MRCP Graduation
Dear Friend,
This week marked a proud milestone in my medical career — I officially graduated as a Member of the Royal College of Physicians (MRCP). For many of us on the path through postgraduate medicine, this is a significant step — both symbolic and practical — as we transition from the foundation years to formal higher specialty training.
🏛️ What is the Royal College of Physicians (RCP)?
Founded in 1518, the Royal College of Physicians (RCP) is one of the oldest professional medical institutions in the world. Based in London, the RCP is dedicated to improving medical practice, setting standards in clinical care, and supporting doctors throughout their careers.
It boasts a prestigious history, with alumni that include William Harvey (who discovered the circulation of blood), Thomas Sydenham (the “English Hippocrates”), and more recently, leaders in global health and NHS policy.
Becoming a member of the RCP is more than just passing exams — it’s about joining a global community of physicians committed to clinical excellence and lifelong learning.
📚 The MRCP(UK): What It Takes
To gain Membership of the Royal College of Physicians, doctors must complete the MRCP(UK) — a rigorous set of three postgraduate examinations designed to assess knowledge, clinical skills, and decision-making in internal medicine.
The MRCP is made up of:
Part 1 – A written exam covering the scientific and clinical knowledge expected of a foundation year doctor entering core medical training. It focuses on core topics in medicine and tests how well you understand and apply them.
Part 2 Written – This is a more advanced written exam that tests diagnostic reasoning, clinical judgment, and knowledge application. The scenarios are more complex and require greater depth of understanding.
PACES (Practical Assessment of Clinical Examination Skills) – A practical clinical exam, often considered the most challenging. It assesses how you gather information from patients, perform physical examinations, communicate findings, and make clinical decisions in real time. You rotate through five stations with real patients and trained examiners, simulating the complexity of day-to-day medical practice.
🎓 What Membership Means
Now that I’ve completed all parts of the MRCP, I’ve been formally admitted as a Member of the Royal College of Physicians — an achievement that not only acknowledges the knowledge and clinical skill I’ve developed, but also serves as a gateway to the next stage of my training.
Most importantly, this means I can now officially begin training as a medical registrar, taking on greater responsibility, managing acute medical takes, and stepping into a leadership role on the wards — all under the supportive framework of specialty training.
Medicine often teaches us to dwell on the difficult moments—the long nights, the mistakes, the near-misses. We’re trained to reflect, to improve, to carry the weight of responsibility. But it’s rare that we pause to truly celebrate the milestones.
For those of you on the MRCP journey — enjoy the course! It’s tough, but every hour of study and every late night on call builds the skill set needed to deliver safe, compassionate, and expert care. And trust me, graduation day makes it all worth it.
If anyone has questions about the exams or what to expect, feel free to reach out — I’d be more than happy to share tips or experiences.
Drug of the week
Bleomycin
Bleomycin is a medication primarily used to treat cancer, such as Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, testicular cancer, ovarian cancer, and cervical cancer among others.
Bleomycin acts by induction of DNA strand breaks.
The exact mechanism of DNA strand scission is unresolved, but it has been suggested that bleomycin chelates metal ions (primarily iron), producing a pseudoenzyme that reacts with oxygen to produce superoxide and hydroxide free radicals that cleave DNA.
One of the most serious complication of bleomycin, occurring upon increasing dosage, is pulmonary fibrosis and impaired lung function.
A Brain Teaser
A 70-year-old man is seen in the clinic with a red skin lesion on his right hand that has slowly been growing over the last year. He denies any itchiness, pain, or changes in sensation. His past medical history includes multiple sunburns throughout his lifetime, and he does not regularly use sunscreen.
On examination, a 10 mm erythematous, scaly patch is seen at the base of the thumb of the right hand. It is well-demarcated and there is no telangiectasia.
Given the likely diagnosis, what is the treatment of choice?
A: Photodynamic therapy
B: Radiotherapy
C: Surgical excision
D: Topical 5-fluorouracil
E: Topical corticosteroids
Answers
The answer is D – 5-fluorouracil.
The presence of any skin lesion that is slowly growing on a sun-exposed site (such as the face, hands, or legs) should raise suspicion of either a malignant or pre-malignant skin condition. Red, scaly patches that grow on sun-exposed sites in older patients should raise suspicion of Bowen’s disease, which is a precursor to squamous cell carcinoma (SCC). SCC differs in that it ulcerates, grows much faster (over weeks to months), and there may be areas of bleeding.
Topical 5-fluorouracil is correct as the first-line treatment of choice for Bowen’s disease. It is a topical chemotherapy agent which allows for high concentrations of the agent at the site of the skin lesion without causing significant systemic effects. It often results in inflammation and erythema, and topical corticosteroids are often co-prescribed.
Photodynamic therapy (PDT) is incorrect as this does not play a role in the management of Bowen’s disease. PDT is instead considered in actinic keratoses (AKs) if topical therapies are ineffective and cryosurgery is not feasible. AKs are different to Bowen’s disease as they tend to be small, crusty lesions that may be pink, brown or the same colour as the skin, and often there are multiple lesions present.
Radiotherapy is incorrect as this is considered second-line therapy for Bowen’s disease if topical 5-fluorouracil is inappropriate or ineffective and surgical excision is not feasible. There is nothing in this patient’s history to suggest this would be the case.
Surgical excision is incorrect as this is considered if topical therapies such as topical 5-fluorouracil are ineffective. Using topical therapies first may be sufficient to eliminate the skin lesions without the risks associated with surgery, such as infection, bleeding, and cosmetic problems such as scarring. Since this patient has had no treatment yet, this step may not be necessary.
Topical corticosteroids is incorrect as this is not indicated in the treatment of Bowen’s disease unless it is co-prescribed with topical 5-fluorouracil as mentioned above. Giving topical corticosteroids is likely going to mask the patient’s symptoms, allowing Bowen’s disease to progress into SCC, which can have worse outcomes.
