MRCP UK Exam regulation(1 )

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Constitutional Framework:

Powers and Responsibilities of the Royal Colleges of Physicians
The Royal Colleges of Physicians of the UK have the power to:
• determine the terms and conditions of entry to the MRCP(UK) Examination. The Royal Colleges of Physicians reserve the right to refuse admission to any part of the MRCP(UK) Examination;
• recognise appropriate periods of training, in fulfilment of the entry requirements of the MRCP(UK) Examination, and determine when this training has been completed successfully by candidates;
• confer the MRCP(UK) Diploma on persons who have passed the MRCP(UK) Examination.

To maintain the academic quality of the Examination, the Royal Colleges of Physicians have the responsibilities of:
• appointing examiners with appropriate qualifications and experience;
• producing syllabuses for appropriate parts of the Examination;
• monitoring candidate performance;
• arranging suitable examination facilities.
In the exercise of these powers and responsibilities, the Royal Colleges of Physicians will comply and ensure compliance with the requirements of relevant legislation, such as the:
• Race Relations (Amendment) Act 2000;
• Disability Discrimination Act 1995;
• Special Educational Needs and Disabilities Act 2001;
• Employment Equality (Age) Regulations 2006;
• Data Protection Acts 1984 and 1998.

The MRCP(UK) Management Board believes that equality of opportunity is fundamental to the many and varied ways in which individuals become involved with the Colleges, either as members of staff and Officers, as advisers from the medical profession, as members of the Colleges’ professional bodies or as doctors in training and examination candidates.
Accordingly, it warmly welcomes, and actively seeks to recruit, contributors and applicants from as diverse a population as possible, regardless of race, religion, ethnic origin, disability, age, gender or sexual orientation.

Route Map: MRCP(UK) Diploma
There have been a number of key changes introduced to the structure and eligibility requirements of the MRCP(UK) Examination for 2009. These are incorporated into these Regulations, but an overview of the changes and new eligibility requirements is as follows:
Candidates may now apply to sit the MRCP(UK) Part 1 Examination provided they graduated at least 12 months in advance of the examination date (and have had at least 12 months’ experience in medical employment, i.e. have completed Foundation Year 1 or equivalent). This was previously 18 months. There is no restriction to the
number of times a candidate can apply to sit the MRCP(UK) Part 1 Examination in order to pass. Once a candidate has passed this examination they will be permitted a further 7 years from the date of the Part 1 Examination at which they were successful to pass the remaining parts of the MRCP Qualification.
Candidates who have passed the Part 1 Examination are now able to apply simultaneously to sit the MRCP(UK) Part 2 Written and Part 2 Clinical (PACES) Examinations in any order. They are now permitted unlimited attempts at the MRCP(UK) Part 2 Written and Part 2 Clinical (PACES) Examinations within their 7-year period of eligibility. However, all applications for the MRCP(UK) Part 2 Written and Part 2 Clinical (PACES) Examinations must be supported by the candidate’s current or most recent educational supervisor or current or most recent supervising consultant.
Once a candidate has successfully completed their final Part of the examination (irrespective of whether this was the Part 2 Written or Part 2 Clinical (PACES) Examination) they must then complete and submit the Form of Faith and a testimonial for election to membership. The testimonial must be completed by a Fellow or Member of the Royal College of Physicians of the United Kingdom (the latter should have worked with the candidate within the previous 3 years and must be a holder of MRCP(UK) for at least 8 years).


Transitional arrangements for existing candidates
Candidates who enrolled in the MRCP(UK) Examination system before January 2009 should refer to the table below for further information as to how the changes will affect their status. The changes take effect from the 2009/01 diet:
Category
Current examination status
Arrangements under the new regulations

A candidate has passed the MRCP(UK) Part 1 Examination but has not passed the MRCP(UK) Part 2 Written Examination.
The candidate will be permitted a total of 7 years (from the date they passed the MRCP(UK) Part 1 Examination) in order to succeed in both remaining parts of the MRCP(UK) Examination.

A candidate has passed the MRCP(UK) Part 1 and Part 2 Written Examinations and is still within the 7-year eligibility period from the date they passed the MRCP(UK) Part 1 Examination. However the candidate is either past the end of their 2-year Part 2 Clinical Examination (PACES) period of eligibility or has used all three of their PACES attempts by the end of 2008.
The candidate has from now until 7 years from the date they passed the MRCP(UK) Part 1 Examination in which to sit and pass both the MRCP(UK) Part 2 Written Examination and the Part 2 Clinical Examination (PACES). Candidates will be permitted to attempt the examinations as often as they wish within that period.

A candidate has passed the MRCP(UK) Part 1 and Part 2 Written Examinations and is still within the 7-year eligibility period from the date they passed the MRCP(UK) Part 1 Examination. The candidate is also within an existing 2-year Part 2 Clinical Examination (PACES) period of eligibility and has at least one of their three PACES attempts remaining by the end of 2008.
The candidate will have either 2 years from the date they passed the MRCP(UK) Part 2 Written Examination (previously known as the PACES period of eligibility) or 7 years from the date they passed the MRCP(UK) Part 1 Examination in which to sit the Part 2 Clinical Examination (PACES) – whichever is greater. Candidates will be permitted to sit the Part 2 Clinical Examination (PACES) as often as they wish within that period. All applications will need to be supported by the candidate’s current or most recent educational supervisor, or current or most recent supervising consultant.

A candidate has passed the MRCP(UK) Part 1 and Part 2 Written Examinations, the 7-year eligibility period has expired but the candidate is within an existing 2-year Part 2 Clinical Examination (PACES) period of eligibility and has at least one of their three PACES attempts remaining by the end of 2008.
The candidate will keep their 2-year PACES period of eligibility and will be permitted to sit the Part 2 Clinical Examination (PACES) as often as they wish within that period. The new entry requirements/arrangements will be applied. If the candidate is unsuccessful at the Part 2 Clinical Examination (PACES) during this time they must re-sit the MRCP(UK) Part 1 Examination, starting the process again under the new arrangements.

A candidate has passed the MRCP(UK) Part 1 Examination more than 7 years ago.
The candidate must return to Part 1 and start the process again under the new arrangements.

Framework: The Aims and Objectives of the MRCP(UK) Examination

The MRCP(UK) Examination plays an essential role in the overall educational experience and continuing professional development of physicians in the United Kingdom. It is a prerequisite for physicians wishing to undergo training in a medically related specialty in the United Kingdom.
The MRCP(UK) Examination also plays an increasingly important role in the international arena of postgraduate medical education. It provides a professional standard against which physicians working outside the United Kingdom can measure their level of attainment. It is also being used by medical educationalists in other countries in respect of local postgraduate assessments.

Aim
The aim of the MRCP(UK) Examination is to identify those physicians who, having undertaken a period of general training, have acquired the necessary professional knowledge, skills and attitudes to enable them to benefit from a programme of higher specialist training with confidence and enthusiasm.

Objectives
The MRCP(UK) Examination evaluates the professional competence of medical graduates during medical training with regard to:
• core clinical knowledge and problem-solving, including clinical science, epidemiology and statistics;
• clinical skills, including taking and interpreting a clinical history and undertaking a physical examination;
• attitudes to patients, including communication skills and ethical obligations.
The standard of the various parts of the examination will reflect the development in the knowledge, skills and attitudes which can be expected during medical training, and is in keeping with the principle of lifelong learning.

methodology
The MRCP(UK) Examination includes questions and assessments that require an understanding not only of common medical emergencies in diagnosis and management, but also of the social, psychological and cultural backgrounds of diseases and evidence-based practice.

(UK) Part 1 Examination
Purpose
The purpose of the MRCP(UK) Part 1 Examination is to identify those physicians in training who, having satisfied the entry criteria, possess a broad knowledge and understanding of common and important disorders as well as clinical science.

Aims
To test the acquisition of a representative sample of medical knowledge as specified in the published Syllabus for the Examination (MRCP(UK) Part 1 Syllabus). To measure the candidate’s ability to apply their medical knowledge in regard to common and important disorders and clinical science, as outlined in the Syllabus, and make appropriate clinical judgements.
For further information candidates should consult the MRCP(UK) website and the documents referred to in Section 15. MRCP(UK) Examination Publications.

MRCP(UK) Part 2 Written Examination
Purpose
The MRCP(UK) Part 2 Written Examination can be taken by physicians in training who have passed the MRCP(UK) Part 1 Examination or who have exemption from the MRCP(UK) Part 1 Examination (see Section 6.4). Success in this Examination demonstrates the attainment of the minimum level of knowledge expected of a physician in training and the ability to apply this knowledge to clinical problem-solving and clinical practice.

Aims
The MRCP(UK) Part 2 Written Examination will test the ability to apply clinical understanding, make clinical judgements and take responsibility for:
• prioritising diagnostic or problem lists;
• planning investigation;
• selecting a plan for immediate management;
• selecting a plan for long-term management;
• assessing prognosis.

MRCP(UK) Part 2 Clinical Examination (PACES)
Purpose
The MRCP(UK) Part 2 Clinical Examination (PACES) can be taken by physicians in training who have passed the MRCP(UK) Part 1 Examination or who have exemption from the MRCP(UK) Part 1 Examination (see Section 6.4), in accordance with the recommendations for necessary clinical experience detailed in Section 8.2.3. Success in this Examination demonstrates in a clinical setting the knowledge, skills and attitudes appropriate for a physician in training.

Aims
The MRCP(UK) Part 2 Clinical Examination (PACES) will test the ability to:
• demonstrate the clinical skills of history taking;
• examine a patient appropriately to detect the presence or absence of physical signs;
• interpret physical signs;
• make appropriate diagnoses;
• develop and discuss emergency, immediate and long-term management plans;
• communicate clinical information to colleagues, patients or their relatives;

• appreciate the ethical issues that relate to day-to-day clinical practice.
The above is set out in the published guidelines for the Examination, MRCP(UK) Part 2 Clinical Examination (PACES) and Clinical Guidelines 2001/2 Edition (see Section 15. MRCP(UK) Examination Publications).

MRCP(UK) Part 1 Examination
Format
The MRCP(UK) Part 1 Examination is designed to assess a candidate’s knowledge and understanding of the clinical sciences relevant to medical practice and of common or important disorders to a level appropriate for entry to specialist training.
The MRCP(UK) Part 1 Examination has a two-paper format. Each paper contains 100 multiple-choice questions in one from five (best of five) format, where candidates choose the best answer from five possible answers. Candidates are tested on a wide range of common and important disorders in General Medicine as set out in the published Syllabus.
The composition of the papers is as follows:
Specialty Number of questions*
Cardiology 15
Clinical haematology and oncology 15
Clinical pharmacology, therapeutics and toxicology 20
Clinical sciences** 25
Dermatology 8
Endocrinology 15
Gastroenterology 15
Neurology 15
Ophthalmology 4
Psychiatry 8
Renal medicine 15
Respiratory medicine 15
Rheumatology 15
Tropical medicine, infectious and sexually transmitted diseases 15
200
* This should be taken as an indication of the likely number of questions – the actual number may vary by up to 2.
**Clinical sciences comprise:
Cell, molecular and membrane biology 2
Clinical anatomy 3
Clinical biochemistry and metabolism 4
Clinical physiology 4
Genetics 3
Immunology 4
Statistics, epidemiology and evidence-based medicine 5
A proportion of the questions will be on adolescent medicine and medicine for the elderly.
The questions in each specialty are distributed across both papers.
The Examination may include pre-test questions (trial questions that are used for research purposes only). A small number of pre-test questions may appear in any paper. Responses to them do not count towards a candidate’s final score. The use of pre-test questions is in line with the assessment criteria set out by the Postgraduate

Medical Education and Training Board (PMETB). More information on PMETB is available at http://www.pmetb.org.uk/pmetb.
Drugs are almost invariably referred to by their recommended International Non-Proprietory names (rINN) rather than by their trade names.
Biochemical and other measurements are expressed in SI units and normal or reference ranges are provided.
The marking system for the MRCP(UK) Part 1 Examination is as follows:
One mark (+1) is awarded for each correct answer;
No mark is deducted for an incorrect answer;
No mark is awarded or deducted if a question is left unanswered;
No mark is awarded if more than one response is recorded or the
answer is not sufficiently clear;
No mark is awarded for any answer that the scanner queries as:
• insufficiently erased;
• smudged;
• a double response to a question.
In these circumstances the Royal Colleges of Physicians do not consider it is appropriate to interpret a candidate’s intentions.
Since the 2008/3 MRCP(UK) Part 1 Examination diet, candidates’ overall results are calculated using a process called equating. This is a statistical process based on Item Response Theory, and it is used to ensure that candidates receive comparable results for comparable performance in different diets of the examination.
Instead of an overall percentage score, all candidates are given an ‘overall scaled score’. This score is a number between 0 and 999, which is calculated from the number of questions a candidate has answered correctly in the two examination papers and also takes into account the relative difficulty of the examination. Since no two examinations can contain exactly the same set of questions, it is inevitable that some papers may be slightly harder (or easier) than others, and equating is a statistical process that addresses this by calculating the exact difficulty of each question.

The MRCP(UK) Part 1 Standard Setting Group has determined that an overall scaled score of 521 or greater will be considered a pass. Please note that this score will be subject to review and candidates are advised to consult the website for the latest information. As a result of this process the pass rate (i.e. the percentage of candidates who pass) may vary slightly from one diet to another.

How to complete the MRCP(UK) Part 1 Examination answer sheets
Candidates should identify themselves by writing their family name and initials in the boxes provided. The examination number should be entered by marking the appropriate rectangles.
The answer sheets for the MRCP(UK) Part 1 Examination contain a row of rectangles for each question. Candidates should indicate the single correct answer in accordance with the instructions given on the Examination Paper.
All papers are marked by an Optical Mark Reader (OMR). The OMR output is processed by computer and marks are allocated according to the candidate’s

responses. Scores are then calculated and statistical data across candidates are derived relating to individual questions. This information is produced in printed form for the MRCP(UK) Part 1 Examining Board.
As the completed answer sheets are computer marked, candidates must comply fully with the instructions given on each answer sheet, otherwise answer sheets may be rejected by the machine or the candidate’s intention misinterpreted.
Candidates should use only the pencil (Grade 2B) supplied in the Examination. Answers in ink or a different grade of pencil cannot be read by the OMR and will therefore result in a zero score.
Candidates may erase an answer by using the rubber provided. To avoid too many erasures on the answer sheet, they may indicate their choices in the question book in the first instance, before transferring them to the answer sheet. Candidates should remember to allow sufficient time to do this, as additional time will not be allowed.
The answer sheet must not be folded or creased.
It is important that candidates fully understand how to complete the answer sheet before sitting the Examination. A sample version of part of a completed MRCP(UK) Part 1 answer sheet is shown below for information.

Entry requirements
Every candidate for the Examination must hold a medical qualification recognised by the Royal College of Physicians.
Candidates will not be admitted to the MRCP(UK) Part 1 Examination until 12 months after the date of graduation given on their diploma of medical qualification. If the date of graduation is significantly later than the date of completion of training, the date on which candidates received notice of passing their final examination may be considered. In such cases, candidates should submit documentary proof.
Candidates must have had at least 12 months’ experience in medical employment, i.e. must have completed Foundation Year 1 or equivalent.
All applications will need to be supported by the candidate’s current or most recent educational supervisor or most recent supervising consultant. Candidates will be required to provide details of their educational supervisor or supervising consultant in their application and confirm that their application has been discussed and is supported by them.


If, at the time of making an application to sit any Part of the MRCP(UK) Examination, a candidate is suspended by the UK General Medical Council (or equivalent regulatory body if a candidate is not resident or practising in the United Kingdom), they must notify the MRCP(UK) Central Office of this at the time of application, providing details of the length of the suspension.

Exemptions
For information on claiming exemption from the MRCP(UK) Part 1 Examination, please see Section 6.4.
Registering for an online account / My MRCP(UK)
All MRCP(UK) candidates can register for a personal account through the MRCP(UK) website. To register for an online account candidates will need a unique email address which will remain as their username. Candidates with an online account will have access to their personal area of the website entitled ‘My MRCP(UK)’. Registration permits candidates to view and amend certain personal/contact details, view and apply for the written examinations within the respective application periods in all UK centres and some overseas centres (as detailed on the MRCP(UK) website), view the details of any current examination attempt and view their personal examination history.
It is intended that the online application facility will be rolled out to more overseas centres in future.

How to enter the MRCP(UK) Part 1 Examination
Method of application
Candidates sitting in UK centres can apply for the MRCP(UK) Part 1 Examination via the online or paper (manual) method. Candidates sitting in overseas centres may also apply via the online method where that facility is currently available (for up-to-date details see the MRCP(UK) website). Instructions for applications made via each of these methods are provided (see Sections 5.6.2 and 5.6.3).
The submission of an application is in effect an application to register for the examination, for which the full examination fee will be incurred, irrespective of whether or not the application is complete. It is the responsibility of the candidate to ensure that their application is completed by the required deadline.
In the case of paper applications, the application form(s), complete in every detail and accompanied by the appropriate fee and any other documents required, must reach the appropriate Administration Office (or Centre in the case of overseas applications) by 5 p.m. on the published closing date. In the case of online applications, applications will need to be submitted via the MRCP(UK) Examination website by 11.55 p.m. on the published closing date.
Details of fees (which are subject to annual revision), method of payment, Examination dates and opening and closing dates for applications, are published annually and can be checked on the MRCP(UK) Examination website. They can also be obtained directly from Centres. Cheques should be made payable to ‘The Royal College of Physicians’.

Candidates transferring fees from outside the UK should remember that banks deduct their charges from the sum being transferred. The Royal Colleges of Physicians must receive the full Examination fee in pounds Sterling, so candidates must themselves pay the bank charges. Enquiries relating to examination fee payments for applications to overseas centres should be submitted directly to the Centre concerned.
Concessionary fees
Doctors with refugee status may be eligible for a concessionary examination fee (see Section 10.5 for further details).
Visas
If a candidate requires a visa to sit an examination, it is the responsibility of the candidate to ensure that the visa application is made in sufficient time before the examination date for which it has been sought. A refund will not be given if a candidate is unable to attend the Examination as a result of visa-related problems. For more information on this, please visit the following section of the MRCP(UK) Examination website:
www.mrcpuk.org/Candidate/Pages/VisaStatement.aspx

Applying via paper (manual) method
New entry and re-entry candidates
Candidates applying via paper (manual) method must complete the appropriate form(s) which, together with the Examination Calendar, are available to download from the Examination website. Outdated copies of the application form, i.e. with no ‘Proposer’ section, will not be accepted. If for any reason you are unable to download a form, please contact the Administration Office to which you intend to submit your application, and a form will be downloaded from the website and sent to you.
Faxed applications will not be accepted.
Applications will not be accepted earlier than the published opening date.
Applicants are advised to submit their applications at least two weeks before the closing date: allowances cannot be made for postal or other delays, and late applications cannot be accepted.
Candidates should check carefully that they have enclosed all relevant documentation before sending their applications. Applications that are not complete in every detail and/or arrive after the closing date may be returned. Allowances cannot be made for postal or other delays.

Applying via online method
New entry candidates
First-time entry candidates may apply in part for the MRCP(UK) Part 1 Examination online after setting up an online account (see Section 5.5).
All first-time entry candidates who apply online must also print off and submit via hardcopy a completed form (e-Form), which can be generated after the online application has been completed; if necessary the e-Form can be submitted after the application closing date but should be received as soon as possible. The e-Form includes a checklist indicating any additional documents or information the candidate needs to submit to their Administrative Office along with the signed form. First-time

entry candidates who are not registered with the UK General Medical Council must submit an original or appropriately attested copy of their primary medical qualification along with the e-Form (for an application checklist see Section 5.8.2).
Re-entry candidates
Re-entry candidates may also be able to apply for the MRCP(UK) Part 1 Examination online after setting up an online account.
Re-entry candidates who opt to make payment online using the credit/debit card method can complete the application process entirely online. Candidates who choose to pay by cheque or bank draft, however, should submit their e-Form along with their payment by post (for an application checklist see Section 5.8.2).
Payments
Cash or cheque payment methods may increase the application processing time.
Candidates applying online who select to pay by either cash or cheque, and those who do not successfully complete the credit or debit card payment, will have their application marked as incomplete. It is the responsibility of the candidate to ensure that the payment is made and their application is completed promptly. In the case of cash payments, candidates are advised not to send cash by post.

Submission of documentary evidence of primary medical qualification
Photocopies of certificates and/or official translations (in English)* will be accepted only if they have been prepared and/or authenticated by one of the following:
• the issuing University or Medical School;
• a British Consulate or British Council outside the UK;
• the British Embassy;
• the British High Commission;
• the candidate’s own Embassy or High Commission in the United Kingdom;
• a member of the Gardai in the Irish Republic;
• Government Ministries of Health;
• a Fellow or Member of the College or a Chair of the Examining Board of the award body (verification of the Fellow or Member will be sought to ensure that they are affiliated with the issuing University/Medical School and the attested copy should be submitted with an accompanying official stamp/letter from the Fellow, Member or Chair).
* Candidates must submit an authenticated translation if their primary medical degree certificate is not in English.
The College reserves the right to request to see the original documents if there is any doubt as to the authenticity of the attested copies of documents.

Names
Candidates with registration (be it full, limited, or provisional) with the UK General Medical Council (GMC) do NOT need to submit documentary evidence of their primary medical qualification, only their GMC number. This regulation is dependent on the primary medical qualification appearing on the GMC website (www.gmc-uk.org).
Candidates must ensure that the relevant section of Form A (or e-Form in the case of an online application) is completed to include their GMC number, the year and

month they obtained their degree and the category of registration they have obtained.
Candidates who are not registered with the UK General Medical Council must submit documentary evidence of their primary medical qualification (original or authenticated copy).
If the name under which candidates are applying is different from the name that appears on the original diploma of their primary medical qualification or the GMC register, they will need to submit a certificate from the issuing university or an affidavit stating that the candidate (in his or her full name) is the same person as that named on the diploma. A similar certificate or an attested copy of a passport may be used to verify initials and abbreviations, but not changes of name.
Applications will not be accepted if there is any discrepancy in the spelling, order or number of names given, and candidates must retain the same surname or family name in any further applications.
It is the candidate’s responsibility to resolve any discrepancies, including the expansion of initials, by obtaining a statement from the issuing authority certifying that the candidate, in his or her full and correct name, is the same person as that named on the diploma.
Candidates who change their names by marriage or deed poll must submit the original or authenticated documentary proof of this if they wish to be admitted to the Examination in their new names.
Names are phonetically translated into English from some languages and this can lead to spelling variations. Thus ‘Mohammed’ may appear as ‘Mohamed’, ‘Mahammed’, ‘Mahamed’, ‘Muhammed’ and so on. Some candidates are inconsistent in the spelling of such translations and must realise that this does not allow accurate identification and is not acceptable to the Royal Colleges of Physicians.
The records of the Royal Colleges of Physicians and the MRCP(UK) Diploma will show forenames followed by the family name, for example, Alan John Smith. Correspondence will be addressed using the candidate’s medical title followed by initials in place of each forename, then the family name as it appears on the candidate’s diploma of medical qualification, for example, Dr A J Smith.
Candidates, particularly those based outside the UK, are recommended to provide attested copies of any original documentation. Original documents will be returned as soon as possible after receipt but the MRCP(UK) Examinations Office cannot take responsibility for any items lost in transit.

Centres
The MRCP(UK) Part 1 Examination is held in various centres, both within and outside the UK. Candidates should refer to the MRCP(UK) Examination website for the most up-to-date information about which centres are holding the MRCP(UK) Part 1 Examination.
Centres in the UK
Edinburgh Administration Office
Aberdeen

Edinburgh
Leicester
Manchester
Newcastle
Sheffield
Glasgow Administration Office
Belfast
Glasgow
Leeds
Liverpool
London Administration Office
Birmingham
Bristol
Cambridge
Cardiff
London
Oxford
Southampton
Please note that some centres may not offer the Examination at each diet.
Paper (manual) applications
Candidates may apply to sit the MRCP(UK) Part 1 Examination at any one of the centres listed. However, the number of examination places available at each centre may be limited. Candidates must specify on their application form at which centre they wish to sit the Examination but are requested to give a second and third choice of centre, to which they will be allocated automatically if their first (or second) choice is full. Please note that it may not always be possible to allocate candidates to a centre of their choice.
Candidates should note that there are three Administration Offices dealing with applications. Candidates must send their application to the appropriate Administration Office (see lists above) based on their first-choice centre. Applications sent to the wrong Administration Office will be returned, and their processing is likely to be delayed. Addresses of the three Administration Offices are provided on page 1. Full details are also given on the application form and on the Examination website.
Online applications
Candidates applying via the online method are able to select only one city in which they wish to take the Examination. All city choices initially available for a specific examination are displayed; once the maximum quota for that city is reached its status will be displayed as ‘No more spaces available’ and candidates will have to select a different city in which to sit the Examination.

Centres outside the UK
Bahrain
Barbados
Egypt
Ghana
Hong Kong
India: Chennai; Kerala; Kolkata; Mumbai
Jamaica

Jordan
Kuwait
Libya
Malaysia
Malta
Myanmar
Nepal
Oman
Pakistan: Karachi; Lahore
Qatar
Saudi Arabia: Jeddah; Riyadh
Singapore
Sri Lanka
Sudan
Syria
Trinidad
United Arab Emirates: Abu Dhabi; Dubai
Zimbabwe
Any updates to this list, such as new centres, will be advertised on the MRCP(UK) Examination website.
Please note that some centres may not offer the Examination at each diet.
Usually only doctors who are resident or working in these countries are eligible to sit in these centres. Only a limited number of places are available at each centre and the selection of candidates is the responsibility of the centres concerned.
Contact details for each centre are published on the website. Candidates should refer to this information before submitting their application. Please refer to the MRCP(UK) Examination website for centre contact details and the most up-to-date information on where to send completed application forms.
Doctors working in countries not listed above should decide where in the UK they would like to sit the Examination and send their application form to the appropriate Administration Office (see Section 5.7.1 for details).
Online applications
Candidates applying to sit the MRCP(UK) Part 1 Examination in centres outside the UK can currently do so online to a limited number of centres. For a list of the overseas centres currently open to online applicants please refer to the MRCP(UK) website.
Candidates applying online to centres outside the UK are still subject to the same eligibility rules that hold for paper applications.
Candidates applying via the online method are able to select only one city in which they wish to take the Examination. All city choices initially available for a specific examination are displayed; once the maximum quota for that city is reached its status will be displayed as ‘No more spaces available’ and candidates will have to select a different city in which to sit the Examination (observing the eligibility rules referenced above).

Application checklist for the MRCP(UK) Part 1 Examination
Paper applications

First-time entry candidates
Before making their application, candidates should ensure that their application is supported by their current or most recent educational supervisor or supervising consultant (see Section

For first-time entry, candidates should send:
• completed Form A;
• completed Form B;
• Diploma of Primary Medical Qualification (original or attested copy only – see
Section 5.6.4 for how to authenticate a copy of your diploma correctly) or UK General Medical Council (GMC) Registration Number (meaning that your details appear on the GMC website);
• fee in pounds Sterling (please check current amount as detailed on the MRCP(UK)
Examination website.
Candidates with registration (be it full, limited or provisional) with the UK General Medical Council do NOT need to submit documentary evidence of their primary medical qualification, only their GMC number, so long as their primary medical qualifications appear on the GMC website (www.gmc-uk.org). Candidates must ensure that the relevant section of Form A is completed to include their GMC number, the year and month they obtained their degree and the category of registration they have obtained.
Candidates who are not registered with the UK General Medical Council must submit documentary evidence of their primary medical qualification (original or authenticated copy).
Candidates, particularly those based outside the UK, are recommended to provide attested copies of any original documentation. Original documents will be returned as soon as possible after receipt but the MRCP(UK) Examinations Office cannot take responsibility for any items lost in transit.
Re-entry candidates
Before making their application, candidates must ensure that their application is supported by their current or most recent educational supervisor or supervising consultant

For re-entry, candidates should send:
• completed Form B;
• fee in pounds Sterling (please check current amount as detailed on the MRCP(UK) Examination website;

Online applications
First-time entry candidates
Before making their application, candidates must ensure that their application is supported by their current or most recent educational supervisor or supervising consultant
When making an online application, candidates are required to submit the following:
• a signed e-Form;
• Diploma of Primary Medical Qualification (original or attested copy only) or General Medical Council (GMC) (UK) Registration Number (meaning that your details appear on the GMC website);

• fee in pounds Sterling (if not paying online using the credit/debit card method).
Re-entry candidates
Before making their application, candidates must ensure that their application is supported by their current or most recent educational supervisor or supervising consultant . When making an online application, candidates are required to submit the following:
• a signed e-Form with attached cheque/bank draft payment (if choosing the cheque method of payment). The fee must be in pounds Sterling.

All candidates
No candidate will be permitted to take any part of the Examination unless all outstanding fees are paid in full.
It is each candidate’s responsibility to ensure that applications are completed as soon as possible. The MRCP(UK) Central Office will contact candidates to advise them of any outstanding information and will provide a deadline for receipt. Candidates will be allocated a provisional examination place in the meantime, but complete applications will take precedence and incomplete applications will be rejected if the outstanding information is not received by the deadline. Candidates whose applications are incomplete because the full examination fee has not been received must pay this in order to sit any future MRCP(UK) examinations, even if they subsequently withdraw or are absent from the examination, as a provisional place will have been allocated to them for that examination.
Candidates should check carefully that they have enclosed all relevant documentation before sending their applications. Applications that are not complete in every detail and/or arrive after the closing date may be returned. Allowances cannot be made for postal or other delays.
Special arrangements
Any candidate who has a physical disability, learning disability or any other special need that they believe could affect their performance in an examination may be entitled to special arrangements. All such candidates should inform the Administration Office to which they apply, at the time of application, of their circumstances, by completing the Special Arrangements area on the application form. In all cases a medical report or other appropriate documentary evidence will be required to support an application for special arrangements, and this should be submitted either with the application or as soon as possible thereafter. Failure to include this information at the time of application may affect the arrangements that can be put in place in time for the examination.
Further information is available by contacting the Head of Written and Overseas Examinations, MRCP(UK) Central Office (for contact details see page 1).

Withdrawal from the Examination and refund of Examination fees
Notice of withdrawal from any part of the Examination must be given in writing (letter, fax or email) to the appropriate Administration Office (or MRCP(UK) Central Office if the Examination is to be taken outside the UK). Candidates are asked to quote their RCP Code Number (if known), full name and date of birth in their withdrawal notice to allow College staff to easily identify candidates.

Only written requests to withdraw will be accepted as official withdrawal requests. For example, candidates who are informed that they have submitted incomplete applications and are asked to complete them will not be considered as withdrawn from the Examination if they do not respond in writing to such requests for information and will incur the full Examination fee.
Under no circumstances can Examination applications and/or fees be transferred from one Examination to another.
Candidates whose withdrawal request is received on or before the UK closing date (for applicants to UK centres) or the overseas closing date (for applicants to overseas centres) of that respective Examination will be refunded 90% of the Examination fee paid. Where possible this refund will be paid in the same way as the original payment was made. Refunds will not be made where candidates submit their withdrawal request after the closing date unless there are circumstances deemed exceptional which can be substantiated. This will normally be in the following circumstances:
• illness;
• involvement in an accident;
• death of a close relative (parent, sibling, spouse, child).
Other cases may be considered on their own merit and at the discretion of the Head of Operations, MRCP(UK) Central Office; documentary evidence is required in all cases.
Any request (accompanied by supporting evidence) must be submitted within 4 weeks of the Examination date if it is to be considered. No consideration to refunding fees will be given, irrespective of the circumstances, thereafter. Decisions on these cases will be made by the Head of Operations, whose decision is final.

MRCP UK syllabus(3 continue)

RHEUMATOLOGY

Clinical conditions
You should know the relative prevalence and major associations of the
common rheumatological conditions.
Examples of question topics might include the relationship to:
• Age • Gender • Genetic influences • Constitutional influences •
Environmental influences • Occupational influences
You should be able to answer questions on the symptoms and signs of the
rheumatic diseases.
Examples of question topics might include:
• Rheumatoid arthritis and associated syndromes • Seronegative spondyloarthritis (ankylosing spondylitis, psoriatic arthritis,
reactive arthritis, enteropathic arthritis) • Osteoarthritis • Crystal arthritis (gout, pyrophosphate arthritis) • Connective tissue diseases (systemic lupus erythematosus, Sjogren's
syndrome, scleroderma, polymyositis/dermatomyositis) • Polymyalgia rheumatica and giant-cell arteritis • Systemic vasculitic syndromes • Bone disorders (osteoporosis, osteomalacia, Paget’s disease)
You should be familiar with arthritis associated with other medical
conditions.
Examples of question topics might include:
• Sarcoidosis • Erythema nodosum • Infections and arthritis (e.g. Parvovirus B 19)

Investigations
You should have knowledge of the investigations relevant to the diagnosis
and assessment of rheumatic diseases.
Examples of question topics might include:
• Acute phase proteins • Immunological tests relating to the connective tissue diseases (ANA,
anti-dsDNA, ANCA, anti-Jo1, anti-Ro) • Contemporary imaging techniques in rheumatology (x-ray, ultrasound,
CAT scanning,MRI scanning)
Management
You should be able to answer questions on the management of acute
rheumatological emergencies.
Examples of question topics might include:
• Septic arthritis • Osteomyelitis • Temporal arteritis • Acute spinal cord compression
You should be able to answer questions on the management of rheumatic
diseases.
Examples of question topics might include:
• Non-drug related therapies (education, physiotherapy) • Drug related therapies (indications and contra-indications, adverse
effects, drug interactions) • Simple analgesics • Non-steroidal anti-inflammatory drugs • Corticosteroids • Allopurinol • Disease modifying anti-rheumatic drugs • Immunosuppressive drugs

Anatomy and physiology
You should have knowledge of the basic anatomy and physiology of the
heart in health and disease:
Examples of question topics might include:
• Clinically relevant normal anatomy of the heart, coronary arteries and
great vessels • Determinants of heart rate and rhythm • Cardiac function • Cardiac conduction • Cardiac output • Vascular tone • Blood pressure • Coronary blood flow • Genesis of heart sounds
Pathophysiology and pathology
You should know the mechanisms underlying the main pathological
processes.
Examples of question topics might include:
• Thrombosis • Infarction • Atherogenesis • Hypertrophy • Heart failure • Cardiomyopathies • Dysrhythmias • Hypertension
CARDIOLOGY

Cell biology
You do not need detailed specialised knowledge of cell biology as only topics
of proven clinical relevance will be tested.
Examples of question topics might include:
• Excitation-contraction process • Molecular and cellular aspects of hypertrophy of the myocardium and of
vascular smooth muscle
Clinical pharmacology
You should know the indications for drug therapy in cardiac disease and
understand the actions, interactions and side effects of the drugs used. The
emphasis will often be on new drugs or on novel applications or newly
observed side effects of established drugs. Details of drug dosage are asked
only rarely.
Clinical cardiology
You must know the clinical features and management of the cardiac
disorders encountered in hospital practice by the general physician, though
detailed specialist knowledge is not expected. You should have knowledge
of risk factors.
Examples of question topics might include:
• Clinical features of constrictive pericarditis, cardiac tamponade,
endocarditis, valvular heart disease • Management of acute coronary syndromes • Management of cardiac failure • Management issues in atrial fibrillation • Indications for, and types of, permanent pacemaker
Knowledge of important changes in clinical practice, following the
publication of major clinical trials, is likely to be tested.

Examples of question topics might include:
• Use of ACE inhibitors after myocardial infarction • Use of HMG CoA reductase inhibitors in primary and secondary
prevention of coronary morbidity and mortality • Use of beta-adrenoceptor blocking drugs in left ventricular dysfunction
You should know the:
• Indications for invasive and non-invasive cardiac investigation • Principles of these investigative methods, their limitations and the
clinical relevance of the results
Knowledge of the practical aspects of the investigative techniques is not
required.
Examples of question topics might include:
• Common ECG abnormalities • Basic echocardiographic abnormalities such as hypertrophic obstructive
cardiomyopathy or pericardial effusion • Indications for coronary angiography

Anatomy and physiology
You should understand clinically relevant anatomy of the upper and lower
respiratory tract and thorax including radiological anatomy.
You should have knowledge of the principles of respiratory physiology
including:
• How respiration is controlled • Principles of gas exchange and oxygen transport • Ventilation-perfusion relationships • Lung volumes and transfer factor • Respiratory aspects of sleep and exercise physiology
You should understand the:
• Physical,humoral and cellular aspects of respiratory defence mechanisms • Physiology of the proteinase inhibitors and pulmonary surfactant
Pathophysiology and pathology
You should understand the effects of disease on pulmonary physiology and
anatomy including:
• The pulmonary and bronchial circulations and gas exchange • Adaptations to chronic hypoxaemia • Pleural fluid production and reabsorption
You should understand the application of the basic immunological processes
to pulmonary pathology including:
• Asthma • Alveolitis • Tuberculosis
You should possess knowledge of humoral and cellular immunodeficiency
states and sequelae.

RESPIRATORY MEDICINE

The microbiology of acute and chronic respiratory infections should be
known.
Cell biology and genetics
You should have knowledge of:
• Lung inflammation and repair • Vasculitis • Cystic fibrosis • Anti-protease deficiency
You should understand the genetics of:
• Asthma • Cystic fibrosis • Alpha 1 antitrypsin deficiency
The role and value of gene therapy should be understood.
Clinical pharmacology
The indications for, and mechanisms of action of, drugs used in respiratory
disease together with their interactions and side effects should be known.
Important respiratory complications of other drugs, e.g., NSAIDs and beta
blockers should also be understood.
Clinical conditions
The clinical features, investigation and management of respiratory disease
likely to be encountered by a general physician must be known.
Examples of question topics might include:
• Pleural effusion • Chest pain • Haemoptysis • Breathlessness

The impact of systemic disease on the respiratory system should be known.
Examples of question topics might include:
• Vasculitis • Neuromuscular diseases • HIV infection
Knowledge of occupational lung disease, particularly asthma,
pneumoconiosis, and asbestos related disease is required.
You should know how to assess respiratory malignant conditions and
understand the general principles of oncological management including the
indications for surgery.
The indications for specialised investigations, including bronchoscopy, CT
scanning, lung biopsy, lung volumes and exercise testing should be known.
You should have knowledge of the investigation of sleep related disorders
and of the radiological aspects of respiratory disease.
You should know the indications for, and problems of, lung transplantation.
You should have knowledge regarding the control of Mycobacterium
tuberculosis infection.
Exclusions
Knowledge of detailed pulmonary mechanics, oncology drug regimens, drug
therapy of environmental mycobacterial infection, inhalation drug kinetics
and detailed histological descriptions is not required.

Neuroanatomy
You are not expected to have detailed knowledge of neuroanatomy.
Questions with an anatomical bias will be confined to circumstances where
an understanding of anatomical structure is of critical importance in
appreciating the localisation of a particular neurological problem.
Examples of question topics might include:
• The clinical features of a lesion within the cavernous sinus • The manifestations of a particular nerve root or peripheral nerve disorder • The organisation of pathways within the spinal cord
Neurophysiology
Detailed knowledge of neurophysiology is not expected but, as with
neuroanatomy, certain aspects of the subject are particularly relevant to the
understanding of neurological disease and may be tested.
Examples of question topics might include:
• The formation, circulation, absorption and content of the cerebrospinal
fluid • Aspects of cerebral blood flow • The principles of nerve conduction and its modification by disease
processes
Neurogenetics
You are expected to have knowledge of recent advances in the
understanding of the genetic basis for various neurological disorders.
Examples of question topics might include:
• The role of dystrophin in muscle disease • Genetic aspects of myotonic dystrophy • Genetic aspects of Alzheimer's disease
NEUROLOGY

Cell biology
Questions in this area will relate to advances in the cellular mechanisms of
certain neurological disease processes which have provided better
understanding of disease mechanisms and which might, in the future, lead
to more rational therapy.
Examples of question topics might include:
• The genesis of tissue damage in stroke and the role of certain excitatory
neurotransmitters • The role of the dopaminergic system in various extrapyramidal disorders • The role of other neurotransmitters in certain diseases, for example, in
Alzheimer's disease
Neuropharmacology
You are expected to have some knowledge of new drug developments in
neurology, as well as the established drug therapies.
Examples of question topics might include:
• The role of some recently introduced anticonvulsants • The present status of immunosuppressant therapy in multiple sclerosis
Neuropathology
You are not expected to have a detailed knowledge of neuropathology. You
will be expected to have an outline knowledge of the pathological aspects of
some common diseases, for example, multiple sclerosis, Parkinson's disease
and Alzheimer's disease.

Clinical neurology
Questions in the field of clinical neurology will test your knowledge of the
more common disorders. There will be emphasis on clinical features which
have been shown to be of diagnostic value. The choice of subject matter will
be influenced by areas of recent advance, particularly those which have

either led to better definition of disease entities, or have led to their
improved management.
In the field of cerebrovascular medicine, examples of question topics might
include:
• Epidemiological aspects, in particular the risk factors for stroke • The evidence for the role of anti-platelet agents in transient ischaemic
attacks • The role of carotid endarterectomy in the management of stroke patients

Mental state
You should understand the conduct and scope of a mental state
examination.
You are expected to be familiar with the features of abnormal mental states
and particularly those that present commonly to physicians and to Accident
and Emergency Departments.
Aetiological factors in psychiatric illness
You should understand the primary aetiological factors in psychiatric areas
including:
• Genetic factors • Environmental factors • Life events
Investigations
You should be familiar with the potential value of, and indications for,
common investigations used in psychiatric illness including:
• Psychometric testing • EEG • Brain imaging
Syndromes of psychiatric disorder and their treatment
You should have knowledge of:
• Organic brain syndromes (delirium, dementia, focal brain syndromes,
head injury) • Schizophrenia and related syndromes • Paranoid disorders and related syndromes • Affective disorders (anxiety states, phobic disorders, bipolar affective
disorders) • Grief and bereavement
PSYCHIATRY

• Self-harm, attempted suicide, suicide • Substance misuse (including alcohol dependence) • Eating disorders • Obsessive compulsive disorder • Abnormal illness behaviour • Syndromes associated with medically explained physical symptoms
(including somatization and somatoform syndrome)
Psychiatric aspects of physical disease
You should be aware of the psychiatric presentations of physical disease
including:
• Endocrine and metabolic disorders • Toxic states • AIDS • Neurological disease • Epilepsy • Pain
Mental retardation
You should know the features of the commoner syndromes.

Clinical science
You should understand the:
• Structure and function of the gastrointestinal and hepatobilary tract • Neurohormonal control of gut motility • Secretory and absorptive functions of the gastro-intestinal tract
and liver • Symptoms and signs of gastrointestinal, hepatobiliary and pancreatic
diseases • Genetics of the more common gastrointestinal and liver disorders • Clinical pharmacology of drugs used in gastrointestinal disorders
including their actions, interactions and adverse effects
Examples of question topics might include:
• Control of gastric acid secretion • Autonomic control of gut function • Genetics of familial adenomatous polyposis • Haemochromatosis • Effects of cholinergic, adrenergic and serotonergic agents on gut function
Clinical nutrition
You should be familiar with:
• Nutritional requirements in health • Assessment of nutritional status • Nutritional deficiency states • Primary nutritional disorders
Examples of question topics might include:
• Calorific requirements • Body water distribution • Derivation of the body mass index • Protein calorie malnutrition

GASTROENTEROLOGY

• Essential dietary constituents • Vitamin requirements • Pathogenesis and management of obesity
Disorders of the mouth, tongue and salivary glands
You should have an understanding of:
• Mouth ulcers, periodontal and salivary disorders • Oral manifestations of systemic and dermatological disorders
Examples of question topics might include:
• Causes of mouth ulcers and their management • Skin disorders commonly involving the buccal mucosa
Disorders of the oesophagus and stomach
You should be familiar with the following disorders:
• Achalasia • Carcinomas • Peptic ulceration • Gastritis • Gastrointestinal haemorrhage
Examples of question topics might include:
• Presentation, investigation and management of oesophageal strictures • Role of Helicobacter-associated gastritis in peptic ulcer disease • Management of hypovolaemic shock
Functional disorders
You should have a knowledge of:
• Functional chest pain and functional dyspepsia • Irritable bowel syndrome and functional abdominal pain • Functional constipation and diarrhoea

Examples of question topics might include:
• Neural control of visceral nociception and gut motility • Role of emotional and psychosocial factors in illness • Management of chronic pain and the use of pain-modifying drug therapy
Disorders of the small intestine
You should have knowledge of:
• Malabsorption syndromes and gluten enteropathy • Hormone-secreting tumours of the gut
Examples of question topics might include:
• Aetiology, clinical and histopathological features of gluten enteropathy • Investigations commonly used in the assessment of suspected
malabsorption
Disorders of the liver, biliary tree and pancreas
You should have knowledge of:
• Bilirubin metabolism and the enterohepatic circulation of bile acids • Causes of jaundice and cholestasis • Common pancreatic disorders including carcinoma • Fulminant liver failure • Acute and chronic hepatitis • Drugs, toxins, alcohol and the liver
Examples of question topics might include:
• Aetiology, clinical and histopathological features of acute and chronic
hepatitic disorders • Hepatorenal syndromes and their management • Aetiology, presentation and management of acute and chronic
pancreatitis

The acute abdomen
You should have knowledge of:
• Perforated viscus and peritonitis • Intestinal obstruction • Ischaemic disease of the small and large bowel
Examples of question topics might include:
• Common causes of acute abdominal pain and their investigation and
management • Management of septic shock associated with intra-abdominal sepsis
Inflammatory bowel diseases
You should be familiar with:
• Crohn's disease • Ulcerative colitis • Infective gastroenteritis • Parasitic and protozoal gut infections
Examples of question topics might include:
• Causes, investigation and management of acute and chronic enteric
disorders • Manifestations of inflammatory bowel disease and its complications
Colorectal disorders
You should have knowledge of:
• Polyps • Carcinomas • Diverticular disease • Anorectal disorders

Examples of question topics might include:
• Pathology and clinical genetics of disorders presenting with colonic
polyps • Causes and treatment of haemorrhoids, anal fissures and ano-rectal
fistulae

Although you are not expected to have a detailed knowledge of
biochemistry, it is anticipated that you will have an insight into the
mechanisms of hormone action and the importance of receptors and
substances involved in control of intracellular metabolism. You should have
a knowledge of the clinically relevant anatomical aspects of this specialty.
Examples of question topics might include:
• Factors involved in cell signalling • Anatomical relationships of the pituitary gland • The cell types in the pancreatic islets • A broad understanding of the pathways of carbohydrate, protein and fat
metabolism • Endocrine tests in routine clinical use • Genetic aspects of endocrine disease • Disorders affecting multiple endocrine systems
Thyroid
Since thyroid disease is common you are expected to have a broad
knowledge of the mechanisms of thyroid disease, its clinical presentation
and treatment.
Examples of question topics might include:
• Thyroid hormone biosynthesis and its control • Important drugs interfering with thyroid function • Indications for use of various types of thyroid function test • Autoimmunity and the thyroid • Clinical features of thyrotoxicosis and hypothyroidism • Goitre and its management • Thyroid neoplasia
Hypothalamus/Pituitary
Detailed knowledge of the structure of the pituitary and hypothalamic
hormones is unnecessary.You will require a knowledge of the physiology and
testing of the control mechanisms of the endocrine system.

ENDOCRINOLOGY

Examples of question topics might include:
• The physiology and pathophysiology of control of pituitary hormone
secretion • The mechanisms of maintaining plasma osmolality • Tests of pituitary hormone secretion • Pituitary diseases such as acromegaly, prolactinoma and Cushing’s
syndrome • Drugs used in the treatment of pituitary disease • Pituitary replacement therapy
Adrenal
A detailed knowledge of mechanisms of steroid biosynthesis is not required,
but you are expected to have some knowledge of those parts which are
clinically important.
Examples of question topics might include:
• An understanding of the build-up of precursor compounds when there is
defective cortisol biosynthesis in adrenocortical hyperplasia • Tests for adrenocortical function • Endocrine causes of hypertension and their differential diagnosis • Clinical features and management of adrenal hyper- and hypofunction • Complications of steroid therapy
Ovary
You are expected to be conversant with the physiology of ovarian function
and with the conditions presenting to a physician.
Examples of question topics might include:
• Hormonal changes across the menstrual cycle • Physiological changes in pregnancy • The differential diagnosis of hirsutism and virilism • Causes of amenorrhoea and anovulation • Endocrine causes of infertility

Testis
You are not expected to have a detailed knowledge of the urological
investigation of infertility but some concept of relevant investigations and of
the endocrine aspects of testicular function is required.
Examples of question topics might include:
• The aetiology of hypogonadism both primary and secondary • Causes of male infertility related to general medical disease and its
treatment • Causes of erectile dysfunction and its investigation • Androgen replacement therapy
Growth
Growth is a very important topic in relation to general medicine as well as
endocrinology.
You are expected to be conversant with:
• Factors controlling growth hormone secretion • Normal growth patterns • General medical and endocrine causes of short stature • Control of excessive growth • Growth hormone therapy and its complications
Parathyroid/bone
Detailed knowledge of the anatomy and physiology of bone metabolism
is not required. You are expected however to have some broad concept of the
control of bone turnover and the disorders which can result in its failure.
Examples of question topics might include:
• Control of calcium metabolism • Laboratory tests of parathyroid function • The causes of hypercalcaemia • The mechanisms of osteomalacia

• Hyperparathyroidism, both primary and secondary • The differentiation of primary, secondary and pseudo-hypoparathyroidism • The prophylaxis and treatment of osteoporosis • Calcitonin and its role in metabolism
Diabetes mellitus
You are expected to have detailed knowledge of this very common condition.
Examples of question topics might include:
• Control of carbohydrate metabolism • Genetics of diabetes • Aetiology of type 1 diabetes and type 2 diabetes • Long-term complications of diabetes • Insulin resistance • Management of diabetic emergencies • Differential diagnosis and treatment of hypoglycaemia

Disorders of lipid metabolism
Although a detailed knowledge of lipid metabolism is not required, you are
expected to have an understanding of the importance of this group of
disorders.
Examples of question topics might include:
• Control of cholesterol metabolism • Aetiology of different types of hyperlipidaemia including both
cholesterol and triglyceride disorders • Indications for lipid lowering agents and their complications • Types of secondary hyperlipidaemia

Physiology
You should have knowledge of:
• Discrete functions of glomerular ultrafiltration and tubular function • Proximal and distal parts of the nephron, with particular reference to
control of water and electrolyte balance • Renal tubular acidosis • Cystinuria • Fluid, electrolyte, and acid-balance disturbances
Molecular biology and genetics
You are expected to possess a basic knowledge of genetic defects of common
kidney disorders including:
• Polycystic kidney • Alport’s syndrome • Hypophosphataemic rickets
You should have an understanding of inflammatory injury of the kidney
mediated by various cytokines and growth factors.
Glomerular and tubular disorders
You are expected to have some knowledge of glomerular ultrastructure
based upon techniques of light microscopy, electron microscopy and
immunofluorescence as applied to renal biopsy. These techniques form the
basis of current understanding of primary glomerular disorders as in
idiopathic glomerulonephritis, and nephropathies of systemic diseases.
Examples of question topics might include:
• Diabetes mellitus • SLE • Hypertensive nephrosclerosis • Vasculitis • Amyloidosis

NEPHROLOGY

Knowledge of interstitial nephritis (especially those cases with reversible
aetiology such as drugs , heavy metals and analgesics) is expected.
You should be acquainted with the metabolic sequelae of acute nephritic
and nephrotic syndromes.
You should be aware of the investigation and assessment of glomerular and
tubular disorders, including ultrasonic studies and nuclear medicine.
You should have an understanding of disturbed renal and metabolic
functions in nephrotic syndrome from a variety of causes.

Infections of the kidney
You should be familiar with the management of urinary tract infections
including their detection, predisposing factors, prevention and treatment. A
knowledge of anatomical abnormalities leading to repeated urinary tract
infection is expected.
Examples of question topics might include:
• Reflux nephropathy • Prostatic hypertrophy
You should be aware of other infections that could affect the kidney by direct
invasion or by immune-complex deposition.
Examples of question topics might include infection of the urinary tract with:
• Mycobacteria • HIV • CMV • HBV • HCV
Calculus formation within the urinary tract
You should possess a knowledge of metabolic disorders predisposing to
\
stone formation, their investigation, prevention and treatment.
Examples of question topics might include:
• Idiopathic hypercalciuria • Primary hyperparathyroidism • Cystinuria • Hyperoxaluria

Acute and chronic renal failure
A knowledge of the management of acute and chronic renal failure and of
the disturbed physiology involved is expected. You should be familiar with
pathophysiological changes and non-dialytic treatment in different stages of
progressive renal failure.
Principles of nutritional requirements and dietary intervention for patients
with chronic renal failure is required.
Other therapeutic means to slow down the progression of renal failure
should be understood.
Hypertension and renal problems in pregnancy
You are expected to be familiar with renal adaptation to pregnancy, the
management and prophylaxis of renal disease and hypertension in
pregnancy.

Drugs and the kidney
A knowledge of the role of the kidney in the normal elimination of drugs is
expected and you should understand the mechanisms by which drugs cause
nephrotoxic damage. The principles of dose adjustment according to
residual renal function should be known.
Renal replacement therapy
A knowledge of different dialysis modalities and their complications is
expected. You should know the complications related to immunosuppressive
therapy following renal transplantation.

Basic science
You will be expected to have a working knowledge of the structure and
function of the epidermis and dermis.
Clinical dermatology
Many diseases affecting internal organs will present with skin signs or
symptoms. You are expected to be able to recognise the cutaneous
symptoms and signs of systemic diseases.
Examples of question topics might include:
• Collagen vascular disease such as SLE, systemic sclerosis • Metabolic and endocrine disorders • Infectious diseases • Cancers • Leukaemias • Respiratory and cardiovascular diseases • Common inherited diseases such as neurofibromatosis
You should have knowledge of the main dermatological complications of
therapeutic immunosuppression (for example, systemic corticosteroid
therapy, cyclosporin etc.) or of diseases such as HIV which cause
immunosuppression.
In addition you should know the differential diagnosis and plan of
investigation of patients who present with the following cutaneous signs or
symptoms which may indicate internal disease:
• Itch • Hyperpigmentation • Generalised erythema • Loss of hair • Increased hair growth • Common patterns of nail dystrophy such as clubbing • Erythema nodosum

DERMATOLOGY
• Erythema multiforme • Purpura • Ulceration • Vasculitis
A knowledge of the clinical features of the following skin diseases is
required:
• Psoriasis • Eczema • Urticaria • Superficial fungal infections (dermatophytosis, pityriasis versicolor) • Common skin cancers such as melanoma • Vitiligo and alopecia areata • Pemphigus and pemphigold • Cutaneous herpes virus infections (herpes simplex, varicella zoster) • Cutaneous staphylococcal and streptococcal infections • Leprosy
Investigation
You should know the principles but not details of dermatological
investigation such as patch testing.
Drugs and therapy
You will not be expected to have a detailed knowledge of the treatment of
skin diseases or dermatoses. However you should know the drugs which
cause life-threatening skin conditions such as erythroderma or Stevens-
Johnson syndrome, angio-oedema and toxic epidermal necrolysis.

MRCP UK syllabus(2 continue)

SYLLABUS

You should have an understanding of the structure and function of
chromosomes and genes and a knowledge of the principles of inheritance of
chromosomal and genetic disorders.
Examples of question topics might include:
• Inherited diseases • Chromosome structure • Common chromosome abnormalities
The cell is the fundamental unit of the structure of organs. It is important
that you understand the structure and function of the components of the
cell and its membrane. You should understand how cells communicate
internally and with each other by means of chemical substances and
membrane receptors.
Examples of question topics might include:
• Function of intracellular organelles • Cellular communication
GENETICS
CELL, MOLECULAR AND MEMBRANE BIOLOGY
Clinically relevant anatomy will be tested, including neuroanatomy.
Examples of question topics might include:
• Peripheral nerve lesions • Cranial nerve abnormalities • Dermatomes,myotomes and reflexes
It is essential that you understand the structure and function of the different
organs which make up the body and how these organs interact, such as
through hormonal and neural influences. You should know the broad
principles of metabolism such as the production of energy and the pathways
of carbohydrate, protein and lipid metabolism, but a detailed knowledge of
the chemical processes in the steps of the metabolic pathways is not
necessary. You should have an understanding of the principles of nutrition,
water, electrolyte and acid-base balance. Knowledge of the physiology and
biochemistry of each organ system is examined under that specialty.
Examples of question topics might include:
• The mechanism of blood pressure control • Acid-base balance

ANATOMY
PHYSIOLOGY, BIOCHEMISTRY AND METABOLISM


Although a detailed knowledge of basic immunology and immunological
diseases is not required, you should have a sound working knowledge of the
principles of immunomechanisms.
Examples of question topics might include:
• Humoral and cell-mediated immunity • Immunodeficiency syndromes • Phagocytic dysfunction diseases • Complement deficiencies • Hypersensitivities including allergies and autoimmune diseases
Immunology and immunological tests
You should have a basic knowledge of the immune system in health and
disease.
Examples of question topics might include:
• Common immunological laboratory tests • Evaluation of patients with immune disease • Intercellular communication and signal transduction • Lymphocyte and phagocytic cell biology • Antigen presentation • Humoral, cellular and mucosal immunity including TH1 and TH2
responses • Inflammation • Complement system and cytokines • Hypersensitivity and autoimmunity
Clinical conditions
You should be able to answer questions on the various immunodeficiency
syndromes.
IMMUNOLOGY

Examples of question topics might include:
• Mechanisms of immunodeficiency • Antibody immunodeficiency disorders • T-cell immunodeficiency disorders • Combined antibody and cellular immunodeficiency disorders • Phagocytic dysfunction diseases • Complement deficiencies
You should know the main clinical characteristics and immediate
management of acute allergic emergencies.
Examples of question topics might include:
• Anaphylaxis • Angio-oedema • Urticaria
You should be familiar with immunology as applied to other medical
diseases.
Examples of question topics might include immunomechanisms in:
• Rheumatic diseases (connective tissue diseases) • Endocrine diseases (thyroid autoimmune diseases, diabetes mellitus,
Addison's disease) • Haematological diseases (pernicious anaemia, autoimmune haemolytic
anaemia, idiopathic thrombocytopenic purpura) • Gastrointestinal diseases (Coeliac disease, inflammatory bowel disease,
hepatobiliary diseases) • Renal diseases (Goodpasture's syndrome, immune-complex
glomerulonephritis) • Dermatological diseases (discoid lupus, pemphigus, pemphigoid) • Neurological diseases (demyelinating diseases,myasthenic syndromes)

Management
You should be able to answer questions on the principles of
immunosuppressive therapy including major indications and side-effects.
Examples of question topics might include:
• Immunosuppressive drug therapy (corticosteroids, cytotoxic agents, and
cyclosporin) • Intravenous immunoglobulin • Monoclonal antibodies • Cytokine therapy • Bone marrow transplantation
You should know about the principles of immunisation and be familiar with
vaccines currently in use.

Microbiology
You should understand the major taxonomy of bacteria in terms of
Gram-staining and aerobic/anaerobic metabolism. Virus classification is
not important except for members and characteristics of the herpes group.
Virus replication with reference to retroviruses should be understood. Major
pathogenic protozoa and helminths should be known.
Examples of question topics might include:
• Aerobic or anaerobic bacteria • Gram-staining characteristics of bacteria
Immunology of infectious diseases
You should understand immune deficiency states linked with types of
opportunistic infections. Principles of immunisation and knowledge of
vaccines currently used should also be known.
Examples of question topics might include:
• Opportunistic infections • Immunisation policy
Pathophysiology
You should have a basic understanding of:
• Septic shock • ARDS • Role of cytokines in infection
Epidemiology
You should have knowledge of the principles of epidemiology relevant to
infectious diseases.
INFECTIOUS DISEASES AND TROPICAL MEDICINE

Examples of question topics might include:
• Mechanisms of transmission of pathogens • How epidemics happen • Knowledge of carrier states, reservoirs, vectors and zoonoses • Elementary concepts of the control of communicable diseases (including
immunisation, isolation, contact tracing, chemoprophylaxis of close
contacts) • Broad awareness of geographical variation in disease including TB, HIV,
Hepatitis B, malaria
Treatment
You should know the broad indications for, and major adverse effects of,
commonly employed antimicrobial agents.
Examples of question topics might include:
• B-lactams • Tetracyclines • Macrolides • Aminoglycosides • Quinolines • Trimethoprim • Metronidazole • Antituberculous drugs • Antimalarial drugs • Antiviral agents
Specific infections
Knowledge of the characteristics, recognition, prevention, eradication and
pathological effects of all commonly encountered bacteria, viruses, rickettsia,
fungi, protozoa, parasites and toxins, including an understanding of the
principles of infection control, will be required. Special attention to
differential diagnosis, appropriate investigations and awareness of when
presumptive therapy is indicated is essential.

Examples of question topics might include:
• Septicaemia • Meningitis and encephalitis • Endocarditis • Pneumonia (community-acquired, hospital-acquired, lung abscess,
empyema) • Tuberculosis • PUO (appropriate investigations, when empirical therapy might be
indicated) • Soft-tissue infection and osteomyelitis • Streptococcal infection, rheumatic fever, nephritis • Intra-abdominal sepsis • Food-poisoning (especially salmonellosis, campylo-bacter, verocytotoxin
producing E coli) • Tropical infections (especially malaria, bilharzia, amoebiasis, filariasis,
leishmaniasis, hookworm and viral haemorrhagic fevers) • Viral hepatitis • HIV/AIDS (course of typical infection; CD4 count and HIV viral load as
markers of progression; main opportunistic infections including
Pneumocystis pneumonia, CNS toxoplasmosis, cryptococcal meningitis,
tuberculosis) • Glandular fever syndrome and its differentiation from HIV
seroconversion illness • Spirochaetosis - syphilis, leptospirosis, borrelia • Toxic shock syndrome and staphylococcal infections

You should have a basic understanding of the usage and limitations of the
common statistical tests used in reporting the results of research in clinical
journals. The following lists of terms should give some idea of the range of
terms and techniques which you should understand, all of which can be
found regularly in journals such as The Lancet, British Medical Journal and
New England Journal of Medicine.
You are not expected to have any knowledge of computer packages for
carrying out statistical calculations. You may be expected to carry out simple
calculations that do not require the use of a calculator. You are not expected
to memorise formulae for statistical tests, but should understand their
conceptual basis.
The following lists are not intended to be inclusive but as illustrative of the
type of knowledge that you need to possess.
Descriptive statistics
Examples of question topics might include:
• Mean, median, mode • Standard deviation, standard error • Confidence interval • Variance • Range, quartile, inter-quartile range • Percentile • Skewness • Contingency table • Population • Missing values • Outliers
Graphical techniques
Examples of question topics might include:
• Histogram • Box-plot • Scattergram
STATISTICS, EPIDEMIOLOGY AND
EVIDENCE-BASED MEDICINE

Inferential techniques
Examples of question topics might include:
• Null hypothesis • Alternative hypothesis • Parametric and non-parametric tests • Normal distribution • Type 1 and Type 2 errors • False positive and false negative • Statistical power • One and two-tailed tests • Statistical significance, P value • T-test • Mann-Whitney and Wilcoxon test • Chi-square test for 2 x 2 contingency table • Correlation (Pearson's and Spearman's) • Linear regression • Study design
Evidence-based medicine
You are expected to have an understanding of evidence-based medicine and
an ability to apply this understanding in the management of patients.
Clinical trials
Examples of question topics might include:
• Interpretation of simple clinical trial data • Randomisation • Placebo-controlled trial • Open trial • Single-blind trial • Double-blind trial • Intention-to-treat • Bias

You will be expected to have knowledge of the following:
• Physiology, control and function of formed blood elements • Bone marrow structure and function • Applications of biochemistry, genetics, immunology, and virology to
blood disorders • Effects of age and pregnancy on blood disease • Splenomegaly, lymphadenopathy, and their causes • Principles and hazards of blood and blood product replacement therapy • Principles, but not detail, of anti-tumour chemotherapy • Principles of marrow transplantation • Adverse effects of drugs on the blood
Iron metabolism
You should have an understanding of:
• Physiology of iron, including its absorption • Iron overload • Iron deficiency states including diagnosis, causes and treatment • Iron metabolism, including anaemias of chronic disorders and
sideroblastic anaemias
Megaloblastic anaemias
You should understand the physiology of vitamin B12 and folic acid and the
mechanisms and investigation of deficiencies and their management.
Examples of question topics might include:
•B12 deficiency •Folate deficiency
Haemolytic anaemias
You should understand:
• Mechanisms of shortened red cell survival • Features and management of congenital and acquired haemolytic states
CLINICAL HAEMATOLOGY

• Molecular pathology of thalassaemia and common
haemoglobinopathies
Examples of question topics might include:
• Causes of haemolysis • Diagnosis of haemolytic anaemia
Other anaemias
Examples of question topics might include:
• Anaemias complicating systemic disease • Aplastic anaemia • Myelodysplastic syndromes
Polycythaemia and myeloproliferative disorders
You should know the causes, investigation and management of
polycythaemia and myeloproliferative disorders.
White cell disorders
You should understand the:
• Physiology of leucocytes • Leucocytosis and leucopenia • Acute and chronic leukaemias, including diagnosis, management and
prognosis • Lymphoproliferative diseases including Hodgkin's disease, non-Hodgkin’s
lymphomas, and plasma cell dyscrasias
Disorders of haemostasis
You should possess knowledge of:
• Platelet function and coagulation • Thrombocytopenia and impaired platelet function • Thrombocytosis • Common congenital and acquired disorders of coagulation (especially
anticoagulant therapy and disseminated intravascular coagulation)

You are expected to have a good knowledge and understanding of the
principles of clinical pharmacology, therapeutics and clinical toxicology.
Pharmacology
You should understand the:
• Mechanisms by which drugs produce their pharmacological effects • Basic principles of agonism and antagonism • Clinical implication of drugs that act at different receptor sites • Links between the pharmacological effects of drugs at the molecular
level, the cellular level, and the tissue/organ level, and how these are
affected by disease processes and other drugs • Principles by which both therapeutic and adverse effects occur
Clinical pharmacokinetics
You should understand the principles that underlie:
• Processes of drug absorption and distribution • Biotransformation and excretion • Concepts of drug half-life and clearance • First order and zero order kinetics
Application of this knowledge to clinical situations is necessary but detailed
kinetic calculations will not be required.
Monitoring drug therapy
You should understand the principles that underlie the monitoring of drug
therapy including:
• Direct measurement of therapeutic response • Measurement of plasma drug concentrations • Knowledge of the scientific basis for the measurement of drug
concentration and its link to the principles of pharmacokinetics

CLINICAL PHARMACOLOGY, THERAPEUTICS AND
CLINICAL TOXICOLOGY

Emphasis will be given to the areas of clinical practice and therapeutics
where the narrow therapeutic range of particular pharmacokinetic
properties of the drug make this approach important.
Adverse drug reactions
You should have an understanding of the epidemiology of adverse drug
reactions and know how to recognise and avoid them. You must also be
aware of important adverse effects of commonly used drugs and have an
understanding of the importance of adverse drug reaction reporting
schemes.
Drug interactions
You should have an understanding of the epidemiology of adverse drug
interactions, and of the mechanisms by which interactions may occur. You
should also have a knowledge of common drug interactions and their clinical
consequences.
Pharmacogenetics
You should understand the principles of pharmacogenetics and its
importance in determining variations in response to drugs in man, both in
terms of efficacy and toxicity. You should have knowledge of the clinical
consequences of the common pharmacogenetic variations relevant to
clinical practice.
Therapeutics for specific patient groups
You should understand the principles of therapeutics as they apply in the
following circumstances:
• The elderly • Pregnancy and breast feeding • Patients with renal disease • Patients with hepatic disease
You should understand that the altered physiology in these patient groups
may affect the pharmacokinetics and pharmacodynamics of drugs. You
19
should know the principles underlying drug choice, in pregnancy and breast
feeding, and have an understanding of the teratogenic effects of drugs that
may be used in pregnancy. In the case of renal and hepatic disease it is also
necessary for you to have an understanding of drugs that may produce
toxicity of these organs and whose use is particularly affected by disease of
these organs.
Clinical toxicology
You should understand the principles of management of patients who have
been poisoned with drugs or other toxic substances. This should include
assessment, recognition of common symptom patterns, principles of
removal of toxic substances, and their antidotes where these approaches
may be appropriate.
Examples of question topics might include:
• Paracetamol poisoning • Salicylate poisoning • Tricyclic antidepressant poisoning • Lithium poisoning • Iron poisoning • Digoxin poisoning • Intoxication due to drugs of abuse
Criteria for selecting drugs in a therapeutic class
You should understand the criteria that may be used to select a drug from
among drugs in a popular therapeutic class. This would include:
• Differences in pharmacokinetics and pharmacodynamics • The approved indications of the drug • Possible adverse effects or drug interactions • Cost effectiveness
You should also be aware of the nomenclature used in describing studies
that may be used to underpin drug selection.

Drug formulations and routes of administration
You should be aware of the various formulations of medicines available, and
of the routes by which medicines may be administered. You should also
understand the advantages and disadvantages of various routes and
preparations. From this knowledge, you would be expected to be able to
select the most appropriate formulation and route of drug administration in
common clinical scenarios.

Detailed knowledge of all the rheumatic conditions is not required.However,
you should have a sound working knowledge of the basic principles of the
common musculoskeletal conditions.
Examples of question topics might include:
• Inflammatory arthritis • Back pain • Periarticular disorders • Osteoarthritis • Connective tissue diseases • Bone diseases
Clinical science
Basic physiology, biochemistry, anatomy and pathology relating to
musculoskeletal disease should be known.
Examples of questions topics might include:
• Physiology of pain • Physiology of inflammation • Urate metabolism • Bone metabolism • Applied anatomy, particularly of cervical and lumbar nerve roots, and of
peripheral nerves commonly involved in disease
The pathology of the common rheumatic conditions should be known.
Examples of question topics might include pathological findings in:
• Rheumatoid arthritis • Osteoarthritis • Connective tissue diseases • Bone diseases

MRCP Syllabus

Here we put the MRCP UK syllabus so that you can prepare accordingly: you can also down load the syllabus from MRCPUK.org



Although divided into two parts the MRCP(UK) is a single examination.
MRCP(UK) Part 1 is not in itself a diploma, nor does it carry Membership
status.
To meet the entry requirements for the Part 1 Examination, you must hold
an acceptable medical qualification. You will not be admitted to the
Examination before the expiry of 18 months from the date of your
graduation. Further details are given in the Regulations.

INTRODUCTION
ENTRY REQUIREMENTS
PURPOSE AND ACADEMIC AIMS
The Part 1 Examination is set at a level which is appropriate for medical
graduates of some two years standing. The MRCP(UK) Part 1 Examination is
designed to identify those physicians in training who have a broad
knowledge and understanding of basic sciences relevant to medical practice
as well as of common or important disorders.

The MRCP (UK) has three main academic aims:

• To test a wide range of up-to-date medical knowledge so that physicians
in training are encouraged to develop their full clinical and academic
potential;
• To maintain and improve the practice of clinical medicine;
• To provide a sound basis for continuing medical education.

The practice of high quality medicine necessitates that you have knowledge
of important new advances in disease mechanisms, an understanding of
evidence-based medicine, and an ability to apply this knowledge and
understanding in the management of patients. Preparation for the
Examination will encourage you to acquire relevant knowledge and
understanding.
It is important that you develop skills and acquire professional habits which
will enable you to keep abreast of current medical knowledge and new
developments. Preparation for the Examination will help you to develop such
skills and professional habits. Hence, reading the medical literature and
attending relevant medical meetings should be a normal part of your
professional life.


CONTENT OF THE EXAMINATION
Your answer sheet is machine read and it is therefore imperative that you
adhere strictly to the Examination instructions in completing your answer
sheet.
The MRCP(UK) Part 1 Examination currently assesses your performance in
relation to that of other candidates and not by means of an external
standard of performance set by the examiners. As a result the pass mark
(but not the pass rate which is currently approximately 35 per cent) does vary
at each Examination.
The MRCP(UK) Part 1 Examining Board considers each question prior to its
appearance in the paper and subsequently reviews each question’s
performance. In addition to the final scores obtained by the candidates, the
MRCP(UK) Part 1 Examining Board will also note the mean score for the
Examination and the mean scores for, and the discriminatory power of, the
questions that comprise the paper. A detailed analysis of the responses to
each item (including a separate index of discrimination for every item), and a
coefficient indicating the internal reliability of the Examination as a whole
are also considered by the Board to ensure the quality of the Examination is
maintained.
No syllabus can be comprehensive. Hence, this Syllabus is indicative of those
areas of knowledge with which you are expected to be familiar, but is not
intended to be exhaustive or to exclude other items of knowledge which are
of similar relevance. You can expect, however, that the majority of questions
will test knowledge in the broad areas specified.