The 'new' MRCPsych Exam

Introduction

From March 2008, the MRCPsych exam will change from a two-part exam to a four-part exam, primarily in response to changes in postgraduate education. Details of the individual exams are given below, with a summary table explaining what this might mean for you.

Essentially, there are now three written exams and a Clinical Assessment of Skills & Competencies (CASC). A simplistic view is that Papers I and II have replaced the old Part I written exam, and Paper III is similar to the Part II written. The most significant change perhaps is that there is no clinical exam until you have passed all of the written exams. The CASC is likely to be similar to the OSCE, but with the addition of linked stations consisting of two stations of 10 minutes duration each.

The College is planning to run three 'diets' over the course of the year, with all papers being held in Feb/ Mar & June; Jun/ Aug & November; and November.

Workplace-based assessments will be completed throughout training and will be recorded in the trainee's portfolio. Interestingly, you can 'bank' a Paper III pass for 18 months allowing three tries at the CASC before having to resit Paper III.

The format is subject to change and you are advised to check out the information on the RCPsych website regarding Paper I, Paper II, Paper III, and the CASC.

The Three Written Exams and the Clinical Exam

  Paper I Paper II Paper III CASC
Duration
3 hours
3 hours
3 hours
80mins + 120mins
No. of questions
200
200
200
Clinical Exam
Type/ Style of Questions
MCQs and EMIs
MCQs and EMIs
MCQs and EMIs
Similar to OSCE
Requirements
12 months whole time equivalent in psychiatry.
At least 18 months whole time in psychiatry.
Between 24 and 36 months whole time equivalent in psychiatry.
Between 30 and 48 months.
Workplace-based assessments
4x Mini-ACE
2x CBDs
4x Mini-ACE
2x CBDs
4x Mini-ACE & 2x CBDs (at ST1 level) AND 4x Mini-ACE & 2x CBDs (at ST2/3 level)
8x ACE (2 in developmental psychiatry and 6 in other areas)
Cost
£195
£195
£195
£565

More detailed breakdowns of the specific requirements can be found in the RCPsych exam regulations 2008 (PDF file).

ACE = Assessed Clinical Encounters
CBD = Case-based Discussion

Paper 1

Curriculum

History and mental state examination
Cognitive assessment
Neurological examination
Assessment
Aetiology
Diagnosis
Classification
Basic Psychopharmacology

Basic psychological processes
Human psychological development
Social psychology
Description and measurement
Basic psychological treatments

Prevention of psychiatric disorder
Descriptive psychopathology
Dynamic psychopathology

History of psychiatry
Basic ethics and philosophy of psychiatry
Stigma and culture

Breakdown of Paper I - Number of questions per subject heading.
Content
No. of Questions
History and Mental State
12
Descriptive Psychopathology
24
Cognitive Assessment
10
Neurological Examination
10
Assessment
16
Description and Measurement
6
Diagnosis
12
Classification
8
Aetiology
12
Prevention of Psychological Disorder
6
Basic Psychopharmacology
14
Human Psychological Development
8
Social Psychology
4
Basic Psychological Processes
14
Dynamic Psychopathology
12
Basic Psychological Treatments
8
History of Psychiatry
8
Basic Ethics and Philosophy of Psychiatry
8
Stigma and Culture
8

Paper 2

Curriculum

General principles of psychopharmacology (pharmacokinetics, pharmacodynamics)
Psychotropic drugs
Adverse reactions
Evaluation of treatments
Neuropsychiatry (physiology, endocrinology, chemistry, anatomy, pathology)
Genetics
Statistics and research (basic)
Epidemiology
Advanced Psychological Processes and Treatments

Paper 3

Curriculum

1. Research methods

Evidence based practice
Statistics
Critical Appraisal

2. Clinical Topics

Liaison
Forensic
Addiction
Child and adolescent
Psychotherapy
Learning disability
Rehabilitation
Old age psychiatry

Format of the Written Exams (Papers I-III)

The format of each paper will be the same and will consist of multiple choice questions (1-5 single best answer) and extended matching items (EMIs). Although the balance of the two types of questions will vary slightly, it will generally be around 75% MCQs and 25% EMIs.

1-5, single best answers

Consists of a stem of 1-2 sentences, followed by five options. The candidate is required to choose the single option which best fits the question stem.

Extended Matching Items

Each set of EMIs is given a theme, followed by a 'lead-in' statement explaining what the candidate is required to do. There is an option list. A series of vignettes are then given and the candidate is required to choose the best option from the option list.

Marking Scheme for the Written Papers

The Royal College states that there is "no pre-determined number of candidates who pass or fail" because the papers are 'standardised'. Then it gets a little more complicated.

They use something called the Angoff Method to standardise Papers I-III. This process works in the following way:

  1. Subject Matter Experts independently rate each question in the paper. The College are currently using college
    tutors, educational supervisors, and recently appointed ST 4 trainees to act as SMEs. The ratings are used to determine the likelihood that an acceptably competent person will answer the question correctly.
  2. The SMEs then review each question as a group, and a consensus is reached for the rating of that question. Any question that is too vague, has more than one possible correct answer, etc. is eliminated from the scoring process
  3. After agreement is reached, the average score for all the questions is calculated and this becomes the overall pass mark for the exam.

More details on the scoring for the exams is provided by the College.

Clinical Assessment of Skills and Competencies (CASC)

The RCPsych haven't released much info on the format yet, but according to the College:

"The Clinical Assessment of Skills and Competencies (CASC) examination for June 2008 will be a 12 station examination testing candidates' competency in clinical skills appropriate to their stage of training. Stations will comprise linked pairs (i.e. 6 linked pairs) of stations with a clinical task in the first station linked to a second, related task in the second station. Candidate instructions in the first station of each pair will inform, in broad terms, the candidates as to what task they will carry out in the second of each pair. Each station will consist of 2 minutes preparation time followed by ten minutes attempting the defined task. A one minute warning will be given."
http://www.rcpsych.ac.uk/exams/about/mrcpsychcasc.aspx

It is important to note that the format will change further to the final vision of the CASC exam:

“The Clinical Examination...will be an OSCE type examination of two parts, completed in one day. The first part will contain ten single, 'stand alone' stations each lasting 8 minutes (including reading time of 1 minute). The second part will consist of 5 pairs of 'linked' stations, which will allow for the assessment of more complex competences. Each station will last 12 minutes (to include 2 minutes reading and preparation time).”
http://www.rcpsych.ac.uk/exams/newassessmentprogramme2008/newstructure.aspx

Those sitting the exam in June 2008 will be guinea pigs for the new format but will potentially get a slightly easier time of it and will avoid the extra single stations!

Focus for each Exam

The college have suggested that Paper I will focus on "areas such as history taking, treatment explanation and record keeping". Paper II will concentrated on areas "such as psychotropic drugs, advanced psychology and neuropsychiatry". Finally, Paper III will test "a) clinical areas of psychiatry, mapping on to the specialty areas (including general adult as a specialty) of knowledge expected at this level of training, and b) critical appraisal of research relevant to clinical practice".

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