DO-HNS subgroup of Intercollegiate

Committee for Basic Surgical

Guide to the Intercollegiate MRCS

January 2022
Guide to the intercollegiate MRCS
(ENT) examination

The DO-HNS subgroup of the Intercollegiate Committee for Basic Surgical

Examinations (ICBSE) has produced this guide to the intercollegiate MRCS (ENT)

examination. It contains the following sections:

Section 1 – Introduction Page 3

Section 2 – Topics and Skills that may be examined in the MRCS (ENT) Page 5

Section 3 – The intercollegiate MRCS (ENT) examination Page 10

Section 4 – MRCS Part A information Page 12

Section 5 – MRCS (ENT) OSCE information Page 13

Note that this guide is a living document that will change over time.

Please check the intercollegiate MRCS website for updates:

http://www.intercollegiatemrcsexams.org.uk

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Section 1 – Introduction
The purpose of the MRCS (ENT) is to test the breadth of knowledge, the clinical and

communication skills and the professional attributes considered appropriate by the

Colleges for a doctor intending to undertake practice within an Otolaryngology

Department in a non-consultant career grade or trainee position.

The complete syllabus for the MRCS (ENT) is contained within the General Medical

Council (GMC)-approved curriculum for the "Early Years" of Otolaryngology Training

in the United Kingdom, and can be found at: https://www.iscp.ac.uk/iscp/curriculum/.

This is a useful resource for candidates to understand the level of knowledge, clinical

and technical skills required to be successful in the examination and candidates are

advised to consult the Standards for Knowledge and Skills within the syllabus. The

curriculum is competence based, requiring the trainee to demonstrate both applied and

theoretical knowledge and practical skills, together with the professional behaviours

described in the Good Medical Practice document of the General Medical Council of

the United Kingdom (http://www.gmc-uk.org/). The provision of excellent care for the

surgical patient, delivered safely, is at the heart of the curriculum.

Note:

 In order to be awarded the MRCS (ENT), a candidate is required to pass both

the MRCS Part A examination (comprising two Multiple Choice Question

papers) and the MRCS (ENT) OSCE. Candidates are advised to consult the

regulations currently in force, which may be found at:

https://www.intercollegiatemrcsexams.org.uk/dohns/dohns-regulations-and-

formal-documents/, and also the Guide to the intercollegiate MRCS

examination for further information about the MRCS Part A, which may be

found at: https://www.intercollegiatemrcsexams.org.uk/mrcs/candidate-

guidance/.

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The Otolaryngology Specialist Advisory Committee has deemed that the possession

of either the MRCS (ENT) or the MRCS plus the DOHNS is required to allow access

to the National Selection Process for transition from CT/ST2 to ST3. Candidates are

advised to consult the MDRS website for the latest regulations

(https://specialtytraining.hee.nhs.uk/).

This guide has been produced in order to indicate to candidates and their supervisors

the extent and level of knowledge that is required to pass the MRCS (ENT)

examination. Each examination will contain a range of questions that cover a

representative sample of the syllabus, but not every topic will be tested on each

occasion.

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Section 2 – Topics and skills that may be examined in
the MRCS (ENT)

Candidates are advised to consult the complete syllabus for the MRCS (ENT)

examination, which is contained within the curriculum for the "Early Years" of

Otolaryngology Training in the United Kingdom, and which can be found at:

https://www.iscp.ac.uk/iscp/curriculum/.

This is a summary of the knowledge required:

1. Elective otology

Detailed knowledge is expected of the anatomy and physiology of the ear and auditory

pathways, the cranial nerves, the relationship of disease to the temporal bone, and

general knowledge of embryology and genetics in relation to congenital ear problems.

Candidates are expected to understand anatomy and physiology related to the

maintenance of balance; to understand the aetiology, classification, presenting

symptoms, signs and management of common acute and chronic conditions, including

conductive and sensorineural deafness in adults, facial paralysis, tinnitus, trauma

(including barotrauma), dizziness, and infective and non-infective conditions of the

inner, middle and external ear; to understand the potential intra- and extra-cranial

complications of ear disease; to understand the principles and practice of audiological

assessment and the interpretation of audiological investigations; to understand the

basics of auditory rehabilitation, including hearing aids and implantable devices; and

to understand the role of imaging and be able to interpret radiological investigations at

a basic level. Candidates should have general knowledge of the microbiology of

organisms commonly associated with ear infections, and the pharmacology of

medications used in ear disease. Candidates are expected to be able to perform a

competent clinical examination of the ear, using appropriate instruments and to be able

to explain a common condition or treatment to a patient.

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2. Paediatric otolaryngology

Candidates are expected to have general knowledge of applied embryology and the

anatomy of the head and neck in children, and of the anatomical differences between

the adult and paediatric airway. They are expected to understand the aetiology,

presenting symptoms, signs and management of common conditions including neck

masses both congenital and acquired, airway disorders at birth and later in childhood

including obstructive sleep apnoea, congenital deformities affecting the head and neck

including the ear and cleft lip and palate, the commoner congenital syndromes seen in

an ENT clinic, deafness including otitis media and its complications, facial palsy, otitis

media and its complications, balance disorders, nose and sinus infections and their

complications, inflammatory nasal disease and investigations, nasal polyps, foreign

bodies in the ear and airway, epistaxis with particular reference to children, trauma to

the head and neck, disease of the tonsils and adenoids and their complications,

oncology, speech and language development and the management of the drooling

child. They are expected to have knowledge of the presentations of non-accidental

injury in an ENT clinic, and to be aware of age-appropriate hearing tests and hearing

aids. They are expected to be able to take a thorough history from a child or parent.

3. Disease of the head and neck

Candidates are required to have detailed knowledge of the anatomy and physiology of

the head and neck. They should understand the aetiology, pathology (including

microbiology), presenting symptoms, signs and management of common conditions,

including congenital abnormalities of the head and neck (e.g. branchial arch

abnormalities, cleft lip and palate), oral pathology, airway obstruction, voice disorders,

disorders of swallowing, sleep related breathing disorders, adenoid and tonsillar

pathology, benign and neoplastic salivary gland disease, thyroid and parathyroid

disease, malignancies in the upper aerodigestive tract (including the oral cavity to the

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extent that an ENT surgeon will be involved in diagnosis and multi-disciplinary

management), craniocervical trauma in adults, cervical sepsis, lymphadenopathy and

other neck lumps. They should also understand the classification of head and neck

malignancies, in particular that for squamous cell carcinoma, and understand the

pattern of spread of malignancy in the head and neck. They should understand

common postoperative complications and their management. They are expected to

be able to take an appropriate history, carry out an appropriate examination of the neck

and upper aerodigestive tract, and to be able to explain a common condition or

treatment to a patient.

4. Rhinology

Candidates are expected to have detailed knowledge of the anatomy, embryology and

physiology of the nose and sinuses, including olfaction and the lacrimal system. They

should understand the aetiology, presenting signs, symptoms and management of

common conditions, including congenital abnormalities, nose and sinus infections and

inflammation (including allergy), nasal polyps, facial pain, epistaxis, nasal trauma and

deformity, rhinological oncology, granulomatous conditions, septal and rhinoplasty

surgery including some understanding of the role of cosmetic surgery and

reconstruction. They should understand the aetiology, pathophysiology and

microbiology of sinonasal infections, and the general concepts behind sinonasal

surgery for infection. They are expected to have knowledge of disorders of olfaction;

the aetiology and management of epiphora; knowledge of the basic types of skin

grafts, local flaps, regional flaps and free flaps; and knowledge of the pharmacology of

drugs commonly used to treat nasal conditions. Candidates are expected to be able to

take an appropriate history, carry out an appropriate examination of the nose using

instruments in common use in an ENT clinic, and to be able to explain a common

condition or treatment to a patient.

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5. Emergency otolaryngology

Candidates should understand the aetiology, presenting signs, symptoms and

management of common conditions, including epistaxis, otitis externa, otitis media

(and its complications), auricular trauma, foreign bodies in the ear and airways, acute

oropharyngeal infections, acute sinusitis (and its complications), and simple fractures

of the facial skeleton. They should understand the principles of acute airway

obstruction and its management, including tracheostomy, and be able to resuscitate a

critically ill patient. They should be familiar with the Glasgow Coma Score.

6. General

Candidates are expected to be familiar with taking a history from a patient with a

common otolaryngological condition, to be competent at carrying out an appropriate

clinical examination (including the use of instruments in common use in an ENT clinic)

and to be able to discuss and explain a condition or treatment to a patient or relative.

This includes the effective communication of prognosis, risk, benefit and alternative

managements in an appropriate manner. They are expected to demonstrate

communication skills and empathy. An understanding of the concept of consent is

required. Commonly used measures to prevent cross-infection are to be observed.

Knowledge of epidemiology, statistics, evidence-based medicine and audit is

expected. Recognition of the importance of clear written and verbal communication is

required. Candidates will also be required to have knowledge of topics common to all

surgical specialties, including the use of blood and blood products, the use of

antibiotics in the surgical patient, the role and complications of diathermy, pain relief,

thrombo-embolic prevention and management, wound care and suture techniques and

materials. Candidates will be expected to be able to interpret basic blood tests

(including coagulation) and overnight pulse oximetry. They will also be required to

have knowledge of the advantages, disadvantages and appropriateness of various

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imaging techniques, and to be able to make basic interpretations and to draw

conclusions from images presented to them in the examination.

Note: All parts of the examination will be conducted in English and will use

terminology and procedures relevant to the NHS in the UK. Candidates should be

familiar with UK guidance issued by NICE or SIGN, and with standards issued by the

British Society of Audiology.

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Section 3 – The intercollegiate MRCS (ENT)
examination

The MRCS (ENT) examination consists of two parts; the MRCS Part A (MCQ) and the

MRCS (ENT) OSCE. Though it is divided into two parts, the MRCS (ENT) is a single

examination, and passing the MRCS Part A alone does not carry any diploma status.

Topics may be examined in either MRCS Part A or the MRCS (ENT) OSCE or both

parts of the examination. The examinations are held three times a year.

The MRCS Part A is a five-hour MCQ examination consisting of a three-hour paper

(Applied Basic Science) followed by a two-hour paper (Principles of Surgery in

General), taken on the same day. The Applied Basic Science paper will consist of 180

questions and the Principles of Surgery in General will consist of 120 questions. There

is a break between the two papers. Candidates may sit this examination in various

centres both in the UK and abroad.

The MRCS (ENT) OSCE is an objective structured clinical examination (OSCE),

lasting approximately three-and-a-half hours. This examination is held in one of the

Royal Colleges of Surgeons. The examination is held at one College on each

occasion, and this location rotates between the four Colleges, i.e. the examination is

held in London, Edinburgh, Glasgow or Dublin.

Entry requirements

To meet the entry requirements for the MRCS (ENT) examination, candidates must

hold a recognised medical qualification, and are strongly recommended to have been

engaged in acquiring professional knowledge and training in Otolaryngology for at

least six months in a full-time or equivalent part-time position.

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Candidates may attempt the MRCS Part A six times only, and the MRCS (ENT) OSCE

four times only.

Further details of entry requirements for the examination are given in the Regulations

(see https://www.intercollegiatemrcsexams.org.uk/dohns/dohns-regulations-and-

formal-documents/) and candidates are advised to consult the website for up-to-date

information.

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Section 4 – MRCS Part A information

Information about the MRCS Part A examination, including test structure and sample

questions, can be found in section 5 of the MRCS Content Guide at

https://www.intercollegiatemrcsexams.org.uk/mrcs/candidate-guidance/. Candidates

are advised to familiarise themselves with this information before entering for the

exam.

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Section 5 – MRCS (ENT) OSCE information

1. Structure of the MRCS (ENT) OSCE Examination

The MRCS (ENT) OSCE consists of a “circuit” of up to 28 “Active Stations” and

sometimes some “Preparation Stations” and “Rest Stations”. The 28 Active Stations

are of two types:

 There are approximately five “clinical stations”. These are designed to assess

clinical skills, clinical examination, clinical history-taking and communication

skills. These stations are manned by both a patient (or an actor playing the

part of a patient) and an examiner. Each candidate’s performance is observed

and marked directly by the examiner.

 There are a further approximately 23 stations where candidates are presented

with questions to be answered on a written question/answer sheet. These

stations allow assessment of anatomy and physiology, pathology/histology,

audiometry, otology, rhinology, laryngology, neck conditions, written

communication skills, radiology, instruments and paediatric ENT surgery.

Candidates are each provided with a cardboard folder to hold their completed

question/answer sheets. The folder is labeled with the appropriate candidate

number. Candidates keep their folder throughout the examination, carrying it

on to the next station, and accumulating completed question/answer sheets as

they progress around the circuit.

Some stations require the presence of a “Preparation Station” just before the active

station. This Preparation Station provides instructions for the next station, so that the

candidate is fully aware of the task which he/she will be asked to complete at the next

station.

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The examination is also likely to include a variable number of “Rest Stations”. During

the rest stations, candidates may review their answer sheets from previous stations if

they wish to do so.

2. Standard Setting

The pass mark for the MRCS (ENT) OSCE examination is determined by the

examiners attending the examination, and includes a modified Angoff process.

3. Duration

The candidates have 7 minutes at each station to complete the task or the questions

posed. After 7 minutes each candidate moves on to the next station. The examination

will normally last approximately 3 hours 20 minutes.

4. Conduct of Examination

4.1 Proof of Identity

Candidates must bring proof of identity to the examination. Proof of identity must be

an official document, such as a current passport or driving licence that includes the

candidate’s name, signature and photograph. For the purposes of visual identification,

any candidate sitting the examination will be required to remove any clothing and/or

other item which covers all, or part of, the candidate's face. The Colleges will observe

sensitivity and, in specific circumstances, privacy in the visual identification of

candidates.

4.2 Dress Code

In line with modern infection control practices, and in view of the variety of stations and

the limited time available between them, it has been decided to adopt a standard dress

code for all stations in order to ease the pressure upon candidates who would

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otherwise be required to modify their dress between stations. The dress requirements

for candidates are as follows:

• Arms to be bare below the elbow

• No jewellery on hands or wrists with the exception of wedding rings/bands

• No tie

An acceptable form of dress would be a conventional short-sleeved shirt/blouse, open

at the neck or for a long-sleeved shirt/blouse with the sleeves rolled up throughout the

examination. T-shirts and polo shirts are not acceptable dress.

Candidates with religious or cultural reasons for not observing this code for all stations

will be expected to comply with the dress code for those stations involving the physical

examination of patients/actors.

To facilitate the assessment of non-verbal communication skills and interaction with

the examiner and patient (or actor in the role of the patient as the case may be), the

Colleges will require candidates for the duration of the station in question to remove

any clothing and/or other item which covers all, or part of the candidate's face.

4.3 Briefing

All candidates will undergo a detailed briefing, normally by a member of the

examination administrative staff, prior to the commencement of the MRCS (ENT)

OSCE examination. It is very important that candidates listen carefully to the

information that they are given at the briefing and also follow any instructions that they

are given by the administrative staff during the circuit. The briefing will cover the

checking and issuing of candidate numbers, layout of the stations, rest stations, the

candidates’ starting position, timing arrangements and arrangements for emergency

evacuation of the centre. Candidates must make sure that they fully understand how

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the examination circuit is to be run. At the end of the circuit there will be a debriefing

session and candidates will be invited to complete a feedback form.

4.4 Equipment

All equipment required for the tasks set in each station will be supplied. Candidates

are not required to bring any equipment for their own use.

There are a number of stations that use tablet computers to show a particular image.

In the unlikely event of a malfunction candidates should immediately make an

invigilator aware of the issue and another copy of the image will be supplied. Under

these circumstances candidates will not be disadvantaged. Candidates are

encouraged to use the zoom function if required but all other functions of the tablet are

disabled. Any tampering with the internet function of the tablet will be deemed as

misconduct.

4.5 Electronic / Communication Devices

Mobile phones or other electronic/communication devices must not be carried by any

candidate during the examination circuit. These can be switched off and left with other

property. Any candidate who is found to be in possession of an

electronic/communication device after the start of the examination will be subject to

disciplinary action.

5. Candidate Instructions

Each station has specific candidate instructions. It is important to read each instruction

carefully as this will describe precisely the task(s) that each candidate is required to

undertake at each station. Should the candidate complete the task at one of the clinical

stations within the 7-minute period, he or she may move outside the station and sit on

a seat provided until the bell signals the beginning of the next station.

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In stations involving the examination of patients or actors the examiner will usually

watch candidates performing the required tasks. Candidates will not be prompted and

will not be required to give a running commentary. If the examiner judges that a

candidate is not performing the task requested, the candidate may be prompted to re-

read the instructions for the station. Hand gel is provided for the use of candidates

where contact with patients or other clinical material requires hand cleaning.

6. Examination Papers

It is essential that candidates mark their candidate number in the top right hand corner

of each question/answer sheet in the space provided. Papers with no candidate

number will not be added into the examination results. Candidates should ensure that

their writing is legible. Abbreviations for medical terms are best avoided. In common

with current clinical practice, the words "Right" and "Left" should be written in full. If a

question requires a candidate to state laterality, then marks will not be awarded for the

use of "R" and "L". Where a question requires a candidate to list, for example, three

items of information, but the candidate lists six items of information, then only the first

three will be marked. At the end of the examination, the cardboard folders containing

each candidate’s completed question/answer sheets are collected by a member of the

examination staff.

7. Results

Details about the release date for the results will be given to candidates at or around

the time of the examination.

8. Feedback

Candidates will receive a breakdown of their marks for the content areas: otology,

rhinology, laryngology/head and neck and clinical/communications skills, together with

their overall result. No further feedback will be available.

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9. Discipline

This examination will be conducted according to the disciplinary procedures published

by the Intercollegiate Committee for Basic Surgical Examinations. If a candidate is

suspected of any misconduct the Supervising Examiner may make reasonable

enquiries at the time and will notify the candidate of what the concerns are and how

the matter will be resolved.

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