Which MRCP Part Is the Hardest?

TL;DR

If you’ve ever wondered which MRCP part is the hardest, the answer depends on your strengths. Most candidates find MRCP Part 1 conceptually challenging because of its vast syllabus, while Part 2 Written demands higher-order reasoning, and PACES tests bedside skill and fluency. For many, PACES feels toughest overall — but the steepest learning curve starts with Part 1.

Why this matters

The Membership of the Royal Colleges of Physicians (MRCP UK) examination is a three-stage process:

1. Part 1 – written, knowledge-based.

2. Part 2 Written – clinical reasoning and data interpretation.

3. PACES (Practical Assessment of Clinical Examination Skills) – hands-on patient assessment.

Each stage tests progressively different competencies. Understanding which part most candidates struggle with helps you plan your preparation timeline, resource allocation, and revision strategy effectively.

Comparing difficulty across the three parts

MRCP Part	Focus	Typical Challenges	Why It Feels Hard
Part 1	Core medical sciences, pathophysiology, and basic clinical concepts	Enormous syllabus; abstract reasoning; long exam sessions	Volume overload and recall fatigue
Part 2 Written	Clinical reasoning, data interpretation, imaging, and ECGs	Integrating knowledge under time pressure	Requires applied pattern recognition
PACES	Practical and communication skills with real patients	Clinical confidence, fluency, and exam nerves	Performance anxiety and UK-style expectations

While PACES often gets labelled the hardest because of its subjectivity and performance element, Part 1 defeats many first-time candidates. It’s the foundation on which everything else depends.

Why MRCP Part 1 feels overwhelming

• Syllabus size: The exam spans medicine, pharmacology, neurology, cardiology, infectious diseases, and more.

• Recall pressure: 200 best-of-five questions over two three-hour papers.

• Conceptual difficulty: It rewards understanding mechanisms over rote memory.

• First exposure: Most international doctors encounter the UK exam style here for the first time.

👉 For a full structure breakdown and prep roadmap, read our MRCP Part 1 overview.

Practical examples: how difficulty shifts across parts

Example 1 – Diagnostic reasoning

• Part 1: “A 65-year-old smoker presents with polycythaemia; what is the likely cause?” (tests physiology recall)

• Part 2: “Interpret this blood gas and CT showing pulmonary nodules—what’s the next step?” (tests synthesis)

• PACES: “Elicit signs in a chronic smoker with finger clubbing and counsel appropriately.” (tests communication and confidence)

The knowledge–application–performance gradient explains why each part feels successively harder in different ways.

Five common pitfalls and their fixes

1. Studying passively.

   • Fix: Use active recall and spaced repetition (e.g., QBank sessions daily).

2. Ignoring weak systems.

   • Fix: Rotate subjects weekly; use your weakest area weekends for focused revision.

3. Underestimating exam fatigue.

   • Fix: Practise full-length timed mocks to build stamina — try our Start a mock test.

4. Using too many resources.

   • Fix: Stick to one high-yield QBank such as Free MRCP MCQs and concise notes.

5. Neglecting exam technique.

   • Fix: Practise best-of-five reasoning—eliminate distractors logically, not emotionally.

     
     

Evidence-based preparation strategy

1. Phase 1 – Foundation (Weeks 1-4):Build core recall for physiology and pharmacology; aim for 50–100 questions daily.

2. Phase 2 – Integration (Weeks 5-8):Revise case-based reasoning, mix timed blocks, and weekly mock review.

3. Phase 3 – Refinement (Weeks 9-12):Focus on error patterns, subject-wise performance, and final stamina mocks.

This plan mirrors the structured approach in our Crack Medicine MRCP App, which adds monthly mock tests and performance analytics to guide progress objectively.

Common candidate perspectives

“I failed Part 1 once—not because it was harder than PACES, but because I didn’t know how to prepare.” “PACES terrified me the most; one wrong communication cue and you lose marks despite good knowledge.”

Such reflections remind us that ‘hardest’ is relative—it depends on study strategy, prior exposure, and comfort with patient interaction.

FAQs

1. Is MRCP Part 1 harder than Part 2?

Part 1 is broader, but Part 2 questions are more analytical. Many find Part 1 harder initially, while Part 2 feels easier once concepts are consolidated.

2. Why do many fail MRCP Part 1?

Because of the vast syllabus, inadequate question practice, and poor time management. Regular QBank use improves pass rates significantly.

3. Is PACES harder than the written exams?

Yes for many, since it tests real-time performance and communication—skills that require deliberate practice, not just reading.

4. How many attempts are allowed?

According to MRCP(UK) regulations, there’s no strict limit, but repeated failures may affect training timelines and visas.

5. What’s the best way to prepare efficiently?

Combine systematic question practice, spaced revision, and mock testing with consistent feedback loops—techniques built into Crack Medicine’s ecosystem.

Ready to start?

Every MRCP part brings its own challenges—but preparation method decides the outcome. Begin structured practice today:

• Review our MRCP Part 1 overview for syllabus mapping.

• Practise daily with Free MRCP MCQs.

• Simulate exam conditions with Start a mock test.

Consistent, data-driven preparation turns the “hardest” part into your strongest.

Sources

• MRCP(UK) Official Website

• Royal College of Physicians (London)

• General Medical Council – UK Postgraduate Exams