Book review

There are many books that will be recommended for the MRCS part B OSCE. Helpful friends and seniors will insist that there is THE book which you need to read to pass the exams. I listened to many and tried almost all of them, probably a bit of over-reading and I regret spending time on books which were not really geared towards studying. Read the reviews (and the time and prep section) and decide which books you want to concentrate on. In the end, a few essential books which you consolidate your knowledge into and practise over and over again will probably be better than reading a whole library without actually retaining the knowledge. Every book has its mistakes (even the infallible Netter with its plate on the pulleys of the hand is numbered wrongly). Do not write off a book just because of the errors contained within, I almost did that for Dr Exam but later found it to be not too shabby if a little too skimpy. Publishers/authors if you are reading this - take note if I slammed your books - they probably really do suck that much, so stop trying to cheat people of their money and time.

If you looked at the past year accounts, you will realise that many of the answers are not in the books thus you have to create your notes for them early in your prep. You have to use wikipedia, emedicine, wheeless ortho to find the specific answers needed to the scenarios. My advice is read the past year accounts early, list down all questions you need to google and make your own notes early. Some of my friends made all their notes in one or 2 generic books like Cracking. I like tech and prefer the google drive/evernote way for easy editing and reorganising later on.

Anatomy

1. Simon Overstall (Get through MRCS: Anatomy Viva) . Amazing little book that is so small so good. I went through this book 5 times before my own exam and it sears the knowledge into your brain. Good to warm up with the book before doing other things nearer to the exam. Split it into 3 big chapters - Limbs, Trunk and thorax, head and neck. You will need about 3 hours to finish each chapter so just do one big chapter per warm-up session per day. If you have not gotten it, stop thinking and just buy it now, you will not regret it! MRCS is very heavy on anatomy. This is one small book you can carry with you anywhere.

2. Harold Ellis (Clinical anatomy) - The book to read for anatomy. It is small, can be finished in a week and does not waste much time on useless trivia like the larger anatomy textbooks. It lacks in pictures and muscle attachments. Read it cover to cover with an atlas beside you.

3. Netter's (Atlas of human anatomy). This should be the first atlas you pick up to gain a good understanding of structures and their relationship. Needless to say, Netter is the god of anatomy. Muscle attachment pages are really useful if you cannot picture in your head how things are supposed to run, memorise these images to help in your understanding. Do note that the coloured diagrams will not help you in identifying brown structures on a cadaver

4. Some form of cadaveric atlas - consolidate your knowledge into real cadavers. Rohen is amazing and was what I used. McMinn has a so-so version of an atlas which is quite thin. There is another McMinn out there which offers a superb cross-sectional cadaveric atlas that is probably overkill.

5. Prof Raj's anatomy tutorial - awesome stuff, mainly for the chance to view prosections again. 3 days of tutorials lasting about 3 hours each, nominal fee ($200) made payable to NUS. Prof Raj may ask Prof Voon to give tutorials on his behalf if he is not available but I feel that Prof Raj is the real deal for those who recall the difference in anatomy lectures/tutorials back in med school. email to: antrajen@nus.edu.sg

6. Dr Exam Book 1 Anatomy. Nice coloured pictures. Some mistakes (e.g. the cerebral angiogram). Some diagrams of cross section a bit strange too (ankle one has the configuration deviating from the usual Tom, Dick And Very Naughty Harry, others like the calf cross-section is cut at such a strange level). Do Overstall first before attempting this. When in doubt, refer to an atlas.

7. Stuart Currie (Essential radiological anatomy for the MRCS). Great radiology book. Worth about 2 read throughs. You will be confident about readings scans from most parts of the body. Demonstrates anatomy not pathology. So for images such as the various Balthazar grades of pancreatitis, please look it up on the web.

8. Wikipedia. You must memorise the attachments of major muscles. I cannot emphasize this enough. So many people have come out grumbling about why they asked about muscles, attachments, actions and innervations. Read the TYS for examples.

9. Acland's DVD atlas of human anatomy - WOW is all I can say. This is a compilation of prosection videos of fresh cadavers that will take days of solid viewing to finish a first view-through. Very useful in your career as a surgeon, the closest you can get to fresh prosections. Maybe not so useful for the MRCS as it is just too long to finish before your exams but this is real high quality stuff compared to the videos you get off youtube. But if you have time, do consider spending about a week viewing these videos especially if you did not manage to attend any fresh prosection anatomy tutorial (e.g. by Prof Raj from NUS).

10. Snell/Moore/Gray's anatomy - really too thick to read, not focused but has all the muscle attachment tables. Then again, Wikipedia has it too.

11. Lifern's anatomy notes - good for nice summaries of key nerves such as median, ulnar, radial, femoral.... Otherwise not for hardcore mugging.

12. Jeremy Lynch (MRCS part B anatomy) - did not use this book personally but quite well reviewed by those who have used it and includes diagrams. Some have used this instead of Simon Overstall. Pick one, learn it really well.

Physio/Crit Care

1. Kanani - Good thin book, has Physio and Crit Care editions. Do not bother with Physio book for part B. The Crit Care book is much more relevant. Worth about 1-2 read throughs.

2. Generic books - Most generic books (see below) have rather good sections on physio and crit care which you will need to mug. Kanani itself is not enough without the generic books.

Pathology

No specific book. There is one out there by Lowe but not really worth it. Information can be found scattered in Andre's notes, Cracking and the other generic books.

Operative surgery

They have NEVER asked a single question about it in the new OSCE format. You need to know the layers that you will be cutting through though for simple procedures. If your anatomy is strong, this should not faze you. They do ask about how to diagnose, investigate and treat a condition though, but not the exact details of the surgery. Principles of surgery such as laparoscopic vs open hernias may be tested too.

Generic books

1. Cracking the MRCS viva - really good book although it was meant for part 3. Some say the pathology part of this book is all you need for the pathology section of MRCS. Not entirely true but close. Out of print now, borrow a copy. Read, annotate, correct all mistakes. It will form the bulk of your studying and helps you understand things a bit better. Worth about 2 to 3 read throughs.

2. Dr Exam Book 1 - Covers same topics as cracking. Anat section short but good with pictures. More mistakes than other books so beware. But nice summary tables and some mnemonics that are so stupid but work (eg FAT HIPS). Worth about 2 to 3 read throughs.

3. Goodfellow - wordy book. Not essential. Not worth the time. But do learn the style of answering. Some answers with graphs are helpful (like the swan-ganz diagram). Some wrong explanations.

4. Nikhil Pawa - Did not personally use this book. Some have told me it is more up to date in certain sections than other books. Weak in the anatomy section.

5. How to pass the MRCS OSCE volume 1 and 2 by Pradip Datta. Prose form, not conducive for reading. Some additional information but not essential. Not really worth your time too.

6. The web - Go read up management of common stuff like burns (different formulas used - I based mine on the well known Parklands but included guidelines from COBIS), GOO, hyponatraemia, thyroid storms, addisonian crisis, potassium supplement formulas in the UK, perioperative managment of valves, warfarin, pacemakers, acid-base stuff, enterocutaneous fistula, enterohepatic circulation, rhabdomyolysis, epidurals, spinals... Know all the prevalent guidelines.

7. Alfred Kow's notes. Crazily essential for part 3 previously but getting kind of irrelevant for part B as the knowledge scope tested is not as broad or in-depth.

8. Viva Practice by Christopher Chan - A thin book, information basically repeated if you read all the other books. Geared towards Part 3 Not worth that much of a read in my opinion.

9. OSCE for the MRCS part B (Bailey & Love) - Another thin book with repeated information. Not enough on its own by miles.

Clinical steps

1. Dr Exam Book 2 - Has a DVD on the examination steps. Nice summary tables. Seems brief - but really, OSCEs are not very heavy on clinical exams. Nice summary of consent taking, info giving and all specific to UK. Also chapters on procedures, comms. Partially essential, worth about 1-2 read throughs mainly for a structure in your head.

2. Catherine Parchment Smith - Eh ok lah, too many cases that never ever seem to come out for OSCEs these days including Dupuytren's. Has a messy back chapter about comms, procedures in prose form. But good paragraphs on how to present your case. Not absolutely essential. Worth about 1 read through if you have the time.

3. Ramanchadran - Good for certain approaches. Not essential. Worth about 1 read through if you have the time.

4. Alfred Kow's notes. Similar to the generic ones but covers all the surgical subspecialties. I felt that Andre was presented in a more structured format for the GS parts.

More importantly - practise on pts if you are out of touch for a while. Real cases would be great. Critique by a tutor would be the best. Tutors should be strict. Go through all motions in your head. Practise on your friends, your dog (true story, I was busy palpating Isaac's dog's abdomen once because she let me). Handwashing is overrated for the exams but still do it anyway.

GS/Urology

Andre Tan's Surgical Notes. The Legend. Mistakes that need updating around, spot and correct by yourself. This should form the bulk of your clinical knowledge for GS. Also helps for the pathology section of the exam. Worth about 5 read throughs. Ok just kidding, you will probably have time for 1-2 read throughs.

Washington Manual - I found it useful for citing investigations needed but did not really use it towards the end. If you have never done GS in your life, you may want to read a bit of these for things such as parathyroid stuff.

Ortho/ENT/Neurosurgery/Cardiothoracic

No consensus man. No real nice books out there. Use your MBBS ones. No specialty specific knowledge required.

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