What happens in the RCPCH START exam
RCPCH START (Specialty Trainee Assessment of Readiness for Tenure) is the Royal College of Paediatrics and Child Health’s formative multi-station assessment for senior paediatric trainees (typically in ST7), evaluating readiness for new-consultant practice. Delivered online in a single circuit, it comprises 10 eight-minute stations, each preceded by four minutes of preparation time. A different consultant paediatrician assessor rates each station across six consultant-readiness domains to generate structured developmental feedback for the trainee’s educational supervisor and ARCP.
Checked against the official sources on 24 October 2026.
The parts, in order
Eight-minute consultant-level scenario discussion after four minutes of preparation on an acute general paediatric or neonatal emergency, covering stabilisation, diagnostic reasoning, escalation, retrieval and communication with parents.
Eight-minute consultant-level scenario discussion after four minutes of preparation on an outpatient or chronic general paediatric problem, covering diagnostic formulation, multidisciplinary care, community interface and transition.
Eight-minute consultant-level scenario discussion after four minutes of preparation on a complex multisystem or subspecialty paediatric presentation, shared care across local and tertiary services, and long-term management.
Eight-minute discussion after four minutes of preparation reviewing a paediatric ward, assessment-unit and neonatal handover list, setting clinical priorities, deploying junior staff safely and managing departmental flow.
Eight-minute discussion after four minutes of preparation on a consultant child protection scenario, covering clinical assessment, documentation, multi-agency referral, Strategy Discussion and Section 47 processes under Working Together to Safeguard Children.
Eight-minute discussion after four minutes of preparation critically appraising a structured paediatric research abstract and explaining whether its findings should change departmental clinical practice.
Eight-minute discussion after four minutes of preparation reviewing a paediatric prescription chart and clinical vignette to identify weight-based dosing, infusion, allergy, interaction or organ-impairment prescribing errors.
Eight-minute discussion after four minutes of preparation on a paediatric clinical ethics and law dilemma, including consent, parental responsibility, Gillick competence, treatment refusal and best-interests decision-making.
Eight-minute discussion after four minutes of preparation on consultant clinical governance, patient safety incident response, statutory Duty of Candour, complaints, rota risk or supporting a colleague in difficulty.
Eight-minute live teaching station after four minutes of preparation in which the candidate teaches a junior colleague on a focused paediatric topic, checking baseline understanding and confirming learning.
How it is marked
Each of the 10 stations is assessed by a consultant paediatrician assessor across six RCPCH START domains: decision making and prioritisation; knowledge; management of complexity; professional approach; safety and risk management; and communication. Assessors record structured ratings and written developmental feedback for each station rather than a numerical pass mark.
Passing
RCPCH START is a mandatory formative assessment rather than a high-stakes pass/fail examination. Trainees receive a written feedback report across the 10 stations and six domains, which is reviewed with their educational supervisor to create a targeted personal development plan before CCT and ARCP.
Worth knowing
- UK paediatric trainees normally sit RCPCH START during ST7 so that there is time in training to act on any developmental feedback before CCT.
- Each station gives four minutes to read the scenario and prepare before an eight-minute assessment with the assessor (or role-player in the Teaching station).
Sources
- RCPCH START — about the assessment | RCPCH
- RCPCH START — how to apply | RCPCH
- RCPCH START — preparing for assessment day | RCPCH
Formats change. MedMock is not affiliated with any examining body; always check the current regulations on the official site before you book.
Practise the RCPCH START out loud
MedMock runs spoken RCPCH START practice with AI and marks every session. Start with a £5 taster: 30 credits: 30 minutes of speaking practice. One-off payment, no subscription.
Start with the £5 taster