Introduction

TOACS (Task-Oriented Assessment of Clinical Skills) is a key part of the Psychiatry exam conducted by the College of Physicians and Surgeons Pakistan (CPSP). This exam isn’t just about testing your clinical knowledge—it also checks how well you manage time and perform under pressure. It covers the exam format, common mistakes to avoid, time management tips, and the best preparation strategies to help you perform at your best. This guide contains everything you need to easily pass your TOACS exam in Psychiatry.

  TOACS Format

Structure and Key Details

1. Number of Stations
   
   • You will face a total of 12 stations during the exam.
2. Stick to the Time Limit
   
   • You will get exactly 5 minutes per station—no extra time is given.
   • Practice strictly following this limit, so that you will be able to perform within that limit in the actual exam.
   • Learn to phrase your questions so that you can perform the tasks within the time limit.
   • Take 10 – 15 seconds to make a strategy in your mind about how you will perform the task. Do not just speak bluntly after reading the station.
3. Station Scenarios
   
   • Each station will present you with a clinical scenario.
   • Usually, you’ll first need to quickly identify the likely diagnosis, then complete a specific task (like performing a relevant physical examination).
   • For example, the scenario will start individuelle with a patient who takes psychiatric medication develops muscle stiffness and fever, you will be asked to perform relevant physical examination of this patient. Your job will be to identify neuroleptic malignant syndrome (NMS) and perform the relevant examination.

Remember: Students usually anticipate that they will be asked straightforward tasks like “perform physical examination of NMS.” Remember, it will not happen. They will test your skills on an evaluative level.

   Time Management

Strategies for Efficiency

• Avoid Lengthy Introductions
  
  • Do not waste your time on long greetings, detailed introductions, or overly formal consent-taking. Speak in 1 – 2 sentences that cover all of these to save your time.
  • These parts barely carry 0.5 to 1 marks, so quickly move on to the main task.
• Focus on the Main Task
  
  • Each station has a clear, main objective. Your first priority should be to achieve this objective.
  • If the station involves a physical examination, begin your assessment immediately.
  • If risk assessment is required, promptly achieve this task with the key questions clearly and directly.

Remember: Not completing the main tasks within the given time can cost you important marks.

   Common Mistakes and How to Fix Them

Pitfalls and Solutions

1. All-or-None Thinking
   
   • Many candidates worry about needing to know everything perfectly at each station. In reality, partial knowledge can still earn you significant marks.
   • For example: Even if you are unsure whether the scenario is NMS, but you notice muscle rigidity, proceed with a focused neurological exam to secure partial marks.
2. Losing Confidence After the First Station
   
   • Two to three stations are new and slightly difficult in every exam. The first station plays a big role in your confidence, so go in expecting that it might be difficult. If it feels difficult, don’t lose hope—it can happen to everyone. Focus on getting as many marks as possible, and then move to the next station without carrying the burden of the previous one. Nobody is perfect, and everyone makes mistakes.
   • Sometimes, you might get the NEW station as your first one and do not make judgements based on that station and do not proceed with the perception that this exam is difficult.
3. Language Concerns
   
   • Examiners mainly assess your clinical skills and knowledge, not your language proficiency.
   • Speak clearly in the language you are most comfortable with (English or Urdu). Clear communication matters more.

   Evolving Focus

Emerging Trends in CPSP TOACS

Recently, CPSP has started emphasizing skills beyond traditional psychiatry. You might see stations covering areas such as:

1. Administrative Responsibilities
   
   • Steps for setting up a psychiatric clinic such as anger management clinic, repeated multiple times.
   • Resolving conflicts within the department.
   • How to make a discharge report of a patient.
   • How to conduct a world mental health day, third year exam and workshop etc.
2. Research and Critical Appraisal
   
   • Research designs such as Randomized Controlled Trials (RCTs) and their uses like RCT is gold standard to check cause and effect.
   • Understanding a forest plot or critical appraisals. How to do the literature review Boolean Operators.
3. Psychotherapy Approaches
   
   • Key points of Cognitive Behavioral Therapy (CBT) and other psychotherapy methods such as deep breathing/progressive muscle relaxation (PMR).
4. High-Yield Pharmacology
   
   • Managing medications like Clozapine and Lithium, their side effects, monitoring and their uses in pregnancy.

Remember: Even though using scales (like depression, personality or anxiety rating scales) might not be a major focus currently, it’s good practice to be familiar with them in case they appear unexpectedly.

   Practical Tips for the Exam Day

Preparation and Conduct

1. Carry Necessary Instruments
   
   • Bring your own stethoscope, pen torch, reflex hammer, and any other basic instruments in a separate bag.
   • Although they usually provide these instruments, it is better to bring your own equipment to reduce stress caused by uncertainty that whether or not they would provide it themselves.
2. Maintain Professional Attire
   
   • Wear a clean lab coat (overall) as required.
   • Greet examiners and the mock patients politely, such as by saying “Salam” or another culturally appropriate greeting.
   • Politely thank the examiners and the mock patients at the end of each station.
3. Stay Focused and Calm While Waiting
   
   • One of the most important tips that we can provide here is that avoid discussing stations or scenarios with other candidates while waiting, as this can cause anxiety or confusion. Your body needs to be in a relaxed state before your exam.
   • If you need something to do, quietly review your brief notes or quickly remind yourself of important concepts.
4. Mind Your Body Language
   
   • Appear confident, calm, and attentive.
   • Even if a station is difficult, maintain your composure to maximize your chances of scoring marks.

   TOACS Psychiatry – The Complete Course

Course Overview and Benefits

There’s no book that fully covers the TOACS Psychiatry exam due to low demand and limited resources. To fill this gap, we created a complete TOACS Psychiatry Course in 2023 and have been updating it ever since.

• 100% exam coverage – Every possible station included
• Easy-to-understand notes – Feels like practicing while reading
• Proven success – Alhamdulillah, almost all students passed on the first attempt and continued with advanced courses

InshaAllah, this will be enough for you too!

Price: Just 3000 Rs. Enroll now!