Dr. Wajiha Zia’s Journey Through MRCPsych Exams

My Journey through MRCPsych exams (By Dr. Wajiha Zia)

I have heard a lot of negative remarks about MRCPsych exam, such as “they are next to impossible to clear” “Very difficult exam if you are an IMG or a non-English speaking person”.

So, plan to write a guide to ace your MRCPsych exam.

I graduated in 2008 from Pakistan, I am an IMG with English not being my first language.

Basic run through of MRCPysch Exam:

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

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

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

For MRCPsych CASC, a 24 months 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.


Before you start your written exam, you need to know this important fact

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.

How to survive MRCPsych written exams:

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 and it is really easy to run out of time if you don’t pace yourself.

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 is two parts- each part is 90 minutes exam-worth 100 marks each(total 200 questions over 3 hours), both parts done in one day.

A(i) comprises of topic 1,2 and 5

A(ii)comprises 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).

MRCPsych written exams are not difficult, you need to put hard work in it to ace them.

From my experience, I thoroughly read SPMM notes and did MCQs after reading a module. I also used MRCPsychmentor MCQs.

I also used to do SPMM MOCK test prior to written paper.

Some other useful books are:

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 et al. 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 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’t 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 don’t take that advice.


How to survive MRCPsych CASC exam:

First a run through about Casc

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


Morning Circuit :

6 stations focused on Management

1 x station focused on Examination

1 x station focused on History Taking

4 minutes reading

7 minute task


Afternoon Circuit :

4 x stations focused on Examination

4 x stations focused on History Taking

90 seconds 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 historye.g. in dementia
  • Risk assessment following self-harm
  • Information-giving.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 manager.
  • Physical examination.g. EPSEs, cardiovascular, neurological, thyroid and cognitive examination.

How to prepare for MRCPsych CASC:

I have personally used SPMM CASC course (which includes notes and videos osce) and

Pass the CASC’ by Dr. Seshni Moodliar, plus did cross check with Maudsley guidelines for psychopharmacology.

Also looked up further details online about Psychotherapies.

For Physical examination: I used Geeky medics- clinical examination Osce guide

Find all the above very helpful in clearing my exams

Key to passing my  MRCPsych CASC exam:

Being an IMG with English not been my first language, of course, it can be challenging but it’s a DOABLE exam!!

I had same worries that English is not my first language and 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.

You need to put lot of practice in place for this exam, this is for IMGs or non-IMGs.


Reason for same is 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 recognize what seven minutes feel like – timed practice as early as possible is very important.

You also need the practice to refine your communication skills and how to phrase a question.

Off course you need to be understandable for the patient you are interviewing and examiner, for that I would recommend the above source to read and look at interviewing videos (SPMMor youtube).

Best way to pass this exam is to find who is doing the exam with you whether in person or via SKYPE or hangout, and practice at least 4 to 5 days a week closer to the exam.

Honestly, I did practice persistently for 6 months, to say the least, and closer to exams nearly 5 -6 days/ 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 the previous stations together. I did use this website to look at all the past CASC papers


See the left column( it has CASC recollection from 2008 till 2016)

Find someone to practice 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 2 other people who did the exam with me and we practiced on Hangout (video call) one will give feedback, other will do role play and interview. We used to take turns (2 hours every day after work) and also had some sessions with clinical supervisor/consultant.

Practical issues before and during the exam:

1-Sleep properly the night before the exam

2- Make sure you are properly dressed for the exam. Not to causal and not high heels, formal dressing like in the clinic with comfortable shoes.

3-This exam is anxiety provoking, but if you have done good preparation- remind yourself “All is well”- I did it!!

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!

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 you’d like to cover.

5-You need to be clear when talking to the patient. So, talk confidently and clearly!!

6-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. Don’t 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.

7-Once you are done with a station, move on to the next one. DO NOT ruminate about the station which is done already.

8-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 overall exam and also a minimum of 12 stations)

Good Luck

Dr. WZ

About Myself:

In the end, I would like to introduce myself, my name is Dr.Wajiha Zia, graduated in 2008 from Pakistan, an IMG with English being my second language.

I worked in the Republic of Ireland from 2011 till 2017 in Psychiatry, worked in General adult, Psychiatry of Later Life, CAMHS, Addiction Psychiatry, Community MHS, and Rehabilitation psych/Tutor job. Moved to New Zealand for 6 months for a change, worked in Crisis Psychiatry Team in Manukau DHB there and got enrolled inFRANZCP, but taking a break from it and was back in Ireland in Jan 2018.

Now working in NUI Galway /University Hospital Galway as Senior Reg/Clinical Lecturer.

Plan to explore my options in UK or Canada.

Please feel free to contact me on Facebook/email if need any further guidance (after reading this Blog Post)

Wz Rehman/dr.wajihazia@hotmail.com

Common FAQs:

Who can give MRCPsych exam?

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

Exam Eligibility Euide:


Can I sit Papers A and B in any order?

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

I have 24 months experience in Psychiatry. Does this need to be in certain psychiatric specialties in order to be eligible to sit the clinical exam (CASC)?

There’s 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 setting the CASC. It’s your sponsor’s role to confirm you have met these competencies in the ARCP process or equivalent for overseas doctors.

Please Note: 

This Blog post was written in December 2018. The MRCPsych exam regulation and format may change with time. Please refer to the RCPsych website for the latest guidance on eligibility criteria and format of the exam.