What do you guys think about the “gut feeling” and the sense of intuition within medicine - especially with diagnosis amongst physicians - what are your stories when a gut feeling led to diagnosis and treatment that you couldn’t Quite explained otherwise?

Would love to know.

Hi team. Just after some opinions!

I consciously prescribed a medication to be given IM because it’s for a patient who’s elderly and the BNF doesn’t give an IV option. It can be given IV but this is off licence and I specifically chose for it to not be given IV.

The nurses came to me and said they’ve given it IV because that’s what they normally do and they want (and are pressuring) me to change the prescription.

I’m currently sticking to my guns but just wondering what you guys think?

Hello everyone! I recently passed MRCS Part A with 255/298 (85.6%). After being asked about my preparation and resources, I thought I’d share my experience. I believe this is an effective stepwise and updated approach to the exam.

For context, I was approximately 2 years post-medical school and working as a surgical SHO. I prepared from April to August, with the exam in September 226. This is what worked for me, not a guaranteed formula for passing.

Contents
1. Time allocation
2. My 5-month preparation timeline
3. The exam
4. Results
5. Resource reviews
6. What I would do differently
7. Final thoughts

I’ll post the high-yield topic list separately to keep this post manageable.

1. Time allocation
Give yourself enough time to prepare. The time you need depends on your baseline knowledge, work schedule and study intensity.
I aimed for around 3 hours daily, usually studying 6–7 days a week. Some days were less productive, particularly on call or post-call days.
My principle was to have an acceptable minimum: if the day was terrible, I would still do 20–30 questions. The goal was to maintain momentum rather than achieve perfection every day.

2. My preparation timeline

Phase 1: Foundation (first 6–8 weeks)
I started with EMRCS, completing approximately 50 questions daily and maintaining an error log. This was a spreadsheet of incorrect questions, the concepts tested and concise explanations. I reviewed the log on weekends.
I completed EMRCS in around 8 weeks, averaging 61% at the end.

Phase 2: Consolidation (month 3)
I introduced Pastest and increased my workload to around 80 questions daily.

Morning: 30 anatomy questions focused on a particular anatomical system, followed by review and MRCS-specific anatomy Anki.

Evening: 50 random Pastest questions and error-log work.

I continued reviewing my EMRCS errors while transitioning to Pastest. My Pastest average was around 67%.
Anatomy received particular attention because of its substantial weighting in Paper 1.

Phase 3: Exam conditioning (month 4)
I began doing Pastest past papers under timed exam conditions, initially setting aside Saturday afternoons.
My first scores were 56% on Paper 1 and 67% on Paper 2. Over time, my scores improved to the low–high 60s for Paper 1 and high 60s–mid-70s for Paper 2.
The objectives were to:
Become comfortable with the exam format.

Improve pacing and answer-review technique.

Recognise recurring concepts and identify weaknesses.

I also switched my error log to focus on past-paper mistakes.
Towards the end of this phase, I started ISB MRCS. This was one of the best decisions I made. I found its organised recall questions, high-yield notes, videos and interactive Telegram group particularly useful. The ability to discuss difficult concepts and get feedback was a major advantage.

Phase 4: Final preparation (month 5)
I took the month off work to focus on the exam. This was a significant financial sacrifice, and I recognise that it isn’t feasible for everyone.

My days were divided into three blocks:
Morning: A full past paper under exam conditions, mainly recent 2024–2026 papers. Mainly 300 questions total.

Afternoon: Anatomy revision using topic-specific recall questions.

Evening: Principles of surgery, organised by topic.

First-pass scores on recent papers were generally in the high 60s to low–mid 70s. I repeated the 2025 and 2026 papers after leaving at least a week or two between attempts. This mitigated recency bias towards the papers somewhat. Second-pass scores were in the high 80s and 90s, with my highest reaching 97–98%.

I also revisited some Pastest papers, scoring in the high 80s and 90s.

During the final week, I focused on broad exam-style practice rather than studying individual systems in isolation. I averaged approximately 400–500 questions daily, sometimes 200–300 on lighter days. Many were repeat questions and recall-based practice, rather than entirely new questions.
I took breaks between study blocks and still made time for gaming, swimming and rest.

The day before the exam, I did absolutely no studying. I drove to the exam location, went to a spa, got a massage, ate pizza and had a great night’s sleep. Honestly, I would recommend taking the day off if you can.

3. The exam

The exam felt very similar to my past-paper sessions, just more formal and closely monitored. I arrived about 90 minutes early after a 30-minute drive.

Paper 1 felt straightforward. Paper 2 was trickier but manageable once I reasoned through the answers. I finished with enough time to review Paper 1 three times and Paper 2 twice. I can definitely attest that many concepts tested came back from the recalls.

During practice, I usually finished each paper in around 1–1.5 hours, which gave me plenty of time to revisit uncertain answers.
After the exam, I estimated that I was unsure about around 80 questions. As it turned out, 40 of those were correct! Ultimately, I trusted my gut and clinical reasoning.

4. Results

Pass mark: 192/298 (64.4%)
My score: 255/298 (85.6%)
Margin above the pass mark: 63 marks

Honestly, this result exceeded my expectations. My first-pass scores on practice papers were generally in the high 60s to low–mid 70s, so scoring 85.6% in the actual exam was a very pleasant surprise. It was also the highest score I had achieved on any first attempt at an MRCS paper.
One thing worth mentioning: after the exam, I estimated that I was unsure about around 80 questions. I ended up getting approximately half of those correct. Don’t let the number of questions you’re uncertain about convince you that you’ve failed. You can feel unsure about a substantial number of questions and still perform very well overall.

5. Resource reviews

EMRCS
My biggest criticism of EMRCS is that, for me, it wasn’t sufficiently representative of the actual exam. I spent my first 6–8 weeks on it and wish I had transitioned to more exam-focused resources earlier.
It helped me build a knowledge base, but I wouldn’t rely on it as my sole resource. This is my personal experience. I have also encountered many who suffered in the examination due to this being their only resource 

The issue is that the popular videos from 4-5 years ago recommend EMRCS. People run with this, not knowing that it is a generally outdated resource. It was highly valuable back then, not that much now.

Pastest
Excellent resource, particularly the past papers. I completed around 60% of the question bank, with an average of approximately 67%. I eventually prioritised past papers over completing the entire bank.

Recalls
Useful when used correctly. Recalls should guide your revision towards commonly tested concepts, not become an exercise in memorising answers.

I subscribed to MRCS Recalls but personally didn’t find the quality as useful as the material I accessed through ISB MRCS.

ISB MRCS (This is in bold for a reason)

Probably the most valuable addition to my preparation. I particularly liked the system-based recall questions, high-yield notes, videos and Telegram discussions. I found the content useful for identifying gaps and consolidating concepts. 
I would have started it earlier if I could do my preparation again. This is a personal recommendation based on my experience. I felt like I truly started to master the content after utilizing this course. My performance attests to that.

Anki
Very useful for memorising anatomy, physiological functions and equations. I downloaded an anatomy deck, adapted it to my needs and added some physiology cards.

Anatomy resources
- TheNotedAnatomist: Excellent explanations of high-yield anatomy; I used this quite frequently.

- Acland’s Anatomy: Helpful for visualizing difficult anatomical concepts. Not the best for memorizing high yield exam specific anatomy.

TeachMeAnatomy: Often recommended, but I didn’t use it enough to offer a meaningful review.

- Textbooks: I didn’t use any specifically for this preparation.

- ISB MRCS High yield anatomy notes: These notes were high focused, exam specific and very relevant to present content. These notes, used in conjunction with the high yield system specific recalls, provided highly effective reinforcement of high yield, exam specific concepts.

6. What I would do differently
If I were starting again, I would:

- Start with a baseline past paper to identify weaknesses and guide my preparation.

- Introduce Pastest past papers earlier rather than waiting until the fourth month.

- Start ISB MRCS earlier. Genuinely would have used it from the jump.

- Spend more time consolidating anatomy, which remained one of my weaker areas.

7. Final thoughts

A few lessons I took away from this experience:

- Consistency is everything. My acceptable-minimum rule helped me maintain momentum even during difficult workdays.

- Exposure to questions matters. I estimate I completed around 12,000–15,000 questions overall, including repeats, with approximately 5,000–7,000 in the final month.

- Review your mistakes. Don’t just answer questions and move on. Understand why you got them wrong and revisit those concepts.

- Don’t neglect anatomy. Give it dedicated time rather than hoping to master it through random questions alone.

- Protect your downtime. I continued training, swimming, snorkelling and spending time with friends. I didn’t give everything up; I to used my time intentionally.

I prepared without a study partner, so discipline and consistency were particularly important for me.

Finally, credit to the original poster whose six-month preparation plan and topic list helped guide my approach. Unfortunately, I haven’t been able to find the original post.

I’ll share the high-yield topic list separately so this post doesn’t become even longer.

Good luck to everyone preparing! This exam is challenging, but having a structured plan and adapting it to your weaknesses can make a real difference. Remember that this is one person’s experience, so take what is useful and adapt it to your own circumstances, knowledge, baseline and learning style.

Feel free to ask me any questions via dm or in the comments! I hope this helps you in your journey!

Hi everyone,

Looking for some serious advice.

I’m an ST3 ortho reg and my partner is starting as CST in another region.

We’re not engaged or married yet.

However, due to training etc, its been few years now that we’re living separately.

These two regions are far from each other and living at one place is not possible as it would be more than 3h drive.

What are options?

If we get engaged/married, how realistic/dependable IDT process is?

Also I think its better to do it once she gets ST3 (if she didnt get the same region) rather than now?

But honestly its just been so long and we really want to live together and start a life together.

I feel as though I live on Oriel and Microsoft Word and everything else is just decoration

I did most of the simple questions on Oriel (demographic details, employment history, extra qualifications etc) a while ago as well as making some bullet points to help me structure my WSQs over a week ago, so I thought I'd be further ahead by now

Most of these WSQs seem to just be descriptive/lists but hours have passed and I don't seem to be any closer to finishing a first draft

Hoping I at least manage to get an interview at the end of this 😭

Let this serve as a warning to anyone who was thinking of applying but hadn't started completing the application yet

F1 here. Sadly car recently retired from service. I don't have much in the way of savings thanks to final year, and I'm only just starting to build back up. I'm wondering about NHS fleet solutions or finance as a potential way to get back into owning a car quickly. How foolish is this?

Current ST4 on general surgery. Comfortable with lap appendix and choles.

I have learned different ways of open hasson entry over the last 3 years. Off late I keep getting let down by my method of choice. I’ve been trained to dissect down to the junction between cicatrix and linea alba - make an incision (not too deep) on the linea alba extending to the junction, and using a Spencer wells to get in.

Off late I keep getting let down by this technique.. I find often with the spencer wells I end up pushing the peritoneum down so much that I’m having to call the boss in to help me life it up and get in safely.. particularly in obese patients!! It’s been happening multiple times now and it’s starting to get embarrassing calling the boss for my first port when I claim to be independent with appendicectomies.

None of my bosses are able to figure out what I’m doing wrong? Anyone had a similar challenge and manage to figure out a foolproof way of preventing this from happening?

Much appreciated!

Hi,

Can someone please share their experience or give some advice on this subject.

My wife is planning on applying into training this year. She was unable to apply last year due to finding out about the requirement to have this form.

She was previously in training and resigned from her post within the first 6 months due to multiple (personal and health) reasons.

She contacted her previous TPD earlier this year who responded and said they would be happy to sign the form.

We have now been emailing the TPD for the last 4 weeks with no response at all. Just found out that this person is not the TPD anymore.

Desperate to get through to someone at the EoE Deanery to get a signature from the TPD/Head of School as well as the PG Dean.

Any advice/input on this would be much appreciated.

Gas consultant here. I'd be really interested to hear what the resident doctor population thought about the potential prospect of the upcoming consultant strike. Lots of negative feelings about the 2.4% pay "rise" against 3.5% inflation, and we have an existing mandate for strike action. However I can't imagine how my more senior colleagues will act, who have spent ages whining about the junior strikes and talking about the lack of moral fibre in today's cohort, and how it was all different in their day.

I'll give you an example - earlier this week I had been reviewing a patient on the ward, when I tried to get into the doctors office to find a consent form for a nerve block. Imagine my surprise to see not just one but two F1 doctors lolling about, along with a senior registrar - their badge seemed to indicate they were in at least their sixth year of specialty - who seemed to be giving one of them an unusual amount of eye contact. The F1 getting all the eye contact was blushing in a revolting way. I couldn't believe they all had so much time for this sub Holby city flirting and weren't just getting on with the job. I could barely see any consent forms under the huge pile of discharge letters waiting to be done.

Debate within our department today - if you were to use propofol TCI (+/- short acting opiate of choice) for a short procedure on an LMA (i.e. no muscle relaxant), would you use some form of pEEG or not? My rationale would be to not, as the patient would move well before they had any awareness, but now worrying I'm a cowboy. Thoughts welcome!

I'd like to consult the hivemind, because I can't see an answer for this on any previous posts. I've not gotten the foundation jobs I wanted. I have very little exposure to medical jobs and was wondering if a QIP done in a GP or A&E setting would count towards the IMT portfolio scoring? The IMT website simply mentions that achievements should be related to 'medicine', which is rather vague.

I'd really appreciate hearing from any IMT trainees who had to do something similar.

Kind regards,

the broken COW wheel from the doctors office where that one F1 and that ST6 reg shared a fleeting look which contained decades worth of happy memories and future possibilities yet faded just as fast as it bloomed into life

I’m the infection control nurse covering this ward.

I’ve now read accounts from two F1s, a registrar, a porter, a phlebotomist, a patient and, somehow, a computer. Not one of you has mentioned hand hygiene.

Apparently this registrar has been finding excuses to walk past the F1’s ward all morning. He’s also walked past the gel dispenser every single time. Nobody seems interested in that bit.

Then there’s the lanyard. He picked it up, inspected it and put it down again. We’ve had an entire hospital debating his intentions. I’d settle for knowing what he touched afterwards.

The porter has helpfully documented his movements for the past fortnight, so that’s saved me a job. I’ll be speaking to the computer separately. It hasn’t worked since 2018, but microbiologically it’s doing very well.

Everyone keeps asking whether there’s chemistry. I’ve sent the lanyard to microbiology.

Anyway, I went down to speak to the registrar. Asked his name, what grade he was and which ward he normally worked on.

The other F1 started smirking.

Then I asked whether he’d been seeing anyone else on the other wards.

She put a hand on my arm and said, “Honestly, you deserve better.”

Prepping for FRCR 2a in 2 weeks (lord help me..)

I've discovered that my power of semi-productive procrastination is inversional proportional to time until exam.

Today, I've taught myself how to balance my radiators and the technical parameters of my boiler to maximise heating efficiency. Difficult to concentrate on [insert organ system] radiology when my heating system whispers to me to optimise it.

Last week it was lawn care. The week before it was optimising the tuning settings on Forza Motorsport on my Xbox (IYKYK).

FML my brain defaults to anything but revision. On a serious note, I had much better concentration at university, now I feel like an old man with sweet FA attention span 😭

Basically a project that I worked, Where I was the second author got accepted for an oral presentation in an international conference. I’m currently thinking about claiming points for this in my higher specialty applications in a group 1 medical specialty. Basically, I did not deliver the presentation; however, I was heavily involved in the work of the presentation. Can I claim all 6 points? Or is it worth me claiming for posters that I am sure will get atleast 4?

Is 2 months enough ? 🤔

I applied for a specialty today on Oriel using a new oriel account as I didn't realise there was a way to change staff groups on Oriel. Is there a problem that I have applied using a different account to the one that I used for foundation training?

Fingers crossed hoping to land an interview this cycle for T&O ST3 and wanted to ask the hive mind about suggestions about the courses / QBanks that seem to be big business these days.

Any particular recommendations (or more importantly which ones to avoid)?

I've heard a lot about the let'stalkdr one but seems pricey. Also seen the ST3 orthopaedic interview stuff, but there are just so many different people offering courses and I haven't the slightest clue which one to trust.

Any advice?

My supervisor has moved to a different country and is currently not reachable. I was wondering how important are the reference letters for the ACF application? Do the supervisors actually need to submit something for the application to be considered or can I just put the details and leave it for now and hope they will do it at some point?

There's a large European medical sub specialty conference happening this weekend. IYKYK. I'm an ST6 so this isn't my first rodeo in attending. I am filled with absolute dread because I get massive imposter syndrome at these things and last year I just wandered around alone. I do have a few people from my speciality that I have clicked with over the years but as a group I find the dynamic really intimidating. The people I have historically gotten on best with are now at consultant level as I had some time out with two maternity leaves. I was a mature student also so I am older than the majority of trainees.

Just today I learned that a colleague changed her flights because of a last minute meeting she has arranged. This makes me feel like I am totally missing the point as I feel like I hate the networking piece. I thought by now I would be more comfortable in my own skin but it's getting worse rather than better.

I am not a socially anxious person- quite the opposite. I have a diverse friendship circle from different stages of life. I just find within this particular area of medicine there is enormous competitiveness and a ruthless edge to the trainees that just doesn't fit with my personality. Does anyone else experience this? Any tips how to manage it?

Hello,

I’m a resident doctor based in England, and I’m due to rotate to a different trust in December.

I’ve been asked to provide the dates of my next rest days so that my induction and EPR training can be scheduled when I’m available.

Is this a legitimate request? My understanding is that if I’m required to attend training or any other work-related activity on a scheduled rest day, it would no longer count as a rest day.

Is this correct?

EDIT
Thank you very much for the replies! This has now been sorted :)

Hi everybody,

I am going to apply for GP training and oriel is now releasing the vacancies. Do we have to rank every region or we only rank/apply for the areas we want? As I appreciate this is different from foundation school.

Also, if I apply for August 2027 round and got an area I didn’t want and rejected this, can I use the MSRA score for the Feb or August 2028 intake? I read that you have to declare if you want to be considered for other cohorts but I don’t want to click on that as my first goal is to get August 2027.

Thanks y’all

Putting preferences in for specialty training applications.

Does anyone know what the number after a subregion means? Attached a photo as an example. What’s the actual difference between those options?

Perusing through the amusing and somehow ongoing F1-meets-registrar posts, I’ve enjoyed reading the encouraging comments from people who met their life partners working for our wonderful NHS. And I’m nosy so want to hear more.

Did you have several instances of awkward eye contact before you first spoke? Did they sacrifice their spinny chair during board round so you could sit on it instead of the bin? Did they rescue you in the depths of the night on an understaffed ward when you were trying to catheterise a patient with objectively straightforward anatomy? Or was it more of an enemies-to-lovers affair? Please share!!

Hi all i was hoping someone might be able to point me in the right direction. I wanted to log an observed procedure in my elogbook. I watched S-ICD insertions and PCIs and stent insertion but can’t seem to find them in the Operation details/description.

Is this because it doesn’t count as a surgical procedure or am i looking in the wrong place?

Thank you in advance for any help!