INTERCOLLEGIATE MRCS

INTERCOLLEGIATE MRCS EXAMINATION SYLLABUS May 2004

The Royal College of Surgeons of Edinburgh

The Royal College of Surgeons of England

The Royal College of Surgeons and Physicians of Glasgow

The Royal College of Surgeons in Ireland

Whilst every effort has been made to ensure the accuracy of the information contained in this publication, no guarantee can be given that all errors and omissions have been excluded. No responsibility for loss occasioned to any person acting or refraining from action as a result of the material in this publication can be accepted by The

Royal Colleges of Surgeons. First published May 2004

Contents

A. Introduction.

B. Generic Knowledge......................................................................................... 7

C. Generic Clinical Section...............................................................................12

D. Outline Syllabus .............................................................................................14

D1 Basic Sciences .........................................................................................14

D2 Principles of Surgery-in-General.........................................................15

D3 Surgical Specialties................................................................................20

E. Main Syllabus .................................................................................................30

E1 Basic Sciences:

Applied Surgical Anatomy....................................................................30

Physiology ...............................................................................................38

- General Physiology ...........................................................................39

- System Specific Physiology ............................................................40

Pathology .................................................................................................42

- General Pathology.............................................................................43

- System Specific Pathology ..............................................................46

E2 Principles of Surgery-in-General.........................................................49

E3 Surgical Specialities:

Cardiothoracic.........................................................................................60

General Surgery ......................................................................................62

Oral and Maxillofacial Surgery ............................................................71

Neurosurgery...........................................................................................72

Otorhinolaryngology and Neck Surgery..............................................74

Paediatric Surgery ..................................................................................76

Plastic and Reconstructive Surgery......................................................78

Trauma and Orthopaedic Surgery ........................................................79

Urology ....................................................................................................82

E4 Communication Skills ............................................................................84

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A. Introduction

The syllabus for the examination fully integrates basic science and clinical

knowledge. It has been agreed by, and is common to, the Surgical Royal Colleges of

Great Britain and Ireland.

The aim of the syllabus is to set out for candidates a comprehensive description of the

breadth and depth of the knowledge, skills and attributes expected of them. The

syllabus thus provides a framework around which a programme of preparation and

revision can be structured. It also sets out the areas in which candidates will be

examined.

It should be noted that a syllabus is not the same as a full curriculum, which would

consist of a structured educational programme designed to prepare learners for a

professional role or examination. (The full curriculum for surgical SHO training will

be published separately.) Nor does it set out a test specification, which would define

the frequency with which each element of the syllabus would appear in the

examination and the weighting that it would carry.

The examination is set at the level appropriate for exit from Basic Surgical Training

and for entry to any specialty within Higher Surgical Training.

The syllabus will be constantly revised and updated. The examination will not

normally test areas that are not explicitly or implicitly included in the syllabus, but it

should be noted that research and changes in the medical environment might

sometimes lead to changes in scientific theory and clinical practice before the syllabus

is updated to reflect them. Candidates will be expected to keep abreast of such

developments by reading the appropriate literature. Topics set out in the syllabus will

be widely sampled in every sitting of the examination, but each topic will not be

tested on every occasion.

The syllabus reflects the division in the examination between basic science and

clinical knowledge/skills, but the basic sciences and clinical knowledge should be

seen as a continuum, with the basic sciences being used as a foundation for clinical

knowledge. The syllabus adopts a systems-based approach. It has a separate section

covering knowledge required for Part 1, the MCQ papers on Applied Basic Sciences,

but aspects of this are repeated where appropriate in the rest of the syllabus, principles

of surgery- in-general and surgical specialities. The syllabus makes explicit where

necessary what knowledge is not required as well as what is needed.

Regional anatomical knowledge of the human body is considered an essential part of

the knowledge base required for safe surgery. Lack of such knowledge can have

serious consequences for patient safety. It provides the important spatial foundation

for understanding pathological processes, for performing clinical examination, for

interpreting radiological and other investigations and for performing all operative

procedures, whether investigative or therapeutic. The anatomical knowledge required

to pass this examination encompasses both basic regional anatomy of the whole body,

typically learnt at undergraduate level, and general surgical anatomy of the whole

body. Examples of the latter include the surgical anatomy of varicose veins or the

thyroid gland. Specialist surgical anatomy of relevant regions such as the detailed

Page 5

anatomy of the temporal bone and the spatial anatomy of the knee joint relevant to

arthroscopy is examined during Higher Surgical Training.

The syllabus is based upon the intercollegiate curriculum but also draws upon the

precepts contained in the General Medical Council’s publications Good Medical

Practice (2001) and Duties of a Doctor (1995), and the Royal College of Surgeons of

England’s publication Good Surgical Practice (2002). Candidates should be familiar

with these publications.

The College would also like to acknowledge the use allowed by the Royal College of

General Practitioners of some generic material from its publication Good Medical

Practice for General Practitioners.

In addition to knowledge of the applied basic sciences relevant to surgery and clinical

knowledge, the MRCS examination aims to assess:

· Good clinical care

· Maintaining good medical practice

· Relationships with patients

· Working with colleagues

· Probity

· Health

Topic Grids

The content of the syllabus is given both as a list and as a series of grids. Each

individual topic in the syllabus that can be assessed is listed within a grid that

indicates, by means of horizontal shading, in which part of the examination it can be

tested and the level of knowledge that is expected. The aim of the grids is to provide

assistance to candidates and examiners by:

· allowing candidates to gain an idea of the level of knowledge they require for each

topic and hence its relative importance. This will be particularly valuable in the

clinical examinations for candidates who have not had a job in a particular

specialty.

· allowing candidates to focus their revision by setting out clearly the topics that will

be covered. Candidates will also be able to see what areas do not need to be

revised.

· giving the examiners who are writing and asking questions the basis of a blueprint

for question selection and clear guidance on what topics can be asked at what level.

· giving examiners clear guidance on the scope and level allowable in asking on

particular topics within specialties, and thus contributing to the uniform standard of

the examination.

· giving the internal and external Quality Assurance bodies and the Postgraduate

Medical Education and Training Board an authoritative guide to the standard at

which questions will be asked.

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The levels specified within the grids relate only to knowledge and understanding and

their application and thus give an indication of the relative importance of the topics.

The levels do not indicate the level of practical skills expected, e.g. examination

technique in the clinical section.

Candidates should note that topics to be examined may be listed in either principles of

surgery- in-general, the specialty specific or the basic science grids, or in more than

one of these.

Level 1

A basic knowledge and understanding that does not go much beyond bookwork and

general reading. At this level there is only an elementary linkage of cause and effects

between basic sciences and clinical conditions.

Level 2

Deeper knowledge and understanding that allows links and cause and effect to be

demonstrated. At this level there is an expectation of a basic ability to define

conditions and outline principles of management and the process of diseases.

Level 3

In depth knowledge and understanding that can, where appropriate, be applied to

clinical situations. At this level there is an expectation of an ability to synthesize

information to draw appropriate conclusions, to explain complex conditions and

processes, to make diagnoses and to discuss conclusions and management in detail. It

is also expected that candidates' grasp of subject matter would be sufficient to enable

them to justify their conclusions and suggest alternative approaches or explanations.

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B. Generic Knowledge

Understanding of the following generic areas, based on the General Medical

Council’s publication Good Medical Practice, is expected and may be assessed in the

examination.

1. Good clinical care

· Elucidating and evaluating a patient’s condition, based on information

gathering (history and symptoms) and, when necessary, clinical examination

(interpreting signs) and appropriate procedural skills and/or special tests.

· Demonstrating the ability to make competent clinical decisions (diagnoses)

and selection of appropriate investigation and/or treatment and knowing when

no investigation or treatment is indicated.

· Employing sound skill-based clinical judge ment to assess the seriousness of an

illness in order to prioritise care.

· Respecting the autonomy of patients as partners in medical decision-making.

· Recognising and working within the limits of one’s professional competence,

showing a willingness to consult with colleagues, and where appropriate

delegating or referring care to those who are recognised as competent.

· Performing consistently well.

· Practising ethically.

2. Maintaining good medical practice

Patient care

· Treating the patient as an individual.

· Integrating information on physical, psychological and social factors that

impact on patients. Demonstrating awareness of individual and family

psycho-dynamics and their interaction with health and illness.

· Demonstrating an appropriately focussed assessment of a patient’s condition

based on the history, clinical signs and examination.

Clinical issues

· Managing uncertainty, unpredictability and paradox by displaying an ability to

evaluate undifferentiated and complex problems (at a level appropriate to this

Diploma).

· Applying and being able to justify the practice of contextual evidence-based

medicine.

· Demonstrating the appropriate use of equipment routinely used and a

familiarity with the breadth of tests offered in secondary care.

Managing oneself and working with others

· Recognising and working within the limits of one’s professional competence.

· Possessing self-insight sufficient to identify one’s own strengths and

weaknesses

Page 8

· Managing time and workload effectively and showing an ability to cope with

pressure.

· Showing a flexibility of approach according to the different needs of a wide

variety of patients, irrespective of their age, cultural, religious or ethnic

background, their sexual orientation or any other special needs.

· Having an ability to work effectively in a team, either as a member or leader,

accepting the principles of collective responsibility, and consulting colleagues

when appropriate.

· Having knowledge of support systems.

3. Relationships with patients

· Empowering patients to make informed choices.

· Respecting patients as competent and equal partners with different areas of

expertise.

· Respecting the patients’ perception of their experience of their illness (health

beliefs).

· Acknowledging and integrating the patients’ ideas, concerns and expectations,

especially with regard to the nature of their complaint.

· Showing an interest in patients, being attentive to their problems, treating

them politely and considerately and demonstrating listening skills.

· Establishing rapport with the patient. Effectively developing relationships

with patients, especially by being empathic and sympathetic.

· Communicating and articulating with patients effectively, clearly, fluently and

framing content at an appropriate level, including in written communications.

· Involving patients’ significant others such as their next of kin or carer, when

appropriate, in a consultation.

· Sensitively minimising any potentially humiliating physical or psychological

exposure by respecting patients’ dignity, privacy and modesty.

4. Population, preventive and societal issues

· Understanding the contemporary compact with patients and the rights and

responsibilities of Government, the medical profession and the public.

· Demonstrating an understanding of demographic and epidemiological issues

and the health needs of special groups.

· Demonstrating an awareness of socio-political dimensions of health, for

example, health care systems, strategy and funding.

· Possessing knowledge of population-based preventive strategies including

immunisation and population screening. Having knowledge of contemporary

screening and recall systems.

· Understanding the acceptable criteria for screening for disease, and applying

the concepts of prevention.

Page 9

5. Professional, ethical and legal obligations

· Understanding the importance of and demonstrating possession of the

appropriate professional values and attitudes, including consistency,

accountability, and respect for the dignity, privacy and rights of patients and

concern for their relatives.

· Showing knowledge of and adhering to contemporary ethical principles.

· Observing and keeping up to date with the laws and statutory codes governing

otolaryngological practice.

· Respecting the principle of confidentiality; and, when passing on information

without a patient’s consent, being able to justify the decision.

· Understanding the importance of, and demonstrating a commitment to,

maintaining professional integrity, standards and responsibility.

· Ensuring that, whenever possible, the patient has understood what treatment or

investigation is proposed and what may result, and has given informed consent

before it is carried out.

· Demonstrating knowledge of the guidelines for the treatment of patients under

16 years of age, with or without the consent of those with parental

responsibility.

· Demonstrating knowledge of issues relating to clinical responsibility, e.g. with

regard to drug treatment.

· Showing awareness of the ‘good Samaritan’ principle, i.e. offering to anyone

at risk treatment that could reasonably be expected.

· Demonstrating knowledge of safe practice and methods in the working

environment - relating to biological, chemical, physical or psychological

hazards - which conform to health and safety legislation.

· Understanding and applying the main areas of relevant legislation, including

human rights, equal opportunities, disability, employment, data protection,

access to medical reports, consumer protection, health and safety, children and

child protection, deaths, controlled drugs, driving motor vehicles.

6. Risk and resource management

· Understanding of how to practise in such a way as to minimise the risk to

patients of harm or error.

· Informing patients about their diagnosis, treatment and prognosis, including

the effective communication of risk by exchanging information, preferences,

beliefs and opinions with patients about those risks.

· Explaining why a treatment is being prescribed, or a management plan

proposed, and the anticipated benefits and potential side effects.

· Providing clear explanations of the nature of clinical evidence and its

interpretation.

· Ensuring appropriate follow-up arrangements are made.

· Understanding the role of critical event reporting, clinical audit, analysis of

patients’ complaints and information provided by colleagues in improving

patient safety.

· Responding to criticisms or complaints promptly and constructively, and

demonstrating an ability to learn from them.

Page 10

· Demonstrating knowledge of the obligations for notifying outside agencies,

for example, regarding safety of medicines and devices to the Medicines

Control Agency, and the procedures regarding notifiable diseases.

· Recognising and reporting concerns about underperformance by an

	D1 Basic Sciences .........................................................................................14
	D2 Principles of Surgery-in-General.........................................................15
	D3 Surgical Specialties................................................................................20

	· Good clinical care
	· Maintaining good medical practice
	· Relationships with patients
	· Working with colleagues
	· Probity
	· Health

	· Elucidating and evaluating a patient’s condition, based on information
	gathering (history and symptoms) and, when necessary, clinical examination
	(interpreting signs) and appropriate procedural skills and/or special tests.
	· Demonstrating the ability to make competent clinical decisions (diagnoses)
	and selection of appropriate investigation and/or treatment and knowing when
	no investigation or treatment is indicated.
	· Employing sound skill-based clinical judge ment to assess the seriousness of an
	illness in order to prioritise care.
	· Respecting the autonomy of patients as partners in medical decision-making.
	· Recognising and working within the limits of one’s professional competence,
	showing a willingness to consult with colleagues, and where appropriate
	delegating or referring care to those who are recognised as competent.
	· Performing consistently well.
	· Practising ethically.

	· Treating the patient as an individual.
	· Integrating information on physical, psychological and social factors that
	impact on patients. Demonstrating awareness of individual and family
	psycho-dynamics and their interaction with health and illness.
	· Demonstrating an appropriately focussed assessment of a patient’s condition
	based on the history, clinical signs and examination.

	· Managing uncertainty, unpredictability and paradox by displaying an ability to
	evaluate undifferentiated and complex problems (at a level appropriate to this
	Diploma).
	· Applying and being able to justify the practice of contextual evidence-based
	medicine.
	· Demonstrating the appropriate use of equipment routinely used and a
	familiarity with the breadth of tests offered in secondary care.

	· Recognising and working within the limits of one’s professional competence.
	· Possessing self-insight sufficient to identify one’s own strengths and
	weaknesses
	Page 8
	· Managing time and workload effectively and showing an ability to cope with
	pressure.
	· Showing a flexibility of approach according to the different needs of a wide
	variety of patients, irrespective of their age, cultural, religious or ethnic
	background, their sexual orientation or any other special needs.
	· Having an ability to work effectively in a team, either as a member or leader,
	accepting the principles of collective responsibility, and consulting colleagues
	when appropriate.
	· Having knowledge of support systems.

	· Empowering patients to make informed choices.
	· Respecting patients as competent and equal partners with different areas of
	expertise.
	· Respecting the patients’ perception of their experience of their illness (health
	beliefs).
	· Acknowledging and integrating the patients’ ideas, concerns and expectations,
	especially with regard to the nature of their complaint.
	· Showing an interest in patients, being attentive to their problems, treating
	them politely and considerately and demonstrating listening skills.
	· Establishing rapport with the patient. Effectively developing relationships
	with patients, especially by being empathic and sympathetic.
	· Communicating and articulating with patients effectively, clearly, fluently and
	framing content at an appropriate level, including in written communications.
	· Involving patients’ significant others such as their next of kin or carer, when
	appropriate, in a consultation.
	· Sensitively minimising any potentially humiliating physical or psychological
	exposure by respecting patients’ dignity, privacy and modesty.

	· Understanding the contemporary compact with patients and the rights and
	responsibilities of Government, the medical profession and the public.
	· Demonstrating an understanding of demographic and epidemiological issues
	and the health needs of special groups.
	· Demonstrating an awareness of socio-political dimensions of health, for
	example, health care systems, strategy and funding.
	· Possessing knowledge of population-based preventive strategies including
	immunisation and population screening. Having knowledge of contemporary
	screening and recall systems.
	· Understanding the acceptable criteria for screening for disease, and applying
	the concepts of prevention.

	· Understanding the importance of and demonstrating possession of the
	appropriate professional values and attitudes, including consistency,
	accountability, and respect for the dignity, privacy and rights of patients and
	concern for their relatives.
	· Showing knowledge of and adhering to contemporary ethical principles.
	· Observing and keeping up to date with the laws and statutory codes governing
	otolaryngological practice.
	· Respecting the principle of confidentiality; and, when passing on information
	without a patient’s consent, being able to justify the decision.
	· Understanding the importance of, and demonstrating a commitment to,
	maintaining professional integrity, standards and responsibility.
	· Ensuring that, whenever possible, the patient has understood what treatment or
	investigation is proposed and what may result, and has given informed consent
	before it is carried out.
	· Demonstrating knowledge of the guidelines for the treatment of patients under
	16 years of age, with or without the consent of those with parental
	responsibility.
	· Demonstrating knowledge of issues relating to clinical responsibility, e.g. with
	regard to drug treatment.
	· Showing awareness of the ‘good Samaritan’ principle, i.e. offering to anyone
	at risk treatment that could reasonably be expected.
	· Demonstrating knowledge of safe practice and methods in the working
	environment - relating to biological, chemical, physical or psychological
	hazards - which conform to health and safety legislation.
	· Understanding and applying the main areas of relevant legislation, including
	human rights, equal opportunities, disability, employment, data protection,
	access to medical reports, consumer protection, health and safety, children and
	child protection, deaths, controlled drugs, driving motor vehicles.
	6. Risk and resource management
	· Understanding of how to practise in such a way as to minimise the risk to
	patients of harm or error.
	· Informing patients about their diagnosis, treatment and prognosis, including
	the effective communication of risk by exchanging information, preferences,
	beliefs and opinions with patients about those risks.
	· Explaining why a treatment is being prescribed, or a management plan
	proposed, and the anticipated benefits and potential side effects.
	· Providing clear explanations of the nature of clinical evidence and its
	interpretation.
	· Ensuring appropriate follow-up arrangements are made.
	· Understanding the role of critical event reporting, clinical audit, analysis of
	patients’ complaints and information provided by colleagues in improving
	patient safety.
	· Responding to criticisms or complaints promptly and constructively, and
	demonstrating an ability to learn from them.
	Page 10
	· Demonstrating knowledge of the obligations for notifying outside agencies,
	for example, regarding safety of medicines and devices to the Medicines
	Control Agency, and the procedures regarding notifiable diseases.
	· Recognising and reporting concerns about underperformance by an