Your Wish is My Demand: Here are some of my tips for sitting MRCPath in Micro/Viro

I posted about the FRCPath exam last Friday and in response I’ve had some people reach out and ask about MRCPath (or FRCPath part 1) and if I had any thoughts that might help in preparing for it.

Now, I have a bit of a part 1 confession. I sat part 1 in 2007, the exam was in September and my contract was due to end in a matter of weeks, and I had no idea what my next steps might be. In those days you had to work for 4 years to get your registration as a Clinical Scientist, but the training scheme only funded 3. You therefore had to find someone prepared to fund your 4th year, otherwise you dropped off the scheme with no registration and therefore you couldn’t get a subsequent role. I registered to take part 1 in case my contract ended, as I thought it would give me the best opportunity to try and find someone who would pay for my 4th year if my Trust couldn’t keep me. When I registered the exam conditions (as that time) said it was possible to defer the exam, but didn’t really give any more information. Two weeks before the exam my contract was renewed, and to be honest as it was looking likely I hadn’t even begun revising. I was just waiting for it to become official so I could confirm the deferral with the college.

My continued employment confirmed I phoned the college to defer, they said, of course! They also said that they hoped that I knew that although I could defer I would have to pay another £384 (see I still remember it to this day) to sit in the spring. I put down the phone and hyperventilated in the infection control office. I couldn’t afford another £384, I was a trainee who barely made ends meet on less that £20,000 a year in London. I walked out of the IPC office and into see my consultant (John Hartley, always a legend) who looked me in my tear-stained eyes and said, ‘well you’d better go home and start revising, see you after the exam’. My husband told me to hit Foyles bookshop on the way home, and that was that. I cancelled everything for the following 2 weeks, revised for 18 – 20 hours a day, and my poor husband asked me more exams questions than I’m sure he’d care to remember. I sat the exam and passed with (I believe) 80%, but this all means that my pathway to part 1 is probably not the one I would recommend for others. So instead of telling you more of what I did, below are some thoughts about how I would do it if I had to sit the exam over again.

Know what’s expected

Part 1 hasn’t changed much in structure since I sat it, although some of the focus of the question content has been updated as medical trainees are now joint Infectious Disease/Microbiology. There is, as expected, plenty of information on the Royal College of Pathologists website about this, but here are some of the things that I think are important to be aware of. The exam is aimed at people who are fairly early on in their speciality training, so for medical trainees this means those who have spent a year or so as a registrar. The exam itself is a different beast from what I described in my post on sitting FRCPath. It is a single 3 hour exam, consisting of what the college calls ‘best answer’, what the rest of us call a ‘multiple choice’. It covers Microbiology and Virology, as it is the same part 1 for both later FRCPath options. For context, unlike FRCPath, most people I know sitting part 1 prepped hard for about 6 weeks rather than for 6 months before the exam.

I’ve spoken to a few people recently who were prepping for part 1 and they were spending most of their time running case studies and learning a lot of detail about HIV treatment etc. I can only talk from my experience (I don’t write or have anything to do with the exam) but for me that is much more FRCPath prep. I think part 1 is much more about understanding the fundamentals of clinical microbiology: whether viruses are DNA or RNA, single or double stranded, what is the difference between decontamination and sterilisation, what are the key toxins associated with Clostridial species? There is more clinical in it now than when I sat it, and if I can I will find someone who passed more recently to write a guest blog (drop me a line to volunteer), but it’s mostly about identifying clinical risk. Part 1 is a lot about facts and memorisation of microbial characteristics and so books are where it’s at!

Get a current view

This brings me onto my first top tip. Find someone who has sat the exam recently and pump them for information. The thrust of the exam changes from year to year and so to really get prepared you need to get the most recent view you can. No one is allowed to share question information, but they can talk through and prepare you for what the current clinical vs organism balance is. They can also talk you through how much basic microbiology you need to bring into the room, and what the best resources are currently available to help you prepare. Most of your consultants will have sat this exam a long time ago and so you really need to be reaching out to your peers. If you are lucky enough to have a consultant in your department who is involved in writing the exam questions, they are still likely to be restricted as to what guidance they can give, so using your network is key.

Find a study buddy

One of the things that I would recommend for any college exams is that you find a study buddy. I did both of mine on my own, partly because of circumstances and partly because not that many scientists were sitting the exams back then. If you can pair up with someone else you will have a much easier time of it. I think this is probably true for three main reasons:

Firstly, you will probably have different areas of strength and weakness. For part 1, if you are a virologist try to find someone who is mainly a bacteriologist, you will then have a ready-made expert to help you go through concepts and visa versa. Even if you are both from the same main domain you are likely to have different interests. This is likely to help you with splitting some of the prep work. Also, if you are like me, you may only realise the gaps in your knowledge when you are trying to verbalise explanations to someone else and so it helps to have someone you can talk things through with.

Secondly, networks are really important and the more of you there are, the larger your combined networks are going to be. You will use your network to find good resources, have prep conversations and sign post you to key topics or challenges. They are the people you will go to in order to discuss how long you should prepare for ahead of the exam, to send you some test questions if you struggle to access them elsewhere, etc. As I said, you can do this on your own, but the richer your access to these, the easier your prep is likely to be. They may even be able to guide you to places that support funding the exam.

Finally, these exams are periods of high stress, by doing it with a peer you can provide each other with support during the process. Sometimes just having a friendly face to walk into the exam room with can make all the difference, or who you can text ‘OMG what is Citrobacter, I’ve had a massive blank’ when doing your reading. Building these relationships will help you throughout your career, and there’s nothing like shared high stakes moments to help bonding 😉.

Read not once but twice

There is a lot of exam technique that can help in passing both part 1 and part 2, and the sooner you start refining yours the easier it will be. The greatest piece of advice I received about sitting part 1 was ‘read through the question twice so you answer the question they’ve asked, not the question you think they’ve asked’. To be honest, I think this is the reason I passed, not because I am super smart or because I was well prepared.

The questions themselves are sometimes long. There will often be a bunch of information that can lead you to jump to conclusions about the answers the examiners are looking for. Most of the questions will have 4 options for answers. A lot of the time you can easily exclude 2 of them, just by reading the question properly. If you skim read the question though and don’t take a minute to appreciate what they are actually asking you can however go down a rabbit hole in your train of thought and pick one of the 2 that were only there for this reason. Save time by reading each question twice and asking yourself ‘what is it they are really asking me’.

Reading not once but twice also extends to checking the barcode answer sheet (if they still use these). It’s far too easy to get out of sequence or accidentally skip a line. No matter how close you are for time (and to be honest you should have plenty to spare), make time to cross-check your answer sheet at least twice. It will save you from unnecessarily losing precious marks.

Don’t over complicate things

Having said that you need to read the question carefully, there was one other thing that I remember finding really challenging in the exam itself. There was an extended matching question where you had to match the type of organism with the right molecular diagnostic test. I remember looking at the list for ages and thinking, ‘I could make a case for using any one of those for any one of these organisms’. Therein lies one of the other problems. It is possible to overthink your responses if you know too much in an area. As I said before, this exam is aimed at medics roughly a year into their training. If you have been a jobbing scientist for some time there will likely be things that you know in far greater detail than they would. It’s important if you find yourself in that kind of spiral to step away and think what would be the approach to someone just starting out in answering this question, what would the most obvious answer be, and let that guide you. Sometimes you may need to move onto other questions and to then return with a fresh set of eyes.

Go old school

One of the common traps we fall into as scientists is believing that all the questions will be based on the latest techniques. Now, it may have changed, but when I sat the exam there was a LOT of old school microbiology in there. Some it now feels old school as most of us don’t use many APIs and biochemical tests anymore. There is however quite a lot of this information that is intrinsically linked to organism characteristics, and as I’ve already said that is a lot of what this exam is about. So, if I were you, I’d pull some microbiology textbooks (not just clinical microbiology) and remind yourself what a VP/citrate/indole etc, test looks like and what they could differentiate. Remember that parts 1 and 2 are sat by international clinicians and so the exam has to serve a global purpose and reflect widely available diagnostics.

Listen to the advice but go your own way

Now, I’ve just written 2000 words of advice but I suppose this is one of the key ones. You don’t have to listen to any of it. Everyone prepares and studies for exams differently. What works for me may be completely the wrong thing for you. There is plenty of advice out there, and there are many people who will be more than happy to share their thoughts and opinions with you. Only you know what might work for you. If you’re unsure, try out different things in plenty of time and discard the ones that don’t serve you. I’ve already talked about my rather unconventional route to sitting part 1, but I made it work. You will make whatever route work that is right for you.

If at first you don’t succeed

Finally, sometimes these things don’t go your way first time. Sometimes, the questions aren’t what you expected. Sometimes, you frankly just have a bad day. I’ve known plenty of people who did not pass first time, all of whom are excellent in their posts. This can be a bitter pill to swallow for high achieving scientists who aren’t used to failure. Bear in mind however that it is more common in medical exams for people to sit multiple times. These exams are benchmarks for safety, and so there is understandably little wiggle room in terms of marks.

Sometimes, when people fail they close off to that failure and double down, rather than opening themselves up to what it can teach them. If you can, be open and take all you can from it. You will come out all the stronger. If failure happens to you, and I know this is hard, you have to let it go. Sitting these exams is in itself a learning experience. You will gain valuable insight into the exam itself to help you prepare for the next time. You will learn a bunch about how to revise, what to revise and how to read the questions. In short the process in itself will make you better, irrespective of the outcome, if you open yourself up to the learning it can provide.

Resources

There are a lot of great resources out there, and I’m sure your networks will help you identify even more. Below are just a few things I found useful when I was sitting the exam or that some of my amazing trainees have signposted that have been useful to them. I wasn’t involved in creating any of them, so they are just suggestions. As ever, pick and choose what works best for you.

https://firstline.org/microbial-pursuit

Not a resource, but if you want to sympathise with my husband for living with the girl who just won’t stop studying, here is a Girlymicro podcast that we recorded about that very subject.

Hope this is all a little useful and please do drop me a line and let me know how you all do and if you’ve got any advice to add!

All opinions on this blog are my own

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