MRCPath written exam tips

By Esther Palmer,2014-06-26 20:46
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MRCPath written exam tips ...

    Tips for MRCPath Written Exam

Some of this may be what you have already done/ planned to do. However, I’ve

    tried to put together some things that I found very helpful when doing exams to

    make them slightly less daunting. There is no denying that there is quite a bit to

    cover but it can be focused on certain topics that tend to come up in exams. Also

    the way you actually approach the essays at the time is very important so as not

    to be tripped up by the marking scheme.


    ? Breadth of knowledge more important than depth (egs molecular

    /management/ autopsies/ cytology/ surgical/ technology) Make sure broad

    range of topics covered and don’t get bogged down in intimate details –

    will get more marks for answering all 4 questions with slightly less detail

    than only 3 (in which case will fail, see marking scheme below)

    ? If concentrate on hot topics (but again not the finest details or it is

    impossible to cover it all) aswell as the basics of general and systemic

    pathology such as in Robbins then this should narrow down the amount of

    studying required. Most of these can be ascertained from the following

    (there is a lot of overlap between these different sources too):

    1. Reviews in Histopathology, JClinPath, JPath over last 1-2 years

    2. Recent Advances/ Progress in Pathology

    3. ACP year books / RCPath Update topics

    4. Basic gist of Current Diagnostic Pathology topics(these are often

    quite detailed and too time consuming to be worthy of lengthy


    5. Other (list enclosed as example this was collated by looking at

    recent journals etc listed above to see what things were trendy


    ? Practice essay PLANS. These are the key to passing each essay. If

    you go through the last 5 years papers you’ll also get a flavour of the

    type of exam topics. In addition read the examiners comments (copy

    of summary from website attached but more detailed comments on each

    question from the past is on the website:

    on the past papers on the College web site. They pick up recurring

    themes that are very important - they tell you what the examiners want in

    the essays and it’s often nothing to do with how much you know!!

Doing the paper

    ? Choose the questions that you can mostly fully answer rather than ones

    you know selected fine details about but have gaps in other areas.

    ? on each question pick out the key words that the question wants you to



    Describe your approach and use of immunohistochemistry when dealing

    with a pleomorphic spindle cell tumour of the skin.

    ? Brainstorm for things you know about each of these keywords.

    ? Structure these facts and comments into your essay plan with:

    Introduction briefly say what you are going to cover in the essay

    Body sticking to details specifically asked for in the question

    Conclusions briefly summarise any key points that you have made (often

    just the intro with different emphasis)

    ? The examiner wants to know you think in a structured way, that you do

    know some stuff but above all that you are safe therefore you need to

    show him/her that.

eg of intro:


     A pleomorphic spindle cell tumour in the skin could be a range of entities

    therefore a careful methodical approach is required in attempting to come to a

    conclusion. In this essay I shall discuss the differential diagnoses, then briefly

    discuss my general approach to diagnosis using more straightforward laboratory

    methods before going into more details about my approach and use of

    immunohistochemistry in dealing with such a specimen.”

     stfollowing on to 1 para:

“Differential Diagnoses

    When confronted with a pleomorphic spindle cell tumour in the skin one has to

    decide if it is benign or malignant and if malignant whether it is primary or

    secondary and what cell type is making up the tumour in order to guide

    management. This requires careful assessment of clinical details including site

    and patient demographics and history and appropriate macroscopic sampling

    followed by H and E histological assessment etc”

     but not too much detail until describe immunohistochemistry which is one of the

    key words then expand on how you would do a panel and why, check positive

    and negative controls and why and appreciate the shotcomings of

    immunohistochemistry etc.

eg of conclusion


    While sensible use of an immunohistochemistal panel is invaluable when dealing

    with a pleomorphic spindle cell tumour in the skin, it is essential to recognise the

    limitations and means of reading immunohistochemical tests in addition to the

    importance of the clinical details and H and E histological appearances of

    specimen before reaching a conclusion.”

    ie show them that if you have one of these to report you will be safe and sensible.

    ? If you run out of time at least write a good structured legible essay plan

    and you may get adequate marks from that.

    Marking Scheme =CLOSE MARKING.

    Pass mark is 50%, if 46% or below you cannot make up with the other paper.

    Each of 4 questions is 25% BUT can only get Maximum 15%. pass is 13-15, not

    pass is 11-12 and fail is 10. If write very little get 5, but most marks are 10-15.

     THEREFORE need rounded answer to every question but extra clever little

    details will not save your bacon if you have missed or not fully answered a

    question. steg 1 essay is very good and get 14 (have to have amazing assay to get 15,

    so very unlikely) nd 2 essay is very good and get get 14 rd 3 average but passable get 13 th4 not finish (perhaps because spent a lot of time going overboard on your

    good essays)so get 5

total is 45 % and even with amazing paper 2 you cannot pass

To reiterate:


    STRICT EXAM TIMING technique required so as not to fall foul of this marking

    scheme. Must answer ALL 4 questions long answer in one q will NOT

    compensate for short/no answer to another q

These are some of the hot topics when I did exam (so some

    are a quite out of date but it gives you an idea):

    MOLECULAR AUTOPSIES ? Mismatch Repair Genes ? Shaken baby/SIDS ? Cell Cycle ? Techniques ? Apoptosis ? Sudden Death ? Telomeres (cell senescence) ? Health + Safety ? Cell Adhesion Molecules ? Diffuse Axonal Injury/head

    injury (J Clin Path) (esp CD44)

    ? Viral infections + human ? Maternal death

    cancer - EBV - HD + PTLPD ? Prematurity

    - HPV ? Post-op death

    - HBV/HCV ? Organ retention

    - HTLV1 ? CJD ? Nitric Oxide ? p53 (brief) ANATOMICAL

    ? Dead-box (brief) ? Minimum data sets ? Growth factor receptors (brief) ? HIV - CNS, Tumours, Infections ? Trefoil (v brief) ? Childhood tumours ? Metallothionein (brief) ? Melanoma/Spitz/dysplastic ? Soft tissue tumours - genetics naevus ? Oncogenes/TSGs ? Neuroendocrine tumours esp ? Cell proliferation/markers - Ki lungs

    67, PCNA, BrU ? Colorectal carcinoma

     ? Mesothelioma - markers METHODS (HP Review) ? FISH ? Cervical Neoplasia, ? Telepathology endocervical ? PCR new methods ? Biliary ductopaenia (HP Review) ? IHC T markers/histogenesis ? Prions ? IHC - Ag retrieval (HP Review) ? Prostate esp PIN, Molec ? Ploidy (brief) ? Neurodegenerative disorders ? Confocal EM (brief) ? Brain tumours

     ? Vascular tumours CYTOLOGY ? Glomerular path (Robbins) ? FNA - thyroid ? Hepatitis (brief)

    - breast ? Classifications of lymphomas ? Principles of screening ? Classification of gastritis

    programmes/adv disav/sensitiv ? Early malignancy detection etc (HP Review) ? Salivary ? H. pylori ? gastric Ca

    ? Hodgkins D

    ? Bullous skin

    ? ? BP

    ? Tumour + Matrix

RCPath examiners’ comments from website, reemphasize many of the points above:


    Communication skills are particularly important for pathologists who need to be able to

    communicate adequately with colleagues and clinicians in both written and verbal reports.

    Candidates need to demonstrate that they have the ability to produce concise, clearly presented

    and informative answers to questions. Typical comments received from examiners who have

    marked written papers have not varied greatly over a period of several years and include:

    lack of:

    ? organisation and planning

    ? evidence of familiarity with current practice

    ? real awareness of recent advances in the specialty

    ? sufficient detail, including quantitative information where appropriate

    ? evidence of adequate practical experience of laboratory and related clinical


    tendency to:

    ? stray from or fail to answer the question asked

    ? answer only part of the question

    ? include irrelevant material

    ? generalise

    ? list facts without discussing

Additional criticisms from examiners include bad spelling (especially of medical and technical

    terms) and poor presentation in general.

    Currently, all the College's written examinations comprise two essay papers of three hours each,

    requiring candidates to answer four out of five or six essay questions in this time. It is important

    to allow the same amount of time for each question ie 45 minutes. The College operates a close

    marking system and your aim should be to answer each question as evenly as possible; there is

    a danger that if too much time is spent on one question this will leave insufficient time for

    another question which could jeopardise chances of success in the examination. It is not

    possible to pass the paper on only three questions, even if top marks are scored.

    It is important to read each question carefully, perhaps three or more times. Try to decide what

    the examiners are looking for in the answer. Then allow a few minutes to make a brief plan of

    the main points: this will also serve as a reminder when writing the essay. Put your points into

    an order of priority. Use headings for different sections of your answer. A good essay has a

    beginning, a middle and an end: that is, a brief introduction before the essay and a short

    summary to finish. Writing everything you know about a subject in an unstructured way is not

    going to impress the examiners; your knowledge must be channelled into a logical framework

    which answers the specific question. In addition, always try to show that your theoretical

    knowledge has been supplemented by practical experience and that you are aware of relevant

    recent advances.

    Examiners are looking for knowledge, but also some critical faculties and it is not appropriate,

    therefore, to include long lists from the textbook in an answer. The keywords in a question such

    as "discuss", "compare and contrast" look for an indication of the advantages and disadvantages and a sensible opinion is required. What examiners want to see is a process of logical thought, a weighing up of pros and cons, a clear and coherent response to the question. Samples of past papers may be requested from the Examinations Department, free of charge, with a stamped addressed envelope and indication of the specialty required. Candidates are well advised to practise questions under mock examination conditions for subsequent discussion with their supervisor.

    Chairman, Training and Examinations”

Richard Bishop January 2003

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