MTI in Psychiatry guide for the IMGs – By Dr Amitkumar Chougule

Dr Amitkumar Chougule is an IMG Psychiatrist from India with an MD in Psychiatry.

Amit came to the UK on the MTI via RCPsych scheme and has now also successfully completed his MRCPsych exam.

He has written a helpful and comprehensive guide focused on the things IMGs should know about the MTI Psychiatry.

Amit has also written about his experience of securing the MTI which you can read from the link below.

PLAB vs MRCPsych

Psychiatry aspiring IMGs commonly ask me, which route is better for the purpose of GMC registration? PLAB or MRCPsych?

Having done both exams in my career. I thought I should compare them.

Disclaimer: Please note this is based on my experience only and not an official guide or version of the Royal College or the GMC. This is written in Jan 2021 and exam criteria, free and regulation will change with time so check the official websites for updates.

Who are the exam conducting authorities:

PLAB: General Medical Council – UK

PLAB is a medical licencing exam for the UK and results in the award of GMC registration.

MRCPsych: Royal College of Psychiatrists – UK

MRCPsych is a membership postgraduate exam i.e. post graduate qualification so you will gain you a Membership of Royal College of Psychiatrists. MRCPsych is also a well-recognized qualification outside of the UK as well.

MRCPsych can also be used to gain GMC registration.

What is the level of knowledge tested?

PLAB: Foundation doctor or internship level, which is broad based knowledge involving multiple specialties expected of a recently qualified doctor.  

The level of knowledge is that you would expect from a well-trained foundation doctor in the UK.

MRCPsych: The level of knowledge you would expect from a middle grade or a ST level Psychiatrist.

MRCPsych tests the knowledge required to understand and manage common mental conditions. It requires a greater depth of understanding and experience of Psychiatry.

The current MRCPsych syllabus includes:

Behavioural Science and Sociocultural Psychiatry, Human Development, Basic Neurosciences, Clinical Psychopharmacology, Classification and Assessment in Psychiatry, 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

Check this for further info on the MRCPsych exam syllabus:

How many parts are there and the exam format?

PLAB = Two parts

PLAB-1: 180 (MCQs) multiple choice questions – 3 hours exam time

PLAB – 2: 18 scenarios (OSCE stye stations) each lasting 8 minutes and aims to reflect real life settings including a mock consultation or an acute ward. 

MRCPsych = Three parts

Paper A & B: 150 questions (mixture of MCQs and EMI) – 3 hour time

CASC: 16 stations OSCE style

CASC morning circuit will allow 4 minutes to read the instructions and 7 minutes to complete the consultation task.

CASC afternoon circuit will allow 90 seconds to read the instructions and 7 minutes to complete the consultation task.

What is the Eligibility Criteria:

PLAB:

Medical qualification awarded by an institution listed on the World Directory of Medical Schools.

English language criteria for example:  

  • IELTS academic – 7.0 in each testing area and an overall score of 7.5
  • OET medicine version – Grade ‘B’ in each testing area (speaking, listening, reading and writing)

For a full article on English criteria:

You can take PLAB following your graduation and during internship in the home country.

MRCPsych:

You do not require to have GMC registration or UK experience to take MRCPsych.

You do not need English language exam to sit MRCPsych but English competency will be required for the GMC registration after passing the exam.

Paper A: Can be taken by any fully registered medical practitioner (doesn’t require GMC registration)

Paper B: 12 months experience in Psychiatry (further info below in link)

CASC: 24 months experience in Psychiatry  (further info below in link)

How much is the exam fee?

Please see the latest information from the exam websites.

PLAB:

PLAB 1 = £239 (240 from April 2021)

PLAB 2 = £875 (879 from April 2021)

MRCPsych:

Pre-Membership Psychiatric Trainees (PMPT) and affiliates of the College taking exams in the UK and Ireland are entitled to a discount.

Paper A: £486 (PMPT and affiliates) £539 otherwise

Paper B: £437 (PMPT and affiliates) £485 otherwise

CASC: £1004 (PMPT and affiliates)  £1115 otherwise

What are the exam dates and locations?

Since Covid-19 the schedule of the exams have been disrupted and the best advice is to check the official websites for the most recent updates.

PLAB:

PLAB-1: All across the world, various countries and dates.

PLAB-2: GMC testing centre, Manchester, United Kingdom.

GMC has continued to conduct the PLAB-2 examination during the Covid-19 crisis.

MRCPsych:

The MRCPsych including all parts, has been continued during the Covid-19 pandemic as an online exam including the CASC exam. All part of MRCPsych  can be taken from your own home.

Before Covid 19, the papers and CASC exam took place twice a year in the UK with a few overseas options. However, the situation has now changed.

Please check for ongoing updates on the RCPSych website.

How many times can I attempt the Exam?

PLAB:

You must pass PLAB 2 within three years of the date you passed PLAB 1. 

You can attempt the exam (PLAB-1 and 2 each) four times.

If you’ve failed the exam four times, you can apply for one final attempt. You will need to demonstrate evidence of additional learning over a 12 month period and make an application

MRCPsych:

Once you have passed your first written paper  (Paper A or B). You have 1,643 days from the date the results are published to complete all remaining parts of MRCPsych.

If you haven’t completed all parts within the 1,643 days, you’ll need to re-sit all parts to pass. 

However there are special circumstances which you may be granted an extension, for instance if you took maternity leave, or worked part-time.

Where can I find Covid-19 related updates?

PLAB:

MRCPsych:

What is the recommended time required for preparation?

This will depend on the individual doctor, their expertise and experience. In my own experience:

PLAB: 4 months for PLAB-1 and 6 weeks for PLAB-2 (during and immediately following my internship in Pakistan).

MRCPsych: 4 months for each paper and around 3 month active preparation for the CASC exam (whilst I was training in the UK).

Both exam require research of the curriculum, online learning, courses and study partners.

Which exam would you recommend for the purpose of GMC registration?

This will depend on your experience, expertise and future goals.

The PLAB exam is a much easier in comparison to the  MRCPsych in my opinion and for the junior IMGs I usually suggest considering the PLAB initially.

The PLAB is also less expensive than the MRCPsych exam in terms of fees. However, since Covid 19 the MRCPsych can be taken from your home country and you can save money on travel and visa fees.

The MRCPsych requires a certain level of expertise and experience in Psychiatry and is relatively easier to pass if you are working in the UK. However if you working outside of UK, it will require more effort in compare to UK trainee but it is possible. If you are an experienced psychiatrist you should certainly consider it.

Best wishes:

Psychiatric Secrets of Success: Who Wants to be a Specialist Registrar?

Based on:

Naeem A. Psychiatric secrets of success: who wants to be a specialist registrar? Psychiatric Bulletin. 2004;28(11):421-424. doi:10.1192/pb.28.11.421


Introduction

This paper aims to help trainees successfully negotiate the important ‘step up’ from senior house officer or equivalent grade to specialist registrar. It outlines the current structure of higher specialist training programs in psychiatry, stresses the importance of early planning during basic specialist training, and provides a guide to success in the shortlisting and interview stages.

Completion of basic specialist training, with the award of the MRCPsych, is an important milestone for psychiatric trainees. By this stage, most trainees will know which branch of psychiatry they wish to pursue at specialist registrar level. Since 1997, completion of the Calman reforms to higher specialist training has required specialist registrars to be recruited to training programs rather than to individual posts. These reforms aligned the UK system of specialist training with the European Union directives on medical training. The subsequent restriction of national training numbers available for each psychiatric training scheme has placed an important hurdle in the path of prospective higher trainees – the specialist registrar interview.

Higher specialist training programs

There are currently six higher specialist training schemes in psychiatry, covering general adult, old age and forensic psychiatry, child and adolescent psychiatry, the psychiatry of learning disability and psychotherapy. They make applications through regional deaneries, who advertise any vacancies in BMJ Careers. Training in a single specialty, leading to the award of a single certificate of completion of training, or CCT (formerly CCST), requires 3 years of training. Trainees undergoing training in the psychiatry of learning disability, general adult or old age psychiatry may spend one of these years in another appropriate specialty. Training in a combination of specialties (leading to a dual CCT), or in a lecturer post in a single specialty, requires 4 or 5 years, depending on the combination. The College’s Higher Specialist Training Handbook  outlines the requirements for specific dual CCT combinations. The number of regional specialist registrar vacancies is restricted by the availability of national training numbers. Vacancies depend upon existing specialist registrars completing their training and securing a consultant or locum consultant post, or moving to train in an additional sub-specialty, or the acquisition of funding for an additional national training number. Trainees can get helpful careers advice from regional higher specialist training programme directors, and by looking at any published regional ‘competition ratios. In recent years, specialist registrar recruitment to general adult psychiatry has become less popular compared with the psychiatric sub-specialties, owing to the perceived increased workload for general psychiatry consultants without improved resources.

Specialist registrars wishing to transfer to another training program in the same specialty should plan well ahead, liaising with the program directors, postgraduate deans, and future trainers. Although temporary geographical transfers (6–12 months), to gain specialist experience offered by another region, can be done with the trainees retaining their existing national training number, permanent transfers require allocation of a new number by the new region.

Wide regional variations exist for specialist registrars wishing to train flexibly, with some regions unable to fund all their flexible trainees. Over recent years, child and adolescent psychiatry has seen a rise in the number of flexible trainees.

Overseas doctors without UK residency rights can apply for fixed-term training appointments, which carry a fixed-term training number. They categorize these as ‘type 2’ specialist registrar training programs.

Senior house officer training experience

In applying for specialist registrar schemes, trainees who have given some thought to higher training during their senior house officer (SHO) years can reap the rewards of any earlier work. Although gaining a broad clinical experience and passing the MRCPsych examinations are the priorities for most SHOs, they should also be encouraged to engage in other activities that might benefit their future career plans. This includes participation in audit projects, undergraduate medical student teaching, management meetings (involving service development or risk management), and learning basic computing and research skills (e.g., performing literature reviews). Educational supervisors should ensure that clear, focused education and training objectives are set at the beginning of each SHO placement. Each target should be realistically attainable, as the European Working Time Directive can considerably shorten SHOs’ available ‘training time’. Therefore, a trainee interested in a future career in a ‘organic’ branch of psychiatry (such as learning disability psychiatry, old age psychiatry and neuropsychiatry) could realistically:

  1. Complete a regional audit looking at ‘off-label’ prescribing in old age psychiatry.
  2. Lead seminars for medical students on the ‘physical theories’ of schizophrenia.
  3. Perform a literature review on the use of antipsychotics for challenging behavior in people with learning disability.
  4. Contribute to a management meeting looking to develop a local protocol for the pharmacological treatment of challenging behavior.

Trainees should aim to complete an audit cycle by either ‘closing the loop’ themselves or asking their successor to do so. Some trainees may complete a minor research project, either in an SHO research post or during their regional day-release course (if it doubles as a MSc course). However, for most SHOs participation in formal research is an unrealistic aim. Writing up an interesting case report or responding to published papers (by e-letters to journals) is more realistic. Writing e-letters can sharpen trainees’ critical appraisal skills, increase the chance of journal publication, and provide a topic for discussion at the specialist registrar interview.

Use of the College’s logbook allows an accurate, up-to-date record to be kept of the training experiences and competencies gained during basic specialist training. It can also make the hurdle of getting shortlisted for a specialist registrar interview easier to tackle.

Getting shortlisted

Most training programs require the submission of a completed, detailed application form rather than a traditional curriculum vitae. The form usually reflects a locally agreed ‘competence framework’, aimed at selecting future psychiatric specialists. Although its structure varies from region to region, they request certain information in all specialist registrar application forms (Box 1). Referees are asked to complete a ‘structured’ reference form under good recruitment practice. Shortlisting committees score each applicant based on the information in the form, using a pre-determined score sheet, which identifies ‘essential’ and ‘desirable’ criteria for appointment. Candidates need a minimum score to be invited for an interview.

Trainees should read the guidance issued with the form carefully. Some sections of the form may need to be filled in using your own handwriting; in others, typed information may be acceptable (easier to do if they can download the form from the Internet). Use your logbook to extract the salient points in your training that apply to the program you are applying for. Describing an audit on urinary drug screening in a general adult ward might look impressive in an application for a general psychiatry scheme but is less likely to stand out when applying for a learning disability scheme: quoting an audit on ‘out of license’ prescribing might look better there. Some training experiences (such as teaching or examining medical students, computing skills, and published e-letters) can apply to all training schemes.

Make sure the handwritten entries in the forms are legible, as they make copies for the interview panel to read if you are successful at reaching the shortlist. Small handwriting in blue ink does not photocopy well! If typing any sections, use a simple Sans-serif text, avoiding any fancy fonts or italics.

Properly completing an application form can take several hours. Compile a rough draft on a copy of the form and ask your educational supervisor to look through it. Respond to any changes recommended before completing the actual form.

The interview

Specialist registrar interview panels in psychiatry can daunt because of the number of panel members, who include:

  1. The relevant program director (or directors)
  2. A deanery representative (usually the postgraduate dean)
  3. A representative from the Royal College of Psychiatrists
  4. A lay representative (who usually chairs the interview)
  5. A selection of current specialist registrar trainers (including a university nominee) from the relevant specialties.

Remember that most panel members are looking for potential future colleagues. A smart dress code, appearing relaxed and ‘politely’ confident and displaying an ability to answer questions in a diplomatic and balanced way, can help to attain success.

Box 1. Generic information needed for most specialist registrar application forms

  1.  Professional qualifications (with dates)
  2. Current and previous employment details
  3. Courses attended (can include MRCPsych, section 12 approval, life support and computing courses)
  4. Audit experience
  5. Teaching experience
  6. Information technology experience
  7. Management experience (including committee work)
  8. Presentations made at local, regional, and national level (e.g., case presentations, journal clubs)
  9. Experience of evidence-based medicine
  10. Research experience (past and in progress)
  11. Prizes and publications
  12. Goals for specialist registrar training
  13. Three references (one of whom must be your most recent or current supervisor)

To ensure equal opportunity at any regional interview, they ask each candidate the same set of initial ‘stem’ questions, with follow-up ‘probe’ questions based upon their responses. The College’s competency-based curriculum for higher specialist training provides an excellent guide for specialist registrars to the topic areas that are likely to be covered in the interview (http://www.rcpsych.ac.uk/traindev/curriculum/index.htm). Table 1 summarizes the main competencies, with some suggested examples. Trainees can usually adapt these to suit their own intended career plans, by quoting specific examples (e.g., realistic research projects that could be completed during higher specialist training). Think about how you would like to spend your ‘special interest sessions’, ensuring that they relate to your intended career plans.

Table 1. Core professional competencies for specialist registrars in psychiatry.

CompetencyExample
ClinicalTraining as a general adult psychiatrist with expertise in eating disorder
ProfessionalPractice autonomously and ethically, using authority appropriately
Education and teachingExperience supervising, teaching, and examining pre-MRCPsych trainees and allied health care professionals
Leader and teamworkProvide specialist input within the context of a multidisciplinary team
ResearcherContribute to the development and dissemination of new knowledge by participating in audit/research (e.g., developing a screening tool to detect eating disorder among medical in-patients)
CommunicatorMaintain good therapeutic relationships with patients, carers and other professionals
Management and service developmentDevelop a new clinical service or teaching innovations in psychiatry

Trainees should be able to describe any memorable cases they have been involved with, together with cases they did not handle so well. Saying that you have never had difficulty managing a case is unlikely to impress the interview panel. As E. J. Phelps said, ‘The man who makes no mistakes rarely makes anything’!

Be aware of topical issues regarding the National Health Service (NHS), and how they relate to psychiatry. Examples include current NHS regulatory agencies (such as the National Institute for Clinical Excellence and the Commission for Health Audit and Inspection), clinical governance, revalidation, personal development plans and continuing professional development. Do not be surprised to be asked ‘broader’ questions requiring debate, such as the value of research in specialist registrar training, the benefits of audit to the NHS or controversies surrounding the consultant contract. Have knowledge of the mental health National Service Framework documents, the role of assertive intervention teams and the proposed changes to the Mental Health Act 1983. Think about where you see yourself in 5–10 years’ time.

Satisfy the panel members (who may have differing views), by giving balanced arguments, highlighting the points ‘for’ and ‘against’. Advances in Psychiatric Treatment, Psychiatric Bulletin, BMJ, Hospital Medicine and Hospital Doctor are reliable sources of review papers on topical developments. In throwing you a ‘clinical vignette’ to discuss, the panel are testing your thought processes and powers of reasoning rather than your factual knowledge; for example, how would you deal with a team member who is ‘behaving inappropriately’ towards patients? Apply your MRCPsych clinical skills by thinking broadly like the bio-psycho-social model, incorporating immediate, short-term and longterm management. Avoid extreme views or flamboyant management ideas. Most selection panels rank applicants based on the interview, application form and references, with some schemes putting more weight on one or other of these components. The panel may discuss and alter rankings if any applicants have similar scores.

Practice for the interview by asking your educational supervisor or current specialist registrar to conduct videotaped ‘mock’ interviews. Change your techniques in response to any constructive feedback.

What to do if you are unsuccessful

The reality for many SHOs wanting a specific but sought-after specialist registrar rotation is that they may be unsuccessful at their first interview. This is for those who have just got the MRCPsych. Such trainees have a range of options available, which could help strengthen their application for a second attempt.

Look out for any advertised 6–12 months locum ‘approved for training’ specialist registrar posts in the region. Although such appointments are competitive, they have the advantage of eventually counting towards the CCT award upon obtaining a national training number, as they carry the same training elements as substantive specialist registrar posts. Alternatively, locum ‘approved for service’ specialist registrar posts, with locum pay rates, may be available, although these lack formal training elements and do not count towards the CCT award.

Discuss the availability of other posts with your rotation tutor, who could also help you refine your interview techniques. Taking another SHO post might allow you time to complete an audit project or enhance your teaching and management skills (by attending relevant courses, instead of the regional MRCPsych course). A staff grade or associate specialist post would provide experience at a higher grade (including section 12-related work) but might lack formal training opportunities. A clinical research fellow post would allow a combination of specialist clinical and research experience, where the latter could be continued during higher specialist training. However, beware of opting for a post that bears little relevance to your intended specialty. Time spent in a clinical research fellow post in eating disorders might raise uncomfortable questions at a specialist registrar interview panel for old age psychiatry or learning disability! An extra 6 months in an SHO post in the intended specialty would have looked better.

Bottom-line

The College is actively continuing to review the higher specialist training programs in psychiatry. Debate continues about the possibility of having ‘generic’ general psychiatry training awards for all trainees, new training programs (e.g. in neuropsychiatry or addictive behaviour) and modification of the specialist registrar ‘research day’. Whatever changes occur over the next 5 years, the principles of obtaining a national training number will remain the same. Early planning, focused training and good careers advice are essential. Educational supervisors have a pivotal role in this. In applying for a specialist registrar scheme, try a little ‘role reversal’—what attributes would you look for if you were on the selection panel?

Source:

Naeem A. Psychiatric secrets of success: who wants to be a specialist registrar? Psychiatric Bulletin. 2004;28(11):421-424. doi:10.1192/pb.28.11.421


References

  1. Catto, G. (2000) Specialist registrar training – some good news at last (editorial). BMJ, 320, 817–818.
  2. Department of Health (1998) A Guide to Specialist Registrar Training. Leeds: NHS Executive.
  3. Heard, S., Appleyard, J., Aitken, M., et al. (2002) Using a competence framework to select future medical specialists. Hospital Medicine, 63, 361–367.
  4. Naeem, A., Rutherford, J. & Kenn, C. (2003) The new MRCPsych Part II exam—golden tips on how to pass. Psychiatric Bulletin, 27, 390–393.
  5. Newlands, C. & Mckinna, F. (2001) Career focus – geographical transfers in specialist registrar training. BMJ, 322(suppl. 27 Jan), s2–3.
  6. Pidd, S. A. (2003) Recruiting and retaining psychiatrists. Advances in Psychiatric Treatment, 9, 405–413.
  7. Royal College of Psychiatrists (1998) Higher Specialist Training Handbook. Occasional Paper OP43. London: Royal College of Psychiatrists.
  8. Sims, A. C. P. (1997) Has psychiatry become an unpopular specialty? British Journal of Hospital Medicine, 58, 306–307.
  9. Weston, R. (2000) Equal opportunities in the recruitment and selection of doctors. BMJ, 320 (suppl.15 Jan), s2.
  10. Whitehouse, A. (2002) The way I see it – National Competition ratios should be available for all HST applicants. BMJ, 325 (suppl.17 Aug), s55.

GP vs Psychiatry

IMG doctor in the UK frequently tell me that they are confused between choosing GP training or Psychiatry and ask for my advice.

I am a Psychiatrist, my wife is a GP. We were training and preparing for exams simultaneously , so I have some understanding of what is involved in GP training and as time has passed I have gained better understanding of the workload of GPs. So in this post I make a comparison of basic differences a Psychiatrist and GP based largely on my personal experience.

Disclaimer: This is written based on my own experience and other people may disagree. I am a Psychiatrist so I will be naturally biased towards Psychiatry  despite my best efforts to remain neutral.

Life of a Qualified GP or Psychiatrist:

Time allocated to see patients:

GP: 10 minute per patient,

Psychiatrist: 20-30 minute follow-up and 40-60 minute New patient (most cases)

Number of Patient seen in a day:

GP:  From 32 patients per day (40-50 if on-call) 2-3 average home visits daily.

GPs often refer to sessions. One session is roughly 4hrs. So a full day would be two sessions. Full time GP work around 9 clinical sessions.

Psychiatrist: 6 patients in a clinic (two clinics in a week for me)

My routine home visits will be maximum of two in a week.

Routine day:

GP: Daily clinics, frequent home visits, daily paperwork of results, letters and prescription queries. Liaison with district nurses, palliative care teams and midwives/health visitors varies on a daily basis.

GPs may have set minor surgery clinic, contraceptive clinic and baby clinic/ hospital clinic depending availability and own special interests.

Psychiatrist: Variety of job descriptions depending on the sub speciality, can include clinics, MDT meetings, community based jobs, home visits, inpatient and hospital based roles.

My Current job plan includes 2 clinics a week, one MDT meeting weekly, weekly ward round, some ward based meetings and weekly home visits. I am managing inpatients, community team and memory team.

Age and patient group:

GPs see all age groups and all varieties of medical conditions from simple conditions to complex cases. They are often the first port of call for medical care.

Psychiatry involves sub specialties that are also age specific focusing on different age groups and there are many sub specialities of Psychiatry, narrowing down the scope of work further. i.e super specialism

As an Old Age Psychiatrist most my patient are above 65 . Child Psychiatrists see patients up to the age of 18 years.

Uncomplicated mental illnesses is often managed by GPs for example simple anxiety and depression.

Workload:

GPs work much harder than Psychiatrist (at least in my household).

This simply include more patients for GPs and more paperwork.

Teaching research and becoming a trainer:

GPs: You can train to become a GP trainer and also develop the practice to support medical students placements. There are also routes to train as Academic GPs. GP trainers can train GP trainees from ST1-ST3. Most practices are affiliated with local medical schools and have medical students from year 3 and 5. My wife is also involved in training independent pharmacists and nursing students.

Psychiatrist: We are expected to train and supervise junior doctors even from our ST years. Quite frequently the new consultants are clinical supervisors for juniors and soon train to become educational supervisors.

There are plenty of teaching opportunities for senior psychiatrists, including medical schools, junior doctors and MRCPsych courses. Mental Health research is also getting significant funding and focus with some cutting edge research going across the UK.

Private and locum work:

There is a shortage of both qualified Psychiatrists and GPs across the UK. Plenty of locum work available.

GPs: Some local schemes offer Golden Hellos of up to 20K.  Private GPs and portfolio GP can enhance their earning. There are numerous opportunities to do locums and develop special interests.

Psychiatry: Opportunity to do locums, Section 12 assessments, DOLs assessments and private sector work.

Private companies are managing many psychiatric hospitals / units where consultant psychiatrist salary may start from £140,000 pa.

On-calls, Nights and Weekends:

GPs can choose hours independently and practices have flexibility and organise their own rotas. GP opening hours can vary locally but majority of practices working hours are 8am to 6.30pm. You may wish to work as a OOH GP only or do a mixture of both.

Qualified Psychiatrist are much less frequently on-call and do most on-calls from home. I do only one weekend every 3 months and one weekday on-call after every 20 days.

ST doctors in Psychiatry are also mostly on-call from home.

Scope outside UK

Good opportunity for both specialities to migrate to other in English speaking countries such as Canada, Australia and New Zealand. There have also been very successful recruitment to the Middle East.

Training years:

Training time to CCT: (In most cases)

GP: 3 years (18 months of hospital placement and 18 months in GP for my wife) Recent changes involve 12 months hospital based training and 24months GP based training.

Psychiatry: 6 years (3 years of Core and 3 years of ST training)

Membership Exams:

Both training requires work place base assessments (WPBAs), evidence that you are covering curriculum and to pass the ARCPs

GP (MRCGP) = AKT and CSA

Psychiatry (MRCPsych) = Paper A and B (2 MCQ papers) and CASC (OSCE style practical exam)

Psychiatry membership exams are required to progress to the ST training.

No exit exam in Psychiatry during ST training

Salary:

Similar pay scales as trainees and post qualification for GP and Psychiatrist.

GP Salaried positions have fixed salaries, partners take drawings based on practice performance and enhanced services. GPs can also work for local health boards for fixed no. of sessions or part of NCN groups.

There are plenty of opportunities to earn extra by exploring different options for both GP and Psychiatry. Locum opportunities  are available for both specialties.

Rotations during training:

GP: Rotate between mixture of hospital and GP placements

GP trainee remain relatively local but usually expected to drive and can be sent to GP practice some miles away but close networking with programme directors allows to have flexibility of training at closer practices if required. Hospital based training can be at different hospitals within a trust.

Psychiatry: Core trainees rotate between different subspecialties of Psychiatry and ST trainees rotate in one or two particular specialities of their choosing.

Psychiatry ST trainees also move between different trust within a deanery. My ST training was spread across three different trust in Wales.

CCT:

Following completion of training and membership exams GPs register on a Medical Performers list locally and also the GMC GP register.

Psychiatrist register on the GMC specialist register and there are six different types of CCT for Psychiatrists. (General adult psychiatrist, Old age Psychiatrist, Child psychiatrist, LD psychiatrist, forensic psychiatrist and medical psychotherapy)

What happens if I couldn’t pass my membership exam or ARCPs?

GPs: You will leave GP training without qualification and will not be able to work as a GP.

Psychiatry: You can still work as a Psychiatrist at a speciality doctor level and some even progress to become locum consultants without membership exams and CCTs. You also have the option to take CESR pathway to become a substantive consultant.

Once you have around 3 year experience as a psychiatry junior doctor, you can secure, with relative ease, agency locums as a speciality doctor job and earn up to £80,000 – £100,000 per year.

I frequently say to juniors:

The advantage of choosing GP maybe shorter training period but you will hit the ground running and take on the duties of a seasoned GP immediately. There is more flexibility in working hours and days but your day can be particularly long with a heavy case load. You are often working alone so good supportive colleague and a good efficient team are important to support your working day.

So be careful as by choosing less training time, you may end up with an extremely busy job. So choose the speciality depending on your passion and interest.

This might come to you as a surprise that GPs see more mental health patients than psychiatrist. Research suggest that about 40% of GP appointments are mental health related. A huge variety in clinical conditions and build-up of close connections with patients from cradle to grave still underpins most GP models.

Reference: https://www.mind.org.uk/news-campaigns/news/40-per-cent-of-all-gp-appointments-about-mental-health/

So if you are choosing GP to avoid seeing mental illness you may be in for a surprise.

Best Wishes

Psychiatry Training Activity

Prof. Fareed Aslam Minhas conducted the psychiatry training activity for the residents training 19th, May 2016 at CPSP Karachi in the local training units.

Psychiatry Training Activity

The following is the list of participants who attended the Psychiatry training activity at the Head Office of the College of Physicians and Surgeons Pakistan.

Proceedings of the activity:

The Psychiatry Training Activity started at precisely 1603 hrs. The dean opened the proceedings with a welcome to the trainees and asked them to introduce themselves formally. Forty-one trainees from Civil, JPMC LNH, AKUH, Abbasi, and Shifa Hospital were present at the occasion. The layout of the day’s activity was:

  1. Long Case Presentation by Dr. Ilyas (JPMC )
  2. Long Case Presentation by Dr. Amna (JPMC )
  3. Short Case by Dr. Ajay (JPMC)
  4. Short Case by Dr. Anoop (JPMC)
  5. Objectives of the activity:
  6. Focus on the current examination system.
  7. Presentations by the trainees.
  8. Feedback from within the trainees and Dean.

The Dean explained that he and his team have a responsibility to visit every center and meet the trainees, assign them their roles, make then understand the responsibilities of their respective training institutions as provided by the college (CPSP) guidelines and thus help the trainees to pass through the system smoothly. This was very nicely put by the Dean as ” To leave Mental Health of the country in safe hands.” His vision is to increase the number of supervisors from 40 to 60 initially and keep building it up.  Dean’s mission statement is to increase psychiatry trainees, to increase supervisors, more people pass exams with quality training, improve training, and bring it at par.

Training Activity 1

Long Case

Suggestions by the Dean: 

Long-case is presented for a remarkably interesting reason. You will see a patient for 45 mins, two examiners are watching you and they say nothing to you. At the end of those 45 minutes, examiners leave, and you get fifteen, mins to prepare your formulation for the next 30 mins to encounter two examiners. Art is that you should be able to present your history in 7-8 mins, so you need to organize your presentation in this way. In the last 22 mins, around 10 mins between each examiner, if you have prepared well then you can answer better.

The first examiner will ask about relevant investigations, Probable diagnosis, and MSE. The next examiner will ask about management, recent advances, and the prognosis of your case. “Remember, the long case is a typical representation of your ward round.” So, I am not telling you anything new, this is a clinical exam.

Pointers:

  1. Diagnosis not clear, schizophrenia vs mood Disorder.
  2. ICD Multi-axial Diagnostic criteria have utility in this case, for e.g.
    1.  Axis I: Primary Psychiatric Diagnosis, Medical Disorder.
    1. Axis II: Disability
    1. Axis III: Global Assessment of functioning.
  3.  Relevance of life events and relapses.
  4. They cannot guard the course of illness.
  5. Presentation needs organization.
  6. Mention Bio-psycho-social aspects in the management plan.
  7. Recent advances.

The trainee was competent, and that overall, his style, knowledge, and content are good. The Dean praised the presentation style in terms of short-term and long-term courses. This is an effective way to break the monotony of the case. 

An especially important query from trainees was answered by the Dean here. When asked about the case presentation format, Dean explained that it is ok to use a formulation, summary, case, whichever system a trainee is comfortable in. The examiners can understand. If you cannot assimilate in 8-9 mins, they will stop you. However, if you can speak for 10 mins in a flow you are doing well. 

Training Activity 2

Long-Case by Dr. Ammara from Jinnah Postgraduate Medical Institute

Suggestions/comments by Dean: 

1- Mention the Differential of Depression.
2- Mention the differential of Phobic Anxiety Disorder.
3- Importance of childhood events.
4- Medical Differential Diagnosis like hypoglycemia, pheochromocytoma, not relevant.
5- This case can do better as an out-patient, with no need for admission.

In summary, according to the Dean, this was a good presentation. He had an excellent command over language; his presentation skills were up to the mark.

Short Case 1 and 2

Comments by Dean: 

Dean clarified the expectations of the trainees regarding short cases. There are not over thirty cases/ scenarios, therefore, it is quite easy for you to prepare. Common causes include:

  • Drug history,
  • OCD assessment,
  • Suicidal risk assessment,
  • Borderline personality assessment,
  • Difference between Conversion and Epilepsy,
  • Cranial nerve examination,
  • Informational care plans,
  • Assessing cognitive functions.

Each short case is 10 mins, 5 mins to intervention, and 5 mins to the examiner. You also know that you send to medicine and neurology for 3 months, respectively. How does this role get picked up? My idea is what you know, your supervisor knows. This Hierarchy has been effective. So, I take this task to myself and so this is the job of your supervisor to tell you about the short cases.

  • Regarding the short cases, Dean said, you have 5 mins for the interview, take relevant points in the time.
  • Stay focused on information collection.
  • Keep interrupting your patient to stay focused.
  • Candidates can themselves make a key they present later.
  • Candidates MUST practice.
  • Take twenty histories from twenty drug users and see how it enhances your skills.

The dean appreciated the Journal Club presentation by Dr. Sana (Agha Khan University Hospital). According to the Dean, trainees need to know the importance of reading a journal and the journals they need to read. The aims are to stay updated, improve clinical practice, and improve self-interest in research.

We must confine ourselves to some basic journals, BJP review articles every month is an effective way to stay abreast of all the information. So, in four years of training, 48-50 articles will be read, and the trainees will be aware.

Last lesson by the Dean: The ingredients of structured training is given in the college prospectus. This session was all about that. If you don't do it in your training, please ask your supervisor to follow these guidelines. My supervisors need to help me deliver it right. 

  • The session adjourned at 2000 hrs.
  • Minutes submitted by Dr. Sobia Haqqi.
  • Chaired by: Dean of Psychiatry Prof. Fareed Minhas.
  • Co-ordinators:
  • Dr Sobia Haqqi, Dr Anil Wadhwani, Dr Jawed Akbar Dars

How to prepare for the MRCPsych Exams

Dr. Deoman’s Journey through MRCPsych

Many doctors are interested in the RCPsych examinations and are looking for guides on how to prepare for the MRCPsych exams? Member of the Royal College of Psychiatrists (MRCPsych) is a post-nominal qualification mandated by the Royal College of Psychiatrists. Starting in 2015, the RCPsych reduced the number of Written papers from three to two—Paper A and B. 

  • MRCPsych Paper A: The scientific and theoretical basis of psychiatry.
  • MRCPsych Paper B: Critical review and the clinical topics in psychiatry.

1 Clinical Examination (CASC): Clinical Assessment of Skills and Competencies


FACTS

A new 1643-day (equal to 4 years and 5 months) “Written Paper Validity Period” begun for such candidates. it started from the publication of the results of the first paper PASSED. Those who within the 1643-day Written Paper Validity Period had taken time out from employment and/or training for parental leave would on the production of supporting documentation be entitled to a further maximum of 365 days by reference to the period of parental leave. October 2014, an examination was undertaken and passed whilst outside an approved training post will only count towards a Certificate of Completion of Training (CCT) if the candidate re-enters training within seven years of passing the relevant examination.

ATTEMPTS

Following a requirement imposed by the GMC, with effect from 1 January 2015, candidates are normally allowed a maximum of six attempts within their individual Written Paper Validity Period at any one component of the MRCPsych examinations (i.e. each written paper and the CASC). 22 June 2020 the MRCPsych was conducted as online proctored exams to be taken in the candidate’s chosen location (normally home or workplace, but a few places may be available to test centers). The College will review the situation after January 2021; it is presently undecided whether subsequent CASC diets will be conducted remotely.

CASC

1 January 2020: To ensure equal opportunities for all candidates, whether based in the UK or overseas, only two attempts at the CASC are permitted in each calendar year, regardless of venue. 24 months’ whole time equivalent post foundation/internship experience in Psychiatry by the time of sitting the CASC to include: Individual posts should normally be of a minimum of 4 months duration regardless of the number of weekly sessions. The college expects trainees to work a minimum of 50% (or five sessions a week). Experience gained by candidates is to be verified by sponsors.

MCQs

MCQs are one of five single best answer type. This type of MCQ comprises a question stem, which is usually one or two sentences long but maybe longer. The question stem is followed by a list of five options. Candidates should choose the single best option that fits the question stem. One mark is given for the correct answer.

 Skills needed 

The RCPsych examiners will assess communication skills in every station and expect candidates to demonstrate adaptive communication skills depending on the scenario. Candidates will be examined across a range of clinical scenarios commonly encountered in psychiatric practice. This could include scenarios in in-patient settings, out-patient, emergency care, hospital liaison, prisons, and other situations where a psychiatric assessment might be requested.

4mins to read task+ 7 mins-task Post MI depression mgt with studentSodium Valproate- 5 weeks pregnant lady mgtMorbid jealousy mgt with partnerClozapine initiation explanation Discuss psychological therapy OCDAngry mother- clozapine rehab- discuss her son and managementDelirium Tremens- seeing snakes reach D/DAsperger’s + psychosis History in a young man90 Sec to read task + 7 mins taskGBH dependence and impact on life-HXElderly lady psychosis + delusion of Guilt-MSEFinancial capacity to pay rent assessment – hoarding and believing member of the Royal familyDementia wandering Risk19 Years overdose- EUPD- Risk MSE- Alfa and omega- grandiose delusion PTSD with BZD- HxCollateral history from key worker – patient with moderate to severe LD with bruises and epilepsy 

Communication Skills

  • 1. Organized/structured consultation. 
  • 2. Management of consultation
  • 3. Consultation appears formulaic
  • 4. Show appropriate attitude or behavior
  • 5. Listening skills. 
  • 6. Effective use and response to cues
  • 7. Good questioning style
  • 8. Effective use of language in the scenario
  • Time- limit for this exam:

A new 1643-day (Roughly 4 years 5 months) Written Paper Validity Period will commence for such candidates starting from the date of publication of the results of the first paper PASSED

Those who within the 1643-day Written Paper Validity Period have taken time out from employment and/or training for parental leave will on production of supporting documentation be entitled to a further maximum of 365 days by reference to the period of parental leave.

Following a requirement imposed by the GMC, with effect from 1 January 2015, they normally allow candidates a maximum of six attempts within their individual Written Paper Validity Period at any one component of the Mrcpsych examinations (i.e. each written paper and the CASC).

Changes because of COVID-19: 

22 June 2020 the Mrcpsych are conducted as online proctored exams to be taken in the candidate’s chosen location (normally home or workplace, but a few places may be available to test centers).

CASC- Clinical Examination (CASC)-Clinical Assessment of Skills and Competencies: 

1 January 2020: To ensure equal opportunities for all candidates, whether based in the UK or overseas, only two attempts at the CASC are permitted in each calendar year, regardless of venue 

24 months’ whole time equivalent post foundation/internship experience in Psychiatry by the time of sitting the CASC to include:

  • Individual posts should normally be of a minimum of 4 months’ duration, regardless of the number of weekly sessions. They expect trainees to work a minimum of 50% (or five sessions a week).
  • Experience gained by candidates is to be verified by sponsors

Cost for the exam: In a world where doing exams seems to cost half your salary

Paper APaper BCASC
PMPT Trainees and Affiliates £486£437£1,004
Non-PMPT Trainees and Affiliates £539£485£1,115

Need a few things to be aware of:

  • try to keep life going whilst you do your exams. 
  • Keep eating healthily and keep doing some exercise, even if that’s only a walk to the shops. 
  • Keep seeing friends and give yourself some time off to relax.
  • Positive attitude: Keep exam Hat, Exam is an artificial environment

Royal College of Psychiatrists

Training | Royal College of Psychiatrists (rcpsych.ac.uk)

Dr. Deoman Gurung
Dr. Deoman Gurung

MBBS, MRCPsych. I have Widespread experience including in Addiction Psychiatry, Crisis Teams, Early Intervention Teams, PICU, and Adult Inpatient Units. I am currently a Senior ST4-Dual trainee (adult/old age) in Lancashire care and South Cumbria NHS Foundation Trust, UK.

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How to run a free MRCPsych CASC Mock

For over eight years we have been organising CASC mock examinations for the Welsh Deanery. We are a group of ST doctors and consultants who arrange these exams regularly and with the current COVID-19 restrictions we have adopted the examination to an online format.

Here is a brief outline of how we have been achieving this. We will need the following roles to be fulfilled in order for the exam run smoothly.

  • Organisers
  • Examiners
  • Actors
  • Scenarios
  • Candidates
  • Online platform
  • Mock exam and feedback circuits

Organisers:

 The core group of organisers are usually Consultants and senior ST level doctors with a good understanding of the CASC exam. We divide the roles and responsibilities and stay in touch using WhatsApp and emails. Our current group has two RCPsych CASC examiners.

We set a date about 3-4 weeks before the actual  exam. Roles can be divided as

  • Candidate manager
  • Scenario manager
  • Examiner manager
  • Actor’s manager

Examiners:

We prepare a list of RCPsych CASC examiners in our deanery and approach them directly requesting them to help us with the Mock exam if possible. We aim to encourage the enlisting of college examiners as possible so our junior doctors can get advice from experienced examiners.

After exhausting the college examiners we approach other experienced consultants and ST doctors and also keep some ST doctors on standby last minute changes or emergencies.

Some examiners sign up for whole day event while others for half a day depending on their timetable.

We try and match the the examiners with their subspecialty.

Actors:

This is where we ask for funding from the deanery and approach a local acting agency which usually cover the medical school exams as well. In the past we also used university drama school students as well.

Professional actors help to improve the quality of the CASC Mock.

If a scenario involved speaking to a consultant, we use ST doctors as actors.

If the scenarios involve explanation like for example ECT, Clozapine or Lithium, we can use Medical students as actors.

You can approach local university drama school which will usually have keen acting students looking for opportunities to act.

If you do not have sufficient funds for professional actors, you can request ST doctors to help  out.

Scenarios:

Scenarios are written usually by the ST doctors who recently sat the exam and base them on common exams themes but we do NOT copy the actual exam stations.

Every written scenario will include

  • Candidate instructions
  • Actor’s script and instructions
  • Examiner’s instructions and clinically relevant notes on the topic to help them with marking

Over the years we have developed a good collections of CASC scenarios which include explanation, history taking, information gathering and examination stations.

Candidates:

As the Mock is funded by the deanery, we offer it to the trainees first and the ones going for the next CASC attempt is given preference.

It is also open for speciality doctors working in Wales and other doctors if we have spaces left. Candidates do not pay anything.

To complete a circuit, you need 8 candidates for each event.

Online platform:

Running a Mock on online platform requires certain degree of IT expertise and luckily we have an ST doctor on our team with an excellent expertise to manage Zoom along with breakout rooms.

The stations are created into zoom breakout rooms and candidates moved between them.

The main Zoom coordinator can keep time and send instructions to start reading instructions, stop reading and person, one-minute warning and end station warning.

The examiners are trained to share their screens for the station so that the candidate can read instructions as they would on the day of their exam.

Mock exam day:

Starts with introductions and examiner, actors and candidate briefing.

The examiners are advised to join using laptop with the function of share screen.

The scenario instructions are shared by examiners on the screen and the main IT person had the opportunity to send messages on time

Feedback Circuit:

An important part of this process in the feedback circuit, which starts right after the Mock exam circuit finishes. Every candidate is rotated back into each room for 4 minute where they receive 1:1 feedback from examiners and actors on how they performed and areas required for improvement.

Finally:

All candidates receive their mark sheets via email after the event along with attendance certificate.

Examiners receive their CPD certificate.

If we are using student actors from drama school, they will get acting experience certificate.

We gather feedback on the way the Mock was run in order to improve it.

I hope this was helpful.

How to secure Psychiatry ST training – An IMG Experience by Dr Awab

ACQUIRING AN ST4 PSYCHIATRY POST DIRECTLY FROM PAKISTAN

(Please note this blog was written in Dec 2020 and describes the recruitment round of Feb 2021 – The recruitment criteria and process may change with time)

Introduction:

I am Dr. Awab. Having graduated back in 2011 from Pakistan, I did my FCPS psychiatry training (Pakistani fellowship training) from 2013 to 2016 in Pakistan, after which I got accepted into the 2 year HSE/CPSP scholarship programme in Ireland where I completed the rest of my FCPS training from 2016 to 2018. By the end, I was fortunate enough to have passed the MRCPsych exams along with the FCPS exams that enabled me to work as a senior registrar/ specialist in Pakistan.

What is an ST4 post?

Some IMG’s like myself might not be familiar with the route to becoming a specialist in the UK. The psychiatry training programme in the UK requires 3 years of core psychiatry training (CT1-CT3), passing MRCPsych and then completing another 3-5 years of specialty training (beginning with ST4), depending upon the subspecialty chosen. Upon successful completion of specialty training, one is awarded with either a CCT or a CESR(CP), that enables you to practice as a consultant in the UK. An ST4 post is where you have either completed the 3 years of core training (CT1-3) or equivalent (Certificate-C required), which in my case was the FCPS training.

More information about the different routes to attaining a specialist post is available below:

https://www.nwpgmd.nhs.uk/st4_psy_train_rec_oview

Why choose an ST4 post:

There would not be a definitive answer to that since everyone has their own priorities and circumstances. A few possible reasons could include:

  1. Planning to pursue your career as a consultant in the UK.
  2. To better your skills and competencies via an organized and supervised training programme.
  3. To widen your opportunities in other parts of the world.
  4. A combination of the above.

How to apply:

I applied during the covid-19 pandemic, therefore certain procedures have been modified, and certainly made easy for doctors residing outside of the UK. You can find updated information on the process via this link: https://www.nwpgmd.nhs.uk/st4_psy_train_current_record

Preparing to apply:

There would be certain requirements and their prerequisites you will need to fulfill, such as having a valid GMC registration or being eligible for it. You can check your eligibility here:

https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/application-registration

As for me, I applied for GMC registration via an ‘acceptable postgraduate qualification’ i.e MRCPsych route, having done IELTS to prove my English language skills.

The next steps involve fulfilling the person specification criteria as per https://specialtytraining.hee.nhs.uk/Recruitment/Person-specifications. While the list seems endless, it is worth noting here that if you have an MRCPsych qualification and have been training or working in psychiatry anywhere over the last few years, you would likely have fulfilled many of these criteria and all you need to do is to put the required documentation in place.

Many required skills and competencies are mentioned on the core competence equivalence report a.k.a the certificate C, and you will need your current or previous supervisor to fill and sign it for you. Meanwhile if there are certain intended learning outcomes (ILO’s) on the certificate C that you have not accomplished, you can always complete them in a certain period of time.

Next steps include creating an oriel account, and looking out for the application window to open. Meanwhile you will need to prepare the evidence for your self-assessment. A few documents are required at the very beginning of the application process, including:

  • Certificate C (signed by the supervisor) – Core Competency equivalence report
  • CASC result showing your score (I attached a pdf file of the email I received that included my CASC score)
  • Supervisor’s report (I attached the CPsychI supervisor report form filled by my previous Irish supervisor, however, no specific format is mentioned)

It would therefore help if you have those ready as soon as possible.

The oriel application asks for 3 referees over the past 2 years that can be contacted by your employer. A referee can be any senior, consultant or supervisor in your specialty that you have worked with. I found it important to list the referees only after I took their permission and ensured they were the ones who checked their emails regularly, or were accessible if I needed to request them to check their emails.

Once the window opens, you will be able to score yourself against the self-assessment criteria while making sure you have the required evidence for each domain that you can upload on your oriel account. For me, it really helped to gain a few points given my FCPS training in Pakistan where I had written a dissertation and published an article based on that, as well a few presentations that helped me score more than I was initially expecting. Therefore it might help closely looking at the domains to make sure you avail every point you can.

https://www.nwpgmd.nhs.uk/st4_psy_train_current_record will show you the updated self-assessment criteria, guidance on the scoring and the kind of evidence you can attach for each scoring domain. It even displays the average scores for the previous round that may help reassure you if you feel you are scoring low. If there is time before the window closes, it might be worthwhile completing an audit, presenting a poster, submitting an article or anything that can help you score higher, as well as to request a few letters of recommendation and other evidence for the self-assessment scores.

THE INTERVIEW:

I received interview guidance as well as the oriel link to booking an interview, which, if done at the earliest possibility could help you secure a convenient time slot.

The interview was held online via MS teams, the link of which was shared with me. It is worthwhile testing the link on your computer well beforehand.

The interview structure and questions were shared with me a few days in advance, offering enough time to prepare.

On interview day, I signed in at least 10 minutes prior to the commencement time. I waited quite some time before I was let in and was greeted at the virtual reception. I was required to show my passport and to rotate my laptop around the room to verify I was alone in the room. Then there were another few minutes of waiting before I was in the virtual interview room, where I met the administrator, two clinical assessors, and an observer. After the introduction, I was asked the stems questions/ scenarios I was informed of earlier.

I found the interview rather straight-forward as I had my response ready to the already known stem questions while a few probing questions were asked at the end that were directly related to the respective scenarios. The interview lasted an exact 15 minutes and I was informed at the end to check my account on the offers day.

PREFERENCES:

You will be able to see the recruitment process timelines that will show the preferences window as well. Since covid-19, preferences have become more favorable since one can now choose between all specialties as well as dual specialties, and all we need to do is to rank them in order.

My choice of placement was based on a balance between career opportunities, accessibility, safety rating of the area, family life, proximity to people of my descent, cost of living among others.

OFFERS DAY:

Check your oriel account and email on the offers day. Upon receiving an offer, you will have the choice to accept, reject or accept with upgrades. The latter is if you did not get your first preference and would like to wait and see you can still get it.

Important points:

  1. Do ensure you meet the eligibility requirements for GMC registration, English language requirements, visa and funds’ requirements well in advance to avoid delay when the time comes.
  2. Try and collect the required documents such as good standing certificates well in time for GMC if you are not currently registered.
  3. Certain elements of the process were modified due to covid-19, including the absence of clinical stations that were marked as per the CASC score instead, while the interview was conducted online, saving time and travel costs. The portfolio station was modified in a way that no documents were required apart from the passport for identification. https://www.nwpgmd.nhs.uk/st4_psy_train_current_record will provide accurate and up-to-date guidance on the process should anything change.
  4. Keeping a careful record of your documents such as supervisor’s reports, workplace-based assessments, proofs of workshops, certificates, publication, presentation, feedback reports, letters of recommendation, etc. would come in handy.

BOTTOMLINE:

Contrary to the common assumption that foreign doctors have next to none chances of acquiring a higher training post, I got the post, and that too, within my first preference area and specialty.

How well do first timers in the UK excel as trainees, I have yet to discover.

NEXT STEPS:

Following acceptance of an offer comes a flood of emails and paperwork from several different organizations involved in the hiring and training process. It is crucial to stay organized, and in my case, I created a checklist.

I would like to share a detailed guide regarding the steps leading from acceptance of the offer to first day at work in the UK once I am there.

Best wishes


M. A. Awab Sarwar

Aliawab7@gmail.com

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!


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

How to Pass MRCPsych Exam – by Dr Marium Mansoor

(Please note this blog was written in Nov 2020 and the MRCPsych exam regulation and format may change with time. For up to date exam format refer to RCPsych website https://www.rcpsych.ac.uk/training/exams)

My name is Dr. Marium Mansoor, 28 years old, married, and mum to a lovely daughter. I am from Karachi, Pakistan, and have lived my entire life here. I am a graduate of Dow medical college (2014) and did my residency/ training in Psychiatry from Aga Khan University hospital, Karachi. My first language is Urdu, but I was taught and trained in English. Like many of you, I once dreamt to be an MRCPsych and once upon a time, it looked like an impossible dream.

I am one of the fortunate ones to pass all three MRCPsych exams in the first attempts. I became a member in October 2020. I would like to share my journey with all of you with the hope to be of some help for all the IMGs aspiring for MRCPsych.

I started thinking of MRCPsych back in 2016, as soon as I started my Psychiatry training. The initial bit was to do homework on the core syllabus and structure of the exam and the eligibility criteria. I was mindful from the beginning that if I plan for MRCPsych during my training I will have to ensure I fulfil my primary training requirements, goals, and objectives; one of which was to give my local postgraduate exams timely (FCPS psychiatry).

The MRCPsych Exam:

The exam consists of 3 parts:

  • Paper A (MCQ Paper)
  • Paper B (MCQ Paper)
  • CASC (Practical Exam)

I will share my preparation journey for all three exams. Please note that I have taken the syllabus topics and eligibility criteria from the RCPSYCH website (https://www.rcpsych.ac.uk/ )

Please note that the eligibility criteria can be updated. You can check you the criteria from https://www.rcpsych.ac.uk/training/exams/can-i-take-an-exam

Paper A:

I gave my paper A in December 2017, in the second year of my psychiatry training. I started my preparation around 6 months ahead of the exam date, but in my opinion, the duration can vary according to your usual study style. Some of my colleagues passed with 2 months’ preparation. My advice would be to go with your natural style, but make sure you are well prepared by the exam date.

Remember! It’s an expensive exam and includes planning about traveling as well (The Royal college took exams on online platforms in 2020 due to COVID. The college might stick to the online format of theory exams for good, which is certainly a plus point for international candidates).

Topics for Paper A:

Paper A covers the following sections of the syllabus:

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

Further details of syllabus, scoring, and sample questions can be found on:

https://www.rcpsych.ac.uk/docs/default-source/training/examinations/exams-syllabic-curriculum-mrcpsych-december-2013.pdf?sfvrsn=20c35fdb_6

Eligibility Criteria (as of Nov 2020):

You are eligible to take Paper A if you are a fully registered medical practitioner. You do not need GMC registration to sit the Paper A of MRCPsych. As long as you are registered with a medical council, you can sit the exam.

Exam pattern and duration:

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).
Course materials I used:
  • SPMM high yield (notes and MCQs)
  • Fisch’s psychopathology
  • Stahls psychopharmacology
  • Atkinson & Hilgard’s Introduction to Psychology

I would recommend doing SPMM mock as well, it will give you a good idea of the real exam. Spend more time with EMIs, time yourself while doing mocks. Despite all the preparation, I struggled with times.

The number of questions has come down to 150 in 3 hours so I believe it should be easier to manage time now.

How I prepared:
  • A printout of the syllabus and orientation of the SPMM notes.
  • I kept both a hard copy and soft copy of SPMM notes, hence I was able to prepare with whatever suited me with my work schedule.
  • I started with 1-2 hours a day on weekdays initially and gradually increased it to 3-4 hours every day in the last 3 months of exam preparation. 15 days before the exam I took leaves and studied up to 8 hours a day.
  • I initially started SPMM notes and did MCQs and EMI given with every topic. After reading through notes I used to skim through the syllabus to ensure I have covered every topic.
  • SPMM notes will only cover the syllabus, a very helpful tool. The flip side is it doesn’t help develop concepts, if you cant rote learn and given an exam without concept, just doing SPMM will be insufficient.
  • If you have core concepts of the syllabus or if you give exams with rote learning, SPMM alone will work fine.
  • I did SPMM notes cover to cover, I gave four reads to the notes.

Travelling and exam day:

(You may not have to travel as the exam has gone online since Covid-19 crisis and can be taken from you own house)

  • In case you have to travel for more than 3 hours before the exam, make sure you reach your destination at least 36-48 hours before the exam. You can’t afford jet lag on exam day.
  • Get a good night’s sleep. It will help you get through the day swiftly.
  • The exam starts at 0900 Hours UK time, so please convert it to the exam venue time. I gave my exam in Singapore and my exam started at 1700hours.
  • There will be other candidates, some might be discussing things enthusiastically. Avoid overhearing them, avoid studying or learning something new at the last minute.
  • Don’t get intimidated by the huge number of candidates, it’s pointless and won’t affect your results.
  • Grab a coffee and a light meal before the exam, make sure you take a water bottle along.
  • Take your time in solving your exam, don’t follow the group dynamics of the room to leave early. They have given you 3 hours, use them wisely.
  • After the exam, don’t waste your energy on how you did the exam. It’s done, no amount of stress and energy invested worrying for the result will change your results.

Paper B

I wrote my paper B in September 2018, Singapore center again. I was in my third year of psychiatry training at that time. Duration and style of preparation were more or less like paper A.

Topics covered in Paper B:

Paper B will cover the following sections of the syllabus:

  • Organization 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

Further details of syllabus, scoring, and sample questions can be found on:

https://www.rcpsych.ac.uk/docs/default-source/training/examinations/exams-syllabic-curriculum-mrcpsych-december-2013.pdf?sfvrsn=20c35fdb_6

Please note: There are two files for the psychiatry and critical appraisal syllabus.

Eligibility criteria (as of Nov 2020):

You are eligible to take Paper B if:

  • you’re on an approved training programme. We recommend you have 12 months’ experience in psychiatry before attempting Paper B.

OR

  • you are in a post recognized by your hospital or trust as having contracted time and funding for educational training. Your job plan must include dedicated time for academic and educational activities such as attending journal clubs, grand rounds, attending an MRCPsych course of equivalent, study leave, and weekly educational supervision

Exam pattern and duration:

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 reviews.

Two-thirds of the paper covers clinical topics

Course materials I used:
  • SPMM high yield (notes and MCQs)
  • SPMM mock (It’s very close to real exam)
  • Superego café critical appraisal course (online one I did the videos and the book they provide)
  • SPMM critical appraisal videos
  • Shorter Oxford Textbook of Psychiatry
  • ICD-10 (very superficially for criteria)
  • Maudsley prescribing guidelines 13th edition
How I prepared:
  • It was the roughly same number of hours as paper A
  • The only change was I divided my study time equally between critical appraisal and psychiatry syllabus.
  • I kept watching the critical appraisal videos and studied the same topics from the books as well.
  • As I mentioned, I can’t study without concepts, so I gave a selective read (covering syllabus topics only) of The Oxford handbook of psychiatry, ICD-10,  and Maudsley prescribing guidelines.
  • In paper B you are allowed a calculator (simple one). Make sure you use the same you plan to use in your exam so your hands are all set on it. I am not sure about the online exam guidelines which were implemented in 2020, so make sure you go through them.

CASC (Clinical Assessment of Skills and Competencies)

I attempted my CASC in Sept 2020. At that time I was working as a faculty at AKUH Karachi. Like my previous exams, I started early, I.e. 5-6 months before exam day. I gave my CASC online due to COVID. The college, however, plans to continue the exam in person after COVID.

Eligibility criteria (as of Nov 2020):

You are eligible to take CASC if:

  1. You have 24 months’ whole time equivalent post foundation/internship experience in psychiatry.

AND

  • A pass in Papers A and B, OR you comply with transitional arrangements (this requirement has been waived for the 2020 exams)

AND

  • You have sponsorship in place, and can demonstrate one of the following:
    • If your post is within a programme of approved training, you have successfully completed the Annual Review of Competence Progression by the time you apply for CASC.
    • for all other posts, you must have successfully completed an Assessment Portfolio, showing achievement of equivalent competencies to those defined in the ARCP, to include competencies in Psychotherapy AND Child and Adolescent Psychiatry, or Learning Disability. 
The format for the CASC?

The CASC format is like an OSCE (Objective Structured Clinical Examination).

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

  • The morning circuit will allow you 4 minutes to read the instructions 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

Course material I used:

  • SPMM notes
  • SPMM and Birmingham videos
  • Oxford weekend course
  • SPMM mock.
Challenges and Myths about CASC:

Before I began preparation, I searched for blogs and posts from those who have casc experience (both successful and unsuccessful ones). The challenges I faced were lack of immediate senior guidance and I didn’t know where and how to start. On top of that, you will find a good amount of candidates/ex-candidates who will narrate horror stories of CASC. Retrospectively, I can safely say that there are a lot of myths around the exam, far from reality. I would like to clarify these myths:

  • Your theoretical knowledge has been checked in paper A and B
  • In CASC they want to see your clinical judgment and decision making skills (0n spot, like in real life)
  • They want to see how you communicate and here:
    • It’s not an English language exam, it’s a clinical exam.
    • You are not at a disadvantage if your English isn’t too great, trust me I passed the exam. One of my biggest fears, before I started the preparation, was spoken English and the British accent (I will share a tip for that shortly).
    • You can pass the exam even if you haven’t worked in the UK/Ireland setup.
    • There are these to pass you, but to pass you they expect a certain competency level.
How I prepared:
  • I started more than 5 months ahead of the exam because there is no shortcut to CASC. I repeat! There is no shortcut to CASC.
  • I looked out for candidates planning to sit their exams in the same attempt. There are Facebook and WhatsApp groups for CASC where I found 4 international candidates and started my practice. I later found some local (within Pakistan candidates and started practicing with them as well at a separate time.
  • I would recommend making a group of no more than 6, preferably 3 candidates so you can practice more.
  • I reached out to seniors who have done MRCPsych and I was lucky enough to get 4-5 ST4 trainees and a generous faculty member who supervised my group’s practice regularly.
  • Go through the CASC mark sheets to get an idea of the marking style. (the mark sheets are available on https://www.rcpsych.ac.uk/training/exams/preparing-for-exams )
  • I started practicing on weekends for 2-3 hours (including reading time) for about a month.
  • Later I increased it to daily for about 2-4 hours a day (duration of practice varied due to work commitments so you have to be very flexible). 15 days before the exam I took my leaves from work and practiced up to 8 hours a day.
  • I started by watching past stations, videos, and collected experiences from those who had attempted CASC already. For the first two months, I focused on understanding the expectations from candidates and I realized that:
    • Clinical knowledge is just a small aspect of your exam
    • They want to see how you communicate the knowledge you have, and how you make decisions on the spot if something is challenging.
    • Empathy, regular pauses, checking to understand (just like you do clinically) is very important.
    • Managing time and sticking to tasks strictly is the key to pass.
  • If you have no exposure to UK practice, I would strongly recommend you take mock. I took the SPMM mock and found it very close to the exam. It helped me add some finishing touches to my CASC preparation.
  • Watch the CASC example videos on the RCPsych website, it will help you understand what they are expecting.

The day before the exam:

  • Get an idea of what kind of stations have come up so far.
  • Only work on new stations. There is no point in studying more than a few hours a day before the exam.
  • Relax and try getting a good night’s sleep.
Some preparation tips:
  • Record yourself to see what you do good and what needs improvement.
  • Never take feedback from peers personally and always give feedback honestly.
  • Ensure you work on body posture. The exam is anxiety-provoking so train yourself during practice to consciously relax your shoulders when taut, and your tone should have situational fluctuations.
  • Use your 90 seconds/ 4 minutes wisely, work on the structure of stations, think of an opening sentence for your station because in the exam you will be in autopilot mode.
  • Tip for communication skills: see a few British dramas. See how they interact and try incorporating that in your style. It will also help you get used to the accent.
  • Do not copy anyone’s style, it looks fake. The practice is to help you enhance your approach, not your style.
  • The majority of stations, up to 13 stations will repeat with slight modifications. So go with an open mind and expect subtle changes. Practice the common stations at least 4-5 times at intervals.
  • Make a notebook, for each station you practice, make a structure, note feedback so you can recall it the next time you practice a particular station.
Tips for online exam:
  • Record yourself and focus on your body language and posture, your tone, and expression.
  • Try looking at yourself from an examiners’ perspective. See if you look like a confident ST4, that’s the level of competency college expects from you.
  • Choose a place for your exam, it should have a neutral background. Ensure the background is clean, uncluttered area, free of distractions. Send your kids and pets away for the exam day. Make sure you have a stable internet connection.
  • Try and practice at the same place where you plan to give your online exam form. This will help you stay calm as it will feel like a daily CASC practice rather than an exam.
  • Make a habit of resting your back on the back of the chair you are sitting on, and intermittently lean forward when there is some concern, and while you are showing empathy. If you are leaning at the screen for whole 7 minutes, it gives an impression of an anxious candidate.
  • Dress professionally, in a clinical attire, even if you are giving the exam from home.
  • Keep a note pad and pen, along with a water bottle.
  • Expect delays between stations, don’t panic if there is a delay.
  • Despite a stable internet, you might face technical errors. The college is very mindful of them and you will get a call from them if they can’t connect to you online.
  • If your connection drops, you might get a chance to resume the station from where you left, or they will offer you to re-run the station. The college tried hard that all candidates get to do all 16 stations and the majority were able to do so successfully.
  • If you hear echo, audio difficulty from actor or invigilators end, SAY IT! They will not know unless you tell them what issue you are facing. These technical issues might affect your performance, so if they are aware of this they will assist you.
Tips for stations:
  • Make your style of starting stations, preferable as you do in your daily routine. Stick to it for all your stations, it will come naturally.
  • Set the scene. The first 30 seconds of your station will give a direction to your station and you can go back and forth on it when you feel the need. I will share my approach here:
    I used to start my stations with: ‘Hello! My name is Dr. Mansoor, I am one of the psychiatrists here. How are you today?’ the reason for asking how they are has two benefits:
    • It will make the actor feel that you are treating them as humans. You aren’t jumping to the task straight away, you value how they feel.
    • They might say I am good. In this case, you can build on the information given in the scenario, ‘I gather you have been referred to me by your GP…’
    • They might respond that ‘I am not so well/ I feel bit upset/ I am a bit anxious’ that is a lead you get in the first 30 seconds of your station. Bingo! Pick up their words, for example, what do you mean when you say you aren’t well?/ can you help me understand what you mean when you say you feel anxious? ( this is helpful in MSE and history stations, it gives a direction to your station quite early in the station.
  • Always start with open sentences, narrow down to closed ended questions halfway through.
  • Let the actor speak. Stop them only and when you feel they are either going off track or you have got the gist of their conversation. Always apologize whenever you cut them.
  • Once the actor has given you a good amount of information, summarize it in a few words and check if that’s what they meant. It makes them feel heard.
  • Make a habit of clarifying, paraphrasing, summarizing, and checking their understanding. It will take you a long way.
  • For history stations:
    • Read the task carefully and never assume a diagnosis based on a hint given in the scenario.
    • Go with an open mind.
    • If the task says to reach a diagnosis, ensure you say the diagnosis in the end. If you aren’t sure of the diagnosis, say that as well (it looks like you a probably suffering from ______ but I would like to see you at a later time to get more understanding of the concerns you have just shared.
    • Ask all symptoms in a go(cluster all the symptoms). For example, if the actor reports feeling low, rule out all mood symptoms then and there. Here, you must always stay mindful not to sound like reading out of a checklist. So, paraphrase and reflect on symptoms as you go.
    • Always come up with a contingency plan. For example, if giving a diagnosis, briefly say in the end that ‘I would like to set up a time to talk to you in further detail about it, to see how we can help you from here onwards. Thank you for coming to see me today!’
  • For management stations, divide the station mentally into three bits, check their understanding, build on their understanding, and deliver them information about the illness and lastly come to a management plan.
  • For MSE stations, you don’t have to go into history bits. Like a past psychiatric history or family history. Clinically, history and MSE go together but not in CASC or you will run out of time.
  • In difficult conversations like substance use, depression, abuse etc. appreciate the actor for their honestly, acknowledge that you understand it’s not an easy conversation, but it’s needed to get an understanding of what they have been going through so you can help them in the best possible way.
  • In risk stations, don’t shy away from saying if the risk is high. Say that you are very concerned, even if the concern is about others and not the patient, be mindful that despite any of the above concern, you still have to mention that you are there to help them.
  • NEVER be judgment. Be very cautious of your expressions, tone, and body language. They matter a lot more than we think.
  • In CASC you can still pass if you fail four stations. A bad station doesn’t mean you have failed the exam already. Leave the station mentally the minute you leave it physically. If you ruminate on a bad station you will lose the current one as well. I know people who failed because their 1st station went bad and that led to a chain of anxiety and negative cognitions. Please be gentle with yourself.

CASC+ Full-time job + family commitments:

As you might have noticed I had a two-year gap between my paper B and CASC. The reason was my family commitments and managing a newborn and of course COVID.

A few things that helped me to manage all of these were:

  • There is no denial of the importance of family support.
  • Acceptance that it’s a hard journey, and there are ways that you can achieve it helps you stay motivated.
  • You need to be persistent and dedicated, dreams don’t become reality so easily or nobody would dream for them.
  • Career breaks are important, but make sure you resume your career after a break.
  • You have to be organized and manage time very effectively.
  • I used to reach work an hour early and practice before starting work. During my clinical work, I minimized my breaks and utilized that time to finish work on time. Even in half-hour gaps (e.g. patient canceled in clinics) I used to study or practice.
  • In expected free times I used to schedule practice ahead of time.
  • I am guilty of watching SPMM/Birmingham videos while doing household chores like doing dishes and laundry, and on my commute to work (in case you don’t drive).
  • There were days I couldn’t practice, it took me a while to accept that IT IS OK! I just have to be persistent.
  • After work, I maintained a strict bedtime routine for my daughter and I used to practice 1.5 hours after putting her to bed. There were times she was sleeping right next to me while I practiced, times when I had a crying baby in my lap.
  • Take regular breaks otherwise, it is going to be emotionally taxing.

Concluding words:

Exams are never easy, but they are doable. You don’t have to be a genius to achieve your goals. All you need is dedication and persistence. Balance your work/ study with some hobbies, set up regular schedules, and follow them. Life doesn’t stop for training and exams, everything has to be done in balance.

It’s not easy to strike that balance, but the constant effort will pay off your efforts for sure. A failure after effort doesn’t mean you aren’t a good doctor or not competent enough. No exam can determine that.

Good luck!

Dr. Marium Mansoor – mariumansoor@hotmail.com

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