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My name is Ray. I'm, I'm one of the surgical registrars based in the Southwest. Um So I'm currently SD five now and um thank you sort of to Lauren Lucian for organizing the event and um asking you to sort of speak um during sort of um the presentation which will probably take about 40 minutes or so, or maybe even a bit less than that, feel free to pop some messages on the group if you can't hear me or if there's some problems or just any questions at all. Um Ideally we keep it as interactive as possible. Um The aim of this sort of next 40 minutes or so is really to give you an introduction and a flavor of what the MRC S exam is like. And hopefully by the end of it all, you've got an idea of what the exam entails, what components is involved and probably a, a sort of a way to hopefully approach the um the, the exam if you haven't already thought about it, sort of in depth. Um a very subtle or not subtle plug at the very start of this is that um I'm affiliated to asset Um I'm the Southwest Representative. Um So if anyone is a member of Asset and wants to get in touch, please feel free. Um Likewise, if you have any interesting ideas or are interested in becoming part of asset, then please go for it. Asset is one of the biggest training. Um It sort of the biggest surgical training association in the UK, does a lot of great work, um does a lot of stuff to support, trainees, does a ton of courses and also sort of in the early parts of March is running its annual conference. So hope to see hopefully quite a few people there. Um And I think the main thing is to say is that um I'm around if anyone needs a hand with anything and I'm always willing to sort of provide a bit of support or help whatever it may be really um great. So thanks Lara for bringing that up for me. Um So if we, yeah, perfect. So in terms of what today is going to involve, I think I wanted to talk a little bit about my personal journey. I think that the story that you hear from people who have gone through the process is quite important just to give you an idea of what um what I went through during my sort of exams and how I kind of approach things cos it's slightly probably different to, to what other people went through. Um And then really, I wanted to focus heavily on what the MRC S exam structure involves. Um I think it's very easy to gloss over that and spending some time going through it looking at actually the criteria of scoring um and breaking things down nice and clearly is quite important and is an really crucial step in approaching exams. Um And I can't stress that enough actually. Um I'll have a few slides on some hot topics. Um depending on how this presentation goes, I might not be asked to come back again, but if I do, then it would be great to actually spend some time um talking about those hot topics in detail, um as part of sort of this revision, this revision course. Um And then really, I want to finish on some resources out there and what my opinions of those resources are. Um, and a few tips and tricks about how to hopefully approach the exam, sit it once sit it well, uh and pass it. All right. Ok. To go on next slide, please. Um Perfect. So my personal journey really began sort of at the end of F two. I knew I wanted to do surgery pretty much at the end of medical school, to be honest. Um, but really thought about sitting exam, um, after my foundation year two, which is kind of in the middle, it's neither too early or too late. I certainly knew people who sat the exam very early on. In F one and also know a number of people who have sat it really late and sort of only getting through part A towards the end of CT two. so II thought, you know what, I'm gonna take a year out, I'm gonna have foundation year three of doing some general surgery, kind of as a, uh, as a fellow slash doing a bit of locum as well. And during that time it'd be great if I could just get part a out, out of the way. Um, and so I booked my exam ready for just after Christmas, um, in January 2019. And, um, I actually got really stuck in with an F job and lo and behold before I knew it, it was already kind of December time and I hadn't really started revising. Um, and you'll hear lots of horror stories of people revising for months and months and months sitting in the exam not getting through. So, um, to be fairly honest, II left things probably a little bit too late, but I had approximately a month and a half, um, before I really started thinking about doing any serious vision at all. Um, but what I did do is I had booked a course. It was the Doctor's Academy course which is, um, originates out of Wales. And, um, that was sort of booked for early December and I kind of went into that course, fairly blind. Hadn't done much revision at all. Um, and it kind of give me a real kick up the backside because, um, the course was quite intense, basically split over two days and tried to cover most of the MRC S, um curriculum. And I realized I knew very, very little. Um, and if anything that course was the big drive for me in terms of, um, how I then approached my revision, um, which ultimately ran up approximately every period of sort of just 4 to 5 weeks or so. Um, came out of the course, realized I had to do a lot of work. Um And I knew that probably wasn't going to be achievable if I was also working. So I went back to my department and just said, look, I, you know, I really don't think I, um I could um realistically continue working, um to which they were fairly upset about. But, um I was in my three, I honestly didn't care at that point because I knew that I paid quite a lot of money and I really didn't want to sit the exam twice. Um But then ultimately, we came to an agreement that I could just have an entire month off, which was really, really important. So I had about 4.5 weeks in total. Um And actually, again, I didn't really spend the first half week doing a great deal of vision. But what I did do is I spend a lot of time reading on forums and really looking at the curriculum of the MRC S. Um, I knew time was tight. I knew that probably I wasn't going to be able to cover the whole of the curriculum in good depth. Um, and therefore I kind of had to tackle this exam in, in as smart as a possible way as I could achieve. And this is what I'm gonna allude to later just in a few slides, time and talking about splitting the um the exam questions into really fine detail and looking at exactly what the components of the exam is. Um Ultimately, I just used one question bank. I used the E MRC S. Um I didn't use any other question banks, nothing like pass test or anything like that. Uh And I really stuck to doing quite a number of different anatomy question banks and books. II wasn't really very fussy at all. If it was anatomy related, I just picked up a book and I just do the questions. Um And ultimately, I passed the first time, um which was a bit of a surprise, probably even to myself at the time. Um But I think the the summary of that is don't um it it's important to revise, but it's also very, very important to revise smart and not to get pigeon holed into dark tunnels of revision into areas of the MRC S which may only yield very, very low sort of um reward ie in terms of marks. All right. Ok. The next slide please. Um So Mr Yes. So hopefully, by this point, everyone knows what it is. It is uh an intercollegiate exam. It's, um, you need to do the exam regardless of what college you ultimately sit your part B with. Um, and it is a written paper, right? So it's composed of two parts, um, paper, one and paper. Two, both are sat on the same day. Um One part will be sat in the morning and the second will then quickly follow sort of in the afternoon and overall encompasses um up to five hours of multiple choice questions. And the original format of the exam was quite tricky in the sense that there were many different types of multiple choice questions, but now it's very much simplified to just SBA so, so, so single center sort of single scenarios and you, you simply pick out of the selection which you think is the right answer. Alright. Uh Next slide, please. Um Paper, one is a sort of sort of written on the slides. It's basic sciences. Um It's divide it again into two further 90 sort of minute sections and you get a sort of comfort break in between. So you're allowed sort of 1010, 15 minutes or so to stretch your legs, have a pause and then go back to it. Um And the numbers here have been very particular about because it's quite important. So part one is longer, it's three hours and it's got 100 and 80 questions. And then part two is a little bit shorter and has 100 and um 100 and 20 questions in total. So part one is definitely the longer and the more beefier section of the exam and covers sort of applied basic sciences. And then part two is usually paper, two is usually a little bit lighter. Uh And the question is it is in it, it is sort of far less heavy in terms of anatomy and focuses more on clinical scenarios and pre and post post operative care. OK. Next slide please. Um This is really just to give you an idea of all the components of the part syllabus and it's ultimately split into 10 modules. This doesn't really make a great deal of sense when I read it. And I don't think it's something that you need to get too bogged down in. But I think the one of the most important things to remember is that ultimately, no matter what the module is, the MRC S exam is a surgical exam. So all the questions, whether it's to do with pathology, whether it's to do with anesthetics. So in terms of pre and POSTOP care, um all professionalism and leadership, all of them are focused around surgery and focused around a surgical theme. All right. So, and, and that's quite important to bear in mind. Um Next slide please. So I want to go into all of this in a little bit more detail um in order to break everything down a little bit. And um we'll also have a look at some of the pass rates in the last couple of years as well. So part A as I said, um has the two papers, paper, one is 100 and 80 questions long. And if you look carefully at the breakdown of the questions and the total marks, then you'll quickly notice that applied surgical, um anatomy and applied surgical physiology by far encompass the majority of the questions in this uh in this paper. OK. And if you go further down, you'll notice that microbiology, imaging data interpretation audit form in in total all of those sections added together form very, very few marks. And so it doesn't really take a genius to work out that if you spend, let's say three days, four days intensely brushing up on your statistics and data interpretation and potentially imaging or microbiology and pharmacology, um which are ultimately big topic areas. And in the exam, you get seven questions or 10 questions in total, encompassing a couple of these categories. Um It's very easy that you can spend a lot of time arising these topics and ultimately yield very, very few marks. Whereas if you decide to omit certain revision topics, and I suppose I should be careful about the way I say, omit a lot of these um a lot of the anatomy and physiology will have a great deal of overlap with microbiology and pharmacology, imaging and data. Um And actually, naturally, if you're advising the bigger topics, you probably will cover some of these areas anyway. Um But you know, it's very, very easy to see that if you spend more time revising anatomy and physiology and pathology, um you're going to probably get far more marks than spending even 50% of the time that you spend on those bigger topics, revising pharmacology and microbiology, and imaging and data interpretation. Um And I want you to keep that in mind because actually when I sat my exam with a heavy time limit before I had to sit it. Um I actually didn't, I didn't revise microbiology at all. Um And II think I did very little pharmacology revision. Um and certainly no data interpretation of revision whatsoever. Um And I, and that the main reason for that was because I looked at the breakdown of scores and I just thought this is a waste of time. II don't have time to, to sit there learning about sort of data statistics or revising, you know, the minutiae of microbiology. Absolutely no point. Instead, if I spend all of my time doing surgical anatomy and ensure that I spend that amount of time and get 770 marks out of the 75 or, you know, 40 out of the 45 marks for physiology, then already, that's pushing me into an area where I only need to collate 1015 more marks to pass the actual exam. OK. So, and I've done the same for paper two. So if we go on to the next slide, we can have a look at what paper two involves. So short of the 220 questions in total. And again, I've sort of broken down what questions are involved in each. Um So as you can see, again, the the much bigger topic areas are acquired surgical conditions, perioptic management, and also trauma, surprisingly, which counts about 30 questions in the exam. Um If you look at how many questions then there are left behind for the surgical care of Children. So pediatric surgery, there's only seven questions. And again, you can get really, really bogged down into sort of revising um pediatric surgery. Uh And actually, there's seven questions, there's seven marks in total which forms a tiny percentage of the actual exam. Um And so these slides, sorry, I've just seen the question on online as well. These slides will be all sort of available for you and the recording will also remain on the side. So you can always come back and then have a look at all the breakdown of the different sort of questions available. Um And I would really um sort of focus on the breakdown of the exam, be really smart about the way you approach your revision. Um I certainly spent a lot of time doing a bit of revision, coming back to it, having a look at what again, breakdown exam was and then going back to hot topics and re revising them and for the topics that really had very few marks, I either spent no time on them or really only picked some of the, um, picked up some of the information and revising just through doing some question banks. Ok. So next slide please. Um So this is to give you a flavor of the MRC S sort of pass rate and I'll just sort of give a minute for everyone to sort of digest a lot of the horrible numbers on this um slide. So from 2018, um to sort of uh 2019 sittings, um, we can see that the passmark, generally speaking, sits around 70%. Um, and the percentage of candidates passing is normally around 40%. Interestingly in the past couple of years, that number has increased ever so slightly to sort of 4543 45%. And the pa mark has also increased slightly in the last couple of sittings. So, um, the past percentage has sort of a past mark percentage has increased slightly to about 73 74%. And I think in a one particular sitting a couple of years ago, it went as high as 75%. And the reason for that is ultimately, the exam board wants the percentage pass, the sort of percentage of candidate passing to be around 40%. So, under 50%. All right. So, um, a and, and that's to guide the college in terms of, sort of how, well they think they've set the exam and how difficult it is. That's the sort of, um, criteria that they've kind of set themselves. So, by no means, is this an easy exam? You know, it's, it's a tricky exam. It requires a lot of effort, it requires a lot of time and dedication. Um, a lot of sitting in front of the computer and doing 100s and 100s and 100s of questions. Um, but it is absolutely achievable. Um And I think your approach is going to be very, very important, um, when you sort of tackle this exam. All right. Um Yeah, next slide. So this is quite, um, an extensive. So selection of topics is to give a flavor of kind of, um, some of the quite important, um, areas that you should be aware of that commonly come up in the exam process. Um We, we're obviously not gonna talk about any of these in any great detail today. Um, but in sort of future sessions, the hope is that probably I'll cover some of these topics for you. Um, and actually go into it in more detail and, and to give you an idea of what kind of areas the exam likes to, to test, um, the exam board has a bank of questions and for each sitting, they will choose from that bank of questions um to cover all of the topic areas that they want to do. Um And therefore the same questions will come up. Is it inevitable? Right? And although the exam board will say that there is no past papers out there in the ea for you to sort of look at or read or et cetera. Undoubtedly, the question banks that are available are created by people who have gone through the exam or have um or have sort of ii suppose in inverted commas insider knowledge of what these um questions are like. Um So I've got AAA question on, on online that says re MRC S questions representative of the level of difficulty. And I think to answer that question bluntly, the answer is no. So E MRC S overall is ever so slightly easier than the real exam. However, E MRC S from my experience is the question bank that has the questions most similar to the exam in the way that it is worded and the quality of the questions that E MSs are very uniform. So um I actually tried a little bit of past tests and a few other question banks as well. Um After I finished the E MRC S and I thought that um actually past tests um and some of the other question banks, the way that questions were phrased, they were not as good there. Certainly were good questions in there. But unfortunately, those question banks obviously are, are, are usually quite big. They contain thousands and thousands of questions and a good percentage of those questions are not very good and often incorrect as well. There's a lot of errors in some of the other question banks. The MRC S question bank is much smaller, it's more compact. Um, but uh the quality I think is, is much better and um what you want to be able to do during your revision is not so much been able to answer thousands and thousands of questions and question topics all correctly and all really sort of aiming for, for gaining sort of all aspects of MRC S revision sort of under your belt and know exactly what, what, what everything involves. But instead, I think it's more important that you know what questions come up or what areas are tested very commonly and that you achieve 100% in those areas, right? Um And this is why all the hot topics that I have included in this slide are all anatomy because anatomy forms an enormous part of the exam. So there may be 70 to 75 very heavily anatomy focused questions if you go back to that paper, one slide and look at it later on. However, in applied physiology, in pathology are all elements of anatomy and it will come up again and again and again uh to be honest with you, the, the, the MRC S exam is a heavily anatomy focused exam and it is very boring. Most of us are not very good at anatomy. Anatomy is incredibly boring to revise. But if you brush it up and you, you, you get that sort of core anatomy and uh sort of well revised, um then you're gonna do very, very well in the MRC X exam. All right. Um If you think about the percentages of the numbers required to pass the exam, um, you're looking at about trying to get 70% and above in each of the papers, right? And if you're able to achieve 70 plus er, marks just on that section about anatomy alone, you've given yourself a very good head start. And generally speaking, the people who pass the MRC S relatively swiftly are those that have taken that to me very, very seriously and, and really gone back to the basics and learned that. And that's me very, very well. Um But the hot topics basically covers some of the areas that, that, that the exam board love to test. So in head and neck anatomy or in head and neck, they love to do sort of cranial anatomy in terms of structure of the brain, um the um exits of the cranial nerves through the skull. Um And also when it comes to head and neck anatomy, a particular focus on anterior and posterior triangles of the neck and the structures in those um in the thorax. Uh it it's generally speaking, all the compartments um each of the compartments in terms of thorax, you know, abdomen, pelvis and the limbs. Um you need to have a good understanding of what compartments. Um what how the body is divided into the various compartments, all the important structures that run through them and also their clinical relevance as well. So knowing about the compartments of the mediastinum is again a very common topic, lung anatomy and focus on sort of the lung roots and the structures that come through that. Um the diaphragmatic apertures and different structures that pierces the diaphragm and then also a little bit of basic anatomy about structure of the heart and also of of the esophagus as well. Um Abdom, the sort of um abdomen has a lot of anatomy and is uh because it's ultimately general surgery holds quite a strong influence over the MRC SA. Lot of abdominal anatomy comes up whether that goes into just simple, straightforward anatomy or trauma or clinical pathology as well. Obviously, there's a lot of topics um from a clinical perspective that focuses on abdominal pathology. Um so good and understanding the abdominal wall anatomy compartments again, structures that line in the sort of transpyloric plane and then different areas of the abdomen which are heavily tested as things like the gallbladder. The calls triangle, um major vessels and tributaries that um courses through the abdomen So the the abdominal aorta and all the tributaries that come off it. Um And then uh also not forgetting things like hernia office as well. And limbs is an incredibly big topic because if you imagine you got upper limbs, lower limbs, the general expectation is that you have an overall appreciation of important areas like the brachial plexus, the fossa, the sort of antecubital popliteal fossa. And then also in terms of the actual arms and legs themselves, knowing the different compartments, knowing how, um knowing at least the names of the muscles involved in each compartment, although you might not necessarily have to know all the attachments. Um And then obviously their neurovascular supply as well. Um And that actually is really big in terms of how, what broad that that area is. Um But like a lot of anatomy, there is a structure and a way to approaching it. And actually, if you figure out that way or know someone that can teach you that way, then it becomes a lot easier to digest. Um A lot of this information, a lot of this anatomy, I put sort of neuroanatomy right at the end because it's quite a, it's quite um a big topic again. And often people look at neuro anatomy and they just think crikey this is too much, but actually, there's only a few areas that get tested heavily in the MRC S and that's really those three areas that are put up So general structure of the C NS. So understanding the sympathetic and parasympathetic sort of nervous systems and how they interact with each other. And the general structure of them, we've kind of covered cranial nerves already in the head and neck as a very, very commonly tested uh questions both in MRC S part A and also in part B. And what I mean by C NS pathways is kind of the overall components of the C NS, the, the central nervous system. And um the way that the central nervous system is put together and the pathways within it. And although again, quite, quite substantial, it feels like these are really heavy chunky topics. Once you break it down, they actually um the way that the exam structure is set up, the, the questions that come up tend to be very repetitive. You start getting a real good feel of what's likely to come up. And the finding really is just a little bit about blood vessels, ultimately, the circle of Willis and then um a bit about sort of CSF and how that's distributed through the brain. Um Crikey. So it's a lot, you know, so this is only looking at anatomy as well. So, uh but I think once you're able to get a good grasp of the anatomy involved in MRC S, the rest actually really is very easy because I don't think that a rest, the rest of the exam requires a huge amount of bookwork and I didn't, certainly didn't do a lot of that at all. I did a lot of questions. Um, I learned, learned about my mistakes through doing questions and if there were topics that I wasn't too, sort of well scrubbed up on then through the questions I'd read up and then kind of try and get a better understanding of the gaps in my knowledge as well. Um, but anatomy, I really did go back to basics, you know, I picked up anatomy book. I learned anatomy. I did questions on anatomy. Um, and just really pounded that sort of that, that topic. I mean, I did it and I just got it straight away. So, um, but for the exam, I think that's the best way to sort of approach it and it's really important as well. Right. So, next question, uh sorry, not next, um, slide piece. Um So just sort of coming up to the last couple of slides really. I mean, I wanna talk a little bit about resources because there are absolute wealth of resources out there. I mean, I don't even know how many there are. There are to be honest with you. 100s probably of question banks that claim that they're, they're the real thing. Um There's 100s of textbooks you can use. There are 100s of website resources, courses, books, um, tons out there and you have a very finite amount of time and you're certainly not gonna be able to trial all of them and see, uh, which ones are better, worse or, you know, accurate enough that they're representative of the exam. Um, by no means, have I tried all of them? But I think my general opinion for your approach to the exam is that you should use one, maybe two question banks at most. I think any more than that, uh, and the quality of your questions or the quality of your, the amount of time you're spending on the question is actually going through them, understanding where you've gone wrong and reading up on the areas that you've gone wrong massively starts to decline. Um And I think the MRC S like all exams is an exam of repetition. So you do a set of questions, you give it some time and you do them again and again and again until it's almost like second nature when you're answering those, when you're going back and answering those questions again. And that takes time, you know, you're not gonna be able to go through a question bank of 2 to 3000 questions and reliably go back through them and answer them all correctly. It's probably going to take two, maybe even three times going around in those, in that set of question banks in order to start really hitting 80 or 90% on your, on your answers. Um When it comes to books, there's a couple of important books that I think is useful. Um And what I'll do is actually I'll compile it and send it to um um to, to the guys and who can distribute sort of a little bit more about the books that I would personally recommend. But ultimately, you need a book that has some information on critical care. Um It's an area which I didn't spend a huge amount on, but I did do a reasonable amount of reading just to get an idea of um of anesthetics and how um anesthetics is used or is important in perioperative care. And that's really important again. And I wanted to highlight which I talked about earlier, which is this is a surgical exam. So even the anesthetic side of it, the perioperative care is all focused around surgery. Um And really, ultimately, it's allowing us to understand as surgeons why anesthesis is important, what the other side does in the management and care of our patients. And that's what the exam is trying to get at it. It's very unlikely. Or you're gonna be incredibly unlucky if they start asking you questions about, you know, how anesthetics is delivered and things like that. It, it's not going to be that kind of exam. Um But I would recommend maybe a very light textbook for that just for some general reading to get a background. Um And then ultimately, all the questions that I used from there on was were um purely anatomy based anatomy with probably a little bit of pathology involved sort of in it as well. But I ended up just going to the library picking up a bunch of anatomy books with questions in them, going through them, reading upon the things that I might have misunderstood or got wrong, er, and then repeat it. Um, and I think I probably ended up choosing somewhere around 3 to 4 anatomy books and managed to get through most of them. Um, but actually, if I had more time, I would have finished those books and redone them again and just gone through all of them again, um, courses. Um, although I did a course, I do not think a course is necessary. I think if you go online, look at some of the information out there on how to approach the exam. Obviously, hopefully this talk has been a little bit useful as well and giving you a kind of a flavor of how you should be approaching this. Um Then I think you need to sit down and really plan out exactly what you're going to do and what you're going to try to achieve and also what kind of learner you are. I can sit here and sort of tell you that I spent a month and a half, took the whole time off and just revise like how from dawn to dusk. Um, and it worked out for me, but for you, that might be completely different and that might be a terrible way to revise and actually, you might need 3 to 4 months or even a bit longer, um, doing a couple of hours a day, um, before you feel comfortable enough that you can sit the exam and that's perfectly fine. So it's a little bit about understanding yourself and planning ahead and that's really, really important. And if I were to sit the exam all over again, that is definitely something that I would have changed. I felt rushed. I was pushed into, um in hindsight, ultimately pushed into negating a lot of parts of the exam that I ended up just simply not revising for. And ultimately, with a bit of luck and with some time off, I was able to get through it. Um And then finally, the curriculum, the curriculum is really important. Now, probably we've gone through enough of the curriculum that you don't need to go into a bit in more depth. But if you go onto the MRC S website, you can find that, you know, the, the PDF document that sort of goes into a lot of depth about the um parts of the exam that they look into the physical breakdown or questions in each component. Um But I think the main thing is getting an idea of how many questions there are the broad breakdowns of the questions that are going to be asked, which is ultimately going to be heavily anatomy focused. Um And then get an idea for yourself, how you're going to approach things going forward. All right. So next slide, please. Perfect. So we're sort of coming up to the last two slides and I think this is where I wanted to talk almost to give you sort of an example plan of how you should maybe approach with your revision. Um I think overall if you're going to be working while revising, which is going to be the case for most people, I was, I suppose in a rather fortunate position to be able to take an entire month off. But for a lot of people that is not realistic, then you need approximately 3 to 4 months preparation time. And I think that's 3 to 4 months of, unfortunately, every night going home and spending up to three hours of sort of three hours of revision and II don't mean sort of three hours of revision while, while you've got a television on and you've got food or something and you're eating a few bites and then doing a few questions. I sort of mean, 2 to 3 hours of sitting down doing nothing else other than revision. Um, and a very good way to actually test yourself to know that you've spent that amount of revision doing actual revision is every time you start revising it is to simply set, set yourself a stop clock. All right. So you start revising, you put the stop clock on the moment you think you've stopped revising or your mind has gone somewhere else, you put the timer off again and then usually you'd be surprised. Actually, if you did that and you were very strict with yourself, you'll find that in your brain you might have thought you've done three hours of vision, but actually you've probably only managed about an hour or two. So, what I suppose I'm trying to get at is three hours of revision a day on paper seems very little out of your sort of 12, no, out of your 18 hour day. But in reality, three hours is actually quite a lot. So three months to three hours is quite a high volume of revision, particularly if you're working. Um, definitely use the question bank from the very start. So I knew some colleagues who felt like they needed to revise first. So they spent probably a good week, two weeks or even longer, even up to a month, reading books trying to get a basic understanding of anatomy, all these kind of things and sort of felt like they could only start the question bank once they could, um, start answering questions correctly. Which is weird. Actually, I mean, II started from day one, just open the question about it. Start doing the questions. It's gonna be a little bit demoralizing to start with. Um I think when I first started, I was getting about 40% less 30%. Right. Um Which is really, really depressing. And again, that is often when people stop, do a question bank, don't do very well. Next thing they know they stop doing the question bank entirely because they just demoralized it by all. Or they start revising thinking that this will improve their scores. And actually, I don't think that's gonna be the case. Um MRC S is repetition. It's about doing questions and it's about again as I keep talking about, it's about anatomy. So you just need to keep pounding the question about doing them again again again. So with those three things in mind, the general strategy I'd recommend is that in month one, you start with your question bank. In which case, I certainly recommend that you do E MRC S. But on top of that, you might be, you know, willing to pay for another um another question bank. I certainly wasn't. Um I would focus heavily on anatomy revision. So, um what I mean by that I suppose is um going back to your basic anatomy. So where there's online resources grades, um you know, all just doing the questions on the question bank, seeing where you get go wrong and going onto Google and searching those areas, it doesn't really matter too much um in my vision, other than the textbooks that I used, I um also use Teach me anatomy, which is a free online resource. It's excellent actually. And the level of anatomy on teach me anatomy is just about. Right. I think, I think it's actually perfect for, er, for MRC S. Um, and, um, during all of this I would select out topics that you did not know very well or understand particularly well or areas that you felt you really needed to focus a bit more on and I'd probably create some notes of your own, focusing on those areas. Right. I don't think you should create notes for everything. I think that's exhaustive and pointless because there's tons of resources everywhere. But I think certainly for areas that you want to brush up on all things that you wanna come back to regularly, you should create your own notes. Um, and, er, and I highly recommend that actually, um, once that month is over in month two, I think, um now that you've sort of got a flavor and an idea of what the exam feels like, um, you should just be hitting the question banks really hard and you should be focusing on it, doing the question banks and then if you're running out of anatomy questions, that's when you should start going to books and finding other resources that, that, that have additional questions that you can then revise. Um, and I think, I think for anatomy, that is the only thing you need to do. I really don't think that you need to focus too much on areas such as pathology and um clinical sort of questions as well. The clinical questions generally are actually really quite straightforward. Um Instead, I think the E MRC S or some of the question banks don't have that much anatomy in them. And therefore, I think that's why you need to bolster it with additional books or additional question banks that focus on anatomy and you'll notice very quickly that anatomy isn't pure anatomy at all. I, most of the question books ask you a clinical scenario which requires some anatomy to work out the problem. All right, I for example, someone has a, has a traumatic car accident. Um, they're presenting with XYZ um hand signs, you know what nerve, what blood vessels or what areas are currently damaged. And that means that you need to get, you need to understand and know what, what the neurovascular supply of the hands are. Um, and then use that to kind of work out the answer. So I know I talk about anatomy a lot, but in fact, most of the anatomy books don't sort of are asking you direct questions that is pure anatomy. It's all based on a clinical context. Um And then finally, sort of as you're hitting your final month, I think you should really be, you know, starting to sit question banks as if they were timed exams. So you should be hitting minimum 50 questions a day. It should really be higher than that. You know, you should be probably getting nearly 100 questions every day and your percentages on getting these questions correct. Should be somewhere between 75 to 80% by that point. Um, and if you have time I would go back, um, and sort of repeat some of the question books that you've done. Um, I think as I said before, 3 to 4 question books is probably more than enough. Um, and if you finish them, I would go back and I would start doing them again. All right. And then finally in your final sort of we run up to the exam. II probably would stop revising II. You know, I wouldn't worry too much about sitting and reading books or reading sort of things. I would just crack on with the questions and you should be timing yourself. So II sort of, by the end of it was doing about 200 questions a day as a time kind of exam. Um, and that's because the, the in total, the exams sort of, um, between the 180 the 120 you end up doing sort of 300 questions throughout the whole of that day. Um, and obviously during the day of the exam, you're going to be reading things slower. You're gonna be spending a bit more time thinking about the questions by this point. You should be in a position that you've already done the question bank probably twice over. Uh And so a lot of the 200 questions per day is really just to get you in that flow of getting through lots and lots of questions, getting a feel of and also a bit of a confidence boost as well. Because undoubtedly if you've been following this, then by that point, you're gonna be scoring relatively high, you know, you're gonna be hitting 80% 80% above. Um and you should be feeling fairly confident um in that little last little final run up to the exam. All right. But most important of all day before the exam, do nothing. If you're taking your exam far away, you're gonna have to travel, make sure you get there the day before. Um That's what I did. Um I, you know, got there the day before chilled out. II sat the exam in London, um bought myself a nice place to stay. Um had a nice evening, tried to, tried to, you know, be as chilled and calm as possible the day before and then get a good night's sleep and then go in and, and sort of smash the exam the next day. All right. Ok. And so last slide I think is coming up, which is just a summary slide. Um So ultimately, after all that rambling, there's only a few key things that I really want you to take away from sort of this evening. And that is the MRC S is ultimately a surgical exam. And anatomy is going to be incredibly important and forms a really big component of the exam, whether that's pure anatomy or anatomy in a clinical context. OK. Um Trying to be as organized as you can at the start of your vision. And if you set out a three month plan as an example and at month two, you're not hitting your month one targets. My my recommendation is move on. So let's say in month one, you said to yourself, I want to complete me MRC S. Um Sorry, I II want you do a question bank. I wanna finish one anatomy book. Um And I want to have read XYZ in terms of a critical care or preoperative care and you don't manage to completely meet those targets. And in month two, your target was I was gonna do, I'm gonna do 50 questions a day and et cetera, et cetera, et cetera. I think you need to move on and you press ahead and you continue with month to two plans. And the reason is, is again from speaking to people who have had trouble taking the exam, what they generally find is that the start of their revision plans, they make plans for month one, which is probably quite ambitious. They don't quite meet their targets and in month two, they think, oh, I'm not ready and I'm just gonna keep going on with what I was planning in month one. And it just completely takes them off the rails and by the time they're hitting month three, they're still start in month one, revising things that they probably didn't need to revise in the very first place. Right. Um, so plan it out, but make your plans realistic and don't, um, don't get too concerned if you fall slightly behind, it's not that important. Um And then finally part A is really, it is a recognizable pattern of questions. Like it's a series of questions that come up again and again, the topics, some of which I have sort of alluded to, but by no means is that the complete list, um, they come up again and again and again. Um, and if you know which topics are heavily examined and you spend some time on them, um, you will not be disappointed in the exam, it will come up for sure. Um And then ultimately don't be too worried if things don't quite go your way. The first time, you gotta remember that it is a hard exam. The pass rate is 40% or so. And if you're unlucky enough that you sit in a particular sitting with lots of great candidates, um, who are all very close to passing, they're gonna push the pa Pathmark up and in that case, failing is certainly not a weakness at all. And as long as you're invested in the process, uh which is ultimately at the end of the day to, to get your surgical number and to get into training, then you will always find a way to get through the exam. All right.