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MRCS Part B OSCEs Essential Revision Notes 2nd Edition C.
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 CONTENTS
About the Authors

Acknowledgements

Permissions

1. Introduction
A. The Intercollegiate MRCS Examination
B. Structure of the OSCE
C. Candidate instructions for the OSCE station
D. How to prepare for the OSCE
E. Survey of past candidates
F. Focus of this book

SECTION 1: CLINICAL SKILLS IN HISTORY TAKING AND PHYSICAL EXAMINATION

2. Overview of Clinical Skills Stations

A. Structure of this content area
B. History taking – a ‘general formula’
C. History to assess fitness for surgery
D. How to present a history
E. Top tips in history taking and clinical examination

3. Head and Neck

A. The Histories
B. The Examinations
C. The OSCE Cases
D. Survey results

4. Trunk and Thorax

A. The Histories
B. The Examinations
C. The OSCE Cases
D. Survey results
5. Limbs
A. The Histories
B. The Examinations
C. The OSCE Cases
D. Survey results

6. Neurosciences
A. The Histories
B. The Examinations
C. The OSCE Cases
D. Survey results

SECTION 2: COMMUNICATION SKILLS

7. Communication Skills

SECTION 3: SURGICAL SKILLS AND PATIENT SAFETY

8. Surgical Skills

9. Patient Safety

SECTION 4: SURGICAL SCIENCE, CRITICAL CARE, ANATOMY AND PATHOLOGY

10. Applied surgical science and critical care

11. Anatomy and surgical pathology

12. Mock OSCE examinations

Abbreviations List

Bibliography

Index

Summary cards
 ABOUT THE AUTHORS
Catherine Parchment Smith BSc (Hons) MBChB (Hons) FRCS (Eng)
Cathy did a degree in Biology at Warwick University and some research in Genetics at Dundee
University before having a great time at Manchester Medical School. She did her BST in Manchester
and was an SpR in Yorkshire. She was awarded the Association of Surgeons Gold Medal in her exit
exam in General Surgery specialising in Colorectal surgery and is now a consultant Colorectal
Surgeon in Pinderfields Hospital, Mid Yorkshire NHS Trust.

Julia Massey MBBS, MRCS (Ed)

Julia graduated from the University of Newcastle in 2003. Following her House Officer year in
Newcastle she completed the Basic Surgical Training Scheme in Leeds. She is now an ST4 in
General Surgery in West Yorkshire.

Richard Young BSc (Hons) MBChB (Hons) MRCSEd

Richard completed his undergraduate training at the University of Leeds in 2006 and is currently a
General Surgical trainee in Yorkshire. He has an interest in medical education and is an examiner for
the University of Leeds.

Ryan Koshy Mathew MBChB (Hons) BSc (Hons) MRCS (Ed)

After reading medicine at Leeds, Ryan completed his foundation training in Yorkshire and is currently
a Specialty Registrar in neurosurgery at Leeds General Infirmary. He has clinical experience in India,
South Africa and Uganda. His primary research into tissue engineering led to placements at Harvard
University and Massachusetts General Hospital in Boston.

Contributing authors to previous edition

Claire Ritchie Chalmers BA BM BCh MRCS

Karen Flood BMedSci, BM BS, MRCS (Ed)

 ACKNOWLEDGEMENTS
I wrote this book in longhand on my kitchen table with my baby in a Moses basket on the floor next to
me. I never imagined that we would still be selling hundreds of copies a year when my baby was
buying skinny jeans and planning her first year in high school. I am grateful to all the trainees who
have come up to me over the years saying that they found the book helpful – that was the plan, and I
hope this new edition helps even more of you into a career which I have found exciting, stimulating
and satisfying over those many years.

I am also grateful to my colleagues and patients at Mid Yorkshire who make it possible to continue
enjoying this career, particularly Mark Rogers, Charles Morrison, Sivakumar Rangasamy, Gillian
Faircliffe and Julie Crossley. Thanks also to my best mate Cath Hernon for always being there even
when she was far away.

I am especially grateful to Julia Massey, a bright and energetic trainee who was able to give the time
and energy to my book that I no longer have! I hope this means that the MRCS OSCE candidates will
get as much use out of it in the future as other candidates have in the past. I would also like to thank
Heather Harford for some of the photos, Sue and Cathy and all at PASTEST who have taken on
working with me yet again, Rick who used his experience of the exam to help us out and everyone
who contributed to this and the first edition.

I dedicate this book yet again to my family, Jon, for his support, Mum for her hard work and the
children Bella, Ben and Zac who are still young enough to delight us all daily.

Cathy Parchment Smith

I would like to thank my wonderful family and friends who I have bored rigid about this book for all
their support – especially my parents Rob and Mary Anne and my sister Louisa.

I also want to thank the people who have helped with this book including: Jonathan Smith and Bobby
Bhartia for the new improved X-rays, Sue Harrison and Cathy Dickens at PasTest for all their help,
and Richard Young and Ryan Mathew for being such reliable and excellent contributing authors. Huge
thanks also to Cathy Parchment Smith for giving me the opportunity and encouragement and having
faith in me to work on her brilliant book.

Julia Massey

We would also like to acknowledge the contributions made by Claire Ritchie Chalmers and Karen
Flood to the previous edition of this book.
 PERMISSIONS
Images on the following pages have been reproduced by kind permission of The Wellcome
Photographic Library, London.
Chapter 3: 58, 63(T), 66(BR), 68(M), 69(L), 71(T), 73(T), 77, 97(TR&B), 105, 107(L), 111(R),
115(T&BL), 121, 127, 128, 129, 131, 132, 133, 137(BL&R), 142(TL&R), 143.
Chapter 4: 207, 209, 211, 212, 213, 217, 219(R), 220, 221(TL&R), 226, 235(L), 237, 264, 269,
271(T), 275(L), 277, 279, 280, 283, 289, 291, 293(B), 299(T),
Chapter 5: 403, 405(B), 429, 445, 455, 456, 458, 459, 461, 463, 465, 467, 469(TL&R), 471(TR),
483, 487, 499, 500, 507(R), 509.

The following figures in this book have been reproduced from ABC of Breast Disease, Dixon, 1st ed.,
1997 by kind permission of the publisher BMJ Books (Wiley/Blackwell).
Page 32 (see here)
Page 35 (see here)
Page 65 (see here)
Page 67 (see here)

The following figures in this book have been reproduced from ABC of Colorectal Diseases, Jones
DJ, 2nd ed., 1999 by kind permission of the publisher BMJ Books (Wiley Blackwell).
Fig. 20.2 Page 76 (see here, here)

The following figures in this book have been reproduced from ABC Urology, Dawson C and
Whitfield H, 1st ed., 1997 by kind permission of the publisher BMJ Books (Wiley/Blackwell).
Page 14 (see here)

The following figures in this book have been reproduced from The New Aird’s Companion in
Surgical Studies, Burnand K et al., 2nd ed., 1998 by kind permission of the publisher Churchill
Livingstone.
Fig. 11.18 Page 317 (see here)
Page 259 (see hereR,
Fig. 16.6a
hereBL)
Fig. 17.3 Page 305 (see here)
Fig. 17.20 Page 318 (see here)
Fig. 19.6 Page 419 (see here)
Fig. 25.13 Page 607 (see hereL)
Fig. 31a,b,c Page 741 (see here)
Fig. 49.5 Page 1356 (see here)
Fig. 49.11 Page 1360 (see here)

The following figures in this book have been reproduced from Concise System of Orthopaedics,
Apley 2nd edition, 1994, by kind permission of the publisher Elsevier Science Ltd.
Fig. 19.21 Page 192 (see here)
Fig. 1922 Page 191 (see here)
Page 193 (see
Fig. 19.24
here(T)
Fig. 20.15 Page 206 (see here)
Fig. 21.8 Page 216 (see here)
Fig. 24.10 Page 251 (see here)
Fig. 24.13. Page 254 (see here)
Fig. 30.4 Page 320 (see here)
Fig. 30.6, 30.6c Page 321 (see here)

The following figures in this book have been reproduced from An Introduction to the Symptoms and
Signs of Surgical Disease, N Browse, 3rd ed., (Arnold 1997) by kind permission of the publisher
Hodder Headline.
Page 39 (see hereB,
Fig. 2.7 A & B
here)
Fig. 3.4D Page 77 (see hereB)
Fig 3.5 Page 79 (see hereB)
Fig. 11.12 Page 258 (see hereL)
Fig. 11.5 Page 260 (see here)
Fig. 13.1 Page 311 (see here)
Fig. 16.19 Page 391 (see here)

The following figures in this book have been reproduced from Clinical Signs, Hayes C and Bell D,
new edition, 1996, by kind permission of the publisher Churchill Livingstone.
Page 60 (see here,
Figs. 87, 88, 89, 90
here)
Fig. 93 Page 62 (see here)
Fig. 104 Page 72 (see hereB)

The following figures in this book have been reproduced from Orthopaedics, Hooper, 2nd edition,
1997, by kind permission of the publisher Churchill Livingstone.
Fig. 127 Page 84 (see here)
Page 116 (see
Fig. 169
here)
Page 118 (see
Fig. 171, 172
here)
Page 128 (see
Fig. 184, 185
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 here)
Page 152 (see
Fig. 218, 219
here)

The following figures in this book have been reproduced from Surgery, Corson J and Williamson R,
1st ed., 1991 by kind permission of the publisher Mosby.
Page 7.30.7 (see here)
Fig. 6.7 Page 4.6.5 (see here)
Page 3.7.16 (see
Fig. 7.28
here)
Page 4.18.3 (see
Fig. 18.6b
here)
Page 4.18.4 (see
Fig. 18.8, 18.9
here)
Page 4.18.5 (see
Fig. 18.10, 18.11
here)

The following figures in this book have been reproduced from Clinical Anatomy for Medical
Students, Snell R, 6th ed. 2000 by kind permission of the publisher Lippincott Williams & Wilkins.
Fig. 3.27 Page 106 (see here)
Fig. 10.11 Page 527 (see here)
Page 536 (see
Fig. 10.18
hereB)

The following figures in this book have been reproduced from Picture Tests in Surgery, Stiff et al, 1st
edition, 1996, by kind permission of the publisher Churchill Livingstone.
Fig. 29A Page 17 (see here)
Fig. 54B Page 35 (see here)
Fig. 82B Page 54 (see hereR)
Fig. 86 Page 57 (see here)
Page 63 (see here,
Fig. 94A & B
here)
Fig. C Page 70 (see here)
Fig. 107 Page 74 (see hereB)
Fig. 141 Page 95 (see hereR)

The following figures in this book have been reproduced from Spot Diagnosis in General Surgery,
Ellis H, 2nd edition, by kind permission of the publisher Blackwell Science Ltd.
Fig.14. (see hereTL&R )
Fig. 30 (see here)
Fig. 32 (see hereT)
Fig. 37 (see here)
Fig. 79 (see hereR)
Fig. 85 (see here)
Fig. 86 (see here)
Fig. 101 (see hereT)
Fig. 102 (see here)
Page 107 (see
Figs. A, B
here)

The following figures in this book have been reproduced from An Aid to the MRCP Short Cases,
Ryder REJ et al, 1991, by kind permission of the publisher Blackwell Science Ltd
Page 141 (see
Fig. 3.4
here)
Fig. 3.15a Page 91 (see here)
Page 195 (see
Fig. 3.66a, b
here)
Page 221 (see
Fig. 3.82
here)

The following figures in this book have been reproduced from Clinical Anatomy, Ellis H, by kind
permission of the publisher Blackwell Science Ltd
Page 262 (see
Fig. 178a, b
here)
Page 287 (see
Fig. 190
here)

The following figure in this book has been reproduced from Oxford Handbook of Acute Medicine,
edited by Remrakha PS, and Moore KP, 1997, by kind permission of the publisher Oxford University
Press.
Insertion of a chest drain Page 87 (see here)

Every effort has been made to contact holders of copyright to obtain permission to reproduce
copyright material. However, if any have been inadvertently overlooked, the publisher will be
pleased to make the necessary arrangements at the first opportunity.
 CHAPTER 1
INTRODUCTION
A The Intercollegiate MRCS Examination

B Structure of the OSCE

C Candidate instructions for the OSCE

D How to prepare for the OSCE

E Survey of past candidates

F Focus of this book

A THE INTERCOLLEGIATE MRCS EXAMINATION
From September 2008 the Intercollegiate MRCS examination has altered in order to reflect the new
pattern of surgical training introduced in the UK in 2007. All new candidates must take this new
exam.

The exam consists of two parts:

• Part A – written component

This consists of two papers of multiple choice Single Best Answer and Extended Matching Items.
Paper 1 focuses on Applied Basic Science and Paper 2 on Principles of Surgery-in-General. Each
paper lasts 2 hours and both are taken on the same day.
• Part B – OSCE (objective structured clinical examination)
This replaces the previously separate viva and clinical components and has been introduced in
order for the MRCS to conform to PMETB (Postgraduate Medical Education Training Board)
requirements.

To be eligible to apply for part B you must have passed part A. Candidates are currently allowed four
attempts in which to pass the Part B OSCE.
B STRUCTURE OF THE OSCE
This is currently under regular review and, as such, the exact details of the examination might change.
It is important to keep up to date by checking the website http://www.intercollegiatemrcs.org.uk.
From May 2010 the exam regulations state:

• There will be 18 examined stations

• There will be 4 broad content areas
• There will be 4 domains
• 3 out of 4 specialties context stations must be chosen
• Domains will not be pass/fail but used to structure the exam and feedback

There may also be one or more ‘preparation’ stations and one ‘pre-test’ station. These will not
contribute towards the final mark.

The OSCE consists of 18 examined stations and one or more rest/preparation stations. There may
also be one ‘pre-test’ station. Each of the 18 examined stations are manned, some with two examiners
and some with one.

The MRCS remains an examination for trainees in the generality part of their surgical training.
However, in order to reflect new patterns of specialty training, six of the stations are specialty-
orientated and 12 are generic.

Each station lasts 9 minutes and there will usually be four rest stations which means the total exam
will last approximately 3 hours and 30 minutes.

The stations are divided into four broad content areas:

• Anatomy and surgical pathology

• Applied surgical science and critical care
• Communication skills in giving and receiving information and history taking
• Clinical and procedural skills

Specialty-orientated stations
There are six stations which are specialty-orientated. These stations are in the following content
areas:

• Anatomy and surgical pathology (1 station)

• Communication skills (history-taking) (2 stations)
• Clinical and procedural skills (physical examination) (3 stations)

On the application form for the exam candidates are asked to specify their choice of a main specialty
area which will be the focus of the anatomy and surgical pathology station, one of the two history-
taking stations and one of the three physical examination stations. The second, different specialty will
be the focus of the other of the two history-taking stations and one of the three physical examination
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