To My Dear IMT colleagues who did not get the results they wanted yesterday for Part 1
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First of all, I just want to say that you have done extremely well to revise and sit the exam whilst being an IMT1, it is extremely stressful and difficult, and just remember that many people have taken time out, particularly those in other countries. It is really not easy to study for an exam like this while working on an IMT on-call rota, and you should be extremely proud of how you've done.
Secondly, you should reflect on your preparation attempt because you need to really understand what you have done and where the gaps are. Doing several past papers and achieving the pass mark but not reviewing where your mistakes were, and honing in on these, is less valuable than doing one or two past papers or even just the sample questions on the official RCP website and really trying to identify high-yield areas where you made mistakes.
Thirdly, just to reassure you: the IMT1 ARCP, while you should take it extremely seriously, is far more flexible than most ARCPs because there is no critical progression point to overcome. Additionally, as I mentioned earlier, working on the IMT rota is not easy, and you'll be extremely surprised to know there are several IMT3 and beyond medical registrars who have not even passed Part 1, it is now possible to complete IMT training without completing the MRCP exams. If you did this, you would get a non-standard ARCP outcome, and yes, you would not be able to enter ST3 or above without the exams, by all means take the exam seriously, they are important, but do not put so much pressure on yourself, particularly during IMT1, as this will not stop your progression to IMT2.
Reassure yourself that performance in the exam is not correlated to your self-worth and your competency as a doctor (I know that's slightly paradoxical, as exam performance is part of the competencies assessed for the ARCP). There are many incredible doctors who have failed this exam many, many times. The two examples that come to my mind: one colleague of mine failed so many times that they went over the six-attempt limit and had to obtain a letter of good standing and recommendation in order to be allowed to sit again, they are now universally understood to be one of the best consultants in their specialty, and many people are even aware of the history of the previous attempts, and it is nothing more than a passing joke. Another colleague of mine failed Part 1 multiple times, had no exams, and entered IMT2, and was teased by all their junior colleagues, who were F1s and F2s, with comments like "why should we listen to an IMT2 who doesn't have any exams?" This colleague has not only passed Part 1 and Part 2, but has stepped up as a medical registrar while still being an IMT2, and most recently, during one of their shifts as the on-call medical registrar, they saved a patient's life with a life-threatening tension pneumothorax, when none of the other, more senior colleagues around them (including an ITU and an anaesthetics registrar) attempted any form of chest drain. So you should also be aware the opposite is true: there are several colleagues who passed the exam on the first attempt and are not as competent clinically.
I'm not sharing these stories to belittle other colleagues. Studying for exams and practising as a holistic and thorough clinician in an extremely overwhelmed system like the NHS are completely different skill sets.
I don't know how old you are or your background, where you graduated from, etc., but just know that IMT training is extremely brutal, and the exams are just the icing on top.
So you need to really understand how to revise and prepare for them whilst also balancing your own life, which may be a new skill for you, or a skill set you have to thoroughly review and adapt.
Many people who passed university exams by preparing through Passmedicine (a great website, by the way) feel they should do exactly the same thing when preparing for these exams during training on-call rotas, doing 10,000 questions in the question bank before the exam. This is completely unrealistic given your situation as a trainee, and may actually be a very counterproductive way to learn.
Putting this all together: people will give you surface-level advice like "just do the questions this many times and you'll pass," but I would strongly encourage you to reflect on your scores, analyse your performance, and compare this to your preparation.
Be honest with yourself too, because remember the official performance feedback you receive for this exam is limited. For example, if you guessed the answer to a random question and happened to get it right, you may have scored "100%" for a specialty like "ophthalmology" , you need to be honest with yourself, compare this to your preparation, and ask yourself whether you actually feel 100% confident in that area.
What worked for several of my colleagues who struggled with Part 1 multiple times, particularly with demanding on-call rotas and family commitments, was an extremely laser-focused preparation, which consisted of the following:
- *Doing no more than the last four to five years of past papers*. While doing more questions will improve your exposure to new topics, guidelines change significantly over time, and looking at past papers from 2014 is unlikely to help you when you're already pushed for time. If you're really struggling for time, only do the last 10 papers starting from the most recent year and diet.
- *Categorise your errors*. When you complete a past paper, don't just look at the breakdown by correct vs. incorrect or by specialty. Go question by question and analyse the category of mistake: was it a silly mistake, did you misread the final question stem (some questions have a long stem but a negative final question e.g. "which of the following is least likely a side effect"), was it a knowledge gap, or, if it was a maths question, at what step did you actually go wrong? Do this for questions you got right too, because sometimes your logic was wrong even though you got the right answer, and you need to catch that early before the pattern cements. Also account for lucky guesses.
- Before answering, *understand what concept they're testing*. There are repeated concepts across the MRCP curriculum, e.g. differentiating specific kidney diseases, or mechanisms of action of specific medications. Once you understand this, you can eliminate wrong answers much faster. For example, you'll notice some questions give answers that are logical opposites (e.g. SIADH and diabetes insipidus appearing as options in the same question) that's a clue you need to understand which concept the question is actually testing.
- *Evaluate all options in direct response to the question stem*. There's usually a specific concept or focus to the question, and sometimes every option is technically a reasonable response or not incorrect, but if you revisit the stem, it's asking something specific, like "most immediate management," "most definitive investigation," or "most likely to yield the diagnosis." These phrasings are subtly different, and with the same stem and same options, the correct answer can change entirely depending on the exact question being asked.
- *Group things together*. Rote-learning the side effects of every medication in pharmacology tends to fail. Instead, group them, e.g. learn the side effects of each anti-epileptic and compare/contrast them, and you'll remember them far better.
- *Identify your biggest high-yield gaps early*. We all have gaps somewhere, maybe from being ill during a topic at university, your university not covering it, never enjoying a topic, or never having a rotation in a high-yield specialty like cardiology, respiratory, or gastroenterology. Focus on the areas dragging your score down.
- *Be patient with yourself*. Some days you'll struggle to do many questions; your scores will go up and down and progress will feel slow, that's part of the process. Many candidates don't see a real jump until the last few weeks, or even days.
- *The RCP sample questions are criminally undervalued*. Past papers are important, but remember they're reconstructed from candidates' memories, the exact answers and explanations may not be fully accurate, since they don't come from the RCP itself. Dedicate real time to the RCP's own sample questions, because not only are they the most representative of the real exam, they also show you the explanation and the line of reasoning the examiners want. For example, some stems are deliberately vague, and the explanation will simply say something like "X type of cancer is the most common, and in the absence of further information this is the most likely answer." There are also spot-diagnosis stems that recur across multiple MRCP questions, which are clearly shown in the RCP sample questions.
I appreciate this is an extremely long response, but I find more and more people are struggling to pass these exams as the years go on, particularly with challenging on-call rotas, and I wanted to give you the best possible advice combining my own experience and that of close colleagues, so you can go into the next exam with the best preparation possible.