Master the TOACS Psychiatry Exam

Introduction to TOACS

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. This guide 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

Number of Stations

You will face a total of 12 stations during the exam.

Stick to the Time Limit

You will get exactly 5 minutes per station—no extra time is given. It is crucial to practice under this strict time limit.

• Learn to phrase your questions concisely to perform tasks within the time limit.
• Take 10–15 seconds to form a mental strategy before speaking.

Station Scenarios

Each station presents a clinical scenario where you must first identify the likely diagnosis and then complete a specific task (e.g., a relevant physical examination). For example, a scenario might describe a patient on psychiatric medication who develops muscle stiffness and fever. Your job is to identify Neuroleptic Malignant Syndrome (NMS) and perform the relevant examination.

Time Management: Strategies for Efficiency

Avoid Lengthy Introductions

Do not waste time on long greetings or overly formal consent-taking. A quick, 1-2 sentence introduction covering these points is sufficient. These sections carry minimal marks (0.5 to 1), so move quickly to the main task.

Focus on the Main Task

Each station has a clear, primary objective. Your priority is to achieve it.

• If it’s a physical examination, begin immediately.
• If it’s a risk assessment, ask key questions directly and clearly.

Common Mistakes and How to Fix Them

All-or-None Thinking

Many candidates worry about perfection. In reality, partial knowledge can still earn significant marks. For example, if you suspect NMS but are unsure, proceed with a focused neurological exam based on the symptom of muscle rigidity to secure partial marks.

Losing Confidence After the First Station

Every exam has 2-3 new, difficult stations. If your first station feels tough, don’t lose hope—it is likely difficult for everyone. Focus on getting as many marks as you can, then move on without carrying the burden of the previous one.

Language Concerns

Examiners primarily assess your clinical skills and knowledge, not language proficiency. Speak clearly in the language you are most comfortable with (English or Urdu).

Evolving Focus: Emerging Trends in CPSP TOACS

Recently, CPSP has started emphasizing skills beyond traditional psychiatry. Be prepared for stations covering:

Administrative Responsibilities

• Setting up clinics (e.g., anger management).
• Resolving departmental conflicts.
• Writing discharge reports and organizing events (e.g., World Mental Health Day).

Research and Critical Appraisal

• Understanding research designs like Randomized Controlled Trials (RCTs).
• Interpreting a forest plot and using Boolean Operators for literature reviews.

Psychotherapy Approaches

• Key points of Cognitive Behavioral Therapy (CBT).
• Techniques like deep breathing and progressive muscle relaxation (PMR).

High-Yield Pharmacology

• Managing medications like Clozapine and Lithium, including side effects, monitoring, and use in pregnancy.

Practical Tips for the Exam Day

Carry Necessary Instruments

Bring your own stethoscope, pen torch, and reflex hammer. Relying on provided equipment can add unnecessary stress.

Maintain Professional Attire & Conduct

Wear a clean lab coat. Greet examiners and mock patients politely, and thank them at the end of each station.

Stay Focused and Calm While Waiting

Avoid discussing stations with other candidates, as it can cause anxiety. Quietly review your notes or important concepts instead.

Mind Your Body Language

Appear confident, calm, and attentive. Even if a station is difficult, maintain your composure to maximize your score.