MRCPsych Paper B Complete Guide

Introduction

This guide provides a detailed overview of MRCPsych Paper B—from its purpose and structure to the syllabus, eligibility criteria, application process, and core study strategies. Whether you are a UK-based trainee or an international medical graduate (IMG) seeking broader opportunities, this blog post will help you navigate each phase of preparing for and taking this important examination.

What Is MRCPsych Paper B and Why It Matters

Position in the MRCPsych Pathway

The MRCPsych exams comprise:

Paper A – focusing on basic sciences such as neuroscience, psychology, and pharmacology fundamentals.
Paper B – emphasizing clinical application, psychopharmacology, advanced therapies, and the critical review of research.
CASC (Clinical Assessment of Skills and Competencies) – a practical exam using simulated patient scenarios.

Paper B builds on the theoretical groundwork from Paper A. It tests your readiness to apply clinical knowledge in real-world psychiatric settings. Passing Paper B indicates that you are equipped with the clinically relevant competencies and critical appraisal skills needed for higher specialty training and, ultimately, for consultant-level practice.

Global Recognition and Career Mobility

UK Training Progression: Paper B is required for moving from Core Training (CT) to Specialty Training (ST).
International Advantage: The MRCPsych credential is acknowledged worldwide, facilitating career prospects and potential consultant roles in various countries.
Breadth of Clinical Knowledge: Preparing for Paper B consolidates expertise across subspecialties—beneficial for long-term clinical reasoning, teaching, and leadership in psychiatry.

Exam Structure and Focus

Core Format

Duration: 3 hours.
Number of Questions: 150 total.
Question Types:
- Multiple Choice Questions (MCQs): Approximately two-thirds (~100 questions). Each MCQ uses a single-best-answer format.
- Extended Matching Items (EMIs): Approximately one-third (~50 questions). Each EMI has a list of possible options to match with different clinical scenarios.

Content Breakdown

Paper B is divided into two major components:

Clinical Topics (around 100 marks)
Critical Review (around 50 marks)

Clinical Topics

Covers a broad range of psychiatric subspecialties and issues, including:

General Adult Psychiatry (approx. 20% or ~30 marks)
Old Age Psychiatry (9% or ~14 marks)
Child and Adolescent Psychiatry (9% or ~14 marks)
Psychiatry of Learning Disability (5.5% or ~8 marks)
Forensic Psychiatry (5.5% or ~8 marks)
Substance Misuse/Addictions (6.5% or ~10 marks)
Psychotherapy (5.5% or ~8 marks)
Organisation and Delivery of Psychiatric Services (5.5% or ~8 marks)

Critical Review

Marks: ~33.5% of total (50 marks).
Emphasis: Statistical analysis, research methods, epidemiology, healthcare economics, and applying findings to practice.
Skills Assessed: Critical appraisal of evidence, recognizing biases in research, understanding study design, and applying evidence-based medicine principles to psychiatric cases.

Time Management and Marking

No Negative Marking: Candidates do not lose marks for incorrect answers, so it is always best to attempt every question.
Criterion-Referenced Standard Setting: The pass mark is determined by the Royal College based on the “minimally competent candidate,” rather than by ranking candidates against each other.
Pacing: With 150 questions in 180 minutes, average ~72 seconds per question. Plan enough time for reading, reasoning, and revisiting flagged items.

Differences Between Paper A and Paper B

Paper A: Tests foundational knowledge—neuroscience, pharmacology basics, psychology, and other core sciences that underpin psychiatric practice.
Paper B: Focuses on applied clinical psychiatry, psychopharmacology, advanced therapies, and critical appraisal of scientific literature.
Complementary Roles: Mastery of basic sciences (Paper A) supports clinical decision-making (Paper B). Both must be passed before attempting the CASC.

Eligibility Criteria

Professional Registration

Must be a fully registered medical practitioner.
For UK-based candidates, current General Medical Council (GMC) registration is typical.
International Medical Graduates (IMGs) should have registration with their national medical council or equivalent.

Minimum Psychiatric Experience

A minimum of 12 months of core psychiatric training (or equivalent clinical exposure) is strongly recommended before attempting Paper B.
This exposure ensures familiarity with real-world psychiatric cases—knowledge that is vital when answering clinically oriented questions.

IMGs and Qualification Recognition

IMGs must hold a recognized primary medical qualification, often verified via the World Directory of Medical Schools.

Key Dates and Exam Logistics

Annual Exam Sittings

Paper B typically has three exam diets per year—often in February (or early Spring), May/June, and October. For the 2025 cycle, the schedule might look like:

Diet 1

Examination Date: February 20, 2025
Application Period: Dec 2 – Dec 13, 2024 (3.30pm cutoff)
Results Publication: March 28, 2025

Diet 2

Examination Date: May 21, 2025
Application Period: March 17 – March 28, 2025
Results Publication: June 13, 2025

Diet 3

Examination Date: October 8, 2025
Application Period: July 14 – July 25, 2025
Results Publication: November 7, 2025

Exam Delivery and Centers

Online Computer-Based Testing: Recently, the College has been delivering the written exams (including Paper B) through an online format with remote proctoring.
In-Center Testing: Some centers may offer in-person computer-based testing, depending on local regulations and availability.
CASC vs. Paper B: Keep in mind that the CASC exam is still offered at specific physical test centers (e.g., Sheffield in the UK, Singapore, Doha) but differs from the written Paper B logistics.

Fees and Budgeting

For 2025, Paper B fees typically are:

£508 for Pre-Membership Psychiatric Trainees (PMPT) and College Affiliates
£564 for non-PMPT trainees and affiliates

Fees can change yearly. Always refer to the most updated fee schedule from the Royal College. Additional costs may include:

Revision Courses (optional but can be helpful)
Travel or Visa Expenses (if choosing an in-person center abroad)
Study Materials (question banks, textbooks)

Application and Registration Process

Create/Access Your Online Account

Visit the Royal College of Psychiatrists (RCPsych) Exams portal.
New users must register for a web login; returning users should verify details are up-to-date.

Complete the Application Form

Provide personal information (name exactly as in ID documents).
Upload primary medical qualification and registration certificates.
Document psychiatric training history (especially if you need to prove 12 months of experience).
Identify which written paper (Paper B) you are applying for.

Pay the Examination Fee

Payment is typically via credit or debit card (Visa/MasterCard).
You will receive two emails:
- An application confirmation, and
- A payment confirmation.

Book Your Exam Slot

Once approved, choose your test center or remote proctoring slot via Pearson VUE (or the designated testing platform).
Book early to get preferred locations or times.

Receive Exam Confirmation

An admission permit or confirmation document is usually emailed or available in your RCPsych account.
Print or save it for exam day identification.

Detailed Syllabus Overview

Paper B’s comprehensive scope means candidates must be prepared across multiple domains:

General Adult Psychiatry (20%)

Schizophrenia, mood disorders, anxiety, personality disorders
Indications for pharmacological vs. psychotherapeutic interventions
Epidemiology, risk assessment, legislation (e.g., Mental Health Act)

Critical Review (33.5%)

Research design, bias, statistical methods (e.g., p-values, confidence intervals)
Critical appraisal of journal articles
Applying evidence-based practice in clinical scenarios

Old Age Psychiatry (9%)

Dementias, late-onset depression, delirium
Polypharmacy considerations, cognitive testing
Social care and legal frameworks

Child and Adolescent Psychiatry (9%)

ADHD, autism spectrum disorders, eating disorders
Family dynamics, safeguarding, multi-agency collaboration

Substance Misuse/Addictions (6.5%)

Alcohol dependence, opioid use disorder, harm reduction
Motivational interviewing, detoxification protocols, comorbidities

Forensic Psychiatry (5.5%)

Legal aspects, mental health law, risk assessment for violence/offending
Court liaison, secure hospitals

Psychiatry of Learning Disability (5.5%)

Intellectual disability, diagnostic overshadowing, challenging behaviors
Tailored assessment methods, community support

Psychotherapy (5.5%)

Therapeutic modalities (CBT, DBT, psychodynamic therapies)
Indications, contraindications, and efficacy
Formulation, transference, and countertransference

Organisation and Delivery of Services (5.5%)

Service structures, multidisciplinary teams
National health policies, roles of mental health professionals
Ethical considerations and resource allocation

Tip: Given the weightings, General Adult Psychiatry and Critical Review require extra attention.

Preparation Strategies

Getting Started

Recommended Timeline: 4–6 months of focused study, extendable to 6–8 months if juggling demanding clinical duties.
Study Plan:
- Initial Familiarization: Read through the official Paper B syllabus, identify strong/weak areas.
- Structured Schedule: Dedicate more time to high-weight topics (e.g., General Adult, Critical Review).
- Early Question Practice: Incorporate MCQs/EMIs from the beginning to recognize question patterns.

Core Study Resources

Textbooks:
- Shorter Oxford Textbook of Psychiatry
- Maudsley Prescribing Guidelines
- Companion to Psychiatric Studies (often called the ‘Edinburgh Textbook’)
Critical Appraisal and Statistics:
- Medical Statistics at a Glance
- Essential Medical Statistics
- Official Royal College guidance on research methods
Online Question Banks:
- Edubros (Mrcpysch Paper B made easy)
- SPMM Course
- BMJ OnExamination
- Pass MRCPsych
Note: Choose 1-2 quality banks to avoid overwhelm. Edubros is highlighted below.
Official RCPsych Resources:
- Sample questions, past examination reports, and Trainees Online (TrOn) modules for extra tutorials.

Active Learning Techniques

Mock Exams Under Timed Conditions: Simulate the 3-hour environment to build stamina and time management.
Study Groups: Discuss tricky topics, share explanations, tackle question sets together.
Flashcards/Quizzes: Promote active recall for core facts (e.g., drug side effects, epidemiology numbers).
Reflection and Feedback: Track your practice scores; review rationales for both correct and incorrect answers.

Example: Handling Complex Topics

Psychopharmacology Example

Compare antidepressant classes: SSRIs vs. SNRIs vs. TCAs.
Note side effects (e.g., SSRIs—sexual dysfunction; TCAs—anticholinergic effects).
Understand dosage modifications in special populations, such as older adults or pregnant patients.
Apply real-life prescribing guidelines from NICE or Maudsley.

Critical Appraisal Example

Practice reading an abstract from a psychiatry journal:

Identify the study design (cohort vs. RCT),
Check the p-value and confidence intervals,
Look for bias or confounding variables,
Assess the overall validity and applicability to clinical practice.

Crafting Your Study Timeline

A common approach is to allocate 3–6 months for structured revision. One example timeline:

Months 1–2: Build Foundations - Read through each syllabus domain overview. Start gentle MCQ practice to identify weak spots.
Months 3–4: Focused Learning - Delve into difficult areas (e.g., forensic or psychotherapy if new to you). Ramp up question practice, especially EMIs.
Months 5–6: Integration and Final Prep - Take multiple timed mocks, refine exam technique, revisit high-yield facts (psychopharmacology, important guidelines). Maintain discipline in your daily schedule.

Exam Day Essentials

Preparation and Arrival

Pre-Exam Checklist:
- Ensure you have the correct photo ID (passport, driver’s license).
- Bring or have access to the confirmation email/admission permit.
- If online, test your equipment (webcam, microphone, reliable internet).
Arrival: Plan to arrive (or log in) 30–45 minutes early to accommodate check-in and security protocols.

During the Exam

Time Strategy:
- Some candidates complete an initial pass answering all “easier” questions quickly.
- Flag complex items for a second pass if time allows.
No Negative Marking:
- Attempt all questions. An educated guess is better than no response.
Stay Calm:
- Use the on-screen timer and question navigation features effectively.
- Double-check flagged questions if time permits.

Technical and Security Guidelines (Online)

Environment: Quiet, well-lit room; clear desk; no additional electronics or notes.
Proctor Monitoring: Avoid suspicious behavior (e.g., looking off-screen). Any misconduct can lead to exam disqualification.

After the Examination: Results and Next Steps

Results Announcement

Typically released 4–6 weeks post-exam. The Royal College will email candidates or post results on their exam portal.
Feedback: You usually get an overall pass/fail plus a performance breakdown by domain. Specific question-level feedback is not provided.

Validity Period

Once you pass either Paper A or Paper B for the first time, a 1643-day (approx. 4.5 years) “written paper validity” clock starts.
You must pass all remaining exams (the other written paper plus CASC) within this window to maintain your earlier passes.

Next Steps for Successful Candidates

If you have passed both Paper A and Paper B, you become eligible for the CASC (Clinical Assessment of Skills and Competencies).
Completing Paper A, Paper B, and CASC—and fulfilling workplace-based assessments—qualifies you for MRCPsych membership.

Retake Policy

You can re-sit Paper B if unsuccessful (up to six attempts total, subject to current Royal College rules).
Reflect on your preparation:
- Was your revision plan balanced?
- Did you struggle with time management?
Revisit question banks, consider targeted revision courses, or form study groups for deeper review.

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