Decoding MRCP: Key Differences - MRCP Part 1, Part 2, and PACES Explained

Membership in the Royal Colleges of Physicians is a prestigious and well-known postgraduate qualification for doctors pursuing a career in internal medicine. It presents an opportunity for physicians seeking to advance their careers in the UK or other countries. 

The full MRCP (UK) degree is awarded only after successfully clearing all three parts of the MRCP examination.

This is the postgraduate qualification comprising three parts: MRCP PART 1, MRCP PART 2, and MRCP Paces.

Let us know the key differences between these 3 parts in brief

MRCP PART I

The MRCP Part I is the entry-level examination, which evaluates the core medical sciences. It is the first step to achieving membership in the Royal College of Physicians.

It is a one-day examination that primarily focuses on the knowledge and foundation of the aspirant. MRCP Part I emphasizes the fundamental principles of general medicine and clinical sciences.

The exam consists of two papers, each with a 2-hour duration, and contains 100 multiple-choice questions in the best-of-five format. The topics that are covered in part I are:-

1. Pharmacology

2. Epidemiology

3. Statistics

4. Clinical specialties: such as Cardiology, Neurology, Respiratory Medicine, Gastroenterology, Endocrinology, and others

The aspirant receives one mark for each correct answer, and there is no negative marking.

Once the aspirant has successfully cleared the MRCP I, they are eligible to proceed with MRCP Part II.

 MRCP PART II 

The MRCP Part II is a more advanced clinical written examination that builds upon the knowledge tested in MRCP Part I. It focuses on advanced clinical knowledge, analytical thinking, and application in real-world scenarios.

The content covers various specialties, including cardiology, gastroenterology, endocrinology, and more. 

The exam is conducted in one day with two papers, each lasting for 3 hours, with the best of five MCQs.

The format of the MRCP Part II not only tests the candidates' knowledge but also evaluates their ability to interpret information and solve severe clinical problems.

Both papers were completed on the same day.

The questions in Part II are more clinically oriented and focus on complex case scenarios, diagnostic reasoning, and management plans, including ECGs, X-rays, CT/ MR scans requiring interpretation and judgment. This examination requires a deeper and more concentrated understanding of internal medicine, reflecting the complexities of real-life clinical decision-making.

Mainly, the candidate will be assessed on the capacity of candidate to utilize the clinical knowledge and make practical judgements and take accountability for the task performed by him/her.

MRCP PACES

MRCP Paces is the final step to get the GMC registration certificate. It is a practical, clinical assessment that tests a physician's ability to apply clinical knowledge in real-life hospital settings. Paces consists of five stations that assess a range of skills. ( input the Paces blog link). The exam is designed to assess the candidate's professionalism, empathy, and ability to clearly and ethically explain complex medical information.

MRCP PACES Structure:   

The structure of the MRCP PACES examination consists of five stations, each for 20 minutes, and a total of 8 patients encountering two examiners in each station.

1. Station 1: Communication & Respiratory exam (10 -10 minutes each)

2. Station 2: 20-minute consultation (history, examination, discussion)

3. Station 3: Cardiovascular + neurological exam (10 -10 minutes each)

4. Station 4: Abdominal exam + communication/ethics (10 -10 minutes each)

5. Station 5: 20-minute brief focused consultation + management discussion 

In these stations, the seven core skills are tested in the candidate

A) Physical Examination, B) Identifying Signs, C) Clinical Communication, D) Differential Diagnosis, E) Clinical Judgement, F) Managing Patients’ Concerns, and G) Maintaining Patient Welfare 

The three MRCP PARTS differ significantly from each other in format and focus. The MRCP Part I, II, and PACES broadly assess the theoretical knowledge. The MRCP Part II tests the applied clinical understanding, and the final MRCP PACES evaluates the practical and interpersonal skills in a clinical environment.