Introduction
The Membership of the Royal College of Psychiatrists (MRCPsych) is a highly prestigious qualification and an important recognition for doctors pursuing psychiatry training in the UK. This qualification is a crucial milestone for medical professionals aspiring to specialize in psychiatry and the exam is sat by medical doctors in psychiatry from all over the world. The final component of the MRCPsych exam, the Clinical Assessment of Skills and Competencies (CASC) exam, is a key requirement for progression to Higher Specialty Training (ST4–ST6) in the UK.
As a UK International Medical Graduate (IMG) currently training in psychiatry, I am pleased to share my journey of successfully passing all three MRCPsych examinations—Paper A, Paper B, and CASC—on my first attempt. Through perseverance, strategic preparation, and the right support, I was able to achieve success in the CASC exam held in January 2025 in Sheffield. I hope this reflection provides valuable insights for fellow candidates preparing for CASC.
Disclaimer: This article was written in March 2025 based on my individual perspective and personalised reflections. Please refer to the Royal College of Psychiatrists' official website for the most up-to-date information on exam structure, fees, and policies.
Understanding the MRCPsych Examinations
The MRCPsych examinations assess a candidate’s knowledge, clinical skills, and communication abilities. The CASC exam, in particular, evaluates clinical competency through a series of structured stations that require candidates to demonstrate essential psychiatric skills within a time-sensitive format.
For IMGs, I feel that passing the MRCPsych exams is a crucial step in establishing a successful psychiatric career in the UK. Given its format and expectations, preparation for CASC requires a tailored approach, emphasizing effective communication, clinical competencies, and the ability to adapt to different scenarios.
The CASC examination is currently conducted at a limited number of exam centres worldwide with new exams being open recently to accommodate for the demand. In January 2025, the exam fee was approximately £1,123, though this may subject to change in the future. Candidates should always verify updated costs and eligibility requirements on the Royal College of Psychiatrists' website (as you will need a sponsor to sit for the exam!)
Challenges faced by IMGs in Passing CASC
Many of the IMGs I came to know finds the CASC exam particularly challenging, often requiring multiple attempts to pass although in my opinion those who had experience working in training posts within the UK have a higher chance of passing the exam on a first attempt provided, they are adequately prepared for the exam. Through discussions with my peers and colleagues who faced difficulties, I identified several common barriers:
1. Limited Understanding of Exam Requirements
The CASC exam primarily evaluates communication and clinical competency in a structured manner. What does this mean? Candidates must demonstrate a highly empathetic way of communication whilst having a personalised patient-centred approach and all of which needs efficiently addressed within a seven-minute timeframe.
2. Lack of Familiarity with Exam Format
The exam comprises different types of stations, including:
• History-taking stations
• Management stations
• Examination stations
Morning and afternoon circuits may also have subtle variations in their structure although all the stations are set at 7 minutes time frame. A strategic approach tailored to each type of station is essential for success. I would strongly recommend candidates to gain familiarity to the exam format before the exam day and understanding exactly which type of station runs in morning (AM) versus afternoon (PM) circuit. I feel that this would help you to be in the right ‘cognition’ to win your battle! I would encourage you to practise the stations every day in the last few months approaching the exam and please make use of the Royal College Leaflets which all available online as they have a patient-friendly approach in communication.
3. Overconfidence or Insufficient Preparation
While clinical experience, particularly having real patient interaction within the local NHS settings, can be advantageous and something you need to sought out, it does not guarantee an exam success. The CASC exam requires specific preparation, including an understanding of structured communication and examiner expectations. I came to know through experience that even experienced psychiatrists may struggle to pass this exam if they do not prepare adequately for this. Having said that, clinical experience I obtained through my core training navigating through different specialities such as Older Age, Adult Mental Health and psychotherapy, all of which are significant experience that I feel helped me to pass this exam on my first attempt itself.
4. Lack of Insight into Effective Communication Strategies
Many candidates fail to adjust their communication style to meet the exam’s expectations that is very much task focussed. You will keep hearing this when preparing for the exam – ‘be task focussed’. It is vital for you to get this drummed into your mindset whilst preparing for CASC. Having said that, please remember that ‘purely memorising’ and ‘being robotic in in your approach’ will not help you to pass. Developing insight into how to engage meaningfully within the limited timeframe is so crucial.
My Preparation Strategies and CASC Experience
Personal Reflection on My CASC Journey
I passed the CASC exam on my first attempt, successfully securing 14 out of 16 stations with a final score of over 72%. I do understand now that my success was not by chance but rather the result of meticulous planning and strategic preparation. Here are some key takeaways from my journey:
Key Preparation Strategies (Final Advice for CASC Candidates)
✅ Consistent Study Routine: Early preparation with a structured approach was essential.
✅ Peer Support and Study Groups: Engaging in study groups helped reinforce learning and provided motivation.
✅ Mock Exams and Feedback: Participating in actual exam-stipulated exam environment through mocks conducted helps to improve my confidence.
✅ Self-Assessment and Reflection: Video/audio recording my performance and seeking feedback helped refine my approach.
✅ Stress and Confidence: I truly believe that the more prepared and confident you are, the less anxious you become. Staying composed during the exam was just as important as clinical knowledge. Please do seek professional support if you struggle with your mental health whilst you are in this journey
✅Develop resilience and cultivate a positive mindset: Remember that failing is part of your success study so please do beat yourself up if you do not make it on your first attempt as everyone’s journey is unique on its own. Most IMGs I know are the most resilient people I have seen and they make it through this exam eventually with the supply of determination and hardwork.
With dedication and the right approach, success is within reach!
Further Support and Resources
If you have any questions about CASC preparation, portfolio building, I would be happy to assist. You can reach me at Trewlink, where I serve as an ambassador. Click on the following profile ( thanes waran ) and message me.
📌 Register at: Trewlink
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References
• Royal College of Psychiatrists. (n.d.). Preparing for the CASC. Retrieved from https://www.rcpsych.ac.uk/training/exams/preparing-for-exams/preparing-for-the-casc
• Royal College of Psychiatrists. (n.d.). Can I take an exam? Eligibility criteria for MRCPsych exams. Retrieved from https://www.rcpsych.ac.uk/training/exams/can-i-take-an-exam