MRCPsych CASC Exam Explained: Format, Marking, Dates, and Everything You Need to Know
Everything psychiatry trainees need to know about the RCPsych CASC, from station structure and marking to the study resources that actually move the n
The Clinical Assessment of Skills and Competencies, known to almost every psychiatry trainee simply as the CASC, is the final and most feared component of the MRCPsych examination suite run by the Royal College of Psychiatrists. It sits at the level of a doctor completing Core Psychiatry Training and moving into ST4, and it tests history taking, mental state and physical examination, risk assessment, and management, all in real time with a role player in the room.
This guide walks through the structure, the venues, the dates, the fees, how marking actually works, and where to focus revision time so the day itself feels manageable rather than overwhelming. For a broader overview of preparation options, the SimsBuddy CASC exam hub is also worth a look.
Exam Structure and Basics
The CASC follows an OSCE format made up of 16 stations split into two circuits of 8, all completed on the same day.
Station Composition
- 5 History Taking Stations — eliciting a history, including risk assessment
- 5 Examination Stations — mental state examination, physical examination, and cognitive or capacity assessment
- 6 Management Stations — psychoeducation, treatment planning, risk management, and difficult conversations with patients, relatives or colleagues
Circuit Breakdown and Timing
| Circuit | Station Breakdown | Reading Time | Consultation Time |
|---|---|---|---|
| Circuit 1 | 6 Management, 1 Examination, 1 History | 4 minutes | 7 minutes |
| Circuit 2 | 4 Examination, 4 History | 90 seconds | 7 minutes |
The College reserves the right to run the circuits in reverse order on the day, so candidates should be ready for either sequence rather than assuming management stations always come first.
Exam Centres
RCPsych runs the in-person CASC at fixed regional venues:
- United Kingdom — Sheffield, primarily at the English Institute of Sport
- Singapore — designated clinical exam facilities
- Doha, Qatar — hosted with Hamad Medical Corporation, a newer centre added to widen access for Middle East candidates
Exam Dates and Application Windows
The UK CASC typically runs twice a year, generally in January and September, with Singapore and Doha running their own annual or twice-yearly diets. Application windows usually open three to four months before the exam date and close six to eight weeks beforehand, so leaving registration late is a genuine risk rather than a formality.
Apply early. The January 2026 UK sitting received a record 937 applications against 826 available places, meaning some candidates were not offered a spot on that diet and an additional sitting had to be arranged in February 2026 to accommodate them. Demand for CASC places is rising, and first-come, first-served allocation means late applicants are increasingly at risk of missing a diet entirely.
Always check the official RCPsych exam calendar for confirmed dates, since diets and application windows are reviewed and can shift year to year.
Exam Fees
Fees depend on whether a candidate is in an approved UK training post or an RCPsych affiliate, versus an independent or non-PMPT candidate, and they are reviewed annually so they tend to rise slightly each year.
| Location | PMPT Trainees & Affiliates | Non-PMPT / Independent |
|---|---|---|
| UK Centre | Approximately £1,100–£1,150 | Approximately £1,220–£1,260 |
| Singapore Centre | Approximately £1,400–£1,470 | Approximately £1,580–£1,630 |
| Doha Centre | Approximately £1,400–£1,470 | Approximately £1,580–£1,630 |
UK candidates can usually claim tax relief on professional exam fees, including the CASC, which is worth checking before or after the sitting.
Pass Rates and Performance Data
Overall CASC pass rates have historically sat somewhere in the 40–55% range across all candidates, though individual diets can vary quite widely depending on cohort size and mix. The gap between UK trainees and non-PMPT or overseas candidates tends to be the more consistent pattern.
Non-PMPT and overseas candidates have historically passed at somewhat lower rates, commonly cited in the 35–50% range depending on the diet. Much of this gap reflects familiarity with UK communication norms and RCPsych's specific station expectations rather than a gap in clinical knowledge, which is exactly why realistic, UK-style practice matters so much in preparation.
Pass rates move around from diet to diet, so treat any single published percentage as a snapshot rather than a fixed target. The more useful takeaway is that trainees embedded in UK training posts consistently outperform non-PMPT candidates, which points squarely at communication style and station familiarity as the differentiator.
Marking Criteria and Standard Setting
The CASC is marked using the Borderline Regression Method, a statistical standard-setting approach used across many UK clinical exams.
How Each Station Is Evaluated
A single trained examiner scores each station on two components:
- Analytic Domain Scores (1–5) — three to five competency domains such as clinical reasoning, information gathering, communication, and professionalism
- Global Judgement — an overall grade against the ST4 entry standard, ranging from Excellent Pass through Pass, Borderline Pass, Borderline Fail, Fail, to Severe Fail
Passing Criteria
To pass overall, a candidate has to satisfy two separate conditions:
- Meet or exceed the total cut score set by linear regression across all candidates' domain scores
- Pass a minimum number of individual stations, historically around 12 out of 16
Scoring brilliantly on a handful of stations cannot compensate for failing too many others. The minimum station threshold means consistency across the whole day matters more than a few standout performances.
Essential Preparation Strategies
Use the Reading Time Properly
Whether it is 90 seconds or 4 minutes, read the candidate instructions carefully and look specifically for negative instructions — phrasing like "you are NOT required to take a risk history" exists to keep candidates focused on the actual task rather than defaulting to a generic full history.
Structure the 7-Minute Station
- Minute 1 — introduce yourself, signpost the consultation, and address the immediate presenting concern
- Minutes 2–5 — detailed inquiry, whether that is history, MSE, or management discussion
- Minutes 6–7 — deliver a structured plan, check understanding, and invite questions
Examiners are not looking for a textbook-perfect history. They want patient-centred communication and a logical structure that a real patient or relative would actually follow.
Prioritise Risk and Safety
Missing a critical safety point, such as active suicidality in a depression station or lithium monitoring in a psychopharmacology station, is one of the most common reasons a station fails outright regardless of how fluent the rest of the consultation was.
Content is what you need to say. Process is how you say it. CASC tests both, and process is where most marks are quietly lost.
Where to Study
Reading about stations only gets a candidate so far. The stations that go wrong on the day are almost always the ones that were never rehearsed under real time pressure with a live role player, which is why the most effective preparation plans are built around repeated, realistic practice rather than passive revision.
Building Repetition Into Preparation
The SimsBuddy case bank covers CASC-style scenarios across history taking, examination and management stations, giving candidates repeated exposure to the exact station types the RCPsych blueprint describes rather than a generic set of psychiatric cases. Because every case sits inside the platform, candidates can run through station after station without needing to coordinate a study partner or book a course slot every time.
The brain map feature is particularly useful for candidates who know their clinical knowledge is solid but want to see where the gaps in station coverage actually sit. It maps completed practice against the syllabus, so revision time goes toward genuinely weaker areas instead of repeatedly covering stations that are already strong.
And because the CASC is, at its core, a test of live interaction under time pressure rather than a knowledge recall exam, AI-powered patient practice lets candidates rehearse the exact rhythm of a timed read followed by a 7-minute consultation, again and again, on their own schedule. The platform's mock exam takes this a step further, letting candidates run through a full timed circuit that mirrors exam-day conditions rather than practising stations in isolation. That kind of repetition is difficult to replicate with peer groups alone, simply because coordinating three trainees' schedules for repeated sessions in the weeks before an exam is rarely realistic.
The stations most candidates fail are rarely the ones they didn't know the answer to. They're the ones they'd never actually rehearsed under a real clock with a real role player before walking into the exam. Building that repetition in early, through a case bank, a brain map to target weak spots, and AI patient practice for timed runs, is what turns theoretical knowledge into a passing performance on the day.
Other Resources Worth Knowing About
Alongside consistent practice, most candidates also draw on a structured course such as SPMM for a syllabus-mapped overview, a core textbook like Get Through MRCPsych CASC for station frameworks, and Dr Natalie Ashburner's CASC podcast and study group, a CAMHS psychiatry registrar who passed the CASC first time with 85% overall, for exam-day perspective and peer support. These are useful supplements, but they work best alongside repeated timed practice rather than instead of it.
Peer Practice Groups
Where possible, small peer groups of three, one candidate, one role player, one examiner, using official marksheets and a real timer, remain a valuable low-cost preparation method too. The value is in the immediate, specific feedback rather than the scenario itself, so even a handful of well-run sessions can meaningfully sharpen performance.
Treat role players as real patients throughout preparation, not just on exam day. Empathy, active listening and jargon-free language are marked communication domains, and they are also skills that only improve with repetition.