How to prepare for the RCPCH START

RCPCH START is a 10-station formative assessment for ST7 paediatric trainees, with four minutes of preparation before each eight-minute station. Prepare by practising consultant-level decision-making across acute, chronic and complex scenarios, ward-round prioritisation, safeguarding, safe prescribing, critical appraisal, ethics, risk and teaching.

Step by step

1. 1

   Understand the purpose and timing of RCPCH START

   RCPCH START (Specialty Trainee Assessment of Readiness for Tenure) is taken in ST7 to guide your final stage of training before becoming a consultant paediatrician. The online circuit has 10 eight-minute stations, each preceded by four minutes of preparation time, and generates developmental feedback across six domains for your ARCP.

2. 2

   Use the four-minute preparation window to structure your opening

   Four minutes of reading time lets you organise your thoughts before the assessor joins. In the three Scenario Discussion stations (acute general, outpatient and chronic, and subspecialty and complex care), use the preparation window to separate immediate priorities, differential diagnosis, investigations, multi-agency input and family communication.

3. 3

   Practise Ward Round & Handover and Safe Prescribing systematically

   In Ward Round and Handover, group the handover list by clinical acuity, identify red flags and safeguarding concerns, and delegate tasks clearly across your junior team. In Safe Prescribing, check the child’s age, weight, allergies, renal or hepatic function, drug interactions and BNF for Children dosing rules.

4. 4

   Revise consultant safeguarding, ethics and clinical governance

   Be ready to lead as the attending consultant in Safeguarding (Working Together to Safeguard Children, Strategy Discussions and Section 47 enquiries), Ethics and Law (Gillick competence, parental responsibility, treatment refusal and best-interests decisions) and Conflict and Risk (incident investigation, Duty of Candour and colleagues in difficulty).

5. 5

   Rehearse live teaching and critical appraisal aloud

   In the Teaching station you teach a junior colleague in real time: check their starting understanding, break the topic into clear steps and confirm learning before the eight minutes end. In Critical Review of a Paper, appraise the abstract’s PICO question, methodology, bias and clinical applicability to your department.

Official resources

• RCPCH START — About the Assessment

  Overview of the 10-station RCPCH START circuit, the six assessment domains and how feedback is used at ARCP.

• RCPCH START — Preparing for Assessment Day

  Official RCPCH guidance on the 10 station types, preparation time and what assessors look for.

• RCPCH START — How to Apply

  Eligibility, ST7 application windows, dates and reasonable adjustments for RCPCH START.

Common mistakes examiners report

• Answering as a middle-grade registrar who escalates to the consultant rather than taking ownership as the new consultant on call. source
• Delivering a one-way lecture in the Teaching station without checking the learner’s baseline understanding or confirming what they have learned. source

Questions candidates ask

Sources

• RCPCH START — about the assessment | RCPCH
• RCPCH START — how to apply | RCPCH
• RCPCH START — preparing for assessment day | RCPCH

Checked on 24 October 2026.