MRCPUKMembership of the Royal Colleges of Physicians of the United Kingdom

Annualreview2016

About MRCP(UK)

MRCP(UK) 11 St Andrews Place, Regent’s Park, London NW1 4LE www.mrcpuk.org

The Federation is a partnership between:

• The Royal College of Physicians of Edinburgh• The Royal College of Physicians and Surgeons of Glasgow• The Royal College of Physicians of London.

Working together, the Federation develops and deliversmembership and specialty examinations, all of which arerecognised around the world as quality benchmarks.

The Membership of the Royal College of Physicians (UK)Diploma tests the skills, knowledge and behaviour ofdoctors in training. It has been approved by the GeneralMedical Council (GMC) as the summative assessment forcore medical training. Successful completion of theentire three-part examination is a requirement forphysicians training in a medically-related specialty in theUK. Internationally, the MRCP(UK) Diploma is a valuedprofessional distinction.

The Specialty Certificate Examinations (SCEs) have beendeveloped in close collaboration with the UK specialistsocieties. Physicians in training in the UK must pass theappropriate SCE in order to gain admission to the GMCSpecialist Register. Success in the SCE certifies physicians ashaving sufficient knowledge of their specialty to practisesafely and competently as consultants. The SCEs are arequirement for physicians in many medical specialties inthe UK and provide an international benchmark ofpostgraduate medical specialist knowledge.

MRCP(UK) works with examination teams in the threeRoyal Colleges and is accountable to the Federation. Staff process applications, coordinate logistics andcommunicate results to candidates. The teams also workclosely with the examining boards to:

• develop the content of the tests• set the standards required to pass the examinations• guide academic development of the examinations toensure that they remain leaders in their field.

MRCP(UK) monitors performance in all the examinationsand generates statistical analyses, which are crucial tomaintaining academic quality. MRCP(UK) also collaborateswith academics in medical education and psychometrics,who use the data to publish work in their field.

The Federation of Royal Colleges of Physicians of the United Kingdom sets internationallyacknowledged standards in medicine, building on a proud tradition of professional excellence,established over centuries by British physicians.

Welcome from the Medical Director page 2

Engagement and involvement page 4

Fit for the future page 5

Integrity and fairness page 6

International partnerships page 8

Investing in quality page 10

People making it happen page 11

Thank you and welcome page 12

Contents

Fairness continues tobe a central driver toour work...

Collaboration and teamwork continue to be integral to thegrowing success of MRCP(UK), which, with almost 25,000candidates per year globally, is the largest provider ofinternational postgraduate medical examinations in theworld. Working together since the 1970s, the three UK RoyalColleges of Physicians in Edinburgh, Glasgow and Londoncontinue to deliver 15 examinations of the highest quality,including the PACES assessment of bedside clinical skills.

Welcome from theMedical Director

MRCP(UK) ANNUAL REVIEW 20162

successive year. Fairness must also characterise academicelements of our examinations and we continue to work to ensure that no aspect of their conduct, structure ordelivery will unfairly disadvantage any individualcandidate or candidate group. This year, we are planningto review our policy for reasonable adjustments and wewill publish further analyses relating to differentialattainment, its explanations and its solutions.

Fit for the futureFinally, it is critical that all examinations remain relevantto patient care in the 21st century. Together withcolleagues in our partner organisation, the Joint RoyalColleges of Physicians Training Board (JRCPTB), we will beworking to create a new curriculum for internal medicinein the UK, which will integrate MRCP(UK) examinationswith meaningful assessments of competence in theworkplace. The assessment of bedside skills will remainfundamental and the PACES 2020 review will ensure thatit, along with all our other examinations, remain fair,relevant and the best in international postgraduatemedical education.

Professor Andrew ElderMedical Director, MRCP(UK)

I continue to be struck by the commitment, enthusiasmand industry of colleagues from all around the world whocome together to deliver our examinations, and thank allthose who give their time.

International partnersThis is most visible for the PACES clinical skillsexamination, and we welcomed new teams in India,Malta and Sri Lanka to the PACES family in 2015.

Partnership will be central to our future internationalsuccess and we are therefore now working with Europeancolleagues to ensure that the very best of British practicein postgraduate assessment is promoted across mainlandEurope. International migration of doctors continues toexpand, and one key to the maintenance of standardswherever doctors travel and wherever they work, iscollaboration in education and training around agreed,unified and consistently high standards.

FairnessFairness continues to be a central driver to our work. High-stakes examinations are extremely resource intensiveto produce but must be fairly priced. We were pleased toreduce fees for 12 of our examinations this year, and havecontinued to freeze the fees for the others for the third

Partnership will be central to ourfuture international success...

it is critical that allexaminations remainrelevant to patient carein the 21st century...

3

Engagement and involvement

Staff working on examinations

Clinicians involved

MRCP(UK) ANNUAL REVIEW 20164

External stakeholders, including trainee physiciansand members of the public, are involved in manyaspects of our examinations, and help to ensurethat we maintain the highest standards. This yearwe continued to share our work with a range ofmedical organisations in the UK and internationally,and to seek the perspective of people involvedwith or affected by our examinations.

Trainee focusThere has been a particular focus on encouraging trainees to siton our committees and boards, so we can remain aware of theirconcerns and ask for their insights. We also give support totrainees who get involved in this work, which provides them withan opportunity to develop leadership skills necessary in theirfuture roles as consultants. We hosted a workshop for traineerepresentatives, and the Joint Royal College of Physicians TrainingBoard (JRCPTB) invited their own trainee representatives to attendas well. It was a productive day that ended with a programme offresh ideas to keep trainees involved and informed.

Academic exchangeOur staff and academics have been very active, networking withcolleagues in other organisations and presenting our work atconferences hosted by the:

• Academy of Medical Royal Colleges• Association for Medical Education in Europe (AMEE)• British Association of Physicians of Indian Origin (BAPIO)• General Medical Council (GMC)

• Icelandic Medical Society• Royal College of Physicians of Ireland• Society for Acute Medicine• Stanford Programme in Bedside Medicine.

Training tomorrow’s physiciansOur examinations are designed, developed and delivered bypractising physicians who want to play their part in advancingpatient care through education and ensuring high standards ofthe profession. It is part of their contribution to medical training,and an excellent opportunity to network with colleagues, learnnew skills and fulfil requirements for continuing professionaldevelopment. We are grateful for their contributions and willcontinue to support them with training, guidelines andinformation, and help from our team of staff and medical leaders.

‘Being a PACES examiner is a great opportunity totest my own clinical skills. Seeing a wide spectrum ofclinical cases and then being able to discuss themwith colleagues who have expertise in that particulararea is a very valuable learning method. It’s also anopportunity to catch up with colleagues, and find outwhat’s happening in other parts of the country.’

Dr Ray Keelan, PACES Examiner

‘The public have only a hazy idea of theexaminations doctors take, but they know that theyare vital in ensuring that the care they receive is safeand of the highest possible quality. My role is toprovide non-medical input with a particular interestin promoting sensitivity to patient needs andfairness to all candidates in the planning anddelivery of the examinations.’

Dr David Steel, lay member, MRCP(UK) Management and Policy Board

‘MRCP(UK) is an internationally respectedexamination and it is a huge privilege to havebeen a member of the MRCP(UK) Managementand Policy Board. As a trainee, I have first-handexperience of the examination process andtherefore act as an advocate to promote traineeviewpoints at board level. It is enlightening to seethe vast amount of work that goes into producingand maintaining high-quality examinations andthis position is an excellent opportunity fortrainees to help shape the future of examinations.’

Dr Chloe Broughton, trainee representative, MRCP(UK)Management and Policy Board

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Fit for the future

The NHS is under pressure as never before, due toan ageing population and rising demand forhealthcare. Increasingly, our patients present withcomplex needs, such as multiple comorbidities. Theyreceive more care in a community setting, ratherthan in hospital, especially for the management ofchronic conditions.

These trends mean that consultants in the future will need astrong generalist grounding as well as specialist knowledge. As always, their training must keep up with advances in science,medicine, technology and working practices. Policy developmentssuch as the Shape of Training Review, the Royal College ofPhysicians of London’s Future Hospital Programme, and theintroduction of the General Medical Council’s generic professionalcapabilities, must also be considered.

To meet these challenges, we are working hand-in-hand withthe Joint Royal Colleges of Physicians Training Board (JRCPTB) tocreate a new internal medicine curriculum for postgraduatemedical training, and a closely integrated system of assessment.

Consultation and studiesLast summer, the JRCPTB ran a consultation exercise on itscurriculum proposals, proactively seeking the views of traineesand those responsible for overseeing their training. After aseries of workshops, an Internal Medicine Committee has beenestablished, and it includes senior representation fromMRCP(UK). It has three sub-groups, which focus on curriculum,assessment and implementation. The assessment sub-group ischaired by our Medical Director, Professor Andrew Elder.

One key goal for the JRCPTB is to simplify workplaceassessment, minimising the ‘tick-box’ approach that hascharacterised recent approaches. As part of this work, they plan a proof of concept study to evaluate the acceptability of a broader, outcomes based approach to assessment, basedaround Competencies in Practice (CiPs).

Review of Diploma examinationsThis is an opportune time to take a fresh look at theMRCP(UK) Diploma examinations and update themwhere needed, so they remain relevant, fair and fitfor purpose, while continuing to protect safety andquality of care for patients.

Review of assessment strategy is a fundamental partof curricular reform and a short-life working group,entitled ‘PACES 2020’, has been established toundertake a detailed assessment of the structure andcontent of PACES. The group will recommend a visionfor the future development of PACES to theAcademic, Quality Management and ResearchCommittee (AQMRC), for implementation by 2020.

Integrity and fairness

MRCP(UK) ANNUAL REVIEW 20166

Postgraduate medical examinations are crucial to aphysician’s career and to patient safety. Therefore,we strive to ensure our examinations provide anaccurate measure of a doctor’s attainment, and donot put any individual candidate or candidate groupat an unfair disadvantage. This work includesensuring high levels of security for our questions andpapers, and using sophisticated electronic measuresto detect and prevent cheating. We also givecandidates clear conduct guidelines and a pathwayfor appeals and complaints, make reasonableadjustments where appropriate, monitor equalityand diversity data, and subject our examinations toindependent scrutiny to ensure they are not biased.

New Code of ConductA new Code of Conduct for candidates is coming into effect forall examinations taking place from 1 August 2016 onwards, inthe UK and internationally.

The Code applies to behaviour and all contact with patients,examiners, invigilators and staff of MRCP(UK) before, during and after the examination. It has been developed in consultationwith trainee and lay representatives, as well as MRCP(UK)officers and staff, and has been approved by the AcademicQuality Management and Research Committee (AQMRC).

We communicated the new Code proactively, giving candidatesample time to learn about and read the Code, which waslaunched on the MRCP(UK) website at the end of April 2016.

The Code was publicised widely through MRCP(UK) mediachannels, the three Federation Colleges, and the Joint RoyalColleges of Physicians Training Board (JRCPTB).

The MRCP(UK) Misconduct Regulations, which now includereference to the candidate Code of Conduct, were reviewedand updated at the same time. These regulations give a clearexplanation of the procedures we follow to:

• protect patient safety and everyone involved in theexaminations, • ensure the integrity of the examination, and • reach an impartial decision in cases of alleged misconduct bya candidate.

It is worth noting that allegations of misconduct are rare, and arose for fewer than 0.5% of candidates taking ourexaminations in the second and third cycles of 2015, and thefirst cycle of 2016.

Equality and diversityStriving for diversity and seeking representative viewpointsenhances the quality of our examinations, making them fairand relevant to all concerned.

We have been continuing our work on differential attainment –where certain groups of candidates perform less well on anexamination than others – both in the research we support,and in monitoring the characteristics of our examiners andcandidates in line with best practice.

We have commissioned a bespoke, online equality and diversitytraining package for our examiners, which is due for launch in2016. The content of the course will be clinician-led, so it

we strive to ensure ourexaminations provide anaccurate measure of adoctor’s attainment...

485Invigilators

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addresses the situations and questions that physiciansencounter in their work as examiners and assessors.

Reasonable adjustmentsIn line with the Equality Act 2010, we have an established policyfor making reasonable adjustments for candidates who have adisability or special circumstances, so they are not unfairlydisadvantaged when taking one of our examinations.

In 2016, we are in the process of reviewing and updating thispolicy, as doing this at routine intervals is standard good practice.

Fair questionsWe apply data and evidence to ensure the examinationsthemselves are fair, and do not disadvantage candidates ofsimilar ability but different backgrounds. We do this throughrobust processes for creating and monitoring our examinations,and by contributing to, and supporting research.

Previous studies have shown that white candidates in the UKoutperform their black and minority ethnic (BME) peers, butthe reasons are unknown. A recent analysis, conducted by Dr David Hope, a psychometrician working with MRCP(UK) atthe Centre for Medical Education, University of Edinburgh,suggests that overall differences in pass rates on theMRCP(UK) Part 1 examination is not explained by unfairquestions. This study looked at the performance of 13,694candidates on 2,773 Part 1 questions and found that amongUK graduates virtually no questions exhibit any bias withregards to sex or ethnicity. The findings were presented to theAQMRC, reported in our e-newsletters, and submitted forpublication in an academic journal.

Computer analysisof papers to detectpossible cheating

Clear, fair process toinvestigate anomalies,allegations or appeals

Code of Conduct andregulations; consider

requests for reasonableadjustments

No ID no entry; invigilators; controlled seating; reasonable adjustments

After examinationRegistration

We have clear and impartial procedures that allow candidates tocomplain or appeal a result when they believe something hasgone wrong in the way they were assessed, or in the conduct ofan examination. Our latest data confirm that while they are onthe increase, these situations still rarely occur.

Examinationday

Examinationsafeguards:

Secure questions,papers and scenarios

Investigating issues

MRCP(UK) ANNUAL REVIEW 20168

International partnerships

With an established international track record, and astrong network of partners around the world, weare now able to develop additional programmes ofincreasing depth and innovation. Currently, a keytheme is integration of assessment and training, andwe are working side by side with our colleaguesfrom the Joint Royal Colleges of Physicians TrainingBoard (JRCPTB) to achieve this. We are also workingwith international partners to develop newqualifications that travel with physicians acrossborders: this is becoming crucial in our increasinglyglobal profession.

Integrated programme in IcelandWith the JRCPTB, we have developed a comprehensive packageof training and assessment for core medical training (CMT),which has been adopted in Iceland. It is the first time this hashappened outside the UK.

Trainee physicians in Iceland are now following the UK CMTcurriculum and system of assessment, including the AnnualReview of Competence Progression (ARCP), and the ePortfoliowhich is the formal method by which a trainee's progressionthrough their training programme is monitored and recorded.

These trainees can sit the MRCP(UK) Part 1 and Part 2 Writtenexaminations in Iceland and the MRCP(UK) Part 2 Clinicalexamination (PACES) in the UK, and so far their results havebeen impressive.

There are also ‘train the trainer’ sessions in Iceland, and anaccreditation visit took place in June 2016.

This model is proving very successful, and we believe it couldwork well in other countries.

Qualifications that travelAt the specialist level, several promising initiatives have beenprogressing across Europe over the past year.

A strong partnership has been established between MRCP(UK),the British Society of Gastroenterology and the European Boardof Gastroenterology and Hepatology. Following three years ofpathfinder (pilot) examinations, a fourth examination will takeplace in 2017. Since 2014, about 250 candidates have taken theEuropean examination.

MRCP(UK) has also been working in partnership with the RenalAssociation (UK) and the European Union of Medical SpecialistsRenal Section, to develop an examination in this specialty. A substantial amount of work has been accomplished. Europeancolleagues have taken part in question writing groups (with trainingprovided) and examining board meetings. The first Europeanpathfinder examination in nephrology is anticipated in 2017.

Encouraged by these positive partnerships, we are also exploringEuropean examinations in other specialties, including neurologyand endocrinology and diabetes. The long-term vision is for arange of qualifications that travel with physicians across Europe,inspiring confidence among employers and patients.

The MRCP(UK) Medical Director, Professor Andrew Elder, has been advising Stanford University Medical School in the USA since 2013 as part of their Stanford 25 BedsideMedicine Programme. He is a Visiting Professor at Stanford, and demonstrates PACES at the programme’sannual symposium.

Professor Abraham Verghese, Department of Medicine, Stanford University, USA, says:

‘The great challenge in America is keeping the bedsideskills that are taught in the first and second year ofmedical school alive in medical training and practice. To do so when there is no formal testing of such skills, no high-stakes exam at any stage of training, just anassumption that somehow whatever rudimentary skillswere taught to the neophyte magically stay the same, is an astonishing kind of faith, not in keeping with thescientific method.

In that regard, the PACES exam and its worldwide use is a model to greatly admire. We at Stanford arebenefitting from the lessons of PACES, from consultationswith Professor Andrew Elder, as we try to teach bedsideskills and implement a voluntary program to assess theskills of our trainees at the bedside.’

We are also working withinternational partners to developnew qualifications that travel withphysicians across borders...

Candidates at international centres

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45Countries worldwide

More internationalPACES places

Sri Lanka

MaltaIndia

New PACES centresAround the world, PACES remains a popular examination. Our efforts to bring PACES to as many doctors possible,wherever they might live, continue to flourish.

In India, MRCP(UK) is in the process of opening two newcentres to complement our existing PACES centres in Chennaiand Kolkata. In Bengaluru, a successful pathfinder (pilot)examination ran in January 2016. Dr Sudarshan Ballal is theFederation lead for this centre, which is based at ManipalHospital. The first PACES examination is scheduled forDecember 2016. A new centre in Kochi ran its first PACESexamination in February 2016 with our partner Aster Medcity.Thanks are due to the Federation lead, Dr Anil Kumar, and his efficient team.

In Colombo, Sri Lanka, a pilot examination confirmed that allthe necessary arrangements were in place, and that everythingcould be expected to run smoothly. In partnership with theCeylon College of Physicians, and under the leadership ofDr Lalith Wijayaratne, the examination is scheduled to go live in November 2016.

Following a similar pathfinder, a new PACES centre has alsoopened at the Mater Dei Hospital in Valletta, Malta. The firstfull examination cycle ran in early 2016, ably overseen by theFederation lead, Professor Stephen Montefort.

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MRCP(UK) ANNUAL REVIEW 201610

Investing in quality

Examination fees are a significant investment forcandidates, and we aim to provide value for moneywithout compromising quality.

In March 2016, we were very pleased to announce a 23%reduction in fees for all 12 of the Specialty CertificateExaminations (SCEs). This was possible because of the rapidexpansion the examinations have enjoyed worldwide, alongwith efficient implementation.

The reduced fee comes into effect from August 2016, andshould ease some of the financial pressures on doctors whoare required to sit the SCEs. We also hope it will enable evenmore doctors to undertake the examination internationally, asan optional way to confirm their professional knowledge andbuild their careers.

This reduction follows a long period where fees have beenfrozen: since 2013 for the SCEs and since 2014 for theMRCP(UK) Diploma examinations.

Ultimately, we want to provide a high-quality examination thatproves a sound investment for candidates, furthering theirtraining and careers, while also safeguarding the welfare ofpatients they will care for in the years to come.

12925,00038,00085,000

UK examination venues

Number of doctors sitting our examinations worldwide

Questions in our question bank

Examination papers and marksheets dispatched

• Organising venues• Dispatching materials• Supporting hosts• On-site administrative

support

• Scanning marksheets• Data transfer (SCEs)• Results report to boards• Final pass mark agreed• Results and feedback to candidates• Reports to deaneries and LETBs• Analysis of examination results

• Question and scenario writing• Peer review• Editing• Setting papers• Standard setting• Question bank management

• Maintaining online system• Processing payments• Scheduling places• Answering queries• Providing study resources

Helping applicants

Delivering the examination

Analysing and reporting

results

Creating theexamination

‘The fee reduction is extremelywelcome news for all trainees. It demonstrates the colleges havebeen receptive to feedback from trainees about the cost ofexaminations, particularlyconsidering the current financialenvironment.’

Dr Jim Macfarlane, trainee representative,SCE Steering Group Academic governance

Administration

Communications

we want to provide a high-qualityexamination that proves a soundinvestment for candidates...

11

People making it happen

Our examinations are for physicians and byphysicians – they simply could not happen withoutthe dedication of hundreds of volunteer questionwriters, examiners and board members. Thesephysicians freely give their time and expertise, toensure that the standard expected of their professionby the public and the regulator is maintained.

2 days

1,500Average clinician’s time per year

Invigilators, organisers and local administrators

The examinations are also supported by a team ofapproximately 60 skilled staff working across the threeFederation Colleges.

Our staff provide a wide range of services for candidates,handling their applications and results securely, ensuring thatexamination centres run smoothly, and assisting with queries.We have strong academic, editorial and policy teams, whomake vital contributions to the quality of the examinations. They also keep in touch with key external stakeholders toensure our examinations remain relevant and fair.

We have strongacademic, editorialand policy teams...

MRCP(UK) ANNUAL REVIEW 201612

Thanks are due to our demitting board members for their hard work and contributions. A warm welcomeis also extended to our new board members.

MRCP(UK) Part 1 Examining Board

Thank youProfessor Kok-Onn Lee

WelcomeProfessor Brian AngusProfessor Gerald ChuaDr Ruben ThanacoodyProfessor Mike Vassallo

MRCP(UK) Part 2 Written Examining Board

Thank youProfessor Rudy Bilous (Secretary)Dr Jeremy DickDr Shona MethvenProfessor Charles Twort

WelcomeProfessor Anthony Nicholls (Secretary)Dr Euan Cameron Dr Neil HopkinsonDr Aneil MalhotraDr Ellon McGregorDr Maung Maung Myat MoeDr Fozia Nazir

Scenario Editorial Committee (PACES)

Thank youDr Hadi Al-Hillawi (Chair)

WelcomeDr Elizabeth Murphy (Chair)Dr Philip Strike

Scenario Writing Group (PACES)

Thank youDr Elizabeth Murphy (Chair)Dr Celia Bielawski Dr Damien CullingtonDr Arthur DunkDr Alison Honan Dr Mike IraniDr Hannah Robertson

WelcomeDr Philip Strike (Chair)Dr Ahmed Al-SharefiDr Fozia NazirDr John Nixon

Acute Medicine SCE Examining Board

Thank youDr Alistair DouglasDr Tanzeem Raza

WelcomeDr Claire GardnerDr Martin Whyte

Acute Medicine SCE Standard Setting Group

Thank youDr Deepak Bhatia

Dermatology SCE Examining Board

Thank youProfessor Nicholas Reynolds

WelcomeDr Hazel BellProfessor David Burden Dr Giles Dunnill

Endocrinology & Diabetes SCE Examining Board

Thank you Dr Neil GittoesProfessor Peter Trainer

Endocrinology & Diabetes SCE StandardSetting Group

Thank youDr Michael Clements

Gastroenterology SCE Examining Board

WelcomeDr Sunil SonwalkarDr Emma Wesley

Gastroenterology SCE Standard Setting Group

Thank youDr Guru AithalDr Antony Ellis

Geriatric Medicine SCE Examining Board

Thank youProfessor Stephen Allen

WelcomeDr Celia BielawskiDr Tomas Welsh

Geriatric Medicine SCE Standard Setting Group

Thank youDr Oliver CorradoDr Lindsey Dow (Co-chair)

WelcomeDr Alexander ThomsonDr Divya Tiwari

Infectious Diseases SCE Standard Setting Group

Thank youDr Raymond Fox (Chair)Dr Sani AliyuDr Brian AngusDr Neena BodasingDr Julia GreigDr Michael JacobsDr Claire MackintoshDr Martin Wiselka

Nephrology SCE Examining Board

Thank youDr Alex CroweDr David Reaich

WelcomeDr Richard D’SouzaDr Stephen Kardasz

Nephrology SCE Standard Setting Group

Thank youDr Catherine Stirling (Chair)

WelcomeDr Arvind Ponnusamy

Neurology SCE Examining Board

Thank youDr Rustam Al-Shahi Salman

WelcomeDr Abhjit Chaudhuri

Palliative Medicine SCE Examining Board

Thank youDr Clare Marlow Dr Shaun Smale

Palliative Medicine SCE StandardSetting Group

WelcomeDr Venkata ChaitanyaDr Craig GannonDr Suzanne Kite

Respiratory Medicine SCE StandardSetting Group

WelcomeDr Manish Gautam

Rheumatology SCE Examining Board

Thank youDr David Rees (Chair)

WelcomeDr Ken Lim (Chair)Dr Kevin Fairburn (Secretary)

Rheumatology SCE Standard Setting Group

Thank youDr Sally Edmonds Dr Vanessa Morris

WelcomeDr Ramasharan LaxminarayanDr Adrian PendletonDr Shaun Smale

Copywriting: Colleen Shannon, Freelance medical writerDesign: Chris Hewitt, WLG DesignPhotography: Jonathan Perugia Production: Ruth LorimerPrinted by: Latimer Trend

Published for the Federation of Royal Colleges of Physiciansof the UK by MRCP(UK)

© Royal Colleges of Physicians 2016

Thank you and welcome

MRCPUKMembership of the Royal Colleges of Physicians of the United Kingdom