This site is intended for health professionals only

At the heart of general practice since 1960

November 2006: Tips for tackling the MRCGP MCQ paper

What question styles are you likely to encounter in the MCQ papers?

What is the best approach to adopt when answering the questions?

Are there any practice papers that are not worth doing?

What question styles are you likely to encounter in the MCQ papers?

What is the best approach to adopt when answering the questions?

Are there any practice papers that are not worth doing?

The MCQ component of the exam is Currently a machine-marked three hour biannual paper, consisting of up to 250 multiple choice questions (MCQs). It is designed to test the core factual knowledge that underpins our work as GPs, as well as our knowledge of the emerging evidence and new guidance. The aim of this assessment is to test the application of this factual knowledge.

The questions are carefully written to avoid ambiguity and chosen to reflect day-to-day general practice. This means rare but serious clinical conditions will be included. Candidate feedback last year indicated that it was these types of topics – eg splenectomy, community-acquired pneumonia – which were regarded as the more difficult. However, it is hard to generalise as candidates also found more common conditions such as migraine and tension headache difficult, too.

Difficult questions are necessary to help differentiate good from poor candidates, but if a question performs badly with the majority of candidates, its contribution to the overall mark will be withdrawn. All items score the same, with one mark awarded for each item correctly answered.

The content of the paper centres around questions relevant to general practice in the three key areas: Clinical Medicine (around 65 per cent of the paper); Administration and Management (around 15 per cent); and Research, Epidemiology and Statistics (around 20 per cent). ‘Relevant' is a broad term encompassing common simple illnesses, as well as rare but serious illnesses. The exam syllabus is detailed on the College website (

Question Format

The old style MCQs have been replaced by:

Single Best Answer type questions (SBAs) – matching the most appropriate statement from several other potentially correct statements
Multiple Best Answer type questions (MBAs) – matching a specified number of correct options from a list of possible options with a given statement
Extended Matching Questions (EMQs) – a scenario has to be matched to the most likely answer from a list of options.

Summary Completion Questions (SCQs), which test your critical reading ability based on an extract from a paper or statistical analysis, have been phased out, although critical reading will still be tested and ‘Algorithm Completion' questions may be included. Expect to find photographs of skin lesions, anatomical questions about the ear or eye, ECGs and other clinical images, too.

Guidance is given at the start of every exam paper to ensure that the meaning of conventional terms such as ‘characteristic', ‘commonly', ‘in the majority' and ‘low chance' are clear and unambiguous.

Answering the questions

Time management is crucial; data interpretation questions and clinical scenarios take time to do, so the following tips might help:

Fill in the marking sheet as you go, making sure you leave the correct space for those questions you cannot answer – you don't want to be rubbing out 200 lozenges because you forgot to leave question 49 blank and therefore answered question 50 on line 49, for example

Skip any difficult ones so that you can come back to them later. It is likely you will have answered 50–60 per cent first time round, and it will make you feel better, as you are more than halfway there. Now you are in the swing of things, it will often seem easier the second time through

Still leave the ones you cannot get unless time is now tight. When you cannot logically work out any more, go back and fill in any remaining lozenges by guessing those not answered. It is important to remember that there is no negative marking

If there's still time, steel yourself and start checking for silly mistakes/omissions again, but remember that your first intuitive answer is often the most reliable.

It definitely takes longer than you think to work through the questions, and this is often an area of complaint from recent candidates sitting the paper. On the positive side, though, it is a valid test of general practice, with the vast majority of candidates who completed questionnaire feedback confirming this.

Some questions will always seem erudite and/or silly because you would usually reach for the BNF. Some seem just plain daft because you'd always ask a colleague. However, remember the questions are set by practising GPs and are intended to discriminate between the candidates and ‘spread' the marks achieved over a range.

Practice papers

Aim for a score of at least 70% when doing practice papers – whether using old College PEP CDs, MCQ books, course preparation or the updated RCGP Scotland ePEP online needs assessment tool. The pass mark has ranged between 64 and 67 per cent over the past five years, with a pass rate of 78–81 per cent. In May 2005 the average score was 150/204 with a range from 62 to 189/204. Remember that old MCQs and exam books can easily become out of date because of changes in medical practice and changes in the style of exam questions.

Don't forget to look at the latest national guidelines for evidence-based management of clinical conditions. If you see a patient with a condition such as diabetes, chronic obstructive pulmonary disease (COPD), hypertension or dyspepsia, then look up the latest NICE or SIGN guidelines for example. Apart from reading up on the common conditions you see on a daily basis, make use of your deanery: have you completed a confidence-rating type needs assessment to identify your weaker areas?


Dr Chris Elfes
GP, Swanage, Dorset, GP trainer, MRCGP examiner, nMRCGP assessor

Top tips

Time management: Don't spend ages agonising over an answer, time is short so move on.
Common mistakes: Running out of time, silly errors, transcribing answers onto the marking sheet

Table 1: Example MCQ question Table 2: Example SBA question Table 3: Example MBA question Table 4: Example statistics question Answers

Table 1: 1 G, 2 O, 3 L, 4 N, 5 B, 6 E, 7 I, 8 R.
Table 2: B
Table 3: B, C, D
Table 4: A 2.5, B 5

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say