MRCP UK — Complete Exam Preparation Guide
The Membership of the Royal Colleges of Physicians (MRCP UK) is the gateway to specialty training in internal medicine across the United Kingdom. This guide covers Part 1, Part 2, and PACES — exam format, eligibility, subject weighting, preparation strategy, costs, and career implications.
What Is MRCP UK?
MRCP(UK) — Membership of the Royal Colleges of Physicians of the United Kingdom — is a postgraduate medical examination jointly administered by the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow.
MRCP is the standard postgraduate qualification for doctors pursuing a career in internal medicine and its subspecialties in the UK. It is a prerequisite for entry into most medical specialty training programmes at the registrar (ST3+) level and is required during Internal Medicine Training (IMT).
The examination consists of three parts: Part 1 (written), Part 2 (written), and PACES (clinical). All three must be passed to obtain full MRCP(UK) membership. The exam is internationally recognised and taken by doctors worldwide.
MRCP Part 1 — Written Examination
MRCP Part 1 is a knowledge-based written examination that tests the breadth of medical knowledge expected of a physician at the end of core medical training. It covers basic science as applied to clinical medicine, common medical conditions, acute presentations, and the principles of investigation and management.
Format
Two papers, each containing 100 best-of-five MCQs
Duration
3 hours per paper (6 hours total, same day)
Pass Mark
Variable (norm-referenced, Angoff standard-setting method)
Cost
Approximately GBP 468 (UK), higher at overseas centres
Frequency
3 diets per year — typically January, May, September
Validity
Part 1 pass valid for 7 years
Negative Marking
No negative marking
Centres
UK and international centres worldwide
Question Format
Each question presents a clinical scenario followed by five possible answers. You must select the single best answer. Unlike some other medical exams, there is no negative marking — you are not penalised for incorrect answers, so you should attempt every question.
Questions span all medical specialties but are weighted toward the conditions most commonly encountered in general internal medicine. Basic science questions are tested in the clinical context (e.g., pharmacokinetics through a prescribing scenario, immunology through a clinical presentation), not as standalone recall questions.
MRCP Part 2 — Written Examination
MRCP Part 2 is a more clinically applied written examination that builds on Part 1 knowledge. It tests the ability to interpret clinical data, manage patients, and make decisions in complex clinical scenarios. The questions are more integrated and often require synthesis of information from multiple domains.
Format
Two papers, each containing 100 best-of-five MCQs
Duration
3 hours per paper (6 hours total, same day)
Pass Mark
Variable (norm-referenced)
Cost
Approximately GBP 468 (UK), higher overseas
Frequency
3 diets per year — typically January, May, September
Prerequisite
Must have passed MRCP Part 1
Negative Marking
No negative marking
Content
More clinical, data interpretation, imaging, ECG
How Part 2 Differs from Part 1
Part 2 questions assume Part 1 knowledge and test clinical decision-making at a higher level. Key differences include: more emphasis on investigation interpretation (blood results, imaging, ECGs, histopathology), more complex multi-step clinical scenarios, questions on management including follow-up and monitoring, and greater use of clinical photographs and data presentations.
Candidates often find Part 2 more challenging than Part 1 because of its clinical depth. Active clinical experience alongside study is a significant advantage, as many questions are best answered by doctors who have managed similar patients in practice.
PACES — Practical Assessment of Clinical Examination Skills
PACES is the clinical examination component of MRCP(UK). It assesses your ability to take a history, examine patients, communicate effectively, and demonstrate the clinical skills expected of a physician at the point of entry into higher specialty training. PACES uses a carousel format with five stations and eight patient encounters in total.
Format
5 stations, 8 patient encounters (carousel)
Total Duration
Approximately 2 hours
Pass Mark
Station-specific and overall (norm-referenced)
Cost (UK)
Approximately GBP 720
Cost (Overseas)
Approximately GBP 1,100–1,400
Maximum Attempts
6 attempts
Prerequisite
Must have passed MRCP Part 2
Centres
UK hospitals and selected international centres
The Five PACES Stations
Station 1: Respiratory & Abdominal
Two encounters (10 minutes each): one respiratory examination and one abdominal examination on real patients. You must demonstrate systematic clinical examination technique, identify physical signs, formulate a differential diagnosis, and discuss investigation and management.
Station 2: History Taking
One encounter (20 minutes): take a focused history from a patient (or simulated patient) presenting with a clinical problem. You are assessed on your ability to gather relevant information, form a differential diagnosis, and discuss your management plan with the examiner.
Station 3: Cardiovascular & Neurological
Two encounters (10 minutes each): one cardiovascular examination and one neurological examination. These stations test your ability to perform systematic examinations and correctly identify clinical signs in these two major systems.
Station 4: Communication Skills & Ethics
One encounter (20 minutes): a communication scenario involving a patient or relative. Scenarios may include breaking bad news, discussing treatment options, addressing complaints, consent discussions, end-of-life conversations, or managing ethical dilemmas.
Station 5: Integrated Clinical Assessment
Two brief encounters (10 minutes each): one focused on skin, locomotor, eyes, or endocrine examination, and one involving a clinical scenario requiring data interpretation (e.g., radiology, ECG, blood results) combined with communication. This station tests integration of examination findings with clinical reasoning.
PACES Marking
Each encounter is marked independently by two examiners using seven clinical skills: physical examination, identifying physical signs, clinical communication, differential diagnosis, clinical judgement, managing patient concerns, and maintaining patient welfare. You receive a mark for each skill at each encounter. The overall pass/fail decision combines station-level and skill-level performance. You must demonstrate competence across all domains — excellence in one area cannot compensate for significant weakness in another.
Eligibility
To sit MRCP Part 1, you must have a primary medical qualification and a minimum of 12 months of postgraduate clinical experience (from the date of graduation to the date of the examination). You do not need to be registered with the GMC to take the written examinations, though GMC registration is required for PACES in the UK and for subsequent clinical work.
The 12-month requirement refers to any postgraduate medical experience — it does not need to be in the UK. Doctors working in any country can sit the MRCP examinations at international centres.
For UK-Based Doctors
Foundation doctors can sit MRCP Part 1 from FY1 onwards (provided they have 12 months post-qualification experience by the exam date). Many FY2 doctors and IMT trainees sit Part 1 and Part 2 during their training. PACES is typically taken during IMT (Internal Medicine Training). Full MRCP is usually required by the end of IMT3 to progress to higher specialty training.
For International Doctors
Doctors from any country with a recognised primary medical qualification and 12 months of postgraduate experience can sit MRCP Part 1 and Part 2 at international centres. PACES can be taken at approved overseas centres or in the UK (GMC registration may be required for UK PACES centres). Many international doctors sit MRCP before or alongside PLAB as part of their pathway to UK practice. MRCP can also serve as an alternative to PLAB for GMC registration in some circumstances.
Career Implications
MRCP(UK) is more than an exam — it is the qualification that opens the door to medical specialty training in the UK. Here is how it fits into the medical career pathway:
Internal Medicine Training (IMT)
MRCP Part 1 is a requirement for entry into IMT. Full MRCP (including PACES) is required by the end of IMT3 to progress to specialty registrar training. IMT replaced Core Medical Training (CMT) in 2019.
Specialty Training (ST3+)
Most medical specialties (cardiology, gastroenterology, respiratory, neurology, endocrinology, nephrology, rheumatology, haematology, geriatrics, acute medicine, etc.) require full MRCP for entry at the ST3 level. It is a hard requirement, not a desirable criterion — you cannot apply without it.
Portfolio and Applications
Having MRCP demonstrates postgraduate competence and is scored in specialty training applications (Oriel). Earlier completion gives you more time to build your portfolio before applications. Some candidates pass all three parts by FY2 or IMT1, giving them a competitive advantage.
International Recognition
MRCP(UK) is recognised in over 50 countries. It is valued in the Middle East, South Asia, Southeast Asia, Africa, and Australasia. Many countries accept MRCP for specialist registration or as exemption from local postgraduate exams. Some Gulf Cooperation Council (GCC) countries specifically require or prefer MRCP for medical recruitment.
Subject Weighting
MRCP covers the full breadth of general internal medicine and its subspecialties. While MRCP(UK) does not publish exact question percentages per specialty, the following weighting reflects the relative emphasis across Part 1 and Part 2 based on the published MRCP curriculum and candidate experience.
| Specialty | Weighting |
|---|---|
| Cardiology | High |
| Gastroenterology & Hepatology | High |
| Respiratory Medicine | High |
| Neurology | High |
| Endocrinology & Diabetes | High |
| Nephrology | Medium |
| Rheumatology | Medium |
| Haematology | Medium |
| Infectious Diseases | Medium |
| Clinical Pharmacology & Therapeutics | Medium |
| Dermatology | Standard |
| Ophthalmology | Standard |
| Psychiatry | Standard |
| Geriatric Medicine | Standard |
| Oncology | Standard |
Weightings are approximate and reflect the relative emphasis across MRCP examinations. The MRCP(UK) curriculum is the definitive reference for exam content.
Study Strategy
MRCP Part 1 — 6 to 12 Months
Months 1–3 (Foundation): Cover the high-weightage specialties systematically — cardiology, gastroenterology, respiratory, neurology, and endocrinology. Use a combination of a comprehensive textbook (such as Kumar & Clark or Oxford Handbook of Clinical Medicine) and a question bank. Aim for 30–50 questions per day alongside reading.
Months 4–6 (Breadth): Cover the remaining specialties — nephrology, rheumatology, haematology, infectious diseases, pharmacology, dermatology, ophthalmology, psychiatry, and geriatrics. Increase question bank practice to 50–80 per day. Begin noting recurring themes and commonly tested facts.
Months 7–9 (Revision, if applicable): For those taking a longer preparation approach, this period is for complete revision cycles. Take full-length mock papers (200 questions, 6 hours) to build exam stamina. Focus on weak areas identified through question bank analytics.
Final 2–4 weeks: Intensive revision of high-yield topics, commonly tested facts, and any remaining weak areas. Take at least 2–3 full mock papers under timed conditions. Review incorrect answers thoroughly. Focus on areas where marks are most easily gained.
MRCP Part 2 — 3 to 6 Months After Part 1
Data interpretation: Practise interpreting blood results, ABGs, imaging, ECGs, and clinical photographs. Part 2 relies heavily on your ability to synthesise clinical data into management decisions.
Clinical application: Focus on management pathways, treatment algorithms, and follow-up planning. Questions often test what you would do next, not just the diagnosis.
Guidelines: Familiarise yourself with UK-specific clinical guidelines (NICE, SIGN, BTS, BSG, BHIVA, etc.). Many Part 2 answers follow guideline-based management.
PACES — 3 to 6 Months of Clinical Practice
Clinical examination: Practise systematic examination of cardiovascular, respiratory, abdominal, and neurological systems on real patients. Ideally, examine multiple patients per week with a senior colleague or study partner providing feedback.
History taking: Practise structured histories for common presenting complaints. Focus on clear, empathetic communication with appropriate differential diagnosis formulation.
Communication skills: Rehearse difficult conversations — breaking bad news, discussing withdrawal of treatment, explaining complex diagnoses, managing angry or distressed patients. Use a structured framework (e.g., SPIKES for breaking bad news).
Courses: Consider attending a PACES preparation course. Many Royal Colleges, deaneries, and teaching hospitals run these. They provide access to real patients with clinical signs, examiner feedback, and group practice sessions.
How MedNext Academy Helps You Prepare
MedNext Academy covers the clinical knowledge base tested across all three parts of MRCP, with structured learning designed for postgraduate-level exam preparation:
1,853 Curriculum Topics
Comprehensive coverage across all MRCP subject areas — cardiology, gastroenterology, respiratory, neurology, endocrinology, nephrology, rheumatology, haematology, infectious diseases, pharmacology, and more.
Best-of-Five MCQ Practice
Thousands of questions in the MRCP format (best-of-five, single best answer) with detailed explanations for every option. Organised by specialty and topic for targeted practice.
Clinical Image Library
3,000+ annotated clinical images across radiology, pathology, dermatology, and clinical medicine — essential for MRCP Part 2 data interpretation questions.
AI Viva Coach
Simulates clinical encounters with follow-up questioning. Practise clinical reasoning, history taking, and communication — skills tested directly in PACES.
OSCE Practice Mode
Structured clinical examination practice for history taking, examination, and communication stations — directly relevant to PACES preparation.
Case-Based Learning
Clinical case studies that develop the diagnostic reasoning and management planning skills tested in Part 2 and PACES.
Quick Revision Notes
Concise, exam-focused revision notes for every topic — designed for efficient final-phase revision before each exam diet.
Progress Tracking
Performance analytics show your strengths and weaknesses by specialty and topic, so you can direct your study time where it will have the most impact on your score.
Frequently Asked Questions
What is the difference between MRCP Part 1 and Part 2?
MRCP Part 1 tests breadth of medical knowledge across all specialties using best-of-five MCQs. It covers basic science as applied to clinical medicine, common conditions, and emergency management. MRCP Part 2 builds on this with more clinical and applied questions, including data interpretation, ECGs, radiology, and clinical photographs. Part 2 assumes you have Part 1 knowledge and tests clinical decision-making at a higher level.
How much does MRCP cost in total?
The total cost for all three parts is approximately GBP 1,650–2,150 (UK candidates). MRCP Part 1 costs approximately GBP 468, Part 2 approximately GBP 468, and PACES approximately GBP 720 in the UK (higher at overseas centres, approximately GBP 1,100–1,400). These fees are set by MRCP(UK) and are revised periodically. Additional costs include study materials, courses, and travel. Fees for overseas candidates at international centres are higher than UK fees.
How many times a year can I sit MRCP exams?
MRCP Part 1 and Part 2 are each held three times per year, referred to as 'diets' — typically in January, May, and September (Part 1) and January, May, and September (Part 2). PACES is held at multiple centres throughout the year with varying dates. Exact dates are published on the MRCP(UK) website each year.
Is there a limit on the number of attempts?
There is no fixed limit on the number of attempts for MRCP Part 1 or Part 2. However, there are rules about the time between attempts and the overall validity of results. Your Part 1 pass is valid for 7 years — you must pass Part 2 within this window. For PACES, you have a maximum of 6 attempts. Check the MRCP(UK) regulations for the most current rules on attempt limits and intervals.
Do I need to pass MRCP to get into specialty training?
For most medical specialties in the UK, passing MRCP (all three parts) is either a requirement or strongly desirable for entry into specialty training at the ST3 level or above. For Internal Medicine Training (IMT), MRCP Part 1 is required for entry. Full MRCP (including PACES) is typically required by the end of IMT to progress to higher specialty training. Specific requirements vary by specialty and deanery.
Can I sit MRCP from overseas?
Yes. MRCP Part 1 and Part 2 written examinations are available at international test centres across the world, including centres in India, Pakistan, Bangladesh, Sri Lanka, the Middle East, Africa, and Southeast Asia. PACES is held at selected overseas centres in addition to UK centres. Overseas exam fees are typically higher than UK fees.
What is the pass rate for MRCP exams?
Pass rates vary by diet and are published by MRCP(UK) after each examination. Historically, Part 1 pass rates range from approximately 40% to 55%, Part 2 from approximately 50% to 65%, and PACES from approximately 45% to 55%. The pass mark is determined using a norm-referenced standard-setting method (Angoff method), meaning it adjusts based on question difficulty. These figures are approximate and vary between UK and international candidates.
How long should I study for MRCP Part 1?
Most candidates study for 6 to 12 months for MRCP Part 1, depending on their clinical experience and study time available. Those in active clinical practice may find 6 months sufficient if studying consistently alongside work. Candidates who are further from medical school or have less clinical exposure typically benefit from a longer preparation period. Consistent daily study (1–2 hours) with regular question bank practice is more effective than intensive last-minute cramming.
What is the best way to prepare for PACES?
PACES preparation requires hands-on clinical practice, not just reading. The most effective strategies are: (1) regular bedside teaching and clinical examination practice with a senior colleague or study partner, (2) attending PACES preparation courses (many hospitals and Royal Colleges run these), (3) practising communication scenarios with feedback, and (4) examining as many real patients as possible to build pattern recognition for clinical signs. Reading alone is insufficient — PACES tests what you can do at the bedside.
Is MRCP recognised outside the UK?
Yes. MRCP(UK) is widely recognised internationally, particularly in Commonwealth countries, the Middle East, and parts of Asia and Africa. Many countries accept MRCP as a postgraduate medical qualification for specialist registration or as exemption from local postgraduate exams. However, recognition varies by country and regulatory body. Always check with the relevant medical council in the country where you intend to practise.
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Go to MedNext AcademyDisclaimer: The information on this page is provided for educational and informational purposes only. MRCP exam format, fees, eligibility criteria, and regulations are subject to change by MRCP(UK) and the Royal Colleges of Physicians. Always refer to the official MRCP(UK) website (mrcpuk.org) for the most current and authoritative information. MedNext is not affiliated with the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh, or the Royal College of Physicians and Surgeons of Glasgow. Fees, pass rates, and regulations quoted are based on publicly available information and may have changed since publication.