A balanced approach to clinical psychiatry, evidence appraisal, questions and timed mock examinations.
What Paper B assesses
MRCPsych Paper B evaluates two connected abilities: knowledge of clinical psychiatry and critical review of evidence. The current examination lasts three hours and contains 150 questions. Approximately two-thirds are single-best-answer MCQs and one-third are extended matching items.
One-third of the paper covers critical review and two-thirds covers clinical topics. This division means that candidates cannot safely ignore statistics, research methodology or appraisal skills. Equally, mastering formulas without a broad clinical foundation will not be enough.
Current Paper B blueprint
| Domain | Approximate marks | What to master |
| Organisation and delivery | 8 | Services, systems, legal and multidisciplinary care principles |
| General adult psychiatry | 30 | Diagnosis, management, risk and common adult psychiatric presentations |
| Old age psychiatry | 14 | Dementia, delirium, late-life disorders and complex physical comorbidity |
| Psychotherapy | 8 | Models, indications, mechanisms and practical application |
| Child and adolescent psychiatry | 14 | Developmental disorders, common presentations, safeguarding and management |
| Substance misuse | 10 | Assessment, intoxication, withdrawal, harm reduction and treatment |
| Forensic psychiatry | 8 | Risk, law, offending, secure care and ethical issues |
| Learning disability psychiatry | 8 | Assessment, communication, comorbidity and person-centred management |
| Critical review | 50 | Study design, bias, statistics, interpretation and evidence-based practice |
Do not separate clinical knowledge from evidence
Paper B is sometimes approached as two unrelated exams: clinical psychiatry and statistics. A better method is to integrate evidence into clinical topics. When studying depression, for example, review treatment comparisons, outcome measures and common research designs used in intervention studies. When studying dementia, connect diagnostic accuracy with sensitivity, specificity and predictive values.
This approach gives statistical concepts a clinical purpose and makes them easier to remember. It also reflects real psychiatric practice, where decisions should combine patient factors, clinical expertise and the best available evidence.
Build clinical topics around a repeatable framework
For every disorder or presentation, revise through the same set of questions:
1. What are the defining features and diagnostic criteria?
2. What important differentials and physical causes must be considered?
3. What investigations are appropriate and what would they show?
4. How should immediate risk and capacity be assessed?
5. What are the first-line and alternative treatments?
6. What adverse effects, interactions and monitoring requirements matter?
7. What psychological, social and service-level interventions are relevant?
8. What predicts prognosis, relapse or treatment resistance?
How to approach critical review
Critical review becomes manageable when it is broken into layers. Begin with study designs and the clinical questions they answer. Then learn bias, confounding and methods of reducing error. Next, understand common statistical tests, effect measures and confidence intervals. Finally, practise interpreting abstracts, tables and short research scenarios.
Do not rely on memorising formulas alone. Ask what each measure means clinically. A relative risk reduction may sound impressive while the absolute benefit is small. A statistically significant result may not be clinically meaningful. A diagnostic test may perform differently when disease prevalence changes.
Create a one-page comparison sheet for cohort, case-control, cross-sectional and randomised studies. Add columns for direction, main measure, strengths, limitations and typical biases.
A phased Paper B study plan
| Phase | Main activity | Outcome |
| Weeks 1-4 | Cover major clinical domains and begin critical review fundamentals | Complete first-pass notes and topic questions |
| Weeks 5-8 | Finish remaining specialties; deepen statistics and appraisal | Build comparisons and mixed-question ability |
| Weeks 9-10 | Mixed questions, weak-topic revision and timed blocks | Improve retrieval and topic switching |
| Weeks 11-12 | Full mocks, error-log revision and concise final review | Develop exam endurance and decision accuracy |
Question-bank strategy for Paper B
Use questions in three modes. First, complete topic-specific sets immediately after studying a subject. Second, use mixed sets to practise identifying the correct domain and applying knowledge without contextual cues. Third, complete timed full-length mocks to test endurance and section management.
For each error, identify whether it arose from missing knowledge, confusion about an exception, weak critical-review reasoning, misinterpretation of the vignette or poor time control. Rewrite the learning point as a concise rule and revisit it within a week.
When a question explanation reveals a guideline or rule that may change over time, verify it against an authoritative current source rather than memorising outdated details from a question bank.
How to revise critical review efficiently
- Learn concepts in pairs: sensitivity versus specificity, absolute versus relative risk, type I versus type II error.
- Use small numerical examples to understand formulas instead of memorising symbols alone.
- Practise interpreting confidence intervals and p-values in plain language.
- Identify the study question before choosing the design or statistical test.
- Link every bias to the direction in which it might distort the result.
- Review common graphs, tables and measures repeatedly until interpretation becomes automatic.
Common Paper B mistakes
One common mistake is spending most of the schedule on general adult psychiatry and postponing smaller specialties. General adult has the largest individual clinical allocation, but marks from old age, child and adolescent, substance misuse, forensic, psychotherapy, learning disability and service organisation together are substantial.
Another mistake is leaving critical review until the final month. Because it contributes around 50 marks, it should appear in the weekly plan from the beginning.
A third mistake is revising management as a list without understanding sequencing. Questions may test the best next step, immediate safety, contraindications, monitoring or what to do after treatment failure. Study management as a decision pathway, not only as a catalogue of interventions.
Using the final month effectively
During the last four weeks, reduce passive reading and increase mixed retrieval. Complete timed blocks, review the error log and revisit high-yield comparisons. Plan at least two full mocks, leaving enough time after each one to correct weaknesses.
In the final week, revise concise clinical algorithms, adverse-effect and monitoring tables, specialty-specific pitfalls and critical-review summaries. Protect sleep and avoid introducing a completely new resource.
Preparing for the 2027 syllabus
The Royal College plans to publish revised Paper A and Paper B syllabi in September 2026, with implementation from January 2027. Candidates sitting Paper B in 2026 should continue to follow the current blueprint. Candidates sitting from January 2027 should check whether subject weightings or learning outcomes have changed and update their study plan accordingly.
Frequently Asked Questions
Is critical review really one-third of Paper B?
Yes. Under the current blueprint, critical review accounts for approximately one-third of Paper B, around 50 of the 150 marks.
Should I study critical review before clinical topics?
Study them together. Begin critical-review fundamentals early and connect concepts with clinical papers and examples as your clinical revision progresses.
Which clinical area carries the most marks?
General adult psychiatry has the largest individual clinical allocation in the current blueprint, but the combined contribution of the other specialties remains substantial.
How can I remember management guidelines?
Use decision pathways that show immediate safety, first-line treatment, alternatives, monitoring and treatment-resistant options. Verify time-sensitive guidance against current authoritative sources.
How many full mocks should I complete?
Two or three carefully reviewed full mocks are a useful minimum for many candidates. Additional mocks help only when errors are analysed and converted into targeted revision.
Sources and verification links
- Royal College of Psychiatrists – Preparing for exams
- Royal College of Psychiatrists – Papers A and B marking scheme
- Royal College of Psychiatrists – Applying for your exam
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