How to Pass MRCPsych Exam- by Dr Saqib Siddique

(Please note: This blog was written in Nov 2020 and is based on a personal experience. Exam regulation and format may change with time, so please check RCPsych website for updated information on the exam https://www.rcpsych.ac.uk/training/exams)

Introduction:

My name is Dr. Saqib Siddique. I graduated from Khyber Medical College Peshawar in 2012. I did 3 years of my Fellowship in Psychiatry training at Khyber Teaching Hospital Peshawar, Pakistan. Then I was selected for a 2-year psychiatry training scholarship program in Ireland, where I worked from 2017 to 2019. My first language is Pashto, but I did all my schooling in English medium schools, including medical school. I live and work in Peshawar, Pakistan currently.

I did Diploma in Clinical Psychiatry (DCP) from Ireland in 2018. I became a Fellow Psychiatry (FCPS) of College of Physicians and Surgeons (CPSP) Pakistan in 2019 and a Member of Royal College of Psychiatrists (MRCPsych) in October 2020.

I started preparing for MRCPsych exams while I was in Ireland in 2018 as many of my colleagues there were also preparing for it. I passed Paper A in 2018, Paper B in 2019 and CASC recently in Oct 2020. I had passed IMM(mid-way FCPS Psychiatry exam in Pakistan) before I applied to Paper A and passed FCPS 2(exit exam of FCPS Psychiatry) before giving CASC.

General Information:

• The MRCPsych exam consists of two MCQ papers (Paper A and B) and a clinical exam (CASC).
• Any registered medical practitioner with any Medical Council can apply for Paper A.
• The college recommends that you have 12 months experience in Psychiatry before you apply to Paper B.
• For CASC, you must have evidence of 24 months post internship/house job experience in Psychiatry. You must also have a pass in Papers A and B. (this requirement has been waived for the 2020 exams)
• The eligibility criteria can be checked here; https://www.rcpsych.ac.uk/training/exams/can-i-take-an-exam
• The details on how to apply for exams, and dates of exams are available on College’s website:  https://www.rcpsych.ac.uk/training/exams/applying-for-your-exam.

MRCPsych Paper A

Exam Fees:

Currently UK trainees pay 486 pounds and Non-UK doctors like Pakistani doctors pay 539 pounds to apply for Paper A (you can pay through Visa or Mastercard Credit/Debit card).

Exam Pattern:

Paper A is a three-hour exam worth 150 marks, comprised of 150 questions.

It is made up of approximately:

1. two-thirds multiple choice questions (MCQ) and
2. one-third extended matching item questions (EMI).

Syllabus:

Paper A covers the following sections of the syllabus:

1. Behavioral Science and Sociocultural Psychiatry
2. Human Development
3. Basic Neurosciences
4. Clinical Psychopharmacology
5. Classification and Assessment in Psychiatry

Further details on syllabus, sample questions, and marking scheme can be found here: https://www.rcpsych.ac.uk/training/exams/preparing-for-exams.

Time required for Preparation:

I gave my Paper A after passing IMM( a mid-way exam in 4 year Psychiatry fellowship in Pakistan). I studied for 3 months with my job as Psychiatry Registrar at CAMHS and I easily passed. If this is your first Psychiatry exam, I would advise to start preparing 6 months before exam.

Resources Used:

I only did MCQ’s on mrcpsychmentor.com website and read explanations. But if this is your first Psychiatry Exam, use SPMM notes and MCQ’s as they are the best.

Since it is an MCQ exam, it is important to practice as many MCQ’s as possible while timing yourself. I started doing 20 MCQ a day and in the last month, I was doing 150 MCQ’s a day.

MRCPsych Paper B

Exam Fees:

Currently UK trainees pay 437pounds and Non-UK doctors like Pakistani doctors pay 485 pounds to apply for Paper B (Visa or Mastercard Credit/Debit card can be used).

Exam Pattern:

Paper B is a three-hour exam worth 150 marks, comprised of 150 questions.

It is made up of approximately two-thirds multiple-choice questions (MCQ) and one-third extended matching item questions (EMI).

• One-third of the paper covers critical review.
• Two-thirds of the paper covers clinical topics.

Syllabus:

Paper B will cover the following sections of the syllabus:

1. Organisation and Delivery of Psychiatric Services
2. General Adult Psychiatry
3. Old Age Psychiatry
4. Psychotherapy
5. Child and Adolescent Psychiatry
6. Substance Misuse/Addictions
7. Forensic Psychiatry
8. Psychiatry of Learning Disability
9. Critical Review

Further details on syllabus, sample questions, and marking scheme can be found here: https://www.rcpsych.ac.uk/training/exams/preparing-for-exams.

Time required for Preparation:

I prepared for 4 months with a busy Gen Adult job, but it usually takes most candidates up to 6 months to prepare for Paper B. The amount of time required depends on your prior knowledge of Critical appraisal too. Remember that you must give almost equal time to Critical Appraisal and Psychiatry topics.

Resources Used and How to prepare:

I did SPMM notes and MCQ’s. But for Critical Appraisal, I suggest ‘Doctor’s Guide to Critical Appraisal’ book by Narinder Gosall. I read it twice and watched SPMM critical appraisal videos a few times. It is also particularly important to read and remember the latest Maudsley Prescribing Guidelines.

For a textbook, I recommend Shorter Oxford Textbook of Psychiatry. Again, practice as many MCQ’s as possible. Making a study group provides support and encouragement. You can also discuss difficulty areas with each other.

CASC Clinical Assessment of Skills and Competencies)

Exam Fees:

Currently UK trainees pay 1004 pounds and Non-UK doctors like Pakistani doctors pay 1115 pounds to apply for CASC (Visa or Mastercard Credit/Debit card can be used).

How to apply:

In order to apply for CASC, you will need a Sponsor who can verify that you have indeed achieved the required competencies for CASC. I asked my Psychiatry Supervisor in Pakistan to be my sponsor. Sponsor will need an account on RCPsych website(takes 5 min to make one). You will be asked to provide full name, title and email address of the Sponsor in the application. The college will then send an email to the Sponsor with a link to verify that competencies have indeed been attached( mostly a checklist). Once the Sponsor has verified, you can proceed further and pay the fee for CASC. All of this takes a few hours.

The list of possible Sponsors is available on the college’s website.

Exam Pattern:

The CASC is made up of two circuits of individual stations which will test your clinical skills:

• The morning circuit will allow you 4 minutes to read the instructions (PDF) and 7 minutes to complete the consultation task
• The afternoon circuit will allow you 90 seconds to read the instructions and 7 minutes to complete the consultation task.

The sixteen CASC station exam is made up of:

• five stations focused on History Taking, including risk assessment
• five stations focused on Examination – both physical and mental state, including capacity assessment
• six stations focused on patient Management.

Circuit 1

• 6 stations focused on Management
• 1 x station focused on Examination
• 1 x station focused on History Taking
• 4 minutes reading time prior to entering each station
• 7 minutes to perform the task

Circuit 2

• 4 x stations focused on Examination
• 4 x stations focused on History Taking
• 90 seconds reading time prior to entering each station
• 7 minutes to perform the task

Due to COVID 19, the college is currently conducting Online CASC. So far, Physical examination stations have not been tested in Online version of CASC.

Further guidance on CASC including marking system, marking sheets, and IT requirements for Online CASC can be found here. https://www.rcpsych.ac.uk/training/exams/preparing-for-exams

Time required for Preparation:

I prepared for 6 months, partly because May 2020 CASC was cancelled due to COVID 19 and we had more time for September CASC. I think 3-6 months of regular preparation is required for most candidates. If you are an IMG and have never worked in UK or Ireland before, start regularly preparing 6 months before exam.

Resources Used:

I started with the book ‘How to get through MRCPsych CASC’ by Zhang and went through it once with my group. Then we started SPMM notes and videos and they were enough. I also gave SPMM Mock and found it remarkably close to the actual exam.

How to prepare for CASC:

• Practice, practice, practice and do some more practice.
• This is one exam which you cannot prepare for on your own. You need a study group.
• First step is to find other candidates who are preparing for CASC. Most recently passed candidates can help you find other candidates who are preparing as well. They can also help adding you to the existing Facebook, Skype, and WhatsApp CASC groups.
• Make your own group of 4 to 6 motivated candidates.
• I would recommend including candidates from UK and Ireland in your group just to have a better idea of how mental health services work over there.
• Help each other find Exam material. Coordinate with each other for timings and stations to be practiced.
• If you cannot practice face to face, use Skype or Zoom. I did my entire preparation for CASC on skype without any issues.
• Once you’ve made a group and have different resources for CASC, you then need Supervisors who can see you perform stations and give feedback.
• Possible Supervisors could be recently passed candidates, ST doctors and Consultants in UK/Ireland, or Consultants who are examiners in actual CASC as well.
• Most days, you may not have any Supervisor and that is ok. DO NOT stop practicing stations and give each other feedback.
• It is best to make a Rota in advance so that there are no rifts that some members are doing more stations than the other.
• It is important to time yourself while reading the station and performing the station. It helps you realize what 7 minutes feel like as it is nearly impossible to keep an eye on the watch in actual exam.
• Record yourself and others doing stations, and feedback given my Supervisor. Watching these video later can help you to improve yourself.
• For every station, watch SPMM or Birmingham Videos, and see how they manage a station as well.
• Familiarize yourself with Exam mark sheets to understand how Examiners assess you in actual exam. There are available on College’s website.   
• Do not take feedback personally. Ask supervisors to be as honest and brutal as possible in giving feedback. This will only help you get better.
• We started with an hour practice daily. We gradually increased it to 3 hours a day, and in last 1 month, we were practicing 4 to 8 hours daily.
• We started with 2 stations per day and gradually increased it to 4 stations a day.
• In the first month, we knew the stations in advance. Later we give each other random station from a particular area. In the last 2 months, we gave each other any random stations from SPMM or Zhang.
• In the last month, we gave each other short mocks too. Like one candidate would do 3 stations one after another without any break and then the others would do. In the last 2 weeks, we increased it to up to 6 stations in one go. I think this technique helps to increase your mental stamina.
• Please see the list of stations which appeared in past 2 years and prepare them first.
• Work on your communication skills as most candidates fail here. Be as gentle as possible.
• Although this is an exam in English, please do not worry if English is not your first language.
• Try to speak as clearly and confidently as possible.
• It is always a good idea to watch some British movies or seasons to get a grip on British accent. I watched Sherlock and Doc Martin. In actual exam, the simulators try their best to avoid an accent.
• Make your own notes for all stations.
• Make your own sentences. Avoid copying exact sentences from Zhang or Seshni. It appears very checklist like or mechanical.
• Work on your own style and approach rather than copying someone.
• Most of the stations in actual exam are repeats with subtle changes. So do stations which have appeared previously while remembering that it might be slightly different.
• Practice making quick notes during reading time. Always write down the name of the patient, or name of the relative and their relationship to patient, and the TASK in your notes. Stick to the task.   

 How to survive Online CASC:

• Make sure that you have at least 2 stable internet connections before giving Online CASC. I arranged a fiber optic connection in addition to my broadband connection.
• Even though you might be home, dress professionally and behave like a Professional.
• Make sure that the room is well lit. It is important to have a generator or UPS if there is load-shedding in your area.
• Make sure that there is no disturbance. Or someone making noise or suddenly walking to your room in the middle of exam.
• Make sure that you have a comfortable chair with back support as you will be sitting for a long time.
• Expect delays as they wait for the whole group to start together. I waited 1 hour after Circuit 1 for my whole group to complete as well.
• Do not panic if due to connectivity related issues, you can’t hear the simulator, or they can’t hear you. They allow re-runs. Do not hesitate to tell the simulator or invigilator if you cannot hear clearly.
• Do not panic if there is a drop in connection. The college will contact you or you will have a contact no to immediately contact them.
• Make sure that you have snacks, water, and tea/coffee around you.
• Remember that you are allowed a notebook and a pen to make quick notes.

Few last words:

I passed all 3 portions of MRCPsych in first attempt being an IMG with English not being my first language. It is crucial to believe in yourself and be consistent. Remember that you can comfortably pass this exam if you have never worked in UK/Ireland. Like all exams, MRCPsych exams are difficult but not impossible to pass.

If you are preparing for MRCPsych and need help preparing for exam, finding candidates for a study group, or supervisors for CASC, please do not hesitate to contact me.

Best of Luck!

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Dr. Saqib Siddique – Email: drsaqibsiddique88@gmail.com  

Tags: How to pass CASCHow to pass MRCPsychMRCPSYCHMRCPsych CASC