How Difficult is MRCP (Membership of the Royal College of Physicians)?

Just how difficult is MRCP? The answer to this question is dependent on who you ask!

In the old MRCP days of negative marking, when candidates answered a question incorrectly, they would’ve lost marks (as opposed to simply being awarded a zero nowadays).

How Difficult is MRCP?

Thankfully, negative marking no longer exists in MRCP but as you can see, pass rates for Part 1 and PACES remain low:

Pass rates at first attempt, averaged over all three diets that year
Pass rates at first attempt, averaged over all three diets that year

MRCPUK state that candidates who did not declare their training details are reported as ‘other trainees’. It’s presumably fair to assume that this group largely consists of doctors who have either trained outside the UK, or are currently not within a formal training programme.

There are many reasons why ‘other trainees’ tend to perform less well than their UK counterparts.

Firstly, as this is a British exam, you would expect a larger emphasis on clinical conditions specific to UK clinical practice. This means alcoholic liver disease rather than malaria in the West of Scotland! Having said that, Part 1 still contains many ‘weird and wonderful’ conditions I’ve still not encountered in real life.

Another reason for the lower pass rate amongst ‘other trainees’ is that English may not be their native language. Certain words or phrases that UK graduates take for granted may not be so familiar for international graduates. After all, it makes sense that if you don’t understand the question, you won’t be able to answer it!

This language barrier becomes even more pronounced in the final clinical exam, PACES, where candidates are expected to take detailed clinical histories, explain investigations and results, break bad news, in addition to presenting entire cases to examiners under immense time pressure.

When referring to exams in general, scores can either be expressed as raw or scaled scores.

For example, a raw score of 70/100 can also be expressed as 70%. However if we want to compare the difficulty of this exam compared to its predecessor from last year then the raw score isn’t very useful.

Let’s imagine that we establish that compared to this year’s exam, last year’s was less challenging.

We introduce a scale from 0 to 300. If a mark of 72/100 last year is deemed equivalent to 70/100 this year by the experts then we assign the same scaled score (for example 220/300) to both marks. This is essentially what happens in the MRCP UK exams.

Instead of a percentage score, candidates are awarded an overall scaled score that ranges from 0 and 999. The current pass score for Part I is 528. The current pass score for Part 2 is 425.

Interestingly, Part 2 pass rates have been historically higher. This could be a result of the lower pass mark required but could also reflect survivorship bias – only candidates who have passed Part 1 are eligible to attempt Part 2 written.

Instead of becoming discouraged from attempting MRCP, I hope you’ll use all this data to your advantage. One thing’s for sure – MRCP isn’t easy!

In conclusion, hopefully I’ve answered how difficult is MRCP? and remember that no matter how impressive they may be, all the registrars and consultants you work with were in your shoes at some point during their careers.

We were also apprehensive, and uncertainty followed us constantly like a dark cloud above our heads. Numerous consultants told me that failing multiple times prior to success wasn’t all that unusual and it certainly isn’t a reliable indicator of clinical ability.

Part of the battle is having confidence in your own abilities and not comparing yourself to other people. Impostor syndrome is very common amongst medics and I’m quite sure all doctors experience this at some point in their lives.

After all, you’ve all passed medical school, which is a great achievement in itself.

If you enjoyed this article make sure you get your own copy of my MRCP Part 1 & 2 Written Guide. In this guide, I explore the above and other concepts such as time allocation and the most preferable resources for the written exams in much more detail.

Alternatively, if you’ve passed the written exams then How to Pass MRCP PACES in 8 Weeks will take you through your next and final hurdle. The reason an entire new guide has been written about this mammoth clinical exam reflects the different skills and attitude you need when tackling MRCP PACES. Instead of simply relying on reading textbooks, you’ll need to utilise a concept called the PACES Triangle to successfully navigate the examiners’ obstacles.