Complete Guide to the MRCPsych Examinations: Paper A, Paper B and CASC

A clear introduction to the examination pathway, eligibility, formats and a practical preparation sequence.

What is the MRCPsych qualification?

The Membership of the Royal College of Psychiatrists, commonly known as MRCPsych, is a major postgraduate milestone for doctors developing a career in psychiatry. The examination pathway assesses scientific knowledge, clinical understanding, critical appraisal and the practical consultation skills expected during core psychiatry training.

The pathway contains two written examinations – Paper A and Paper B – followed by the Clinical Assessment of Skills and Competencies (CASC). Passing all three components is not simply a test of memory. Candidates must progressively develop a connected understanding of psychiatry: why disorders occur, how they are assessed, how evidence is interpreted and how patients and families are managed in realistic clinical encounters.

This guide provides an overview for candidates who are beginning their MRCPsych journey. Regulations can change, so candidates should always confirm their personal eligibility and the latest examination information directly with the Royal College of Psychiatrists before applying.

The three parts of the MRCPsych examination

Component	Main focus	Current format
Paper A	Scientific and theoretical foundations of psychiatry	Three hours; 150 questions; approximately two-thirds MCQs and one-third EMIs
Paper B	Clinical psychiatry and critical review	Three hours; 150 questions; approximately two-thirds MCQs and one-third EMIs
CASC	Applied clinical, consultation and communication skills	Sixteen stations delivered in two circuits on the same day

MRCPsych Paper A: building the scientific foundation

Paper A focuses on the scientific and theoretical basis of psychiatry. The current syllabus includes behavioural science and sociocultural psychiatry, human development, basic neurosciences, clinical psychopharmacology, and classification and assessment in psychiatry.

Candidates often underestimate Paper A because many topics appear familiar from undergraduate medicine. In practice, the exam requires precise knowledge, the ability to distinguish similar concepts and consistent performance across all syllabus areas. Neuroscience and psychopharmacology carry substantial weight, but neglecting behavioural science, human development or classification can create avoidable gaps.

A strong Paper A plan should therefore combine structured notes, clinical examples, comparison tables, repeated active recall and large-volume question practice. Medfortune Academy’s PentaMatrix approach is designed around these needs by linking point-wise explanations with clinical context, comparison, exam relevance and practice questions.

MRCPsych Paper B: applying knowledge across clinical psychiatry

Paper B assesses clinical topics and critical review. The clinical component spans organisation and delivery of psychiatric services, general adult psychiatry, old age psychiatry, psychotherapy, child and adolescent psychiatry, substance misuse, forensic psychiatry and psychiatry of learning disability. Critical review accounts for approximately one-third of the paper.

Candidates need more than a list of facts. They must understand investigation, diagnosis, differential diagnosis, treatment, risk, prognosis, service delivery and evidence-based decision-making. Critical review also requires comfort with study design, bias, statistical concepts, interpretation of results and the clinical significance of research findings.

Paper B preparation works best when clinical subjects and critical review are studied throughout the schedule rather than leaving statistics until the final weeks. Regular mixed-question sessions help candidates switch between clinical reasoning and evidence interpretation, just as the examination demands.

MRCPsych CASC: demonstrating safe and effective clinical practice

The CASC is an OSCE-style clinical examination consisting of 16 individual stations in two circuits. The current format includes five history-taking stations, five examination stations and six management stations. Candidates are assessed on the quality of their clinical work, communication and ability to respond to the precise task in the station instructions.

Success in CASC requires a balance of structure and natural communication. Memorised scripts may provide a starting framework, but they can sound mechanical and fail when the role player introduces emotion, resistance, risk or an unexpected concern. Candidates should practise opening a consultation, clarifying the task, gathering focused information, showing empathy, explaining clinical reasoning and closing safely within the available time.

To pass, candidates must meet or exceed the overall borderline regression score and achieve the station passing score in at least 12 stations. This makes consistency essential: a few excellent performances cannot fully compensate for repeated weak stations.

Who can take the examinations?

Eligibility differs between components. Under the current examination regulations, Paper A requires full medical registration after Foundation Year 1 or internship. Paper B requires full medical registration and at least six months of whole-time-equivalent experience in psychiatry; the Royal College recommends 12 months of psychiatry experience before attempting it. For CASC, candidates need the required psychiatry experience, passes in Papers A and B, and appropriate sponsorship and competency evidence.

International candidates should not rely on a general summary alone because sponsorship, evidence of training and portfolio requirements can be highly individual. Review the current eligibility regulations before paying an examination fee or planning travel.

A sensible preparation order

The best sequence depends on experience and eligibility, but many candidates benefit from the following progression:

1. Build the scientific foundation required for Paper A and practise questions from the beginning.

2. After Paper A, broaden revision into clinical psychiatry and critical review for Paper B.

3. Begin communication practice before CASC eligibility is finalised; do not wait until the examination date is close.

4. Use mock examinations to measure readiness, identify weak domains and improve performance under time pressure.

5. Keep an error log and use it to guide each revision cycle.

What makes MRCPsych preparation difficult?

Most candidates are working doctors. Their challenge is not only the size of the syllabus but also unpredictable duties, fatigue and difficulty maintaining revision over several months. A realistic plan should therefore prioritise consistency over occasional long study sessions.

Another challenge is confusing familiarity with mastery. Reading a chapter may feel productive, but examination performance improves when candidates retrieve information without prompts, compare similar conditions, explain the reasoning behind answers and practise under time limits.

Finally, resources can become a distraction. Using too many books, question banks and unstructured notes may fragment learning. Choose a core resource, map it to the official syllabus and use questions and mock examinations to test whether the knowledge is becoming usable.

How Medfortune Academy supports candidates

Medfortune Academy provides structured support for MRCPsych Paper A, Paper B and CASC candidates. Paper A and Paper B resources are organised through the PentaMatrix Framework: concise point-wise notes, clinical examples, comparison tables, examination relevance and tips, and practice questions with explanations.

Candidates can begin with a seven-day free trial to review the teaching style and learning resources before selecting a full course. CASC preparation is offered through personalised online sessions by enquiry, allowing candidates to work on consultation structure, communication, timing and individual areas of difficulty.

No educational programme can guarantee a pass. The purpose of a structured course is to reduce avoidable confusion, create an efficient revision pathway and help candidates practise the skills needed to perform confidently.

Final preparation checklist

Confirm your eligibility and application dates on the official Royal College website.
Download the current syllabus and map every topic to your study resources.
Create a schedule with weekly learning, question practice and revision targets.
Complete timed mock examinations and review every error.
For CASC, practise aloud with feedback rather than revising only by reading.
Review examination-day guidance and technical requirements well before the exam.

Frequently Asked Questions

Do I have to pass Paper A before Paper B?

The College permits candidates to enter the written examinations according to the applicable eligibility rules, but your training status and experience should guide the order. Confirm the current regulations before applying.

How long do I have to complete all parts?

The current Royal College guidance states that after passing the first written paper, candidates generally have six years from publication of that result to complete the remaining MRCPsych components. Extensions may be available in specific circumstances.

Are Papers A and B negatively marked?

No. The Royal College advises candidates to attempt all questions because marks are not deducted for incorrect answers.

Can an international doctor take MRCPsych?

International doctors can take the examinations if they meet the relevant eligibility, training, experience and sponsorship requirements for each component.

How early should I begin CASC practice?

Begin communication and structured consultation practice well before the examination. Regular short practice over several months is usually more useful than intensive scripting shortly before the exam.

Sources and verification links

Recommended conversion block Ready to begin your preparation? Explore Medfortune Academy’s structured MRCPsych resources and use the seven-day free trial to experience the course before enrolling.