The MRCPsych CASC format rewards candidates who recognise the station type quickly and do the right amount of work in seven minutes. You are not trying to perform a full psychiatric assessment every time; you are trying to complete a specific task, safely and clearly, across 16 OSCE-style stations completed in two same-day circuits.
That matters because this exam is built around focused performance. RCPsych describes stations as history-taking, examination, or management tasks, but communication, consultation management, professional behaviour, and applied clinical knowledge all count.
MRCPsych CASC format at a glance
For most candidates, the simplest way to hold the format in your head is this:
- 16 stations in total
- two circuits completed on the same day
- one circuit with 4 minutes' reading time and 7 minutes' task time per station
- one circuit with 90 seconds' reading time and 7 minutes' task time per station
- 5 history-taking stations, including risk assessment
- 5 examination stations, including physical and mental state work and capacity assessment
- 6 management stations
- the usual split is one management-heavy circuit and one history/examination-heavy circuit, but RCPsych says the order of circuits can change.
As of July 2026, the College still states that digital CASC delivery ended in May 2023 and that CASC diets are conducted in person. The current UK application page lists the September 2026 sitting in Sheffield over 7 days, with each candidate allocated one day, so check the live RCPsych page before you book travel or swap on-call commitments.
How the 16 stations are split
The management-heavy circuit
RCPsych's current blueprint describes one circuit as 6 management stations, 1 examination station, and 1 history station, with 4 minutes to read and 7 minutes to perform the task. This is where candidates often lose marks by drifting into a generic clerking instead of doing what the card asked.
In management stations, examiners usually want you to synthesise, explain, recommend, or negotiate. If the station is 'Explain lithium monitoring to a patient with bipolar disorder', do not spend half the station retaking the mood history. Open, check what the patient already knows, explain the plan in plain English, cover safety and physical health, then check understanding and questions. That is much closer to what the marksheets reward.
The history and examination-heavy circuit
The other circuit contains 4 examination stations and 4 history-taking stations, with only 90 seconds to read and 7 minutes to perform the task. That shorter reading window means you need a rapid routine: identify the setting, find the command verb, spot the station family, and decide your first line before you walk in.
A common example is a focused collateral history from a relative, or a targeted mental state or capacity assessment. You are being marked on whether you can get to the clinically important material fast, not on whether you can display everything you know about the topic.
What examiners are really marking
Each station contains candidate instructions, role-player instructions, and a marksheet. The instructions are there to narrow the task, and RCPsych explicitly notes that they may also include negative instructions, such as being told not to obtain a risk history. If you ignore that and do extra material anyway, you are not showing thoroughness; you are showing poor task recognition.
Across station types, examiners are listening for a few consistent things:
- a professional manner that does not worsen the patient's distress
- a structured consultation with sensible prioritisation
- active listening and responsive communication rather than stock phrases
- language that is clear, tailored, and free of jargon
- clinically sound decisions, including attention to risk, physical health, and legal or ethical issues where relevant.
One subtle but important point: role players are trained to respond to how you behave. An abrupt or dismissive style can make the interaction harder, just as it would in real practice. In other words, communication is not cosmetic in this exam. It changes the station.
A reliable answer structure is simple:
- open by naming your role and setting the agenda
- do the task that was asked, not the task you wish had been asked
- prioritise the one or two must-hit domains for that station
- summarise or explain clearly near the end
- close with safety-netting, next steps, or a check of understanding, if the station type allows it.
That structure keeps you anchored when nerves rise.
Blueprint: what station types can appear
The current syllabus and blueprint, mapped to the 2022 Core Psychiatry Curriculum and applicable from September 2023, say that communication is assessed in every station. The blueprint also states that every running order will include at least one station focused on risk assessment or safety planning, at least one on cognitive examination or capacity assessment, and at least one on physical health history or physical examination.
Specialty coverage is deliberately broad. RCPsych says candidates can encounter stations from child and adolescent psychiatry, general psychiatry, psychiatry of intellectual disability, old age psychiatry, forensic psychiatry, medical psychotherapy, and addiction psychiatry, across settings such as inpatient care, emergency care, general hospitals, community work, and educational or criminal justice settings.
The practical takeaway is simple: don't revise only general adult interview stations. You need to be comfortable with collateral history, risk, capacity, formulation, explanation, and physical-health-aware psychiatry across the life course.
MRCPsych CASC pass criteria
RCPsych's current pass rule has two parts. To pass, you must both meet or exceed the total borderline regression score for the exam and pass at least 12 stations. Doing only one of those is not enough.
The College uses Borderline Regression to set station standards. Each station is marked with analytic domain scores plus an overall global judgement, and the station pass mark is derived from that process; the whole-exam pass mark is then based on the station pass marks for that day. The secondary 12-station rule is based on station cut scores, not simply on whether an examiner's overall label sounded favourable.
What does that mean for you in practice? Aim for breadth and consistency. CASC is not an exam where you can expect a few brilliant stations to rescue several weak ones. The College explicitly says high scores in some stations cannot compensate for low performance elsewhere.
There is one more safety rule to know. If you receive two or more marks that indicate a severe fail in a station, your overall performance is reviewed by the Examinations Committee and you may fail the exam regardless of total score or station count. Unsafe, unprofessional, or seriously flawed performances still matter.
How to use the format in your revision
Revise by station family, not just by diagnosis. A candidate who knows schizophrenia beautifully can still fail if they cannot switch between a collateral history, a cognitive examination, and an explanation station under timed conditions.
A sensible rehearsal loop looks like this:
- run timed stations using the real reading times: 4 minutes for the longer-read circuit, 90 seconds for the shorter-read circuit, and 7 minutes to perform
- practise separate sets of history, examination, and management stations before you do full mixed circuits
- mark yourself or each other against the College marksheets, especially structure, communication, and task focus
- debrief every station under three headings: task recognition, content choice, and delivery
- do at least one full 16-station simulation before the exam, in person if possible, because the current UK CASC is an in-person assessment.
If you freeze in practice, start by asking one question: 'What is the examiner actually trying to see me do here?' That single reset often stops you from turning a focused station into an unfocused monologue.
Common mistakes
- Treating every station like a full psychiatric assessment
- Missing the command verb on the instruction sheet
- Ignoring negative instructions and collecting information that was not asked for
- Using formulaic empathy lines without reacting to cues
- Forgetting physical health, risk, or legal issues when the stem points towards them
- Running out of time because you delayed your summary or explanation
- Speaking in jargon when the station is really testing whether you can communicate clearly to a patient, relative, or colleague.
Practice workflow
Build one weekly session around short stations and one around debrief. In the short-station session, do 6 to 8 stations back-to-back and keep the timing exact. In the debrief session, review recordings or peer notes and rewrite your opening line, your structure, and your closing line for any station that drifted.
If you use AI or a study partner for mock viva practice, keep the feedback specific. Ask: Did I recognise the station type fast enough? Did I prioritise the right domains? Did I sound safe, calm, and clinically useful? Those are the questions that move scores.
Summary
- The MRCPsych CASC is a 16-station, same-day, OSCE-style clinical exam with 5 history stations, 5 examination stations, and 6 management stations.
- One circuit is management-heavy with 4 minutes' reading time; the other is history/examination-heavy with 90 seconds' reading time. Circuit order can change.
- Communication is assessed in every station, alongside task focus, professional behaviour, consultation management, and applied clinical knowledge.
- To pass, you need both the overall borderline regression score and at least 12 station passes.
- Prepare for breadth, not heroics: practise station families, use exact timings, and rehearse closing clearly under pressure.
References
- https://www.rcpsych.ac.uk/training/exams/preparing-for-exams/preparing-for-the-casc
- https://www.rcpsych.ac.uk/docs/default-source/training/examinations/casc-syllabus-march-2023.pdf?sfvrsn=1fe04f2b_4
- https://www.rcpsych.ac.uk/docs/default-source/training/examinations/exams-eligibility-criteria-and-regulations---may-2025.pdf?sfvrsn=83f28e63_62
- https://www.rcpsych.ac.uk/docs/default-source/training/examinations/exams-casc-management-marksheet.pdf?sfvrsn=9ca5f46e_2