What happens in the Psychiatry CASC exam

The CASC (Clinical Assessment of Skills and Competencies) is the clinical exam of the MRCPsych, taken after Papers A and B. It is an OSCE-style exam of 16 stations with professional role-players, taken in person in two circuits on the same day: five history-taking stations, five examination stations (physical and mental state, including capacity assessment) and six management stations. Every station lasts seven minutes, with 4 minutes of reading time before each station in the circuit that holds the management stations and 90 seconds in the other. At each station an examiner scores three to five domains and gives an overall judgement, and to pass you must reach the total borderline regression score and pass at least 12 of the 16 stations.

Checked against the official sources on 26 September 2026.

The parts, in order

How it is marked

Each station is marked by one trained examiner, who gives two sets of scores: 5-point analytic domain scores from 1 (Poor) to 5 (Excellent) for between three and five domains, and one 6-point overall judgement of Excellent Pass, Pass, Borderline Pass, Borderline Fail, Fail or Severe Fail. There are separate marksheets for history, examination and management stations. Communication skills are assessed in every station, and each station's marking guidance allocates percentages of the mark to its tasks (in the College's alcohol-history example, 50%, 30% and 20%).

Passing

Each station's pass mark is set by the borderline regression method: the weighted domain scores are regressed onto the overall judgements, and the score of a borderline candidate on that line becomes the station pass mark. The pass mark for the whole exam is the average of that day's station pass marks, raised by the standard error of measurement. You must meet or exceed the total borderline regression score and pass at least 12 stations; high scores in some stations cannot make up for low scores in others. A candidate with two or more severe fail marks has their performance reviewed by the Examinations Committee and may fail, whatever their score.

Worth knowing

• To sit the CASC you need passes in Papers A and B, 23 months' whole time equivalent post-foundation experience in psychiatry by the time of the exam, and a sponsor.
• The CASC has been held in person since September 2023. The UK CASC takes place at the English Institute of Sport in Sheffield, and the College also runs CASC diets in Singapore and Doha.
• Every running order includes at least one station on risk assessment or safety planning, one on cognitive examination or capacity assessment, and one on physical health history or physical examination. There is also at least one station on each of child and adolescent, general, intellectual disability, old age, forensic and addiction psychiatry and medical psychotherapy.
• The instructions for each station set the scene and then give explicit tasks in bold bullet points, sometimes saying what you are not expected to do.
• No more than two attempts at the CASC are allowed in a calendar year, and no more than six attempts at any one MRCPsych exam.
• The College may change the order in which the two circuits are run.

Sources

• RCPsych: Preparing for the CASC
• RCPsych: MRCPsych CASC Syllabus and Blueprint (published March 2023, applicable from September 2023)
• RCPsych: Eligibility Criteria and Regulations, MRCPsych Exams (27 May 2026)
• RCPsych: Applying for your exam
• RCPsych: Exams news and updates