Exams: surviving the syllabus with a little help from the College

Preparing for postgraduate surgical exams often feels like training for a marathon in a minefield. Rota clashes, service pressure and a never-ending syllabus all conspire against success. The stakes are high, the support often ad hoc. And evidence confirms what many of us feel instinctively: surgical exam success is not just about knowledge.

Performance in the MRCS and FRCS exams correlates strongly with deanery, medical school, ethnicity and training route. In one large national analysis, trainees in regions, such as Thames Valley and London, had more than twice the MRCS Part A first-time pass rate than those in lower-performing regions¹. Even FRCS pass rates vary up to threefold between deaneries². Academic background, course type and prior attainment also play significant roles^3,4.

For me, medical school MCQs were challenging. I performed respectably (honours) in OSCEs, but the syllabus volume remained overwhelming. I didn’t plan to test the maximum number of attempts at MRCS Part A but, over two years, that’s where I nearly ended up. What turned the tide was structure: the Wade Anatomy programme and, crucially, a librarian-led search by Steven Kerr on the anatomy of groin hernias, which finally made the whole region click. Good revision is about clarity, not cramming.

Affiliate membership: a running start

For undergraduates, foundation doctors and pre-MRCS trainees, RCSEd offers free Affiliate Membership – a vastly underused springboard. It grants early access to high-yield revision material and hands-on events that shape both confidence and competence.

Flagship offerings include the ESSS National Undergraduate Surgery and Trauma Conference, which pairs keynote talks with student presentations and suturing workshops. The College’s RSA Webinar Series, which was launched during the pandemic, is the most comprehensive online surgical teaching bank for medical students, delivered by expert trainers across the UK. 

Courses like Foundation of Clinical Surgery and Foundation of GI Surgery introduce concepts through PRS quizzes, hands-on skills and genuinely useful content, including lectures on thyroid exam, perianal sepsis, anterior resection and every variety of hernia. They teach anatomy in a way that sticks.

Affiliate Membership doesn’t just open a door. It lays the foundations for a more equitable start, particularly for students without personal surgical mentors or university-led support.

Membership: from Part A panic to Part B poise

Once you’re through the door, full RCSEd Membership builds the scaffolding. The MRCS Part A Preparation Series, run by the Foundation Trainee Surgical Societies (FTSS), targets high-yield content: trauma, peri-op care, endocrine, urology, orthopaedics. These are the sessions I wish I’d had while circling the date of my first attempt.

The OxFTSS Lecture Series brings clarity through focused 30-minute talks followed by interactive Q&As — revision that’s refreshingly honest and highly applicable. For anatomical terror, there’s the excellent Surgical Anatomy – Difficult Topics and Concepts series. Covering everything from cranial nerves to fascial planes, it uses clinical vignettes to make complex ideas digestible. 

The RCSEd Learning Resources Hub and Acland Anatomy (dear to all our hearts) provide flexible, high-quality revision on demand. It’s not just about memorising content, it’s about accessing it at your own pace, with structure and intent.

One highlight for core trainees is the RAPID (Recognition and Prevention of Injury and Deterioration) course. It simulates multi-disciplinary ward rounds using the RAPID framework: Recap, Assess, Plan, Involve, Document. This hybrid course prepares candidates to manage unselected takes, identify deteriorating patients and lead ward rounds with confidence. The standard is pitched at the final day of core training, though it feels suspiciously close to the first day of real responsibility.

Fellowship prep: from guidelines to gravitas

What’s striking is the shift in focus: from facts to judgment, from ‘what’ to ‘how’. The College’s cross-specialty FRCS webinars are central to this. Delivered by experienced consultants, they prepare you to think aloud, structure answers, and survive the first 90 seconds of any clinical scenario, often the most dangerous territory.

Across specialties – neurosurgery, vascular, ENT, urology, paediatrics, orthopaedics, plastics – the RCSEd webinar archive is extensive. From endocrine to colorectal, from laparoscopic techniques to robotic platforms, there are sessions for every FRCS syllabus item. (To any budding pelvic floor surgeon, the combination of Professor Gordon Findlater’s Pelvis and Perineum anatomy lecture and Mr Andrew Williams’ clinical session on rectal prolapse, solitary rectal ulcer and obstructive defaecation offers a thorough grounding in pelvic disease, beginning, quite rightly, from the most fundamental end.)

Crucially, RCSEd also acknowledges the psychological toll of preparation. The SupportEd programme offers a wellbeing hub and peer-led advice on everything from stress to imposter syndrome. Alongside this, the College’s mentorship programme is an invaluable resource – especially for viva-style practice, framing answers, and navigating the emotional terrain of high-stakes exams.

Fellowship preparation is less about hoarding knowledge and more about recognising patterns, quoting guidelines, and avoiding dangerous waffle. The College helps you get there without the chaos.

Succeeding together: a College-backed journey

Surgical training remains exacting but it need not be isolating. From undergraduate revision to the nuanced judgment required at fellowship level, the Royal College of Surgeons of Edinburgh has established a coherent, longitudinal educational pathway designed to support, structure and strengthen the candidate journey. The scaffolding provided by the College – from webinar to workshop, from mentorship to wellbeing – is not only a resource for success, but a framework for shared endeavour. This is the essence of Operating as One. 

Ultimately, we hope you will not only succeed in your examination, but join us as a Fellow of the oldest surgical College in the world.

References

1. Ellis R, et al. A cross-sectional study examining MRCS performance by core surgical training location. Med Teach 2022; 44(4): 388–93.

2. Brown C, et al. FRCS first pass variance: deanery and specialty contrariety. Postgrad Med J 2018; 94(1107): 48–52.

3. Ellis R, et al. Does performance at the intercollegiate MRCS examination vary according to UK medical school and course type? BMJ Open 2022; 12(1): e054616.

4. Scrimgeour DSG, et al. Prediction of success at UK Specialty Board Examinations using the mandatory postgraduate UK surgical examination. BJS Open 2019; 3(6): 865–71.