Paper B is the clinical written paper of the MRCPsych — and for many candidates, the trickier of the two. This guide gives you a clear breakdown of the syllabus, the question types, and the study strategy that actually works.
What is MRCPsych Paper B?
MRCPsych Paper B tests the clinical knowledge of psychiatry — the topics you will actually use when managing patients. It consists of 200 questions over 3 hours: 150 MCQs (best of five) and 50 EMIs (extended matching items, arranged in 10 themes of 5 stems each).
The pass mark varies each sitting — set by the modified Angoff method — but typically falls between 55% and 65%. Both MCQs and EMIs are scored separately, and you can fail on either component.
The Paper B Syllabus: What Gets Tested
Paper B covers nine broad domains. Some carry far more weight in the exam than others:
General Adult Psychiatry [High yield]
Depression, bipolar, schizophrenia, anxiety disorders, personality disorders — the bread-and-butter. Expect at least 25–30 questions.
Old Age Psychiatry [High yield]
Dementia types (Alzheimer's, vascular, DLB, FTD), capacity, BPSD, delirium — heavily tested.
Child & Adolescent Psychiatry [Medium yield]
ADHD, ASD, conduct disorder, eating disorders, CAMHS principles.
Psychotherapy [Medium yield]
CBT, DBT, CAT, IPT, psychodynamic. Know the indications and evidence base for each.
Critical Review [Medium-High yield]
Study designs, statistical tests, bias, meta-analysis, NNT, sensitivity/specificity. These questions are very learnable.
Substance Misuse & Addictions [Medium yield]
Alcohol and opioid dependence management, CIWA, Wernicke's, detox regimens.
Forensic Psychiatry [Low-Medium yield]
MHA sections, fitness to plead, diminished responsibility, risk frameworks.
Learning Disability [Low-Medium yield]
Genetic syndromes (Down's, Fragile X, Angelman's, Prader-Willi), capacity legislation.
Psychiatric Services [Low-Medium yield]
NICE guidelines, CMHT structure, CPA, recovery model, early intervention.
MCQ Strategy: How to Approach Best of Five
Paper B MCQs are "best of five" — meaning only one answer is correct, but several may be partially right. This trips up many candidates who select a reasonable answer rather than the best answer.
💡 Pro tip: Read the last sentence first — The final sentence usually contains the specific question. Read it first, then read the stem with that question in mind. This prevents you from being misled by the clinical narrative.
💡 Pro tip: NICE guidelines are king — The exam tests evidence-based practice. When the question involves treatment decisions, NICE guidance is almost always the correct answer unless there is a clear contraindication in the stem.
💡 Pro tip: First answer is often right — Research on MCQ performance shows that unless you have a specific reason to change your answer, your first instinct is more often correct. Only change when you can articulate why.
💡 Pro tip: Eliminate the extremes — Answers that are too absolute ("always", "never", "all patients") are rarely correct in psychiatry. Use this to narrow down quickly.
EMI Strategy: How to Score Maximum Marks
EMIs account for 25% of the questions but are systematically overlooked by most candidates. Each EMI theme has a lead-in and a list of 8–15 options, followed by five stems.
✓ Read all options before reading stems — identify the pattern of the theme
✓ Use each option: they are designed so that each option can be used, once or more
✓ Process of elimination: if you know 3 stems, use those answers to narrow remaining ones
✓ Statistical EMI themes are highly learnable — invest serious time here
✓ Drugs and their indications, EPS, and drug-drug interactions are perennial EMI themes
✓ Never leave an EMI blank — random chance gives 1/10+ correct
Common Pitfalls — Especially for IMGs
✗ Revising to pass — not to fail less
Fix: The exam is scored by percentile. Your goal is not just to know the right answers, but to know them faster and more accurately than other candidates.
✗ Neglecting critical review
Fix: UK trainees often skip this section because it feels like statistics. But 15–20 questions come from critical review — and they are the most learnable section in the entire exam.
✗ Using only one resource
Fix: The MRCPsych rewards breadth. Use MCQ banks, textbooks (Shorter Oxford, Stahl), and recall-based questions from recent sittings.
✗ Not doing timed practice
Fix: 200 questions in 3 hours = 54 seconds per question. Without timed practice, many candidates run out of time. Do full 150-question mocks under exam conditions.
A Practical 12-Week Study Plan
Weeks 1–3 — Foundations: General adult psychiatry + old age psychiatry. These two domains alone cover ~40% of the exam. Complete at least 150 MCQs per week.
Weeks 4–6 — Clinical domains: CAMHS + psychotherapy + substance misuse. Add critical review — work through study design, bias, statistical tests, sensitivity/specificity.
Weeks 7–8 — Remaining domains: Forensic + learning disability + psychiatric services. These are lower-yield but still present in every sitting.
Weeks 9–10 — Intensify MCQ practice: Switch from topic-based to mixed-topic practice. Aim for 200+ MCQs per week. Review every wrong answer — do not just move on.
Weeks 11–12 — Timed mocks: Do at least 4 full 150-question timed mocks. Review performance analytics. Prioritise your weakest 2 topics for final revision.
► Psychgateway has 8,000+ MCQs and EMIs, 20 full Paper B timed mocks, and recall-based questions from May 2025, October 2025 and February 2026 sittings. Visit psychgateway.com