MRCS Part B Revision · Procedural and technical skills
ATLS — MRCS Part B Procedural and technical skills
By Dr Richard Miller, MBChB FRCS · Reviewed
ATLS is a procedural station. Two of the seventeen examined stations in the MRCS Part B OSCE are procedural. The procedural stations ask you to perform a practical task, usually on a model, while explaining what you are doing and why.
What you need to know for the ATLS station
ATLS Survey
During the primary survey, life threatening conditions are identified and management is begun simultaneously.
- A-Airway maintenance with cervical spine control
- B-Breathing and ventilation
- C-Circulation with haemorrhage control
- D-Disability: neurological status
- E-Exposure: completely undress the patient
Chest Drain
• Wash hands and apply protective clothing
• Explain to the patient what you are going to do and gain verbal consent
• Infiltrate local anaesthetic into the area of insertion
• The area is prepped and draped appropriately
• An incision is made along the upper border of the rib below the intercostal space to be used.
• The drain track will be directed over the top of the lower rib to avoid the intercostal vessels lying below each rib.
• The incision should easily accommodate the operator's finger.
• Using a curved clamp the track is developed by blunt dissection only. The clamp is inserted into muscle tissue and spread to split the fibres. The track is developed with the operator's finger.
• Once the track comes onto the rib, the clamp is angled just over the rib and dissection continued until the pleural is entered.
• A finger is inserted into the pleural cavity and the area explored for pleural adhesions.
• At this time the lung, diaphragm and heart may be felt, depending on position of the track.
• A large-bore (32 or 36F) chest tube is mounted on the clamp and passed along the track into the pleural cavity.
• The tube is connected to an underwater seal and sutured / secured in place.
• If desired, a U-stitch is placed for subsequent drain removal.
• The chest is re-examined to confirm effect.
• A chest X-ray is taken to confirm placement & position.
What are you asked at the ATLS station?
The station runs to 10 questions over nine minutes. A prompt the station repeats — against each marker on a specimen, for instance — is listed once here; the model answers are in the question bank.
- Surgical Skills: ATLS Survey
- How will you manage this gentleman?
- During the ATLS assessment it is noted that the gentleman is dull to percussion over the left lung field and also has reduced air entry on that side.
A CXR is requested as part of the trauma series
What does the above XR show?
- How should this be managed acutely?
- You are asked to set up a chest drain kit. What will you need?
- Describe the landmarks for inserting a chest drain
- Describe how you would insert a chest drain for the above haemothorax
- The patient does not have a pelvic binder. Describe how you would fit one
- The gentleman's systolic BP is 65 though he has no obvious bleeding or bruising. What will you do next?
How is the procedural and technical skills station marked in MRCS Part B?
The two procedural stations are marked differently from each other. Procedural skills with a patient carries 8 marks for clinical and technical skill and 4 each for knowledge, communication and professionalism. Procedural skills, technical, performed on a model rather than a person, carries 12 for skill and 8 for knowledge, with no communication or professionalism marks available.
FAQ
What does the ATLS station ask?
It opens with "Surgical Skills: ATLS Survey" and runs to 10 questions over nine minutes. The two procedural stations are marked differently from each other. Procedural skills with a patient carries 8 marks for clinical and technical skill and 4 each for knowledge, communication and professionalism. Procedural skills, technical, performed on a model rather than a person, carries 12 for skill and 8 for knowledge, with no communication or professionalism marks available.
What procedural skills are tested in MRCS Part B?
Two of the seventeen examined stations are procedural: one with a patient and one purely technical. Candidates most often report suturing, abscess incision and drainage, catheterisation and chest drain insertion.
How is a procedural station marked?
The station with a patient carries 8 of its 20 marks for clinical and technical skill and 4 each for knowledge, communication and professionalism. The technical station carries 12 for skill and 8 for knowledge, with no communication marks.
Should I talk while I perform the procedure?
At the station with a patient, yes: a third of the marks there are for communication and professionalism, and they are gone if you work in silence. At the purely technical station those marks do not exist, so the technique itself is what counts.
How many stations are in the MRCS Part B OSCE?
Seventeen examined stations of nine minutes each, with a minute to read the task before each one. Two preparation stations and at least one rest station bring the circuit to about twenty, and the exam takes about three and a half hours.
What is the pass mark for MRCS Part B?
There is no published pass mark. The cut score is set separately for Applied Knowledge and Applied Skills, for each circuit, by borderline regression. Published pass rates across the 2024/25 diets ranged from 51% to 66%.
Can I fail a station and still pass?
Yes. There is no rule about how many stations you may fail: the cut score applies to your total mark in each component, so a weak station costs the marks you lost on it and strong stations elsewhere can make them back. Applied Knowledge and Applied Skills are passed separately and must both be passed at the same sitting, so a strong anatomy performance cannot rescue a weak communication one.
Dr Richard Miller, MBChB FRCS
Station summaries are reviewed against the current intercollegiate MRCS syllabus and the published marking blueprint. Guidance changes between diets: check the royal colleges' own pages before relying on a date, a fee or a threshold.
Practise this station
The question bank carries the model answer to every question above, with the rest of the procedural and technical skills stations.
More procedural and technical skills stations