Part I General Medicine XXXX 2013 Examination Results

Candidate Exam/Code Number:

Exam_No

Candidate Examination Result:

Grade

Candidate Examination Mark (normalised):

Score

Result Grades
Pass:
Bare Fail:
Clear Fail:
Bad Fail:

50 - 100
45 - 49
40 - 44
0 - 39

There were XX void responses on your mark sheet.

For information on further MRCPI Examinations please see www.rcpi.ie

Yours sincerely,

26

MRCPI Part II General Medicine Examination Sample Results Letter

27

Part II Clinical
This chapter provides information about the Part II Clinical Examination
The MRCPI Part II clinical examination is the third of three assessments that must be
successfully completed to become a Member of the Royal College of Physicians of Ireland
(MRCPI).
The purpose of this examination is to:
1. Provide an exit examination from Basic Specialist Training
2. Satisfy the application requirement to entry into Higher Specialist Training
3. Admit Members to the Royal College of Physicians of Ireland
It comprises three elements:
2 x 25 minute long cases
4 x 10 minute short clinical cases
1 x 10 minute short communication skills/ethics case

Long Cases

You will perform 2 long cases

Each long case is 25 minutes in duration
Each long case is observed by one consultant examiner
Each long case will be similar to an outpatient encounter, or a clinical assessment of
a patient in a Medical Admissions Unit.
The timing breakdown of the examination is as follows:
o 12 minutes to take a history while being observed by one examiner
o 8 minutes to present a brief summary of findings (active problems and
differential diagnosis) and to perform a focused and directed examination
o 5 minutes to discuss investigations and management with examiner
You should prepare by performing as many of the above encounters as possible,
making problem lists for patients and presenting the cases to senior colleagues
under the time constraints of the examination.
The main assessment outcomes are to assess your competence in
o Clinical communication skills (CCS)
o Managing relationships with patients (MRP)
o Physical examination (PE)
o Identifying physical signs (IPS)
o Differential diagnosis (DD)
o Clinical judgment (CJ)
o Maintaining patient safety and quality of care (MPSQ)

28

Short cases
There are two types of short cases:
1. Clinical cases
2. Communication skills cases
Typically, there will be four clinical cases and one communication skills case

Clinical Cases

Each clinical case lasts 10 minutes, with a standard period of examiner observation
of six minutes, before a four-minute discussion
Each case is examined by one examiner, who remains at this station for the duration
of the examination
The cases will include patients with medical conditions from the following systems:
o Cardiology
o Respiratory
o Abdominal
o Endocrine
o Dermatology
o Neurology
o Rheumatology
You are allowed six minutes to talk to, or examine the patient and four minutes are
allocated for the presentation of your findings and discussion of your management
plan with the examiner

29

Communication Skills/Ethics case

Each communications skills/ethics case lasts 10 Six minutes of interaction with the
actor followed by four minutes of questioning with the examiner
You will be expected to interact with a patient/family member/spouse
Two minutes before entering the station, you will be provided with a written scenario
summarising the case
Each case is examined by one examiner, who remains at this station for duration of
the examination
The cases will include communication scenarios relating to
o Information giving E.g. discussing of treatment options with a patient with
sexually transmitted infection
o Breaking bad news E.g. telling a person her husband died, or telling a
patient he has cancer
o Consent E.g. obtaining consent for treatment from a patient with a mild
cognitive impairment
o Confidentiality E.g. maintaining confidentiality under pressure from family
members
o Managing challenging situations E.g. discussing organ donation with nextof-kin of a ventilated patient who has an organ donor card in her pocket but
the next of kin objects because it is against his/her religion
o Ethics E.g. telling a colleague that you need to report their drug abuse as
they are unsafe to continue to practise
You should prepare by attending the following courses:
o Leadership in Clinical Practice 1 (mandatory for everyone in BST)
o Breaking Bad News (optional)
o Guide to Professional Conduct and Ethics for Registered Medical
Practitioners (Medical Council Guide)
o Good Medical Practice (GMC Guide)
o http://www.med.qub.ac.uk/osce/index.html for online practice

30

Marking scheme

Each mark sheet describes characteristics normally associated with satisfactory and
unsatisfactory performances in each skill
The borderline judgement will be used if the examiner believes that you have not
fully demonstrated the skills required but decides that some credit should be given for
your performance
38 skills judgements will be made on your performance throughout your seven
examiner encounters in 100 minutes, allowing you to score a maximum of 88 marks
(see skills matrix)
In order to pass the examination, you have to satisfy the following conditions:
o Obtain the minimum pass mark for each skill, which have been pre-set
(please see skills marking matrix table below)
o Obtain the overall minimum pass mark, which is determined by the Board of
the Part II Clinical Examination after a thorough data analysis that takes into
account both the difficulty of the examination stations and the overall
performance of the candidates taking the exam
o Pass the minimum number of stations required:
1 long case station out of 2
3 short case stations out of 5

31

Skills marking matrix

Satisfactory = 4 points; borderline = 2 points; unsatisfactory = 0
Satisfactory = 2 points; borderline = 1 point; unsatisfactory = 0
SKILLS DISTRIBUTION

CCS

MRP

DD

PE

IPS

CJ

MPSQ

Total

Long case 1
Long case 2
Communication SC
Cardiology SC
Respiratory SC
Neuro / Locomotor SC
Abdominal SC

X
X
X

X
X
X

x
x

x
x

x
x

x
x
x
x

x
x
x
x

x
x
x
x

x
x
x
x
x
x
x

x
x
x
x
x
x
x

18
18
12
10
10
10
10

Total number of
judgements for each
skill
Total for this skill
Pass mark for each
skill*

38

12
8

12
8

12
8

12
8

12
8

14
10

14
12

88
Set post
examination

* The pass mark for each skill is set by the MRCPI Part II Clinical Examination Board and is subject to
change.

Candidates will fail if:

They fail both long cases stations

They fail more than 2 short cases
They fail one long case station and 3 short case stations
They did not reach the pass mark for the above skills in any of the categories
They failed to achieve the overall pass mark for all skills (set after the exam)

32

Appendix 1 Mark sheets

LONG CASE MARK SHEET
Examiner name:.. Examiner signature:....
1. Skills assessment: Please indicate your judgement for each of the skills listed
below by ticking the appropriate box and include comments if you award borderline
or unsatisfactory.
Skill

Satisfactory

Clinical
communication
skills (CCS)

History is:
Relevant
Fluent
Focused

Managing
relationships
with patients
(MRP)

Listens to patients
concerns
Empathic

Physical
examination (PE)

Borderline

Accurate
Appropriate
Practised
Professional

Identifying
physical signs
(IPS)

Identifies correct
physical signs

Differential
diagnosis (DD)

Presents a sensible
and comprehensive
differential diagnosis

Clinical
judgement (CJ)

Evidence of reflective
problem solving
Suggests appropriate
investigations and
management

Maintaining
patient safety
and quality of
care (MPSQ)

Treats patient
respectfully and
sensitively, and
ensures comfort,
safety and dignity

Unsatisfactory

Comments

Omits crucial areas

Unpractised
Unprofessional

Dismisses patients
concerns
Not empathic

Poor technique
Omits important tests
Hesitant
Lacks confidence

Misses important
clinical signs
Reports signs that are
not present

Inappropriate,
incomplete differential
diagnosis

Poor evidence of
problem solving
Selects unsuitable
investigations and
treatment

Jeopardises patient
safety
Causes physical or
emotional pain to the
patient

2. Global Assessment
CIRCLE the grade you believe is most applicable for this candidate. This grade is
independent of marks awarded in the skills assessment.
Fail

Borderline

Clear Pass

Excellent
33

COMMUNICATION SHORT CASE MARK SHEET

Examiner name:.Examiner signature:..
1. Skills assessment: Please indicate your judgement for each of the skills listed
below by ticking the appropriate box and include comments if you award borderline
or unsatisfactory.

Skill

Satisfactory

Clinical
communication
skills

History is:
Relevant
Fluent
Focused

Managing
relationships
with patients

Clinical
judgement

Maintaining
patient safety
and quality of
care

Borderline

Comments

Omits crucial areas

Unpractised
Unprofessional

Listens to patients
concerns
Empathic

Manages
expectations, distress
or confusion
appropriately

Unsatisfactory

Treats patient
respectfully and
sensitively, and
ensures comfort,
safety and dignity

Dismisses patients
concerns
Not empathic

Fails to reassure or
manage distress /
misunderstanding

Jeopardises patient
safety
Causes physical or
emotional pain to the
patient

2. Global assessment
CIRCLE the grade you believe is most applicable for this candidate. This grade is
independent of marks awarded in the skills assessment.
Fail

Borderline

Clear Pass

Excellent

34

CARDIOLOGY SHORT CASE MARK SHEET

Examiner name:Examiner signature:..

1. Skills assessment: Please indicate your judgement for each of the skills listed
below by ticking the appropriate box and include comments if you award borderline
or unsatisfactory.
Skill

Satisfactory

Physical
examination

Accurate
Appropriate
Practised
Professional

Identifying
physical signs

Identifies correct
physical signs

Differential
diagnosis

Presents a sensible
and comprehensive
differential diagnosis

Clinical
judgement

Evidence of reflective
problem solving
Suggests appropriate
investigations and
management

Maintaining
patient safety
and quality of
care

Treats patient
respectfully and
sensitively, and
ensures comfort,
safety and dignity

Borderline

Unsatisfactory

Comments

Poor technique
Omits important tests
Hesitant
Lacks confidence

Misses important
clinical signs
Reports signs that are
not present

Inappropriate,
incomplete differential
diagnosis

Poor evidence of
problem solving
Selects unsuitable
investigations and
treatment

Jeopardises patient
safety
Causes physical or
emotional pain to the
patient

2. Global assessment
CIRCLE the grade you believe is most applicable for this candidate. This grade is
independent of marks awarded in the skills assessment.
Fail

Borderline

Clear Pass

Excellent

35

RESPIRATORY SHORT CASE MARK SHEET

Examiner name:..Examiner signature:..
1. Skills assessment: Please indicate your judgement for each of the skills listed
below by ticking the appropriate box and include comments if you award borderline
or unsatisfactory.
Skill

Satisfactory

Physical
examination

Accurate
Appropriate
Practised
Professional

Borderline

Identifying
physical signs

Identifies correct
physical signs

Differential
diagnosis

Presents a sensible
and comprehensive
differential diagnosis

Clinical
judgement

Evidence of reflective
problem solving
Suggests appropriate
investigations and
management

Maintaining
patient safety
and quality of
care

Treats patient
respectfully and
sensitively, and
ensures comfort,
safety and dignity

Unsatisfactory

Comments

Poor technique
Omits important tests
Hesitant
Lacks confidence

Misses important
clinical signs
Reports signs that are
not present

Inappropriate,
incomplete differential
diagnosis

Poor evidence of
problem solving
Selects unsuitable
investigations and
treatment

Jeopardises patient
safety
Causes physical or
emotional pain to the
patient

2. Global Assessment
CIRCLE the grade you believe is most applicable for this candidate. This grade is
independent of marks awarded in the skills assessment.
Fail

Borderline

Clear Pass

Excellent

36

NEUROLOGY / LOCOMOTOR SHORT CASE MARK SHEET

Examiner name:..Examiner signature:..
1. Skills assessment Please indicate your judgement for each of the skills listed below
by ticking the appropriate box and include comments if you award borderline or
unsatisfactory.

Skill

Satisfactory

Physical
examination

Accurate
Appropriate
Practised
Professional

Borderline

Identifying
physical signs

Identifies correct
physical signs

Differential
diagnosis

Presents a sensible
and comprehensive
differential diagnosis

Clinical
judgement

Evidence of reflective
problem solving
Suggests appropriate
investigations and
management

Maintaining
patient safety
and quality of
care

Treats patient
respectfully and
sensitively, and
ensures comfort,
safety and dignity

Unsatisfactory

Comments

Poor technique
Omits important tests
Hesitant
Lacks confidence

Misses important
clinical signs
Reports signs that are
not present

Inappropriate,
incomplete differential
diagnosis

Poor evidence of
problem solving
Selects unsuitable
investigations and
treatment

Jeopardises patient
safety
Causes physical or
emotional pain to the
patient

2. Global Assessment
CIRCLE the grade you believe is most applicable for this candidate. This grade is
independent of marks awarded in the skills assessment.
Fail

Borderline

Clear Pass

Excellent

37

ABDOMINAL SHORT CASE MARK SHEET

Examiner name:..Examiner signature:..

1. Skills assessment Please indicate your judgement for each of the skills
listed below by ticking the appropriate box and include comments if you
award borderline or unsatisfactory.
Skill

Satisfactory

Physical
examination

Accurate
Appropriate
Practised
Professional

Identifying
physical signs

Borderline

Identifies correct
physical signs

Differential
diagnosis

Presents a sensible
and comprehensive
differential diagnosis

Clinical
judgement

Evidence of reflective
problem solving
Suggests appropriate
investigations and
management

Maintaining
patient safety
and quality of
care

Treats patient
respectfully and
sensitively, and
ensures comfort,
safety and dignity

Unsatisfactory

Comments

Poor technique
Omits important tests
Hesitant
Lacks confidence

Misses important
clinical signs
Reports signs that are
not present

Inappropriate,
incomplete differential
diagnosis

Poor evidence of
problem solving
Selects unsuitable
investigations and
treatment

Jeopardises patient
safety
Causes physical or
emotional pain to the
patient

2. Global Assessment
CIRCLE the grade you believe is most applicable for this candidate. This grade is
independent of marks awarded in the skills assessment.
Fail

Borderline

Clear Pass

Excellent

38