A practical guide to the 16-station format, performance criteria, live practice and consistent consultation skills.
What the CASC assesses
The Clinical Assessment of Skills and Competencies (CASC) assesses whether candidates can apply psychiatric knowledge safely and communicate effectively at the expected stage of training. It is not simply a test of remembering model answers.
Each station requires the candidate to understand the task, establish an appropriate professional relationship, gather or explain relevant information, demonstrate clinical reasoning and manage time. Performance is shaped by both the content and how the consultation is conducted.
Current 16-station format
| Station type | Number | Examples of skills assessed |
| History taking | 5 | Focused history, risk assessment, substance history, collateral information and clarification |
| Examination | 5 | Mental state, physical examination principles, cognition, capacity and focused clinical assessment |
| Management | 6 | Explanation, formulation, treatment planning, shared decisions, family discussion and risk management |
Two circuits and reading time
The CASC is completed in two circuits on the same day. Under the current format, one circuit provides four minutes of reading time before seven minutes for the task, while the other provides 90 seconds of reading time before seven minutes for the task. The College may change the order in which circuits are presented.
Candidates should practise both reading intervals. Four minutes allows deliberate planning; 90 seconds requires rapid identification of the role, task, safety priorities and consultation structure.
Read the task, not only the scenario
Many weak performances begin before the consultation because the candidate answers a familiar station rather than the task written in the instructions. Highlight the action words: assess, explain, discuss, address concerns, formulate, examine or develop a management plan.
Notice exclusions such as “you are not required to take a full history”. Spending time on an unrequested task can prevent completion of the core station objective.
Use a flexible consultation framework
A useful general structure is:
1. Opening: introduce yourself, confirm the person and establish the purpose.
2. Agenda: clarify the main concern and what needs to be achieved.
3. Core task: gather, examine, explain or manage in a focused sequence.
4. Emotion and perspective: acknowledge concerns, expectations and impact.
5. Safety: address risk, capacity, safeguarding, physical health or escalation where relevant.
6. Plan and close: summarise, check understanding, agree next steps and invite final questions.
Why scripts fail
Scripts can help a beginner remember a sequence, but rigid memorisation often reduces listening. Role players may become distressed, angry, suspicious, silent or confused. The candidate must respond to the interaction rather than continue a rehearsed speech.
Practise frameworks, transition phrases and high-risk content, but vary the scenario details and role-player responses. Record some sessions and check whether you sound natural, empathic and clear.
History stations
History stations reward focused information gathering and advanced listening. Use open questions initially, then clarify relevant symptoms, chronology, impact, risk, physical health, substances, treatment and protective factors as required by the task.
Do not perform a complete psychiatric history automatically. A seven-minute station demands prioritisation. Summarise briefly during the consultation to verify information and demonstrate organisation.
Examination stations
Examination stations may involve mental state, cognition, capacity or relevant physical examination principles. Explain what you are doing, obtain cooperation, observe carefully and report findings in a clinically meaningful way.
Practise giving instructions clearly and respectfully. For capacity, structure assessment around the decision and the abilities to understand, retain, use or weigh relevant information, and communicate a choice, while following the applicable legal framework.
Management stations
Management stations assess analysis, reasoning, decision-making and communication. The strongest answers are personalised. Explain the working understanding, immediate priorities, options, benefits and risks, monitoring, multidisciplinary support and follow-up.
Avoid delivering a long list of treatments. Begin with the patient’s concern, use plain language and check understanding. Involve the person in decisions and address practical barriers, family context and safety.
Practise in a feedback loop
1. Complete a station under exact reading and consultation time.
2. Receive feedback against the task, clinical content, structure and communication.
3. Choose no more than two improvement goals.
4. Repeat the same skill in a different scenario.
5. Review progress after several stations rather than after every sentence.
How the CASC is passed
The current Royal College guidance requires candidates to meet or exceed the overall borderline regression score and achieve the station passing score in at least 12 of the 16 stations. Both criteria must be met.
This rewards consistency. Candidates should practise their weakest station types and not rely on a few strong areas. Serious safety or professional concerns may also affect the final outcome under the applicable regulations.
An eight-week CASC plan
| Weeks | Focus |
| 1-2 | Understand marksheets, station types and consultation framework; record baseline stations |
| 3-4 | History and examination stations; risk, capacity, cognition and physical-health integration |
| 5-6 | Management, explanation, formulation, difficult emotions and family discussions |
| 7 | Mixed circuits under timing; target weak skills |
| 8 | Full circuit simulations, concise feedback and performance stabilisation |
One-to-one training
Individual sessions can be valuable when a candidate has a specific communication pattern, timing problem, confidence issue or repeated weak station type. Medfortune Academy offers personalised online CASC sessions by enquiry, scheduled according to candidate requirements.
The purpose is not to provide a single universal script. Training should help the candidate understand the task, organise clinical reasoning, communicate naturally and respond flexibly to the role player.
Frequently Asked Questions
How many stations are in the CASC?
The current format contains 16 individual stations: five history, five examination and six management stations.
How many stations must I pass?
Candidates must achieve the passing station score in at least 12 stations and also meet or exceed the overall borderline regression score.
How long is each consultation?
Each station currently provides seven minutes for the consultation task. Reading time differs between the two circuits.
Should I memorise model answers?
Use frameworks and key clinical content, but avoid rigid scripts. The exam assesses listening, adaptability, communication and safe clinical reasoning.
How should I practise alone?
Read a task aloud, plan during the official reading interval, record a seven-minute response and review structure, clarity, empathy and completion. Live role-play feedback should still be added regularly.
Sources and verification links
- Royal College of Psychiatrists – Preparing for the CASC
- Royal College of Psychiatrists – Can I take an exam?
- Royal College of Psychiatrists – Applying for your exam
| Recommended conversion block Preparing for CASC? Enquire about Medfortune Academy’s personalised one-to-one online sessions for structured practice and individual feedback. |