The Journey through MRCPsych Exams

The MRCPsych exam consists of two written papers and a practical CASC exam. The written papers can be sat in various centres around the UK and also in Malta, Hong Kong, Oman, India and Singapore. The CASC exam can be sat in Sheffield and also in Hong Kong and Singapore

MRCPsych Paper A

MRCPsych Paper A can be sat by any fully registered medical practitioner.

MRCPsych Paper B

In order to sit MRCPsych Paper B, you must either be on an approved training programme or you must have 12 months of experience in psychiatry before attempting Paper B.

MRCPsych CASC

For MRCPsych CASC, a 24-month whole time equivalent post-foundation/internship experience in Psychiatry by the time of sitting the CASC to include the following:

• Candidates from overseas or in Non-UK approved-Training posts must show their sponsor evidence of having achieved equivalent competencies at appropriate competency levels.
• In addition, competencies in Psychotherapy and Child & Adolescent Psychiatry or Learning Disability must have been achieved by the time of applying for the MRCPsych CASC.

Appropriate experience gained by candidates is to be verified by sponsors.

Source: Eligibility Criteria and Regulations for MRCPsych.

There are now two written exams, paper A and paper B, each consisting of 200 questions over three hours. The exams contain both multiple choice questions (MCQs) and extended matching items (EMIs) with a rough split of 2/3 MCQ and 1/3 EMI.

Candidates are advised to attempt all questions. No marks are deducted for incorrect answers. Timing is key in the written exams; it is really easy to run out of time if you do not pace yourself.

There’s a written paper validity period of 1643 days, which starts on the date results are published for the first exam that you pass. Which means that you have to clear your MRCPsych Casc exam with 1643 days of your first exam you cleared.

MRCPsych Paper A

1. Behavioural science and sociocultural psychiatry.
2. Human development.
3. Basic Neurosciences.
4. Clinical Psychopharmacology.
5. Classification and assessment in psychiatry.

Paper A itself has two parts. Each part is a 90-minute exam. Each part is worth 100 marks. So in total, it is a 3-hour long exam containing 200 questions, divided into two parts. Both parts are held on the same day.

Part 1 consists of topic 1, 2 and 5.

Part 2 consists of topic 3 and 4.

MRCPsych Paper B

• Organisation and delivery of psychiatric services
• General adult psychiatry
• Old age psychiatry
• Psychotherapy
• Child and adolescent psychiatry
• Substance misuse/addictions
• Forensic psychiatry
• Psychiatry of learning disability
• Critical review(Evidence based medicine, advance Stats and Research Methodology)

The critical review component of paper B comprises 1/3 of the paper with the remaining 2/3 covering the remaining clinical topics (of which around 30% will be general adult psychiatry).

Useful Books

1. Fish’s Clinical Psychopathology: Signs and Symptoms in Psychiatry by Patricia R. Casey & Brendan Kelly – easier to read than Sims so can be read cover to cover easily.
2. Maudsley Prescribing Guidelines by David Taylor, Carol Paton, Robert, Kerwin. Some prescribing questions appear to be taken directly from this. Side effects, doses and contraindications are worth learning if you have time.
3. Oxford Handbook of Psychiatry.

My Experience

I thoroughly read SPMM notes and did MCQs after reading a module. I also used MRCPsych mentor MCQs. I also used to do SPMM mock test prior to written paper.

My key to my success is reading and understanding the course material and not cramming it. It is important to do both background reading and practice questions – doing either one or the other won’t work. One strategy I used is that I plan my exam 6 months ahead, I would start with 1 or 2 hours couple of evenings per week then build up the amount of time as you get closer to the exam. There will be times when you just can not do any revision, for example during weeks of night shifts. Although people understandably try to fit in as much studying as possible in the run-up to the exam. It is also important to have some break in between.

Do not delay sitting in your exam, there is no perfect time when you feel you will be fully prepared. People will tell you just do the MCQs and no need to read the study material. Please do not take that advice. You need to read thoroughly for the exams. MRCPsych written exams are not difficult; you need to put hard work in it to ace them.

The CASC is an OSCE-style clinical exam made up of 16 stations in total. There is one circuit of 8 stations in the morning and one circuit of 8 stations in the afternoon.

The sixteen CASC station exam is made up of:

• 5 stations focused on history taking, including risk assessment.
• 5 stations focused on examination – both physical and mental state, including capacity assessment.
• 6 stations focused on patient management.

Example

Morning Circuit

• 6 stations focused on management.
• 1 station focused on examination.
• 1 station focused on history taking.
  .
• 4 minutes of reading.
• 7-minute task.

Afternoon Circuit

• 4 stations focused on examination.
• 4 stations focused on history taking.
  .
• 90 seconds of reading.
• 7-minute task.

Sample Video of a CASC Station

Commonly Tested Stations Include

• Brief history taking e.g. psychosis, depression, anxiety, TLE, ADS.
• Collateral history e.g. in dementia.
• Risk assessment following self-harm.
• Information-giving e.g. ECT, medication (lithium, clozapine, valproate in pregnancy) psychological therapies (family therapy, IPT, CBT, ERP).
• Discussing management plans with consultants or other members of staff e.g. nursing students or ward managers.
• Physical examination e.g.  EPSEs, cardiovascular, neurological, thyroid and cognitive examination.

I have personally used SPMM CASC course (which includes notes and videos OSCE) and Pass the CASC by Dr Seshni Moodliar. I also did cross check with Maudsley Guidelines for psychopharmacology. I also looked up further details online about Psychotherapies. For Physical examination: I used Geeky Medics- Clinical Examination OSCE Guide. I found all the above very helpful in clearing my exams.

Key to Passing My Exam

Being an IMG with English not being my first language, of course, it was challenging but it’s a doable exam. I had same worries that English is not my first language; some people will demoralize you. But I used to remind myself “people from all around the world clear this exam, who are not English speakers so why can’t I” this quote of mine made me pull through.

Practice

You are limited by time and you need to be fast in thinking and quick in your reflexes. You will need to train your body to recognise what seven minutes feel like. Timed practice as early as possible is very important.

You also need to practice to refine your communication skills and to learn to phrase the questions.

Of course, you need to be understandable for the patient you are interviewing and for the examiner. For that, I would recommend the above-mentioned sources to read and to look at interviewing videos (SPMM or YouTube).

The best way to pass this exam is to find out who is taking the exam with you, whether in person or online, and practice at least 4 to 5 days a week closer to the exam.

Honestly, I practiced persistently for at least 6 months, and closer to exams, nearly 5 to 6 days per week. This looks like a lot, but this is the only way to clear this exam.

Have a plan and stick to it. Plan out each day where you work through a list of previous stations together. I used this website to look at all the past CASC papers. See the left column (it has CASC recollections from 2008 till 2016).

Find someone to practice with regularly. Make it fun and schedule in breaks. Be honest with each other when giving feedback. Check that your practice is going in the right direction by asking trainees who have passed the CASC for feedback or your supervisors.

I had two other people who took the exam with me and we practiced on Hangout (video call); one gave feedback, the other two did role play and interview. We use to take turns (2 hours every day after work) and also had some sessions with clinical supervisor/consultant.

You need to put a lot of practice in place for this exam. This applies to IMGs and local graduates, both.

Practical Issues Before and During the Exam

1. Sleep properly the night before the exam.
2. Make sure you are properly dressed for exam. Do not dress casually and in high heels. Dress formally, as you would in a clinic.
3. This exam is anxiety provoking, but if you have prepared well, remind yourself “all is well”.
4. You get a short period of time before each station. There is no defined way to use this time but make sure you do use it.
5. You may decide to take notes. What I used to do is write down the name of the patient and the key task that you have been asked to undertake, and a few areas that you would like to cover.
6. You need to be clear when talking to the patient. So, talk confidently and clearly.
7. During each station, let the role-player set the initial agenda but make sure you steer things in the right direction later on if needed. Summarising is useful to double-check information and re-focus the interview. Listen for cues and address anxieties when they appear. Do not be afraid to answer questions, even if the answer might not be something the patient might want to hear. This may be the only way to move on. Be careful not to ask double questions. The actor might only answer one of the parts.
8. Once you are done with a station, move on to the next one. Do not ruminate about the station which is done already.
9. There are no rest stations on the circuits, but you have a decent break between the morning and afternoon sessions. There is enough time to have a good lunch and get focussed on the afternoon.

Passing Criteria

To meet the minimum standard required in the CASC exam, you must meet or exceed the total borderline regression score and achieve the passing score in a minimum of 12 stations. You must meet both criteria to be successful (in simple words you need to pass the exam overall and also a minimum of 12 stations).

The MRCPsych Examinations can be taken by:

• Doctors in an approved training programme.
• Doctors in the UK who are not in an approved training programme.
• Doctors from the EU who are working or have worked overseas.
• Non-EU doctors who are working or have worked overseas.

Source: Exam Eligibility Guide.

Yes, the written papers can be taken in any order. However, it’s recommended that you have 12 months experience in psychiatry before attempting Paper B.

There is no longer any requirement for specific specialties. However, competencies in specialties as defined in the curriculum/equivalent have to be met by the time of sitting the CASC. It is your sponsor’s role to confirm you have met these competencies in the ARCP process, or equivalent for overseas doctors.