The MRCPCH Foundations of Practice is the first MRCPCH theory paper most paediatric trainees attempt. It tests core clinical paediatric knowledge — diagnosis, investigation, and evidence-based management — at the level expected of a trainee in ST1 to ST3. The exam contains 95 best-of-five SBA questions in two and a half hours, with three diets per year.
The FOP is the most clinically grounded of the three MRCPCH theory papers. Unlike TAS (which tests underpinning sciences) and AKP (which tests advanced application with multi-select questions), FOP tests the pattern recognition and management decisions you make in day-to-day paediatric practice.
Topic weighting
Respiratory disease accounts for approximately 12 per cent — asthma (BTS/SIGN stepwise management, acute management, when to refer to secondary care), bronchiolitis (NICE NG9 — supportive management, when to admit, when to consider CPAP), croup (dexamethasone, nebulised adrenaline), cystic fibrosis (diagnosis, newborn screening, pulmonary management), and pneumonia.
Neurology and development account for roughly 12 per cent — seizure classification and management (NICE CG137 applied to paediatrics), cerebral palsy (classification, associated conditions, GMFCS), developmental delay assessment (when to investigate, red flag features), and febrile seizures (simple versus complex, investigation criteria, parental advice).
Infectious disease and immunology account for 12 per cent — meningitis and septicaemia (NICE NG51, recognition and early management), fever in children (NICE NG143, traffic light assessment), immunisation schedule (UK Green Book — this is high-yield factual content), and primary immunodeficiency (when to suspect, basic investigation).
Endocrinology accounts for 8 per cent — type 1 diabetes (DKA management in children, insulin regimens, HbA1c targets), thyroid disease in children, growth assessment (growth velocity, when to investigate short stature, GH deficiency), and puberty (precocious and delayed puberty, Tanner staging).
The remaining questions cover cardiology (innocent versus pathological murmurs, congenital heart disease recognition, Kawasaki disease), gastroenterology (GORD, coeliac disease, IBD in children), nephrology (UTI investigation, nephrotic syndrome, HUS), haematology and oncology (ITP, acute leukaemia presenting features, sickle cell disease), neonatology (jaundice, RDS, prematurity complications), safeguarding (NAI recognition, referral pathway), and community and public health paediatrics.
Guideline priorities
NICE paediatric guidelines are the primary reference — NG143 (Fever in under 5s), NG9 (Bronchiolitis), NG51 (Sepsis), CG137 (Epilepsies), NG18 (Diabetes Type 1), and CG54 (UTI in under 16s) should all be read. The UK immunisation schedule from the Green Book is directly tested — know the routine schedule, the timing of each vaccine, and the contraindications.
RCPCH guidelines and position statements are tested for safeguarding, child protection, and growth monitoring. BNFC is the reference for all paediatric drug dosing — doses are weight-based and must be accurate.
Developmental milestones
Developmental milestone questions appear in every FOP sitting. You must know the key milestones across gross motor, fine motor, language, and social domains at the standard ages (6 weeks, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years). The exam tests both normal milestones and red flag features that should prompt referral.
This is pure factual recall — learn the milestones by heart and practise recognising when a child's development is appropriate for their age versus when it is delayed.
Revision strategy
Three months. Start with the three largest domains — respiratory, neurology/development, and infectious disease — which together account for over a third of the exam. Read the relevant NICE paediatric guidelines alongside question bank practice. Month two should cover endocrinology, cardiology, gastroenterology, and nephrology. Month three should cover neonatology, safeguarding, remaining topics, and mock exams.
iatroX's MRCPCH FOP bank contains over 1,500 questions aligned to NICE paediatric guidelines, RCPCH standards, and the Green Book immunisation schedule. The adaptive algorithm identifies your weakest clinical domains and prioritises them. All included at £29 per month or £99 per year.