Succeed in the multiple-choice exam

Advance planning and practice are essential for the multiple-choice exam, says Dr Bob Mortimer

The multiple-choice questions are written by a small group of examiners and the questions are defined by the MRCGP syllabus. The questions are divided into three broad areas: medicine (65 per cent of the questions); research, including critical appraisal (20 per cent); administration and management (15 per cent).


The scope for medical questions is wide, and you cannot revise all the medical textbooks. Many of the questions will be based on current guidelines. Some questions are written based on single landmark papers such as the ASCOT trial, while other questions are based on major authoritative texts, such as those published in Clinical Evidence.

Make sure you have revised the evidence base underpinning the management of major chronic diseases, and there will be inevitably a couple of questions on drug interactions.

Candidates generally perform quite well in the questions on research, statistics and epidemiology because this is a much narrower area to revise. Make sure you understand the major trial methodologies and statistical terms.

Candidates generally perform worse in the area of administration and management.Make sure you revise the official forms you are required to complete as GPs, for example, medical certificates, health and safety issues  and the medical aspects of fitness to drive.

Question types

None of the questions require true/false answers, but they appear in several different formats. In ‘single best answer’ you have to select the answer you think most appropriate from a selection of answers. More than one may appear plausible but there will be one clear best answer.

In ‘multiple best answers’ you will be asked to select the two or three best answers from a list of options. In ‘extended matching questions’ you will be given a list of possible answers (generally about eight) and then must select the best option for each of a number of scenarios.

In the ‘table/algorithm completion’ you will be presented with a table or algorithm with some blank spaces and you must choose the correct answers from a list of options. It is advisable to practice as many multiple-choice questions as you can before the exam.

Be systematic

Each question is worth one mark and there is no negative marking. Be systematic in your approach and see if you can exclude some of the possible answers then decide which of the remaining ones seems best.

Do not be afraid to go with your instinct. Do not panic if there is a question you cannot do — some of them are difficult and are there to separate out the high-flying candidates.

On the day

Make sure you get to the exam venue in plenty of time. Wear comfortable clothes in layers to ensure you do not get too hot or cold. Take a snack or a drink because it is a three-hour paper.

For the exam you will be given a question booklet containing 200 questions and two sheets to record your answers, which will be marked by computer.

First of all make sure you read the instructions in the front of the question booklet, then make sure you write your candidate number on both answer sheets.

Work your way through the questions, shading the appropriate answer as you go. Some candidates like to write all the answers in the question book first then transpose them on to the answer sheets at the end. I strongly recommend that you do not do this — the newer format questions will take you longer than the older format true/false questions you may have encountered before in medical exams and you may run out of time. It is also easy to make a mistake and transpose them into the wrong row or column — I have seen it done.

If you finish early, spend a couple of minutes checking that you have completed the answer sheets properly. Make sure you have a guess at any questions you have left blank.

Once you are sure you have finished I would suggest you leave the examination room. I would also suggest you try to avoid a debrief with your friends immediately after the exam because the focus inevitably tends to be on memorable and more difficult questions. The most important point to remember is that almost 80 per cent of candidates pass this exam. 

Dr Mortimer is a GP trainer in Swansea, an MRCGP examiner and a teacher on the Swansea MRCGP course

Learning points

How to succeed in the multiple-choice exam

  1. Read the guidance material on the RCGP website.
  2. Spend any revision time targeted on topics that are likely to come up — landmark papers, current guidelines and regulations.
  3. Make sure you know and understand common statistical terms.
  4. Revise the official forms that you are required to complete as a GP.
  5. Complete as many practice questions as you can.
  6. Give yourself the best chance you can on the day by careful time management and dressing comfortably.
  7. Make sure you complete your answer sheets correctly and answer every question.

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