My MRCPsych Journey – Passing the MRCPsych Exams by Dr Deoman Gurung

READY FOR THE JOURNEY?

TIME-LIMIT FOR THIS EXAM:

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

Those who are within the 1643-day Written Paper Validity Period and have taken time out from employment and/or training for parental leave will, on the 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, candidates usually are 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).

CHANGES DUE TO COVID19:

From 22 June 2020, the MRCPsych exams are conducted as online proctored exams in the candidate’s chosen location (usually home or workplace, and a limited number of places may be available in test centres).

Guidance for Paper A and B 

Guidance for online CASC 

CASC- CLINICAL EXAMINATION (CASC)- CLINICAL ASSESSMENT OF SKILLS AND COMPETENCIES

ELIGIBILITY FOR CASC: 

You are eligible to take CASC if:

1. You have 23 months’ whole time equivalent post foundation/internship experience in psychiatry.AND
2. A pass in Papers A and B, OR you comply with transitional arrangements
   AND
3. You have sponsorship in place, and can demonstrate one of the following:
   1. 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.
   2. 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.

1 January 2020:

To ensure equal opportunities for all candidates, whether based in the UK or overseas, no more than two attempts at the CASC are permitted in each calendar year, regardless of the venue.

At least 24 months whole time equivalent post foundation/internship experience in Psychiatry by the time of sitting the CASC.

This includes the following:

• Individual posts should normally be of a minimum of 4 months duration regardless of the number of weekly sessions. Trainees are expected to work a minimum of 50% (or five sessions a week).
• Appropriate experience gained by candidates is to be verified by sponsors

Cost for the exam:

THE JOURNEY - INITIAL STAGES

What should you be aware of? 

• Try and 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

Read 5 Hacks for the Modern Psychiatry Trainee

Get Motivated:

The critical reason to acquire sound knowledge and skills based on the subject is that it helps your clinical work and career progression. After all, it makes a difference to our patients.

THE MRCPSYCH EXAM

PAPER A

1. Behavioural Science and Socio-cultural Psychiatry 16.67% / 25
2. Human Development 16.67% / 25
3. Classification and Assessment in Psychiatry 16.67% / 25

Total: 75

4. Basic Neurosciences 25.00% / 37 or 38
5. Clinical Psychopharmacology 25.00% / 37 or 38

Total: 75

PAPER B

Please follow the Syllabus of the Royal College of psychiatry U.K. There is no point covering areas that don’t appear in the exam and your time would be better spent learning things that will be relevant.

HOW TO PREPARE?

We all have our ways of revising. However, generally speaking, there are two ways:

1. Read the theory topic and then go to Question & Answers to complete your revision (preferable if you have no or minimal theory base)
2. Go to Question & Answers and refer to theory as you go along (preferable if you have some theory base)

Build your knowledge on what you have learned already

• Always look for connections and link them together. Then, each time you revise, try and fill the gaps in knowledge with additional information.
• Work out exam questions & answers and read and learn explanations as much and as frequently as possible, every time looking for more relevant information (Recurrent Revision Practice).

MATERIALS

• There are numerous revision books, websites, courses and other resources available, though remember that more expensive doesn’t always mean better.
• Revision courses generally come in two types; classroom-based and online.
• However, many training programmes incorporate a local MRCPsych course within their educational teaching programme – these are often subsidised with the cost being covered by your study leave budget.

TRAINEES ONLINE

A series of online modules based on the MRCPsych syllabus. All modules are peer-reviewed by experts, checked by the College’s Examinations Panel for relevance to the MRCPsych syllabus, and supported by our Psychiatric Trainees’ Committee (PTC).

Module topics are drawn from the basic sciences of the MRCPsych curriculum.

Each one will take you around 1-1½ hours to do.

If you complete a module alongside the specific Key reading list, you should get an examination-level understanding of a given topic.

Books: Paper A and B

• Symptoms in the Mind by Andrew Sims
• Fish’s Clinical Psychopathology: Signs and Symptoms in Psychiatry by Patricia R. Casey & Brendan Kelly
• Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications by Stephen M. Stahl
• The Doctor’s Guide to Critical Appraisal by Narinder Gosall and Gopal Gosall
• Maudsley Prescribing Guidelines by David Taylor
• Psychology for the MRCPsych by Marcus Munafo
• Get through MRCPsych: A and B: Melvyn WB Zhang

Tips for written exams:

• Take a mock test in an exam setting
• Test yourself by using flashcards
• Test yourself by doing practice problems without the aid of notes or textbooks material

Remember, you can test yourself anytime, anywhere, and with anything; however, it’s more effective if done after enough time has elapsed between actual learning and practice tests.

Abilities required for effective learning are:

• Intellectual CURIOSITY that keep you going.
• Ability to CONNECT information that expands your knowledge base.
• ATTENTION to details while revising that improve your knowledge base.
• Willingness to go back and CHECK REPEATEDLY that increases the accuracy, knowledge and clarity of thinking.
• Ability to APPLY KNOWLEDGE in your day to day clinical practice that improves your clinical knowledge and skills.

THE EXAM DAY

These are some of my recommendations.

• Keep track of question numbers in order.
• Do not leave any questions unanswered as they all carry equal marks.
• Do not leave any questions for later; answer all questions in order. [Once you have moved away from that part of the exam, you cannot go back to review it, even if you have time left at the end of the exam. ]
• Do not panic when you see a difficult question, or you cannot remember the answer.
• Remember, this is an exam; you should expect difficult questions out of the syllabus.
• You would find up to 30% of questions difficult, and you are not sure of the answer. On the other hand, 10% of questions can be very challenging. Remember, you all have the same questions.
• Use your common sense and logic at all times.
• Recheck the candidate number at the end, make sure you have entered it correctly.

CLINICAL ASSESSMENT OF SKILLS AND COMPETENCIES : CASC

 

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

• 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.

Speak to trainees who have sat the CASC. There is also information available online about past stations.

Contents: The 16 CASC station exam consists of:

Skills needed

Communication skills will be assessed in every station. Candidates will be expected 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.

Example of a recent CASC exam

Communication skills

• Organised/structured consultation.
• Management of consultation
• Show appropriate attitude or behaviour
• Listening skills
• Good use and response to cues
• Good questioning style
• Good use of language in the context of the scenario

History/Risk assessment station:

• Identify issues or priorities
• Recognise the significance of aspects of history
• Elicit the presence or explore in enough detail relevant symptoms/details in the history
• Demonstrate adequate skills in risk assessment
• Pay sufficient attention to patient’s physical health/views
• Identify appropriate psychological or social information

Management

• Formulate problem effectively
• Recognise the significance of findings/results
• Develop an adequate management plan that reflects knowledge of the current best practice
• Pay sufficient attention to patient’s physical health/views
• Develop an adequate risk management plan
• The plan should reflect risks of different management options
• Identify appropriate psychological or social interventions

Challenges:

• Cultural difference
• English is not 1st language
• Unpredictable exam
• Pass rate not promising

Dealing with challenges: 

• They are designed to push you and the best thing to do is rise up to the challenge and do as well as you can.
• Keep persevering, and you’ll get there!!
• Motivate yourself
• You only need to pass once

Materials for preparation:

CASC books are far from perfect

• ‘Pass the CASC’ by Dr Seshni Moodliar
• How to Pass the MRCPsych CASC Book by Andrew Iles
• Get Through MRCPsych CASC by Melvyn Zhang
• MRCPsych: Passing the CASC exam: Justin Sauer
• Psychiatry: Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees’ by Sarah Stringer

Other courses: Online and live courses; some trusts also organise CASC mock exams and interview skills sessions.

Approach for CASC:

• Find someone you want to spend the day with and practice regularly: Many trainees find that organising a small group of three to four trainees who are all about to sit CASC can be helpful.
• If you are in a more rural location and struggle to meet up, consider regular Skype meet-ups instead.
• Check that your practice is going in the right direction by asking trainees who have passed the CASC for feedback.

Final message: train your body to recognise what seven minutes feels like – timed practice as early as possible is very important.

Some tips on Casc Exam- day

• During each station, let the role-player set the initial agenda but make sure you steer things in the right direction later on if needed. Make sure you ask for the name of the patient.
• Summarising is helpful to double-check information and re-focus the interview.
• Listen for cues and address concerns as they arise.
• Don’t be afraid to answer questions, even if the answer might not be something the patient might want to hear – this may be the only way to move on.
• Be careful not to ask double questions – the actor might only answer one of the parts.
• Keep a positive attitude: you need only 12 stations to pass/16, so even if you think you’ve messed up a station – move on.

After the exam:

• You don’t need any advice about what to do when the exam is over!
• Try not to dwell on it too much and bear in mind that through a process of selective abstraction / arbitrary inference we tend to remember the questions we got wrong and forget the ones we got right.
• One hopes to pass when the results come out, but don’t be too hard on yourself if you haven’t.
• It can feel terrible if your colleagues pass but you don’t and although it might feel as though you’re the only one in this situation, you really aren’t.

Read the 5 magic steps to pass the CASC. 

FINAL MESSAGE

Getting through the MRCPsych exams is achievable with the right approach and strategy. It is a worthwhile endeavour on the journey to becoming a Consultant Psychiatrist.

The exams provide a solid foundation as a clinician to apply the learnt skills to real-life clinical practice and make a difference to our patients.

Good Luck with your Journey!

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