Journey Through MRCS Part B: Insights by Rutvik Makwana

Introduction

The MRCS Part B exam is more than just a test—it’s a transformative journey that pushes you to grow as a clinician and an individual. For Indian candidates, the journey comes with its unique challenges. This isn’t just about passing an exam; it’s about adapting to a completely different system of medicine while bearing the weight of financial, emotional, and professional expectations.

Challenges Faced by Indian Candidates

  • Financial Strain: The exam fee of £1,099 (₹1.3–1.5 lakhs) is a huge investment, especially for students coming from middle-class families. For many of us, the fear of failure isn’t just about self-doubt—it’s the worry of not being able to afford another attempt.
  • Differences in Medical Training: Adapting to the UK healthcare system, with its emphasis on politeness, patient-centered care, and teamwork, requires a significant shift in mindset. Indian medical training often focuses on hierarchical structures and managing large patient volumes under resource-constrained conditions. The contrast is stark, and mastering this balance is essential to succeed in the MRCS exam
  • Communication Skills: Communication stations are particularly challenging because our medical education doesn’t always stress empathy and structured interactions. This requires deliberate preparation to ensure that you can effectively address patient concerns and scenarios during the exam.
  • Immense Pressure: The weight of expectations—from family, peers, and mentors—combined with the financial stakes makes this journey emotionally taxing. Yet, it’s also what pushes us to give it our all.

The Morning of the Exam

The day of the exam began with an early reporting time of 7:15 a.m. at the Trident Hotel in Hyderabad. Being in a new city added its own set of challenges. Most hotel restaurants don’t serve breakfast so early, and I didn’t want to risk starting such an important day on an empty stomach

  • Preparation the Night Before: To avoid any issues, I packed some food the previous evening and kept it in the fridge.
  • Morning of the Exam: I had the food I brought and made sure to stay hydrated.
It was only after arriving at the exam venue that I learned they were serving breakfast to early-arriving candidates. For anyone planning to appear for this exam, I recommend checking with the venue beforehand about such arrangements to avoid unnecessary stress.

The Examination Center

The Trident Hotel in Hyderabad provided a truly professional and welcoming environment. From the moment I entered, the staff ensured everything was smooth and organized.

One floor of the hotel was converted into the exam venue, with individual hotel rooms serving as the exam stations. Candidates were guided to their respective stations, and the process was conducted with precision and care.

The environment was designed to reduce anxiety. The staff were polite and approachable, ready to help at every step. This attention to detail and professionalism made a positive impression and helped create a calm, focused atmosphere for the candidates.

The Exam Supervisor

The briefing session was led by a foreigner and an experienced senior member of the Royal College of Surgeons. His demeanor struck a perfect balance between professionalism and warmth, which helped set the tone for the day.

  • Professional Guidance: He clearly explained the importance of treating the exam scenarios as real clinical settings and emphasized that communication and empathy were as important as technical skills.
  • Approachable Personality: Despite his seniority, he was approachable and made light-hearted jokes to ease our nerves.

This interaction made a big difference. The reassurance and positivity he radiated stayed with me throughout the exam.

Pre-Exam Formalities

Once I arrived at the exam venue, I was directed to the designated floor where the MRCS Part B exam was being conducted. The entire process was well-organized, and each step was clearly explained by the staff. Here’s what happened:

  • Device Security All electronic devices, including laptops, tablets, and mobile phones, were collected and sealed. This measure ensured eliminating any possibility of using unfair means.
  • Identification: Each candidate was provided with a roll number card or badge.We were instructed to clip the badge to the front pocket of our shirts for easy identification throughout the exam.
  • Waiting Room:After completing the initial formalities, we had to wait in a comfortable waiting room.Water was provided, and the seating arrangement ensured that candidates could relax before the exam began.

This organized and systematic approach ensured fairness and consistency, giving every candidate a uniform experience.

Exam Format and Flow

The MRCS Part B exam consisted of 23 stations in total, meticulously organized across the designated exam floor of the Trident Hotel in Hyderabad. Each station tested different aspects of surgical competence, communication skills, and clinical knowledge:

  • 19 Main Stations: These covered a variety of tasks, including procedural skills, clinical examinations, communication scenarios, and knowledge-based assessments.
  • 2 Rest Stations:These provided 9-minute breaks where candidates could relax, reflect, and mentally prepare for the upcoming tasks.
  • 2 Preparatory Stations:Designed for communication tasks, these stations allowed candidates to review patient notes and history before proceeding to the actual communication station.

Station Procedure

  1. Candidate Positioning:Suppose there are 19 candidates. Each candidate is stationed in front of a hotel room, which served as an exam station.Candidates have to stand with their backs to the station door, ensuring they can’t see or hear anything inside the room.
  2. Entering the Station:At the sound of the bell, candidates have to turn around to face the station door. A paper containing the station instructions was displayed on the door. Candidates are given 1 minute to read and understand the task.
  3. Reading Instructions:After the 1-minute reading period, another bell rings, signalling candidates to enter the room and begin the task.Each station lasted 9 minutes, during which candidates interacted with examiners, patients (real or simulated), or models, depending on the nature of the station.
  4. Timing Within the Station:A bell or announcement was made at the 6-minute mark to signal that time was running out The final bell at the 9-minute mark indicated the end of the station. If a candidate had not completed the task, the session ended regardless, and they are thanked by the examiner and instructed to move on to the next station .
  5. Moving to the Next Station:
    • At the conclusion of each station, candidates moved clockwise to the next one.
    • The same procedure repeated
    • Stand with their back to the station door.
    • Wait for the bell to turn around and read the instructions.
    • Enter the room after 1 minute to perform the task for 9 minutes
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General Observations

The 9-minute duration for each station is typically sufficient to complete the tasks assigned. In my experience, I found that most of the required tasks could be completed within the first 6 minutes, leaving the remaining time for the question-and-answer session with the examiner.

The Exam Experience

Personally, my body seemed to move on autopilot throughout the process. Everything felt fast-paced and mechanical—there was barely any time to consciously process what was happening. Halfway through the exam, exhaustion began to creep in, and I found myself wishing for it to end. It’s a natural reaction, given the intensity of the exam and the constant mental and physical focus it demands.

Dealing with Nervousness

It’s normal to feel nervous, and the examiners generally try to support and guide candidates. However, there is a noticeable difference between foreign and Indian examiners in terms of their demeanor:

  • Foreign Examiners: They were polite, soft-spoken, and cooperative, making the interactions feel more comfortable and less intimidating.
  • Their accents were clear and easy to understand, so communication was smooth.
  • Indian Examiners: I found their accents harder to follow, and their expressions or tone sometimes gave the impression that I might have made a mistake—even if I hadn’t.
  • Their facial expressions and body language occasionally added to my nervousness, which made me second-guess my findings.

In hindsight, the foreign examiners made the process feel more encouraging and supportive.

Exam Experience :Examination Stations

The exam began with an examination station, which caught me off guard. Personally, I had hoped to start with a knowledge station to build momentum, as that aligns better with how I structured my preparation: beginning with knowledge, then moving to communication, examination, and procedural skills. However, the randomised nature of the stations means you must adapt to whatever comes first, regardless of your preferences. All the stations appear at random and you cannot expect what will come next.

Personal Challenges

  • Communication and Skills Stations: My mentor, Dr. Vinayak Rengan, always emphasised that Indian candidates often find communication and skills stations the most challenging
  • Knowledge Weaknesses: Despite my preparation, I still found anatomy and pathology particularly difficult. I have always had problems remembering anatomy well. I found critical care stations, which require more conceptual understanding, comparatively easier to handle.

First Station: Lump Examination

The first station involved examining a patient with a lump on the medial aspect of the thigh.

My Experience
  • Initial Interaction Upon entering, the examiner greeted me warmly and asked for my roll number (3800), which I provided.
  • Knowledge Weaknesses: Despite my preparation, I still found anatomy and pathology particularly difficult. I have always had problems remembering anatomy well. I found critical care stations, which require more conceptual understanding, comparatively easier to handle.
  • I was then instructed to proceed with the examination.
  • Hand Sanitizer:Candidates are required to sanitize their hands before any examination. In this station, the sanitizer was not immediately visible, so I had to request it. The translator handed it to me from one side of the room.
  • Tip: Always check for sanitizers when entering a station and don’t hesitate to ask if it’s not in an obvious location.
  • Patient Interaction:The patient was a local Telugu-speaking resident, but a translator was present to facilitate communication.
  • The examination was conducted in English, so there was no need to use the local language.
  • The patient was cooperative, likely because it was the third day of the exam, and they were accustomed to the process. The patient lay on the bed and removed their bathrobe without me having to prompt them. I was a reluctant at first whether I should ask for a chaperone or not. So I just asked him , whether he needed anyone ? Was he comfortable ? He replied with a nod and I continued with the examination.
    • ALSO - you don’t have to repeat and recite your examination findings. It is mentioned on the stem you don’t have to recite anything. Just do what you would do in a regular real life situation and continue to talk to the patient as usual.
  • Examination Process: I introduced myself, confirmed the patient’s details, and asked if they were experiencing any pain
  • The examination proceeded smoothly but felt highly mechanical, as everything happened so quickly that there was little time to consciously process the steps.

Another Station: Ear Examination

In this station, I was required to examine a patient with hearing loss in the left ear caused by a road traffic accident.

Key Challenges

  • Muscle Memory
    • Examination stations move at a rapid pace, leaving no room for hesitation. It’s critical to practice these stations repeatedly to develop muscle memory, so tasks feel instinctive under pressure.
    • During my preparation due to lack of time I was not able to practise examination well which costed me a lot during my real performance. Please practise well and memorise the steps beforehand.
    • During this station, I second-guessed whether I needed to examine the facial nerves, causing a brief hesitation.
  • Forgetting Hand Sanitizer
    • After my initial nervousness in the first station, I was still anxious and forgot to sanitize my hands before touching the patient.
    • While the rest of the station went well, this was a small but significant error I realized only after leaving the room.
    • Tip: Develop a habit of repeating “sanitize your hands” to yourself before every station. This simple reminder can help avoid such mistakes.

Lessons Learned

  • Small Mistakes Are Costly: Forgetting something as simple as sanitizing your hands can cost valuable marks that are easy to secure.
  • Practice Makes Perfect: Repeated practice of examination stations helps build the muscle memory necessary to handle the rapid pace of the exam.
  • Stay in the Moment: Once a station is complete, avoid overanalyzing your performance. Focus on the next task instead of dwelling on potential mistakes.

Exam Experience: Rest and Communication Stations

Rest Station

After the first examination station, my next stop was a rest station.

What Happens in a Rest Station

  • The helpers, stationed at regular intervals, guided me to the next room.
  • When I turned to read the paper on the door, I realized it was a rest station—a much-needed break.

My Experience

  • During those 9 minutes, I caught myself replaying my performance in the previous station, analyzing what I might have done wrong. This mental replay added unnecessary stress.
  • Advice: Once a station is over, let it go. Dwelling on your performance only increases anxiety and distracts you from focusing on upcoming stations. Training yourself to stay calm and move forward is crucial for success.

Exam Experience: Communication Stations

The communication stations were among the most structured and challenging aspects of the MRCS Part B exam. These stations tested not only our ability to convey information effectively but also our empathy and professionalism in high-pressure scenarios. Two stations stood out: the Phone Call Communication Station and the Breaking Bad News to an Angry Patient Station.

Phone Call Communication Station

This station was divided into two parts: a preparatory station and the main communication station, which required discussing a patient case with a consultant over the phone.

1. Preparatory Station

  • What Happens:
    • Candidates are given 9 minutes to review a patient’s folder containing detailed case information, such as:
      • Patient history, investigation reports, and operative notes (typically spanning 3–4 pages).
      • Key details like the patient’s name, age, date of birth, hospital details, and GP contact information.
  • My Experience:
    • The patient’s case involved acute kidney injury (AKI) post-surgery, with findings that included:
      • Low urine output despite a patent catheter.
      • Stable vitals and no abnormalities in the abdomen.
    • I carefully noted down key points, such as:
      • Patient identifiers and important dates (e.g., admission, surgery, and findings).
      • Significant abnormalities and investigations.
  • Important Tip:
    • Unlike the other stations, candidates are allowed to take the A4-sized paper with their notes into the main station in the communication stations. This makes the preparatory station crucial for organizing and summarizing key details effectively.

2. Main Communication Station - Phone Call

  • What Happens:
    • Upon entering, additional information, like charts or findings, is displayed on the wall or table. These extra charts were not kept in the preparatory station.
    • In my case:
      • A urine output/input chart was stuck on the wall, with the patient’s date of birth highlighted in blue and the chart’s date in small letters at the top left corner.
      • Initially, I got confused by the date of birth (1949) as all the notes referenced dates from 2021. However, cross-checking the folder confirmed the timeline, allowing me to proceed with confidence. I took a minute to process, recollect, and then proceed with the call.
  • Calling the Consultant:
    • The station involved using a button-operated intercom phone to call the consultant. We had to dial a phone number - 1138 on the phone and then it was picked up by the examiner (consultant on call).
    • After introducing myself, I presented the case details, including:
      • History and investigations.
      • Examination findings (e.g., soft abdomen, no abnormalities).
      • Abnormal parameters, like low urine output.
    • The phone volume was low, which made it challenging to hear the consultant clearly, but I focused on conveying the key points concisely.
    • Example of Dialogue:
      • When the consultant asked about missing investigations like CRP, I explained that it hadn’t been done but assured them it would be sent immediately.
      • For missing vitals - not given in the folder information, I acknowledged that I didn’t know that and committed to checking and updating them post-call.
Key Tips for Success
  1. Use the Preparatory Station Effectively: Note down every detail from the folder, as it’s vital for clear communication.
  2. Observe Additional Details: Pay attention to charts or notes displayed in the room, as they’re often crucial to the case.
  3. Maintain Clarity: Even with distractions, stay composed and concise.
  4. Expect the Unexpected: Be ready to address missing information confidently, explaining your plan to resolve it.

3. Breaking Bad News to an Angry Patient

This station required me to handle a highly emotional scenario where I had to inform an angry patient about the postponement of their arthroscopy due to the consultant being called for an emergency surgery.

Scenario Overview

The situation was particularly sensitive because:

  • The patient’s surgery had already been postponed once before.
  • The patient was in severe pain, which was affecting both their personal and professional life as a postman.
  • The patient expressed frustration and indicated a desire to file a formal complaint.
Preparatory Station
  • What Happens:
    • Like other communication stations, a 9-minute preparatory station allowed me to review a folder containing the patient’s:
      • Medical and personal history.
      • Details of the previous postponement.
      • Preoperative findings and anesthetic evaluation confirming fitness for surgery.
  • My Approach:
    • I skimmed through the folder to understand the patient’s situation, pain, and frustrations. Unlike the phone call station, no notes were needed in this station, since everything had to be conveyed verbally. So I read through the notes, understood the whole story with the patient. Everything will be mentioned, when the patient came and what happened throughout the course of treatment and when his surgery was planned and then cancelled - then planned again today (on the day of the exam).
Main Communication Station
  • Patient Interaction:
    • Upon entering the room, the actor portraying the patient greeted me with visible frustration. His performance was incredibly realistic, making the interaction feel like a genuine doctor-patient encounter.
    • I introduced myself, acknowledged his concerns, and delivered the news calmly and empathetically.
    • I explained the situation, highlighting the emergency nature of the consultant’s unavailability.
  • Challenges Faced:
    • Despite my efforts, the patient remained unconvinced, reiterating how the delay was affecting his ability to work and his personal life. As the conversation progressed, he became increasingly frustrated and demanded to file a formal complaint.
Key Moment: PALS Reference
  • My mentor, Dr. Vinayak Rengan, had emphasized the importance of knowing about the Patient Advice and Liaison Service (PALS) in the UK for such situations.
    • I explained to the patient that PALS could assist in addressing his concerns and outlined how he could proceed with a formal complaint.
    • Notable Reaction: One of the two examiners nodded approvingly when I mentioned PALS, which reassured me that referencing it was the correct course of action.
Examiner Setup

Each communication station typically has:

  1. A Lay Examiner: Evaluates body language, empathy, and overall communication skills.
  2. A Medical Examiner: Assesses technical accuracy and appropriateness of responses.

Both aspects are equally important, so balancing empathy with clarity and precision is crucial.

Reflection and Advice
  1. Preparation is Key: Use the preparatory station to fully understand the patient’s background and concerns.
  2. Know the System: Familiarity with services like PALS is essential for handling sensitive situations effectively.
  3. Stay Calm and Empathetic: Angry patients can make the station emotionally taxing, but acknowledging their frustrations and validating their feelings helps.
  4. Watch Non-Verbal Cues: Observing examiner reactions can provide insight into whether you’re on the right track.
  5. Body Language Matters: Maintaining open and calm body language can help build rapport and reassure both the patient and the lay examiner.
Overall Experience

Both communication stations tested my ability to think on my feet, adapt to challenging scenarios, and maintain composure under pressure. These stations were valuable not just for the exam but also as a learning experience in handling real-life patient interactions with empathy and professionalism.

4. Exam Experience: Anatomy Stations

The Anatomy Stations in the MRCS Part B exam were challenging for me due to my overall weak preparation in anatomy. I had only gone through the anatomy syllabus once, which made it difficult to retain the intricate details and practical aspects needed for the exam. While some stations went relatively better than others, the gaps in my preparation became evident as the exam progressed.

Posterior Cranial Fossa and Skull Foramen Station

This station started well for me, as the initial questions focused on general anatomy and basic structures. However, as the examiner delved deeper into specific details, my struggles with recall began to surface.

  • What Happened:
    • I performed well in the first half of the station, where I was asked to identify and demonstrate the foramina of the posterior cranial fossa.
    • I answered questions about the venous drainage of the skull confidently, covering topics like the flow of venous blood and the involvement of dural sinuses.
    • However, towards the second half, the examiner asked me to identify the cranial nerves passing through specific foramina, and I couldn’t recall which nerve passed through which foramen.
  • Performance:
    • While I was able to handle the general questions and the venous drainage topic, my difficulty recalling the finer details of the cranial nerves made the latter half of this station challenging.

Lesson Learned: Revisiting cranial nerve pathways and their associated foramina in detail is essential. These high-yield topics are commonly tested, and familiarity with their clinical relevance is crucial.

Hand Anatomy Station

The hand anatomy station was particularly difficult for me, and it highlighted my lack of preparation and familiarity with the practical aspects of anatomy.

  • What Happened:
    • The station focused on the extensor compartment of the hand, with the examiner asking questions based on images displayed on the wall.
    • I struggled with key details, such as:
      • The origin and insertion of the flexor and extensor retinacula.
      • The compartments of the hand and the nerves and contents passing through the retinacula.
      • The 3D orientation of the muscles in the compartment.
  • Challenges Faced:
    • Memory Issues: I couldn’t recall the specifics of the retinacula, including the bones they originated from and their insertion points.
    • 3D Visualization: Understanding the spatial relationships of the hand’s structures was difficult, and I struggled to answer questions about the compartments and their nerves.
    • Poor Performance: My inability to provide answers to most of the questions meant the station ended early for me. I had to sit and wait for the 9 minutes to finish before moving to the next station, which added to my frustration.

Reflection: This was the station where my lack of preparation in anatomy was most evident. The inability to recall basic facts and visualize structures in 3D underlined the importance of thorough and repeated practice.

Key Insights and Preparation Tips
  1. Target Weaknesses Early: Anatomy was my weak area, and I should have spent more time revisiting the syllabus and focusing on retaining practical details. For future candidates, identify your weaknesses early and dedicate extra time to mastering them.
  2. Practical and Spatial Understanding: Hands-on practice with models or cadavers is invaluable. Anatomy stations often test 3D relationships and practical applications, so familiarity with spatial relationships is essential.
  3. High-Yield Areas: Focus on topics like:
    • Skull foramina and cranial nerves.
    • Hand anatomy, especially the retinacula and compartments.
    • Abdominal anatomy and retroperitoneal structures.
  4. Staying Composed: Struggling in a station can be disheartening, but it’s crucial to remain calm and focus on the next task. Letting go of frustration is key to maintaining confidence throughout the exam.
Upper Abdomen Anatomy Station

The Upper Abdomen Anatomy Station was one of the more manageable stations for me, largely due to my experience as a general surgeon. Regular exposure to abdominal anatomy in clinical practice meant that I was already familiar with many of the concepts tested in this station.

  • What Happened:
    • In this station, I was required to interact with a real patient and demonstrate specific anatomical landmarks and knowledge related to the upper abdomen.
    • Tasks and Questions:
      • Identify and demonstrate the transpyloric plane on the patient’s abdomen.
      • Locate the fundus of the gallbladder.
      • Answer questions about the layers of the abdomen at L1 and L3, including retroperitoneal structures and peritoneal layers.
    • Examiner Interaction:
      • The examiner, a foreigner, was polite and encouraging, which made the experience smoother. Their demeanor helped reduce any lingering nervousness.
    • Performance:
      • I was able to confidently identify and demonstrate the required landmarks, such as the transpyloric plane and gallbladder.
      • My familiarity with retroperitoneal structures and abdominal layers allowed me to answer most of the questions without difficulty.
Key Observations
  1. Real Patient Interaction: Working with a live patient added realism to the station. The cooperative nature of the patient made the task even easier.
  2. Examiner’s Demeanor: The foreign examiner’s polite and supportive approach helped create a comfortable atmosphere, making it easier to perform confidently.
  3. Preparedness: My clinical experience as a general surgeon proved beneficial, as abdominal anatomy is something I encounter regularly in practice.
Lessons Learned
  1. Leverage Your Strengths: If a station aligns with your clinical experience, focus on demonstrating confidence and applying practical knowledge. This can make a significant difference in performance.
  2. Pay Attention to Details: Even in areas of strength, revisiting anatomy to refresh finer details ensures you’re prepared for any unexpected questions.
Final Thoughts

The Upper Abdomen Anatomy Station went smoothly for me, as I was able to draw on both theoretical knowledge and practical experience. This station highlighted the value of clinical exposure in boosting confidence and performance during the exam. For future candidates, practicing patient-based scenarios and focusing on core anatomical landmarks can help navigate similar stations successfully.

Exam Experience: Pathology Stations

The pathology stations in the MRCS Part B exam were relatively straightforward, with questions often derived from Mortimer Green notes. This predictability made these stations more manageable, as long as you were well-prepared with the basics and familiar with common pathological conditions.

Structure of Pathology Stations

1. Topic Progression

Pathology stations typically start with a single topic and gradually expand into related areas. For example:

  • Giant Cell Arteritis Station:
    • Initial questions focused on temporal arteritis and giant cell arteritis, including clinical features and diagnostic approaches.
    • The discussion progressed to steroid use, its implications, and potential side effects.
    • From there, the examiner transitioned to neoplasia development and eventually to topics like basal cell carcinoma and multiple myeloma.

Key Insight: Be prepared for topic transitions within a single station, as examiners often cover a broad range of related subjects in a limited time.

2. Second Pathology Station: Osteomyelitis

This station started with questions on the basics of osteomyelitis, such as:

  • Pathophysiology and common causative organisms.
  • Diagnostic approaches, including imaging and laboratory findings.

The examiner then transitioned to parathyroid hormone and its role in calcium metabolism (hypercalcemia and hypocalcemia). The final part involved a treatment scenario, where I was asked how to manage hypocalcemia with calcium gluconate. The examiner specifically asked about the dosage: 10 mL in 10 minutes. Initially, I confused the units (milligrams versus mL), but the examiner guided me, allowing me to correct myself.

Advice for Pathology Stations

  1. Master the Basics: Focus on high-yield topics such as temporal arteritis, giant cell arteritis, osteomyelitis, common neoplasias like basal cell carcinoma and multiple myeloma, and calcium metabolism.
  2. Be Ready for Real-Life Scenarios: Examiners often test practical management, such as treatment protocols or dosages. Be prepared to answer in detail.
  3. Flexibility in Topic Transitions: Pathology stations can transition rapidly between related topics (e.g., inflammation to malignancy). Adapt quickly and stay focused.

Exam Experience: Critical Care Stations

The critical care stations were conceptual, with a strong emphasis on applying theoretical knowledge to practical scenarios. These often involved interpreting images (particularly X-rays) and discussing clinical findings.

Structure of Critical Care Stations

1. Scenario at the Door

A brief clinical history or scenario was provided on a sheet of paper outside the station. Candidates had a minute to read it before entering.

2. Example Station: Abdomen X-Ray

An abdominal X-ray was displayed, and the examiner asked me to identify the findings. I began by describing the type and orientation of the X-ray, but the examiner interrupted and requested only the key findings. I identified the primary abnormality as a dilated large bowel loop, which I reported concisely.

Advice for Critical Care Stations

  1. Focus on Findings: Begin with the key finding or diagnosis. Avoid lengthy descriptions unless the examiner specifically asks for them.
  2. Common Themes: Prepare for high-yield topics, such as X-ray interpretation (abdominal and chest) and ATLS principles and critical care scenarios (e.g., shock, sepsis).
  3. Stay Practical: Be ready for real-life clinical decision-making. Offer concise, practical answers focused on clinical relevance.

Procedural Skills Stations: Detailed Events

The Procedural Skills Stations in the MRCS Part B exam were an excellent test of practical proficiency, decision-making, and technique. Here, I’ll provide a detailed account of my experience during the Knotting and Ligature Station and the OT Listing Station to highlight the setup, tasks, challenges, and lessons learned.

Knotting and Ligature Station

This station was divided into three sections, each testing a specific aspect of knotting and ligature skills.

1. Square Knot on a Rubber Band Model

Station Setup
  • The task involved tying a reef knot on a rubber band model.
  • The table was neatly arranged with:Needle holder, plain forceps, tooth forceps, artery forceps, scissors, and pre-cut suture materials.
Task
  • I used a silk thread (a non-absorbable braided suture) and passed it under the rubber bands to tie the reef knot.
  • The examiner observed closely, asking questions about the technique and purpose.
Follow-Up Questions
  1. What is a reef knot?
  2. How does it differ from a surgeon’s knot?
  3. Why are braided sutures advantageous for certain procedures?

2. Knotting in Depth

Station Setup
  • A hook model was placed on a base that was secured with POP or sticky material (not magnets). The task was to tie a knot without dislodging the hook.
Task
  • The examiner asked me to tie a knot using a braided absorbable suture.
  • I selected a 2-0 polyglycolic acid suture (Vicryl) after checking the packaging.
  • My hands were shaking slightly due to nervousness, but my prior preparation helped. During my study phase, I had created a practice model using a plastic bottle, sticky tape, and hooks to simulate this task.
  • Despite a brief slip, I completed the knot without dislodging the hook.
Follow-Up Questions
  1. What is Vicryl, and what is it made of?
  2. What is its tensile strength, and how long does it retain its properties?

3. Ligature of a Bleeding Vessel

Station Setup
  • A sponge model was used to simulate the bleeding vessel.
  • The table had two types of sutures available:
    • PDS (a monofilament absorbable suture).
    • Prolene 3-0 (a monofilament non-absorbable suture).
Task
  • Before proceeding, I confirmed with the examiner:
    • “Do I need to use a non-absorbable suture?”
    • The examiner responded, “Yes, non-absorbable.”
  • Based on this, I selected Prolene 3-0.
  • I performed a figure-of-eight suture to ligate the bleeding vessel.

Key Points to Note:

  • The sponge model was delicate, and overtightening the knot could cause the suture to cut through.
  • Some candidates had shared that when they tightened the knot excessively, it tore the sponge, requiring them to restart the task.
  • I was cautious and ensured that I applied just enough tension to secure the knot, demonstrating proper technique without causing damage.

Key Learnings and Preparation Tips

  1. Practice is Key: Repeated practice builds confidence and reduces nervousness. Use home practice models with hooks, sponges, or even rubber bands to mimic exam setups.
  2. Gentle Technique: Be mindful of the model’s delicacy. Demonstrating control and finesse is more important than tightening excessively.
  3. Clarify Instructions: Always confirm with the examiner when faced with multiple options, as I did with the suture material.
  4. Know Your Materials: Understand the properties and uses of sutures like Vicryl and Prolene to answer follow-up questions confidently.

OT Listing Station

The OT Listing Station focused on prioritizing surgical cases based on urgency, risks, and perioperative considerations.

Station Setup
  • On entering, I greeted the examiner and was directed to a paper listing patient details and diagnoses.
  • Next to each patient’s case, there were boxes where I had to write the sequence number indicating the order of surgeries.
Task and My Approach
  1. Patient 1: Elderly Female with Strangulated Femoral Hernia
    • I prioritized this case first due to the high risk of bowel infarction.
    • Preoperative Considerations:
      • Cardiologist consultation for pacemaker optimization.
      • Pulmonary evaluation for COPD and ICU arrangements.
    • Postoperative Considerations:
      • Monitor for cardiopulmonary complications.
  2. Patient 2: Elderly Male with Diverticular Abscess
    • Scheduled second as it was urgent but less critical than the first case.
    • Preoperative Management:
      • Broad-spectrum antibiotics, imaging confirmation, and fluid resuscitation.
  3. Patient 3: Diabetic Patient with MRSA-Infected Foot
    • Scheduled last due to MRSA contamination risk.
    • Preoperative Preparation:
      • Optimize glycemic control and use chlorhexidine for skin preparation due to povidone iodine allergy.

Examiner Interaction

  • After completing the sequence, the examiner asked me to justify my choices and provide a detailed explanation of:
    • Preoperative steps, including consultations and preparations.
    • Postoperative considerations for each patient.

Key Learnings and Preparation Tips

  1. Structured Thinking: Write the sequence clearly and prepare to articulate your reasoning step by step.
  2. Perioperative Knowledge: Understand preoperative and postoperative care protocols, especially for high-risk conditions like strangulated hernias and MRSA infections.
  3. Clarity in Communication: Take a moment to organize your thoughts before explaining your decisions to the examiner.

Final Thoughts

Both the Knotting and Ligature Station and the OT Listing Station tested not just technical skills but also the ability to stay composed and think critically under pressure. Success in these stations came down to preparation, attention to detail, and clear communication. These stations emphasized the importance of practical preparation, clinical knowledge, and confidence in handling high-pressure situations.

Post-Exam Reflections

After completing all 19 main stations of the MRCS Part B exam, I felt a wave of relief wash over me. The examination, which had tested us on everything from communication and anatomy to procedural skills and decision-making, was finally over. By the end, I was completely exhausted—both mentally and physically—and all I wanted was to leave the hotel and go straight to sleep.

Final Procedures

Once all the candidates had finished their stations, we were escorted back to the common room where we had initially been briefed. This final gathering served multiple purposes:

  1. Snacks and Refreshments:
    • After the grueling session, we were offered snacks to help us relax and replenish our energy. While it was a small gesture, it felt comforting and much needed after such a demanding experience.
  2. Supervisor Interaction:
    • The exam supervisor, along with an external supervisor, addressed us.
    • The external supervisor’s role was not to assess or score candidates but to oversee the entire examination process. His job was to ensure that the exam was conducted fairly, the stations ran smoothly, and no candidate faced unnecessary challenges.
  3. Candidate Feedback:
    • We were given an opportunity to share our reviews and experiences.
    • If any candidate had faced difficulties during a station, they could report it during this session. This feedback was invaluable for refining and optimizing the exam for future sessions.

Issues During the Exam

During our session, I learned about an issue that had occurred in the Foley’s catheterization station earlier in the exam cycle:

  • The task involved catheterizing a patient, but the urine did not come out during the procedure.
  • The foreign examiner, standing near the candidates, questioned why the balloon wasn’t inflated. This put some candidates under pressure to think on their feet.
  • A few candidates responded by saying:
    • “Since urine didn’t come out, I would reassess the patient and check if the bladder is full.”
  • This situation created confusion and stress, leading to inconsistent performances.
  • Eventually, the station was scrapped for fairness, and a replacement station—likely the OT Listing Station—was added to the rotation.

Final Thoughts

The MRCS Part B exam is undoubtedly demanding, but with preparation, composure, and focus, it is manageable. To all future candidates:

  • Stay confident, practice rigorously, and trust your instincts during the exam.
  • Use every station as an opportunity to showcase your knowledge and skills, and remember that perfection isn’t required—just consistent effort and sound clinical reasoning.

All the best for your journey ahead!