The FCPS-I exam, in all the
specialties tests knowledge in the basic sciences. It consists of 2 papers, each
of 3 hrs. duration which take place same day simultaneously. The exam focuses on
those sections of basic sciences that are relevant to its specialty. For example
the FCPS-I exam for Gynecology and Obstetrics will focus more on the Pelvis and
Perineum in its questions of gross anatomy while the FCPS-I exam for ENT will
focus on Head and Neck in its anatomy questions. Similarly, the FCPS-I contains
questions from the other basic sciences (besides anatomy) that are relevant to
its own field besides containing general questions relevant to all specialties.
There is no negative marking
in this exam of 100 questions - however the pass rate is low, ranging from
8-30%. This is because the passing margin is set quite high at approximately
80%, which means a candidate cannot afford to get more than 15-20 questions
The subjects tested in the
FCPS-I exam are:
Anatomy (Gross, Histology,
General and Special
Pathology (Part of special pathology).
Community Medicine (not a
major subject, unless the specialty itself is Community Medicine).
Specialty Related subject:
Although clinical sciences are not included in the FCPS-I exam, reading a
specialty related book would help integrate the relevant basic sciences
information. For example, reading an ENT book for FCPS-I ENT exam would most
definitely be of some benefit.
The FCPS-I exam is held 3
times a year. The dates for the exams are not the same every year, but
approximately in the time-periods mentioned below.
In order to take the FCPS
exam, the application form must reach CPSP two months before the exam date
itself. So if a candidate wants to give the exam in February/March, the exam
application must be in the CPSP offices in November / December. With the
application form candidate must submit his House Job Experience
Certificate and PMDC full registration. Those who have not finished theirs house
job and do not have elevated their provisional registration to a full
registration are not eligible to sit in the examination, so you may lose a
chance to avail FCPS Part I attempt, if your house job session is delayed.
This means that the candidate
cannot appear in the February/March FCPS-I exam and he has to wait for 5 months
till the June/July attempt. CPSP has made another provision that if you have
passed your FCPS in later time and you were working in a teaching hospital in a
capacity of a PG student, that training will be counted towards your FCPS
requirement up to maximum of one year, provided you are working under Registered
It is suggested that to save
time, candidates must plan their FCPS part I according to their house job
completion & eligibility to appear in the exam, and they must apply for some PG
/ MO post under CPSP supervisor, so that the time before the examination is
utilized in the best possible way.
You Pass Your F.C.P.S Part I Exam
After passing, you will apply
for a Post Graduate Trainee post in CPSP recognized hospital. It must be
mentioned here that not all PGs are awarded the post. Every province in Pakistan
has a fixed number of PG posts which it can give and if the number of applicants
exceeds the number of PG positions available then some will be left out. Such
applicants thereafter can either join the PG training as Honorary (i.e. without
pay) or can apply for non-training jobs in private or government hospitals as
Medical Officers. The pay, in private hospitals may be marginally higher for
non-training posts (although this is not always the case), but the downside of
it is that the experience will not be counted towards an FCPS degree.
Due to a limited number of PG
seats available in teaching hospitals, number of doctors are doing their PG
training as Honorary. Pay for PG Trainee is Rs. 10,000 per month in Punjab.
Before joining any hospital,
one must confirm the following
The consultant under whom
supervision you will be working is a registered CPSP supervisor for that
specialty. You can check this from the list of registered supervisors
available on CPSP website.
The department / unit /
ward is recognized for PG training by CPSP. It can also be checked from CPSP
Components of FCPS Training
After you have secured an
FCPS training post, you will begin your duties. It is generally acknowledged
that the workload for PGs is very demanding, more so perhaps than for junior
doctors in the US and UK. In many hospitals, PGs are given a lot responsibility
for patient care and management – with these responsibilities increasing as the
PG moves forward in his training.
During the course of
training, the medical PGs must take 3 mandatory workshops while the surgical
ones must take 4. These workshops have to be taken within the first 18 months of
Computer and Internet
for 5 days and imparts basic knowledge of how to use computers and the
internet. For those who feel they already have such skills, there is an
equivalence test one can pass to attain a certificate attesting to the fact.
Biostatistics, Dissertation Writing.
Lasts for 5 days and gives an intensive course on how to conduct research, how
to interpret the data from such research and how to incorporate these skills
in a Dissertation (see below).
A 3 day course on effective communication techniques in presentations,
workshops and seminars.
These three workshops are
mandatory for all PGs regardless of their specialty and must be taken within the
first 18 months of training.
For the PGs in surgery, an
additional 3 day workshop on Basic Surgical Skills is also mandatory –
also to be taken within the first 18 months of PG-ship.
These workshops cost Rs.
8,500 each except for the Computer and Internet Skills workshop which costs Rs.
7,500. They are held several times a year.
(The workshops can be taken
by any doctor, not just a PG. This fact was mentioned in the UK section of this
manual to point out that such workshops strengthen an individual’s CV as they
are officially organized by the CPSP and therefore recognized abroad.)
These are non-mandatory
courses lasting 5-7 days in which a group of senior doctors volunteer to conduct
a thorough revision of clinical examination procedures to candidates who will
soon be appearing for the FCPS-II exam (which contains a clinical examination
component). The course cost around Rs. 500-2000 and are usually held some time
before the FCPS-II exam dates.
For those non-FCPS-II
candidates who wish to add to their CV, it should be noted that these courses
are not formally organized by the CPSP, and as such will have limited value to a
doctor who is not an FCPS-II candidate. In other words, attending such a course
will not add appreciably to your CV in the way the CPSP-organized workshops
To quote the FCPS
Dissertation Instruction Manual, issued by the CPSP.
of Synopsis/Protocol on a chosen topic, its approval from Research and
Training Monitoring Cell (RTMC), CPSP, and preparing a dissertation,
acceptable to the College, is mandatory for all candidates aspiring to
appear in the FCPS II theory, clinical and oral examinations. In doing so,
the CPSP aims at:
Cultivating an inquiring mind in its potential specialists.
Encouraging in-depth studies related to common health problems afflicting
Generating scientific data in various medical and allied fields.”
Basically, the dissertation
is an original work of research that is carefully preparing over the course of
FCPS training and must be submitted at least 9 months before the date the
trainee wishes to appear in the FCPS-II exam.
dissertation, candidate apply to the CPSP for formal approval of topic of his /
her dissertation, this application with details that how that dissertation work
will be carried out is called as synopsis. So approval of synopsis is
first step towards dissertation writing.
Recently, CPSP has decided that all
candidates (fresh and repeaters) must have passed the Intermediate Module
examination as one of the mandatory eligibility requirements for appearing in
FCPS-II examination in September 2007 and onwards in the subjects listed below
SUBJECT OF FCPS-II
SUBJECT OF INTERMEIATE MODULE EXAMINATION
condition of passing the Intermediate Module examination one year before
appearing in FCPS-II examination has been withdrawn. Thus, if all other
requirements have been completed, candidates can appear in FCPS-II examination
any time after passing the Intermediate Module examination.
Intermediate Module Examinations in Medicine & Surgery are already being held
and they will continue. For all other subjects listed above, the first
Intermediated Module Examination will be held in March 2006.
Those FCPS – II candidates who have passed MCPS examination in the relevant
subject earlier, will be exempted from Intermediate Module Examination.
candidates who pass this examination will be issued a certificate of passing
Intermediate Module examination. Such candidates will also be issued MCPS
Diploma after they have completed all requirements for appearing in final
FCPS-II examination and have appeared in this examination once.
Part II Examination
This exam has two components,
a paper exam and a clinical/oral exam. The FCPS-II paper exam consists of 100
MCQ questions while the clinical/oral exam is held with the cooperation of real
patients. When presented with a patient, the candidate will have to take
history, conduct the clinical examination, and propose a management plan. In the
oral component of this part of the exam, the candidate will be thoroughly tested
for in-depth knowledge of his specialty.
The oral exam is divided into
2 parts, the Long Case and the TOACS (Task Oriented Assessment of Clinical
Skills). Candidates must pass TOACS so that they can move to long case portion.
The FCPS-II is not considered
to be an easy exam. The pass rate is low and it is not uncommon for doctors to
take it more than once before they pass. After passing however, the FCPS period
of training is officially over and the doctor is awarded the highly regarded
FCPS degree, and qualified as a specialist in that field.
stands for Diploma of the College of Physicians and Surgeons. The DCPS is
a two year training program structured just like the FCPS program. The
minimum criteria for eligibility is full registration with the PMDC (i.e., the
candidate must have finished his house jobs).
The DCPS program was
introduced in 2004 and the first batch of doctors are currently (in 2005) in
their first year. There is no entrance exam into the DCPS program (as FCPS-I is
for the FCPS program). However, there is an exit exam which will be conducted in
2006 for the first batch of DCPS doctors - the precise structure and content of
which is still being formulated at the present time.
The DCPS was introduced to
correct the deficiency of doctors at the junior PG level. A DCPS doctor will be
a junior level doctor and will progress only by the strength of his seniority
and experience. His promotion and progress therefore will only come about as the
years pass by or if he enters and completes an FCPS program. Currently, it is
proposed that a DCPS doctor who wishes later on to pursue FCPS training will
have one year of his DCPS training counted towards an FCPS. That is to
say, a DCPS doctor in medicine who enters an FCPS program in medicine will only
have to train for three years as a PG and not the usual four.
The specialties and
sub-specialties in which the DCPS program is offered are listed below. The range
of specialties offered reflects the current shortage of junior doctors in these
The DCPS program has replaced
the MCPS (Member of
College of Physicians and
The MCPS was also a training program designed to produce junior doctors, and was
restructured, renamed, and redesigned into DCPS. This change was effected in
order to bring the program on par with similar programs in developed countries –
a move that will lead to its acceptance in developed countries.
Practical Considerations about F.C.P.S
Unlike the process of
entering UK and US system of post-graduate medical education, in the Pakistani
system there are no visa problems to address, no prolonged, expensive
registration requirements and little (if any) traveling to far off places.
Besides these factors are other practical considerations a doctors must bear in
mind when deciding to pursue the FCPS option.
There is little doubt that a
PG working in practically any teaching hospital in Pakistan would see more
patients, and a greater variety of pathologies than doctors training for a
similar period in the US or UK. This is a consequence of the underdeveloped
health-care system in Pakistan (in which the doctor - patient ratio is very
low), but it ultimately works to the advantage of the trainee. In the 4-5 years
of his PG-ship, the trainee would get much more practical experience and
exposure than his counterparts in developed countries. If the PG is very hard
working and actively incorporates his clinical exposure with formal in-depth
study, he will evolve into a highly competent and experienced doctor. In surgery
for instance, junior PGs and even house officers quickly learn to perform common
major surgeries, an experience which greatly contributes to their confidence and
expertise in a relatively short time.
In the US all residency
programs must adhere to a minimum standard of training, work hours and patient
load. To ensure that these minimum standards are met, these programs are kept
under tight check by a National Residency Control Commission (RCC). Vigilant
supervision of training programs by the RCC ensures that all teaching hospitals
in the US provide - at the very least – an acceptable standard of active
training to its residents.
In Pakistan, while certain
minimum standards are in place (which are mostly concerned with accrediting
hospitals as being fit to offer training) a proactive supervised evaluation of
training standards (similar to that in the US) is not in effect in Pakistan.
With a lack of such standardization arises the inevitable difference in the
proficiency and excellence of the training programs in different hospitals
throughout Pakistan. As a result, the quality of training imparted to FCPS
trainees varies greatly from one hospital to the next.
For the most part, the
quality of training in any hospital is largely in the hands of its senior
doctors. In some training hospitals, where the senior doctors have the time and
inclination, the PGs will be regularly monitored and assessed with an active
interest taken in their professional development to ensure their evolvement into
competent doctors. Such environments makes it easier for FCPS trainees to make
the most of their training and evolve into highly competent doctors.
On the other side of the
spectrum are training hospitals where the senior doctors are overworked and
simply don’t have the time (or inclination) to focus their energies on their
PGs. In such places the PGs suffer the inevitable consequences that come with
such an environment. This is not to say, however, that it will be become
impossible for PGs in such settings to acquire a high degree of competence in
their specialty – rather, they will have to work harder themselves in order to
overcome the short-comings of a training environment that offers them little
Keeping this in mind,
choosing a teaching hospital in which to pursue FCPS training should become an
important aspect of planning the FCPS option. Currently, most doctors choose to
pursue FCPS training in the hospitals affiliated with the medical college they
graduated from - with little or no consideration given to the quality of
training these hospitals can offer them. Such an approach is probably strongly
influenced by the fact that the doctor feels comfortable in familiar territory,
surrounded by old friends and family and would continue to work in the
environment / city he lived in during his days as a medical student.
However, with numerous
teaching hospitals available throughout Pakistan, a more calculated approach
should be taken when pursuing an FCPS training program. If you feel you’ll
receive a good training experience in a hospital located in a city other than
the one you’re currently living in, then that option should be seriously
considered and you should investigate the procedure and requirements needed to
get into such a hospital as an FCPS trainee. Such research is best conducted by
talking directly to PGs working in that hospital as they would be able to give
you the most accurate picture of the quality of training.
By far, entering the FCPS
program is the most cost-effective of all the options mentioned in this manual.
The major costs involved are:
FCPS-I Exam Fee
Registration Fee as a
Rs. 25,000 - 35000
Rs. 1,000 - 1500*
FCPS-II Exam Fee
*The dissertation costs range
from 1,000 to 15,000 depending mostly on whether or not you employ the services
of a computer professional who will type and arrange the format of your
document. If you are skilled at using a word processor and can prepare the
document yourself, the cost of preparing the dissertation will be
Assuming that the exams are
passed in the first attempt (which is not the case for the majority of
candidates), the costs range from Rs. 49,500 to Rs. 72,000. This is hardly 10%
of the costs entailed in the entire USMLE and UK pathways.
It is cheaper to enter the
FCPS pathway, but this fact needs to be considered in conjunction with the “Time
and Money” factors described below.
These two factors are
intertwined. Recall that the FCPS program lasts for 4-5 years (depending on the
specialty). Also remember that in our institute, Allama Iqbal Medical College,
the final year class has been, in recent years, graduating in April - with the
house job starting in May. After the house job, there is a six months - one-year
delay before the FCPS training begins (provided you pass the FCPS-I exam
in the first attempt). After the 4-5 FCPS years are over, most candidates study
for 4-5 months before attempting the FCPS-II exam. If they pass in the first
attempt, they will have successfully completed the pathway. Adding up the years
from graduation, the time taken to complete the FCPS program is approximately 6˝
years (for medicine and surgery) and 7˝ years for other specialties like ENT and
If you graduate at the age of
24, then you’ll be 30-32 years old by the time you finish the FCPS. The long
amount of time spent training and studying for the FCPS degree is not a problem
in itself. However, the situation does become problematic when the time taken to
complete the FCPS pathway is considered in conjunction with the ‘money factor’.
A PG is currently paid Rs.
10,000 a month. He will continue to get this stipend for the duration of his
training. It is generally agreed upon that this amount is hardly adequate to
support oneself, let alone one’s parents or family (i.e., wife and children).
Resultantly, the FCPS trainee is often in a financially difficult position – a
situation that often leads to the great frustration and anxiety that comes from
financial dependence on others. This is a particularly pressing problem in our
poor society where a man in his late 20s or early 30s is usually expected to be
financially independent and be able to contribute to, rather than drain from,
the economic position of his family.
The financial problem is
further compounded by secondary financial demands: The mandatory workshops cost
Rs. 24,500 (for the medical specialties) and Rs. 33,000 (for the surgical
specialties). This is how much money a PG makes in 4-5 months. Besides the costs
of books, are the costs of preparing the dissertation, which ranges from Rs.
From examination of
post-graduate medical training systems in the UK and US, it is apparent that the
primary motive most people have for seeking further education abroad is the
“time-money” factor. Many doctors in our poor society have financial obligations
to their families they would be unable to discharge with a stipend of Rs. 10,000
a month. They feel that the relative lack of a rigorously monitored,
quality-controlled FCPS training program, when combined its associated financial
drawbacks, add up to make the FCPS option an unattractive one. This conclusion
is manifested by the fact that despite the exhausting period of study and
uncertain visa situation in the US option; and the dire job situation in the UK
option - many doctors still prefer to invest their time and money for a chance
to go abroad for further training.